From stigma to solutions: harnessing local wisdom to tackle harms associated with menstrual seclusion (chhaupadi) in Nepal

Abstract

In Nepal, menstrual practices, and particularly chhaupadi, impose restrictive norms affecting women’s daily lives. Chhaupadi is a tradition that involves isolating women and girls during menstruation and after childbirth, along with following other restrictions, which have physical and mental health implications. To date, interventions have yet to fully and sustainably address harms associated with chhaupadi across the country. This two-phase study conducted in Dailekh, Nepal facilitated the development of community-created solutions to mitigate chhaupadi’s adverse impacts on women’s health. Using Human Centred Design and a community-engaged approach, the discovery phase identified key stakeholders and contextualised chhaupadi, while the subsequent design phase facilitated the development of five community-created interventions. These included leveraging female community health volunteers (FCHVs) for counselling and awareness, targeting mothers to drive behavioural change, engaging the wider community in behaviour change efforts, empowering fathers to catalyse change at home, and training youth for advocacy. The FCHV intervention concept was selected as the most promising intervention by the women co-design team, warranting broader exploration and testing. Additionally, while it is imperative for interventions to prioritise tackling deleterious aspects of chhaupadi, interventions must also acknowledge its deep-rooted cultural significance and history and recognise the positive aspects that some women may wish to preserve.

Keywords:

• Nepal
• menstruation
• human centred design
• intervention development
• community-engaged

Acknowledgements

We extend thanks to Bhairabhi Municipality, the Rawatkot community, and the 10 women in Dailekh for their invaluable collaboration and innovative ideas, which formed the foundation of this paper. Our sincere thanks go to the community validation team for their constructive feedback, the key informants for their expertise, and Bhawana Khadka for logistic and translation support. We also acknowledge the Menstrual Health and Hygiene Partner’s Alliance, especially Guna Raj Shrestha and Jyotika Rimal, for their crucial roles in contextualising this study. Lastly, we thank Social Service Centre (SoSEC) Nepal and Hira Singh Thapa for their support in identifying participants.

Declaration of generative AI and AI-assisted technologies in the writing process

During the preparation of this work, the author(s) used Chat GPT to improve the readability of the manuscript. The author(s) then reviewed and edited the content as needed and take(s) full responsibility for its content.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Funding was provided by the University of Pittsburgh Mascaro Center for Sustainability and the University Center for International Studies. Research reported in this publication was also supported by Fogarty International Center of the US National Institutes of Health under award number K01TW012424. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.