How quickly 2024 is going! We are preparing to return to Nepal to discuss the next phase of the project, so we thought it would be timely just to recap on where we had got to and what had been achieved so far.
We are now 18 months into the 5-year project. We have collected some data, started our analysis and are about to go to Nepal again to discuss the next phase – the intervention.
A pilot study into menstrual justice was conducted by Dr Melanie Channon, Dr Fran Amery, Dr Jennifer Thomson and Dr Mahesh Puri in 2019. It highlighted the ongoing discrimination suffered by women and girls in Nepal, in particular the continued impact of chhaupadi, a severe form of restriction in which menstruators are not allowed into the family home. At the time of the study, chhaupadi had just been criminalized, but no research had yet been carried out to look at the impact of that criminalisation. It was (and continues to be) widely practiced in specific districts.1
Thus, the MeJARa project was borne, with the aims to address the negative impacts of menstruation suffered by women and girls in Nepal, and to design an intervention that would improve their menstrual experiences.
Dr Mel recruited Dr Rebecca, and together we set upon designing our study. It was to be a mixed methods study of menstrual experience, and it would include an intervention that could be tested for efficacy.
In December 2023, qualitative data collection got underway with many, many focus group discussions being recorded, under the supervision of Dr Mahesh of CREPHA. Dr Mel and Dr Rebecca visited the field sites to observe researchers at work and participants going about their daily activities and held meetings with some of the key stakeholders.
We found many similarities but also a few differences between the western region and the more central region. When we flew out west to Karnali Province, it really did seem a long way from the bustle of Kathmandu. Surkhet is the provincial capital, but it was largely one long street and we stayed at the main hotel. We conducted our own little experiment into menstrual taboos and availability of products, by walking up and down the street trying to buy menstrual products. Eventually we spotted them in a pharmacy. Once we had indicated that we wanted to buy them, several people came up to help us with the translation, mostly men, eager to be sure we had got what we wanted and recommending some types over others. We reflected that that would not have happened in the UK (and also probably not if we weren’t so obviously white).
Our field sites were a couple of hours by car from there. We really could understand why some of the girls we spoke to lament the long distance to shops or markets and said that they could not easily buy menstrual products for themselves. They were very dependent on the supplies of pads that they could get from school, which many complained were so thin they lasted little more than half an hour.
In contrast, when we visited sites in Gandaki province, despite travelling similar distances from the urban centres, the roads were better and there were more shops and facilities (like pharmacies) in the villages. Girls did not have such difficulty accessing products, and some had even heard of newer technologies such as menstrual cups.
Following our qualitative data collection, we have done a preliminary analysis. Products, water and toilets are, of course, are essential for comfortable menstruation management and discussed a lot. But we have also found a high prevalence of menstrual pain, and enforced menstrual restrictions, making a lot of girls unhappy. We were particularly struck by the fact that so many of the girls we spoke to felt dismissed and isolated – they really just wanted to be heard and supported.
At the end of May we return to Nepal to present our initial findings and having listened to what girls want, to start to discuss an intervention.
1Amery, F., Channon, M., Puri, M.C. and Thomson, J., 2023. Developing the menstrual justice agenda: insights from a mixed method study in the mid-western region of Nepal. Sexual and Reproductive Health Matters, 31(1), p.2204025.
Written by:
Josephine Mcallister