Three members of the Bath team, Mel Channon, Rebecca Evans and Josie McAllister, visited Nepal in June to present the preliminary findings of our qualitative data collection and to discuss with our advisory committees the implications for the intervention we are designing. Our advisory committees are formed of people with a variety of relevant expertise and include a range of representatives from government ministries, NGOs, multilateral and bilateral agencies. Many of them have extensive experience in this area and their contributions are vital for the success of our project, especially in ensuring our intervention is both contextually appropriate and scalable.
First, we met with the National Advisory Committee at the Square Hotel in Kathmandu. Our partners in Nepal, CREHPA, had done an excellent job of inviting and accommodating the members of the National Technical Advisory Committee and it was a full meeting, with over 20 delegates from a number of ministries, international and government organisations, and NGOs in attendance.
We framed our presentation around ‘What matters to girls’ as this is the core of our project. Many concurred with our findings; that access to products, as a significant cause of school absence, was being dealt with by other organisations, and the government scheme, even if its administration was patchy. Our main finding, however, related to the prevalence and debilitating nature of menstrual pain, and delegates agreed that this would provide a target for a novel intervention that could have a significant impact on girls’ daily activities.
Several delegates had embraced the concept of ‘menstrual justice’ and said that they wanted to hear more about ‘environmental justice’. We had a valuable discussion about what that should look like in terms of the intervention, with everybody agreeing that more awareness about the environmental consequences of menstrual management schemes was required and this was an issue for entire communities.
The next day we flew to Surkhet to present the findings to the Karnali Technical Advisory Committee held at the Suva Hotel. Again, our colleagues from CREHPA had mobilised members of the committee and we had a full house again. We presented our findings, focusing particularly on the items that were specific to this area: the greater poverty and lack of access to products and other resources for managing menstruation; the complete lack of analgesics for managing pain; the more extreme menstrual restrictions; and the lower levels of health literacy. Our Nepali colleague Dr Mahesh Puri led the discussions due to the sensitive nature of the topics. Committee members said that menstrual pain had never been addressed before in an intervention. One of the ladies thought that yoga helped with managing menstrual pain, and a doctor suggested that CBT could be effective. There were questions about whether the intervention included the disabled, boys and married girls/women. Some said that it needed to be community wide. There was much discussion about the people who should deliver the intervention, and school nurses, mothers’ groups, youth groups and faith leaders were all mentioned. There was also a long discussion about the merits of the current pad scheme, and whether to change to reusables. Dr Puri reminded everyone that the trial had to focus on one or two elements where impact could be measured.
Our final destination was Pokhara for the Gandaki Technical Advisory Committee. The committee members there were particularly interested in the issue of environmental justice. We had been asked to give feedback on the success of the current government period pad distribution scheme and whilst we were able to commend its ambition, and tell the members that the girls were indeed grateful to receive pads, we had to inform them that there had been many issues with the supply and the quality declining over time. This resulted in much discussion as to whether the scheme should be continued, and whether reusable pads and other alternatives could be introduced.
We are extremely grateful to all of the members of our advisory committees in Nepal for making us so welcome, and contributing so generously to shaping our project.
Written by:
Josephine Mcallister