The Impact of Norms on Adolescent Girls' Menstrual Health in Nepal

This research will explore how norms impact adolescent girls' menstrual health in Nepal & identify how these norms can be addressed. The research will sit within the broader UKRI-funded 'Menstrual Justice in Low- and Middle-Income Countries' (MeJARa) project. It will include primary data collection & analysis conducted in collaboration with the Center for Research on Environment, Health & Population Activities (CREHPA) in Nepal & secondary analysis of data produced through MeJARa.

Menstrual taboos are negative social norms that present a major barrier to adolescent health & wellbeing. In some contexts, menstrual taboos and stigma have translated into restrictive practices that have been normalised within communities over generations. Nepal is characterised by highly gendered discrimination and severe longstanding menstrual norms. A particular concern is the traditional practice of chhaupadi where menstruating women and girls are required to sleep away from their home in a chhau hut, animal shed, or outside. The practice was criminalised in 2018, however the law is rarely enforced. Restrictions such as chhaupadi are tied to religious and cultural beliefs about the impurity of menstrual blood and carry with them fear of retribution if they are not adhered to. Adolescent girls are significantly burdened and risk personal safety by following chhaupadi while simultaneously risking stigmatisation and family reputation if they do not comply to the menstrual norms of their community. These pressures mean many suffer from anxiety and depression.

Advancing our understanding of how norms impact menstrual health is a crucial step towards addressing menstrual injustice. However, there is a dearth of research on menstruation and it has been largely neglected in both national and international policy despite its significance for sexual and reproductive health and rights, education, gender equality and the environment. Addressing individual menstrual practices like chhaupadi on their own will not remove the stigma and taboos surrounding menstruation. It is imperative that the norms that influence these practices are understood, as well as the power structures and intersecting factors that can sustain or disrupt them. An exploratory mixed-methods approach will be adopted and the following questions will guide the research:
1. What influences norms and beliefs regarding menstruation in Nepal?
2. How do menstrual norms and beliefs affect adolescent girls' menstrual experiences?
3. How can the Nepali government support menstrual health?

The research will include qualitative work with religious and community leaders in the form of in-depth interviews and focus group discussions to broaden our understanding of why beliefs exist, their influence on menstrual health and normative expectations of others. MeJARa will also include qualitative research with post-menarcheal adolescent girls, their families and members of the wider community on topics including purity and shame; inclusion and exclusion; and the lived experience of adolescent girls. This will include Photovoice, a community-based participatory method that involves individuals in research to visually document their lived experiences through photography. The research will explore how norms, beliefs and practices differ within Nepal by working with CREHPA to collect data from both chhaupadi and non-chhaupadi affected areas as well as urban and rural areas. Quantitative, longitudinal survey data on girls' experiences of and attitudes towards menstruation, and quality of life outcomes, will also be collected through MeJARa.

This research will contribute to improving menstrual health globally and the outputs will add to the growing literature on norms that are harmful to health. A technical advisory committee in Nepal will advise on materials throughout the study and is eager to utilise the results in policy and programming. It therefore has significant potential for impact.