Final report on KAP on menstrual hygiene management among school adolescents in Doti district.

Research Report.

SUMMARY: Menstrual Hygiene Management (MHM) has been under-researched by the WASH, health, and education sectors in Nepal. Menstruation is a sensitive issue and remains a taboo in many communities in Nepal. Some cultural beliefs about menstruation reinforce gender inequities and have a negative impact on the dignity, health, and education of girls and women. This report provides information on knowledge, attitude, and practices on MHM in Doti District in Far-Western Nepal, a region widely known for the cultural malpractice related to menstruation known as Chhaupadi in the local dialect. A descriptive cross-sectional research design was employed in the study. The information obtained from the respondents (141 girls and 135 boys) provides insight into the current level of Knowledge, Attitude and Practice (KAP) pertaining to MHM. Overall conclusions There are serious challenges that need to be addressed for making proper menstrual hygiene management a reality in the schools in Doti. According to our findings, 186 (67.4%) and 73 (26.4%) respondents had fair and good knowledge on menstrual hygiene management. However, out of 141 female adolescent respondents, only 56 (40%) engaged in good menstrual hygiene practices. Majority 72 (51%) maintained a fair set of practices and 13 (9%) followed poor menstrual hygiene practices. 49% of the respondents had a positive attitude towards MHM related issues whereas the remaining 51% need to change their attitude. The school WASH facilities are currently inadequate for girls to safely manage their menses. There is a lack of water availability along with inadequacy of gender friendly toilets and hand washing facilities at the schools. Adolescent students lack knowledge and information on menstruation as a natural biological process and menstrual hygiene management. Menstruation affects girls' participation and performance at the school: The majority of girls feels shy or stressed at school during menstruation and participate less due to shame, fatigue or pain. Psycho- social support for menstruating girls at school is missing. Girls would prefer discussing menstruation with other girls or female teachers at school. Negative socio-cultural beliefs may lead to forced seclusion and stigma: half of the girls said that there are activities and places that are forbidden for them during menstruation. Key Recommendations: The key recommendations of the study are summarized below: • MHM should be integrated into national education, health and WASH policies, strategies, and programming. • Production of local, low cost and ecological sanitary pads should be encouraged. • Advocacy for the integration of MHM into the school curriculum and imparting knowledge of MHM to girls and boys before they hit puberty. • Training teachers for increasing the level of knowledge on MHM knowledge and promoting gender-sensitive teaching practices. • Encourage child clubs for peer-to-peer support and sensitization. • Interact with the communities and local cultural leaders, and engage the PTAs, SMCs, SWASHCC in the MHM initiatives at the schools. • Launch grassroots advocacy campaigns against taboos, cultural malpractices and evils related to menstruation.