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Empowering Flow

Examining Menstrual Equity in Nepal with a Biosocial Lens


Case Study: Nepali Teenage Girl Dies of Snake Bite, August 2023.

            Anita Chand, a sixteen-year-old from Nepal’s Baitadi district, died on August 9, 2023 from a snake bite. Anita’s death, however, goes beyond the label of a “snakebite.” Her death occurred while practicing Chhaupadi, or menstrual exile— a practice based on Nepal’s age-old belief that menstruators are “unclean” and “untouchable” —highlights a complex reality rooted in ancient traditions, health education gaps, and inadequate menstrual hygiene (Reed, 2023).


Historical Contexts and Sociocultural Perspectives in Nepal

Examining Nepal’s historical and sociocultural contexts reveals structural issues which exacerbate stigmas, aligning with stigma theory —the socio-cultural process of labeling and negative stereotyping (Yang, 2007). Here, menstruators, the “sufferers,” face “stigmatized conditions” from age-old constructs fostering menstrual inequity (Schomerus, 2021; Yang, 2007). 


Nepali Hinduism and Chhaupadi: Menstrual “Untouchability”

Nepali religious beliefs and sociocultural norms have led rise to practices of menstrual “untouchability” (UN Women, 2017; Crawford, 2014). In Nepali Hinduism, menstruating women are forbidden to “enter a temple or kitchen, share a bed with a husband or touch a male relative,” as they are considered “untouchable” (Crawford, 2014). Menstruators must use separate utensils and avoid eating with others, cooking food, and worship. These centuries-old beliefs result in exclusion from social, religious, and familial life (UN Women, 2017). A quintessential example is Chhaupadi, an ancient tradition which banishes, and isolates, menstruating women to unsanitary huts (Amatya, 2018). Through social and religious factors, Nepal has constructed a biological reality that labels menstruation, and thus menstruators, as taboo and shameful.  


Contextualizing Menstrual Inequity in Nepal via a Socio-Ecological Model

1) Individual level factors which exacerbate menstrual stigmas in Nepal include a menstruator’s “religion, caste, education level, socioeconomic status, self-silencing and internalized stigma, lack of knowledge and awareness of menstruation” (Gurung, 2023). Nepali beliefs saturated in misinformation include: contact with a menstruating women can cause food to spoil, or, if near a menstruator, someone could be attacked by a leopard (Gurung, 2023). These misinformed beliefs result in Nepali menstruators self-isolating themselves to protect their loved ones.

2) Influence from immediate social relations —grandparents, parents, significant others, teachers, health care providers, etc. — also heightens stigma. A study conducted on Nepali married women which assessed the prevalence of menstrual restrictions showed, “nearly three out of every four [married] women (72.3 %) reported experiencing many menstrual restrictions, or two or more types of menstrual restrictions” (Gurung, 2023). Moreover, many women acquired their (misinformed) understanding of menstruation from their family members or peers, who were, too, influenced by generational stigmas: “Expectations of purifying... and secrecy around menstruation were imposed by adults” (Gurung, 2023).

3) Within the community level —schools, hospitals, religious institutions, and government-driven organizations — voids in infrastructure and resources surrounding menstrual hygiene drives period poverty. Particularly, the lack of education on reproductive health in schools, coupled with a lack of awareness amongst teachers, providers, and religious leaders regarding menstrual stigma, hinders open conversations about menstrual equity in policy spheres.

4) Policies — ranging from educational to health — too, possess the ability to affect meaningful change in these spheres; however, they must be accompanied by meaningful efforts to remedy harmful stigmas. For example, Chhaupadi was banned in Nepal’s Supreme Court in 2005 (Amatya, 2018). Nevertheless, to this day, the tradition is still practiced due to the entrenched stigmas which defy legal barriers. 


Nepal’s Current State of the Period: Menstrual Stigma’s Impacts on Society and Individual


Chhaupadi Practices: Exile and its Consequences

A study examining Chhaupadi practices revealed that the majority of girls, who were sampled, experience exile during menstruation: “4% were exiled to traditional sheds, 82% to livestock sheds and 11% to outside courtyards... Only 30% of girls who stayed outdoors had toilet facilities” (Sharma, 2022; Amatya, 2018). Study participants reported psychological consequences, such as loneliness and insomnia (Sharma, 2022; Amatya, 2018).

Now, bearing in mind Nepal’s historical and sociocultural contexts, consider again: why did sixteen-year-old Anita Chand die from a snakebite?  

The cultural norm that menstruation is “impure” and “dirty” resulted in her banishment to a period hut, where she died from the poisonous snake bite (Gurung, 2023). Anita’s death serves as a symbol for menstruators who have too suffered severe consequences in Chhaupadi conditions — “animal attacks and from smoke inhalation after lighting fires in windowless huts” (Reed, 2023). These menstruators essentially succumbed to the stigmas within their culture that ostracize “impure” menstruators (Gurung, 2023). Those who survive such traditions still must confront a form of death — not biological but rather social in nature.


