The Challenge Of Menstrual Hygiene Management in Nepal and Uganda


The Adara Group research team have begun looking into the challenge of Menstrual Hygiene Management (MHM) in both Uganda and Nepal. In both countries, MHM is a significant deterrent for pubescent girls attending school. In Uganda, Kiwoko Hospital’s Community Based Healthcare (CBHC) programme has targeted MHM in hopes of improving educational attainment among these girls. In Humla, lack of MHM sensitivity and sanitary products also impacts school attendance, but can have more dire impacts, with women spending nearly ¼ of their adult life outside of pregnancy in chhaupadi (menstruation) huts in the Hindu communities (this practice is not observed in the ethnic Tibetan communities).

Over the last four months, our Burundian American intern Desiree Acholla and I combed the literature on MHM and helped staff at Kiwoko Hospital to explore the efficacy of the CBHC MHM program in the Kiwoko Hospital catchment area. This blog is the product of that partnership and credit goes to Desiree for her exemplary research and keen critiques of this sector of international development. Thanks also to Catherine Sanders and Moses Ssekidde for their work on the ground in Kiwoko.


Eldery lady sitting on roofThe natural and healthy process of menstruation presents obstacles for many females around the world, but for women and girls in Nepal and Uganda, they face the monthly reality that vital routines like cooking, socialising with friends and family, and schooling come to a halt for 3 to 7 days a month. Cultural traditions, such as chhaupadi in Nepal, view menstruation as polluting and harmful to others, so while menstruating, females must remain isolated and abstain from contact with other people. In Uganda, some girls are also prevented from cooking food, in addition to being prohibited from carrying newborn children while menstruating. Though Ugandan girls do not face social restriction on their movement during their periods, they have described the paralyzing fear of staining their clothes and embarrassment from relentless teasing from peers and even teachers. These are significant disincentives to remaining in school once puberty is reached.


Ugandan children at water wellNo woman or girl should have to put her life in danger or on hold while menstruating, so Adara has been hard at work to mitigate the challenges of MHM for women and girls in Uganda and Nepal. At Kiwoko School, we have addressed the lack of girl-friendly facilities by funding the installation of a new latrine block with a private washing area. Additionally, a female menstrual outreach instructor was hired to provide advice and support for girls who may not have a mother or trusted confidant with whom to discuss these personal issues. Adara Nepal has also addressed MHM through our mobile medical camps by treating and advising women who practice chhaupadi.

Researchers working in Kenya, Tanzania, Uganda, Bangladesh, Nepal, India, and many other countries have identified many successes with interventions providing WASH facilities and menstrual management materials as well as puberty education, sensitization of boys, teachers, and the community, and social support. The Adara Group has joined the growing team of MHM advocates in the international development sector such as WashAid, ActionWorks Nepal, UNICEF, the Water Supply and Sanitation Collaborative Council, Menstrual Man, and many others. We are committed to supporting women in maintaining their dignity and health while managing their menstruation, but we also recognize that we each have a responsibility to address MHM, which sometimes plays a surprising, often hidden role in our various programs.


There are several low-cost reusable and disposable sanitary pad production enterprises already located near our project locations that we could support. Adara is currently considering supporting several female entrepreneurs in Uganda and Nepal (India) in providing these materials to women in our project areas. It is important to be aware of our environmental responsibility and the waste disposal limitations if we are to pursue interventions providing menstrual management materials. It may be practical to also consider providing the sustainable alternative of menstrual cups for women and girls in our project areas. Various brands of menstrual cups have a higher up-front cost than reusable and disposable sanitary pads, but in areas with more established WASH facilities, the 10-year durability of a menstrual cup can be an attractive option for many women.

In a soon-to-be published paper, we have identified several other key considerations to take with MHM interventions to mitigate menstrual material disposal, sanitation limitations, and cultural sensitivities around a private, taboo subject as well as the possibilities of success with education-only interventions.

Two Ugandan girls in pinkIt is estimated that 300 million women are menstruating around the world on any given day, so we all must be made more competent and confident when discussing this sensitive topic with each other and our clients. By learning how menstruation negatively affects women and girls with whom we work in Nepal and Uganda, we can recognize where our programs can make an impact in this aspect of their lives. WaterAid has published a helpful resource guide called “Menstrual Hygiene Matters” to help international development practitioners incorporate MHM into their programs across different sectors—including advice on budgeting, creating a puberty education curriculum for primary/secondary schools, working with marginalized and vulnerable women and girls (including physically disabled and HIV positive individuals), and talking to local media about MHM efforts. “Menstrual Hygiene Matters” is available for a complete download or as individual toolkits and modules here. Feel free to contact us for additional details about our forthcoming paper, or to answer any questions about increasing your MHM competency and confidence.

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