No time to rest: Ensuring every girl in Nepal can thrive on her period.

On December 11 2018, the MHM Practitioners’ Alliance Nepal, in collaboration with the Federal Government of Germany through the GIZ coordinated ‘Support to the Health Sector Programme (S2HSP)’, hosted a national workshop in Kathmandu, Nepal. The workshop ‘MenstruAction. No time to rest: Ensuring every girl can thrive on her period’, built upon the first national conference on adolescent health and development ’my Health. my Rights. our Future’, held in Nepal in 2016.

It reflected on the achievements by the MHM Practitioners’ Alliance Nepal and asked how the different organisations in the alliance can better work together to improve menstrual health management in Nepal and globally. It brought together Nepal’s leading policymakers, practitioners, researchers, creators, private sector actors , adolescents, youth and the media. There were discussions on how to advance the agenda and what it will take to design and deliver effective menstrual health management and development packages, as a shared aspiration and responsibility for the future.  

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Results from the 5 technical working groups

The Summit divided into technical working groups to discuss and add to the recommendations drawn up at a preparatory meeting of MHM Alliance members held on 3rd December. These recommendations will inform further discussions for a Plan of Action for 2019/20 to be presented to the Nepali Government and four key ministries for women and children, health, education and water and sanitation.

Working group 1: Education, awareness and learning

Moderator: Ganga Gautam, Associate Professor, Tribhuwan University
International Speaker: Marianne Tellier, Executive Director, WoMena
National Speakers: Sandhya Chaulagain, WaterAid Nepal; Shreelata Rana, Nepal Red Cross Society Community Eye and Health Promotion Programme; Nabin Shahi, Karnali Integrated Rural Development and Research Centre.

Key recommendations

  • The MHM Alliance should work with the government to develop more age-appropriate messages for girls and women.
  • The MHM Alliance is currently working at government level, but should be expanded to local and provincial levels too.
  • The Alliance should run a workshop for curriculum and text book writers so that there is a comprehensive approach to addressing not just hygiene issues, but also social norms.
  • The Alliance should publish a calendar of events and information about initiatives, so that all members are kept informed about what everyone is doing.

Working group 2: Water, sanitation and health

Moderator: Bibek Balla, Hygiene Promotion Officer, Dan Church Aid
International Speaker: Jan-Christoph Schlenk, WASH Policy Adviser, GIZ
National Speakers: Subeksha Poudel, Senior Manager, Possible Health; Phurba Moktan, Sanitation and Hygiene Specialist,CARE Nepal.

Key recommendations

  • There should be an allocation for MHM issues in the annual budget.
  • All facilities should be made user-friendly.
  • Restrictions should be treated as a serious threat to women’s health and wellbeing.
  • There needs to be more evidence-based planning.
  • Community-based health workers are key to holistic planning and delivery of MHM at local levels.

Working group 3: Innovation and sustainability

Moderator: Susma Thapa, Freelancer
International Speaker: Janie Hampton, Author and activist, World Menstrual Network
National Speakers: Rajesh Bhagat – CRS social marketing company in Nepal.

Key recommendations

  • Menstrual pads need to be made more affordable
  • Compared to menstrual cups, manufacturing pads requires considerable energy and transport costs.
  • Since every woman using disposable pads produces at least two mini-buses of waste during her reproductive life, menstrual pads should also be biodegradable and menstrual cups encouraged, to address the growing environmental waste issues.
  • Menstrual products need to be exempt from import duty and sales tax.
  • Toilet facilities need to be gender-friendly, clean, private and appropriate.
  • Education should start earlier (from class four) for both genders, parents and be age-appropriate.

Working group 4: Policy and advocacy

Moderator: Guna Raj Shrestha, National Co-ordinator for Nepal, Water Supply and Sanitation Collaborative Council
International Speaker: Gloria Liehmo, UNICEF Pakistan
National Speaker: Uddhav Khakurel, Nepal Fertility Care Centre.

Key recommendations

  • A co-ordinated MHM policy needs to be formulated with a Plan of Action drawn up to translate intentions into reality.
  • There is a need for multi-stakeholder discussions, including all the government ministries concerned (women and children education, health and water and sanitation).
  • Government policy should be cascaded down to provincial and local levels.
  • Tax exemptions for menstrual products.
  • In order to address the environmental challenge of safe disposal of menstrual products, there is a need to map products being used and then decide what is best, especially in rural areas.

Working group 5: Research and analysis

Moderator: Bisheshta Shrestha, Co-lead Researcher, Roosterlogic
International Speaker: Marni Sommers, Associate Professor, Mailman School of Public Health, Columbia University.
National Speakers: Sanila Gurung, Programme Co-ordinator, Beyond Beijing Committee; Hari Shova Gurung, SNV Nepal.

Dr Marni Sommers discusses recommendations for research and analysis on MHM

Key recommendations

Key recommendations

  • Menstruation should not just be considered a women’s issue – it is everyone’s issue.
  • The major gaps in research and knowledge about target groups need to be addressed. The focus so far has largely been on adolescents, but this needs to be broadened to look at working women, people with disabilities and other groups, all of which will have their different needs.
  • It is important to address both the start and end of menstruation (menarche and menopause).
  • Research projects need to be broader and consider the impact and duplication of centralised projects, which often focus on the same gender, age or ethnicity.

Summaries of these key recommendations were presented by the working groups to the Summit Plenary meeting and the recommendations as a whole will be developed into a MHM Plan of Action for 2019/20 for further discussion with the Government of Nepal in the coming weeks.