Menstrual Inequity Impacting Social Life: Education, Economy, and Social Death

Social isolation in itself, as experienced monthly by menstruators within Nepali customs of Chhaupadi and “untouchability,” negatively impacts mental and physical health. Recent studies link social deprivation with a “host of conditions,” including heart attacks, chronic diseases, mobility issues, high blood pressure, cancer, poor mental health, anxiety and depression, and a weakened immune system” (Umberson, 2010). Social exile also limits a menstruator’s ability to participate in the economy and receive education. Such isolation can therefore be characterized as a social death, where menstruators are exiled from society and endure social and economic hardships — from missing job opportunities to losing time in school.

Particularly, menstrual stigmas impact education — significantly contributing to school absenteeism in Nepal: “the major reasons for school absenteeism were discomfort, lack of continuous water supply, and shame or fear of staining [while on one’s period]” (Sharma, 2022). Statistics also show there is a significant need for improved sex education, as only “47.5% girls learned about menstruation in school” and “only 33.3% of the respondents used sanitary pads” (Parajuli, 2017).

Interventions for period poverty require a multifaceted approach: 1) addressing insufficient resources by providing tangible menstrual products, and 2) addressing menstrual stigmas and taboos, considering the social consequences of inadequate support systems, and ultimately working to dismantle societal structures that exacerbate suffering associated with menstrual inequity.


Health Repercussions of Unhygienic Alternatives

Additional studies which have analyzed the practice of menstrual hygiene in Nepal found that “around 40% used sanitary pads during menstrual flow but most (65.1%) of them did not dispose them” (Sharma, 2022). This disparity sheds light on period poverty’s adverse impact on physical health — including increased risk for yeast infections, vulvar irritation, vaginal discomfort, and sometimes even life-threatening infections such as toxic shock syndrome (Farid, 2021).


Conclusion: Returning to the Case Study 

Anita’s death should, therefore, be regarded as a pressing symbol emphasizing the urgency, commitment, and persistence required to dismantle these harmful, deeply ingrained, practices. Even in the 21st century, impenetrable factors continue to persist, perpetuating stigmas that tragically cost lives. Sustained dedication — refusing to be eclipsed by other global issues — is required to ensure no one's well-being is compromised by their biological needs and no one’s social existence is hindered by a normal bodily process.

 


 

 REFERENCES

 

  1. Amatya P, Ghimire S, Callahan KE, Baral BK, Poudel KC (2018) Practice and lived experience  of menstrual exiles (Chhaupadi) among adolescent girls in far-western Nepal. PLOS  ONE 13(12): e0208260. https://doi.org/10.1371/journal.pone.0208260.

  2. Crawford, M., Menger, L. M., & Kaufman, M. R. (2014). 'This is a natural process': managing menstrual stigma in Nepal. Culture, health & sexuality, 16(4), 426–439. https://doi.org/10.1080/13691058.2014.887147.

  3. Gurung, IImisha. (2023). "Menstruation stigma: A qualitative exploratory study of the lived experiences of Nepali women." Electronic Theses and Dissertations. Paper 4105. https://doi.org/10.18297/etd/4105.

  4. Parajuli, P., Paudel, N., & Shrestha, S. (2017). Knowledge and practices regarding menstrual hygiene among adolescent girls of rural Nepal. Journal of Kathmandu Medical College, 5(1), 23–27. https://doi.org/10.3126/jkmc.v5i1.18262.

  5. Reed, B. (2023, August 11). Teenage girl dies after being forced to stay in a ‘period hut’ in Nepal. The Guardian. https://www.theguardian.com/global-development/2023/aug/11/teenage-girl-dies-after-being-forced-to-stay-in-a-period-hut-in-nepal.

  6. Schomerus G, Angermeyer MC (2021). Blind spots in stigma research? Broadening our perspective on mental illness stigma by exploring ‘what matters most’ in modern Western societies. Epidemiology and Psychiatric Sciences 30, e26, 1–6. https:// doi.org/10.1017/S2045796021000111.

  7. Sharma, A., McCall-Hosenfeld, J. S., & Cuffee, Y. (2022). Systematic review of menstrual health and hygiene in Nepal employing a social ecological model. Reproductive health, 9(1), 154. https://doi.org/10.1186/s12978-022-01456-0.

  8. Umberson, D., & Karas Montez, J. (2010). Social Relationships and Health: A Flashpoint for Health Policy. Journal of Health and Social Behavior, 51(1_suppl), S54-S66. https://doi.org/10.1177/0022146510383501

  9. UN Women. (2017). Abolishing Chhaupadi, breaking the stigma of menstruation in rural Nepal. UN Women. https://www.unwomen.org/en/news/stories/2017/4/feature-abolishing-chhaupadi-breaking-the-stigma-of-menstruation-in-rural-nepal.

  10. Yang, L. H., Kleinman, A., Link, B. G., Phelan, J. C., Lee, S., & Good, B. (2007). Culture and stigma: adding moral experience to stigma theory. Social science & medicine (1982), 64(7), 1524–1535. https://doi.org/10.1016/j.socscimed.2006.11.013.

 
 
 

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