Chhaupadi and health of women and girls: a study on effects of Chhaupadi practices on health status of women and girls in Karnali, Nepal.

Research Report.

Summary: Chhaupadi' is a deeply rooted socio-cultural practice followed in mid & far western regions. In such practice, the menstruating women and girls are considered as 'impure' and they have to follow several restrictions and barriers. In many communities, the menstruating women and girls have to stay in isolated place like Chhau-hut, Cow-hut or separate room in the house. They are restricted to enter into home, consume nutritious foods, touch male family members, use similar toilets and water taps, participate in social functions, and other essential daily activities. All these barriers and restrictions are directly affecting the health and wellbeingof women and girls; which ultimately impact on overall development and livelihood. Considering 'Chhaupadi' as harmful practice and its negative impact on women and girls, the GON promulgated a directive to eliminate it in 2007. Similarly, many development organizations, local institutions, CBOs, and right actors are raising the voice against this mal- practice; and are working to address the issues related to such practice. Similar to this, AWON and BEE Group has been implementing an action in three districts of Karnaliwith the financial support of EU to stop Chaupadi system. This research is a part of the project to assess the existing context of Chhaupadi and its effects on health status of women and girls. Further it is expected that the findings should be captured as strategies to contribute on elimination process in the project working districts. The research applied both quantitative and qualitative approaches of data collection from 21 working VDCs of three districts: Julmla, Mugu and Kalikot. The random sample were taken for quantitative data from 1237 women and adolescent girls; and qualitative information were captured through FGD, KII, group meetings, consultation with district and local committees, and observation of the real context. After the field work, the data were transcribed, tabulated and the information were categorically analysed with their themes and sub-themes. As findings of the research, it was found that the socio-cultural beliefs and values regarding menstruation and Chhaupadi are deeply rooted in the research areas. The adolescent girlsand women wererestricted to enjoy their personal and social life. Similarly, their day to day activities during the menstruation werealso affecting by the traditional and social norms. Generally, all these restrictions and social boundaries are negatively affecting their health and wellbeing. Thematically, the research has explored the following major findings:  The majority of women and girls still stay in unsafe and isolated places at the time of their menstruation. Out of total 1237 respondents, 27.9% stay in Chhau-hut, 36.6% in Cow-shed, and 32.7% in separate room in home. Only 5.9% of them stay in the same room as usual with family members.  Practice of staying in Chhau-hut and Cow-shed is significantly varied in the caste wise population. The data shows the practice is higher in Chhetri (47.0%) and Brahmin (44.2%) then in Dalit (27.6%); andJanajati (19.0%).  The practice of staying in separate places is also experienced by 76.7% of women and girl even during their health problem. Similarly, 74.1% of women have child delivery in separate-hut, and 80.1% of women stayed in such place alone with their infants.  The women and girls have basic knowledge about menstrual hygiene and its management. Similarly, there is the practice of preparing home-made sanitary-pad and its disposal. It is found that 60.1% of them use normal cloths but remaining others use sanitary-pad. There are also a significant proportion of female who use nothing.  There aresome restrictions in terms of entering inside the home. 77.2% women and girls do not enter insidehome as usual. Similarly, 91.4% ofthem do not enter into the Kitchen and/or touch foods.  The essential sanitation practice also affects in menstruating days. It is found that the practice of daily bath even in the cold is followed by most of the female. But, they are compelled to use separate water source. Similarly, 37.6% of them do not use common family toilet at the time of menstruation as they go to open place.  The food habit practice is found significantly varied in the research areas. 42.2% menstruating women and girls do not eat usual food, and almost all women (85.5%) do not eat milk and milk-product. Consuming food, milk and milk-product directly connects to nutrition and health. However, the major proportion of female are excused to eat milk and milk-product because milk is used for worshiping God (70.9%). There is also a myththat if the menstruated women consume milk, the cow becomes ill (50.7%).  Staying in separate hut affect the psychological behaviour of women and girls as 71.7% of them feel insecure/unsafe, 48.0% feel loneliness, and 65.9% feel sad. Moreover, the adolescent girls feel more isolated than the women.  Staying in separate isolated place during menstruation has also became a cause of facing different accidental cases like animal attack and attempt of abuse. 4.1% have experienced the cases of attacking by wild animals; and, there are few cases of sexual abuse, and serious health problem while staying in Chhau-hut.  Regarding the health problem at menstruation, around 41.4% of women and girls have experiences of at least one types of health related complication. The majority of problems are abnormal bleeding (65.0%), back-pain (63.0%), abdominal pain (47.9%), headache (22.1%), Giddiness (19.6%), body-ache (17.2%), and fever (15.5%)  Out of the total adolescent girls who experienced health problem during menstruation, only 63.3% visit for health check-up. Most of them (86.5%) go to local health post, and 12.5% visit the private medical shop. There is practice of visiting the traditional healer.  There is a lack of female health workers in local health posts, as a result the menstruating women/girls hesitate to visitalone there as they feel uncomfortable with male health workers. Based on the data, information, and findings; the research further suggests the following recommendations to contribute on eliminating the Chhauapdi practice in these districts:  Conduct awareness programs led by local institutions on better practices of menstruation hygiene and sanitation facilities among women, girls and their family members. There is a need of special campaigns to aware the women, girls, family members as well as other local actors to accept the practice of staying inside the house at the time of menstruation and facilitation and joint-interaction on food consumptions behaviours.  Health related problems during the menstruation is generic experience of women and girls. However, there are evidences of not having health check-up during such period. Hence, there should beat least a female health worker in each health post who should run basic health education to encourage their behaviours and to seek for health service at the time of menstruation.  Develop and implement Integrated approach of development interventions: Health, Education, Women Empowerment, Institutional Development, Advocacy, etc.  Lobby and advocate for a legislative and administrative mechanism with sanctions to hold accountable of the concerned state authorities, local government, local committee on planning and implementation of "Chhaupadi Elimination Programs".