Summary of panel discussions

A lively panel discussion was held at the MenstruAction Summit to discuss the progress made so far in Nepal on menstrual health management (MHM) and how to tackle remaining challenges.

Panel discussion – are we on the right track?

A panel discussion chaired by TV presenter and former Miss Nepal, Malvika Subba, considered the progress made so far on healthy and safer menstruation and the challenges ahead, and asked ‘are we on the right track? On the panel were Bandana Rana, Nepal’s Committee Member for the UN Convention on the Elimination of All Forms of Discrimination against Women; Sushma Dahal, a researcher at Nepal’s National Health Research Centre; Ruby Raut, Nepali founder of the new start-up WUKA reusable period pants company currently based in the UK ; Sama Shrestha, Nepal representative at UN Women and Tazeen Hossain, Youth Programme Manager for the British Voluntary Services Overseas (VSO) in Bangladesh.

‘It made me feel like an outcast’

Malvika Subba started the discussion by sharing her own experiences of being banned from the kitchen at her in-laws’ house when she got her first period after getting married. ‘It made me feel like an outcast and I started to fight against it. I’m a modern, educated, urban woman – had never faced such discrimination before. It made me realise how hard it must be for others in Nepal.’

She described such discrimination and harmful practices as a form of mental harassment and called for research to be commissioned to generate better data about the long-term social, economic and health impacts of these beliefs and circumstances.

The panellists agreed that, despite the progress made so far, there was still a need to raise awareness about the issues and campaign for improved facilities and products. As well as working with government Ministries, local service providers, clinics and teachers, young people needed to be empowered to address these issues. Laws and policies were important, but real behavioural change could only come from the communities themselves.

Nepal shows other countries how to break the silence

Tazeen Hussein said that it was encouraging to see the activism in Nepal compared to her own country Bangladesh. Although Chhaupadi was not practiced in Bangladesh, she said that there was still a lot of discrimination and silence about menstruation. Many Moslem women (especially in rural areas) also faced restrictions, such as not being able to enter the mosque during their menstruation.

Building up a local industry for menstrual hygiene products

Ruby Raut, a producer of reusable period pants.

Ruby Raut from WUKA Pants grew up in Nepal, but moved to the UK eight years ago. ‘When I was twelve I had my first period and I was sent to my aunts’ house for seven days, where I was almost treated like a prisoner. In school we had a common squat toilet. We had no pads so had to use sari rags, and when these fell off or leaked, it was very embarrassing so we stopped coming to school.’ As a result, when she moved to the UK eight years ago she decided that she wanted to set up a company producing reusable period pants that were both environmentally friendly and comfortable to wear ‘so that no girl has this experience’. She said that with time she hoped she would be able to manufacture the pants in Nepal, and appealed for the government to abolish or lower the current 20% ‘luxury item’ tax on imported menstrual products.

Inclusive policies and coordination are needed to make a difference

Sama Shrestha from UN women said that Menstrual Hygiene Management is a crucial issue for women’s empowerment and equality, and harmful practices and social norms needed to be addressed through policy change and coordinated efforts by partner organisations. These programmes should also be inclusive of all groups, including disabled and LGBTI people, so that all those affected should feel secure and not suffer discrimination, indignities and discomfort.

More research is needed

Sushma Dahal from Nepal’s National Health Research Centre (NHRC) said that broader and better research was needed to understand the scale of the problems women face. She said that many small-scale research projects had been conducted by a variety of organisations, but many of these were poorly designed and badly co-ordinated. As a result, the NHRC has begun to gather data for the first national mental health survey, which included questions about the adverse effect on women of discrimination during menstruation. Three Provinces had been surveyed so far, but is hoped to scale up the survey to cover the whole country.

The panel also discussed how to improve access to sustainable menstrual products and manage waste in an environmentally-friendly way. The consensus was that women would be able to recognise and own their own problems and that young girls and men need to be involved in the debate about MHM as it is a human rights issue.

The Menstrual Health Management (MHM) Practitioners’ Alliance Nepal

The MHM Practitioners’ Alliance Nepal is a national network founded in 2017 with over 50 organisational members covering around 80 initiatives. The Practitioners’ Alliance works on awareness/advocacy, education, policy development, innovation and research around menstrual health and hygiene in Nepal. It is an inter-sectoral, inter-professional, multi-stakeholder platform for the coordination and exchange of ideas aimed at engaging actors around MHM initiatives. The Alliance positions itself as an advisory network for the Government of Nepal and facilitates knowledge management for decision making, promoting the MHM agenda at national and sub-national levels.

German Cooperation improving menstrual health and dignity in Nepal

Since 2015, GIZ’s ‘Support to the Health Sector Programme’ has been working closely with the Government of Nepal to address menstrual health through interventions that include (among other strategies) school-based education and the manufacturing of reusable and disposable low-cost sanitary pads. Under the umbrella of both the Ministry of Health and Population and the Ministry of Education, this programme started with over 500 schools in the 14 districts most affected by the earthquake, as well as other districts in the Mid and Far West Development Regions. It aims to raise awareness and break down the taboos surrounding menstruation by training teachers and health workers to address these issues and by better educating both girls and boys about MHM. The programme teaches pupils how to make reusable sanitary pads and has assisted with the setting up of community-led social enterprises to produce ‘low cost’ sanitary pads and provide employment and income for local women.

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