ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL The Role of WASH in Schools Programme for Girls Education 2016 © UNICEF Nepal/2017/KPanday Authors: Joanna Morrison (PhD), Machhindra Basnet, Anju Bhatta, Sangeeta Khimbanjar and Sushil Baral (PhD) (Health Research and Social Development Forum)

Published on: April 2018

© UNICEF Nepal Country Office Permission is required to produce any part of this publication. Permission will be fully granted to educational or non profit organizations. Results Methods Introduction Executive Summary Acronyms Acknowledgements About thisreport CONTENTS Teasing Absence fromschool Menstrual managementduringtheschoolday Materials formanagingmenstruation Boys currentknowledgeofmenstruation Girls' currentknowledgeofmenstruation Restrictions onmovement Religious restrictions Restrictions inenteringthekitchen,cookingandeating Restrictions onphysicalcontact Menstrual seclusion Cultural PracticesandRestrictions Participation in school Toilet facilities inschools Setting Menarche -practices,knowledgeandinformation Socio-demographic andsocio-economiccharacteristicsofgirlstheirfamilies Programme The WinS Data managementandanalysis Ethical concerns Data Collection Interviews withteachersandmothers Focus groupdiscussionswithgirls Group interviewswithgirls Qualitative MethodsandSampling Structured observationsoftheschools Structured Interviewswithboys Structured Interviewswithgirls Quantitative MethodsandSampling Sampling andDataCollection ...... viii 29 27 26 24 22 20 18 18 17 17 16 16 15 14 13 12 11 11 vii 8 8 8 8 7 7 7 6 6 4 1 8 8 8 8 8 v

ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: i THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 ii ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Annex Tables Tables Websites References Annexes Conclusion Discussion andrecommendations Limitations Table 19Girls experienceofsexualandreproductivehealthmenstruation Table 18Boys’experienceofsexualreproductivehealthandmenstruation Table 5 Table 20Menstrual management Table 17Boys’attitudetowardsmenstruation Table 16Boys’currentknowledgeandexperienceofmenstruation Table 15Oldandexistingrestrictionineachdistrictfromqualitativedata Table andnon-WinS 14SocialtaboosandtheirreasonsbyWins Table andnon-WinS 13SocialtaboosandtheirreasonsbyWins Table andnon-WinS 12SocialtaboosandtheirreasonsbyWins Table andnon-WinS 11SocialtaboosandtheirreasonsbyWins Table andnon-WinS 10SocialtaboosandtheirreasonsbyWins Table schoolsandnon-WinS 9SocialtaboosandtheirreasonsbyWinS schools Table 8KnowledgeofMenstruation Table 7Socio-demographiccharacteristicsofboys Table 6Socio-demographiccharacteristicsofgirls Table 4SupportforWASH inschools Table 3Datacollected Table 2Characteristicsofparticipantsinthequalitativestudy Table 1ListofSchools Table I:Boysopinionaboutactivitiesthatcan'tbedonebygirlsduringmenstruation* Table H:Comfortlevelinschoolduringmenstruation Table G:Observationofschoolfacilities Table F: Teasing Practices Table E:Schoolabsenteeismduringa onemonthperiod Table D.1 Wholedaysmissedatschoolinpast3monthsduetomenstruation Table D:MenstrualManagementatschool Table ReasonsfornotusingDisposableSanitaryPads C: Table B.1Materialusuallyusedtomanage menstruation Table B.Menstrualrestrictionsbydistrict Table AWASH supportivestructuresinschools ...... (SHRM) education (SRHM) education menstruation atschool Menstrual educationandFacilities providedbyschoolstomanage ......

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...... 116 115 30 29 28 27 25 24 23 21 20 16 11 36 35 32 31 57 56 56 55 54 52 51 50 49 48 47 46 44 42 40 39 38 37 36 36 Questionnaires Maps Figures Table 29.a Table 29 Table 25.a Questionnaire 7:Semi-structured InterviewwithBoys Questionnaire 6:Schooltoiletsobservationchecklist Questionnaire 5:Semi-structuredInterviewwithHeadTeachers Questionnaire 4:Semi-structuredinterviewwithmothers Questionnaire 3:Topic guideforgroupinterviewswithmenstruatingadolescentgirls Questionnaire 2:Topic GuideforFocus GroupDiscussionswithgirls Questionnaire 1:SemiStructuredInterviewwithTeacher Map 1:oftheresearchdistrictsinNepal Figure 8:Sometimeshaveleakageduringschoolhours Figure 7:Wholeschooldaysmissedinthepastthreemonthsduetomenstruation Figure 6:Sanitarymaterialsavailableatschoolwhenstudentsneeded Figure 5:Boysknowingsomethingaboutmenstruation Figure 4:Girlsknowingsomethingaboutmenstruationbeforemenarche Figure 3:Ageofmenarche–percentbydistrict Figure 2:Ageofmenarchebydistrict Figure 1:Variables usedinthewealthindexcalculation Table 34Abilitytoparticipateinclassroomandschool Table 33Useoftoiletsduringmenstruation Table 32Conditionoftoilets Table 31Observationofenclosedopen pantoilets Table 30Leakageandwashingmenstrual clothsinschools Table 28Materialsusuallyusedbygirls absentonfirstdayduringmenstruation Table 27Reasonsforbeingabsentbecause ofmenstruationduringfirstmonth Table 26Absenceduetomenstruation Table 25Managingmenstruationatschool Table 24Useofre-usablesanitarypads Questionnaire 9:IndividualField Diary–girls Questionnaire 8:Semi-structure interviewwithgirls Table 23Disposalofmenstrualmaterials Table 22Menstrualmaterialsandschool absenceforpartofthedayinpast3months Table 21Menstrualmaterialsandschool absenceforawholedayinthepast3months (including holidays) Materials usuallyusedbyabsentgirlsonfirstdayofmonth on firstdayofschoo66onmonth pads atschoolwhenneeded Girls describethemselvesasdisabledbyreasonsformissingschool Managing themenstruationatschoolsbyavailabilityofsanitary ......

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...... 113 100 69 69 68 68 66 66 66 65 65 63 63 61 60 60 59 59 93 91 87 84 80 75 72 26 25 24 13 13 12 10 6

iii ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 iv ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 associated withmenstruation, theprogramme an alternativetothestigmaandmarginalization inclusion andindividualself-respect. Offering to genderequalityandthefosteringofsocial attendance andlearningachievements,contribute hygiene-related diseases,increasestudent aimstoreduce management (MHM),WinS on hygienepractices,includingmenstrual access toadequateWASH facilities andtraining sanitation andsafewaterinschools.Byproviding for childrenofhygienepromotion,adequate demonstrating thehealthandeducationalbenefits programme isbasedonabodyofevidence lifelong healthandsafehygienepractices.The with theknowledgeandskillsthatpromote washing facilities(withsoap)andareprovided drinking water, basicsanitationfacilities,hand all childrenhavetherighttoaccesssafe based onachild-rightsapproachthatrecognizes is from theireducationexperience.TheWinS in schoolssothatallstudentscanfullybenefit aims toprovideasafeandhealthyenvironment countries inAsiaandAfrica.Theprogramme has beenreplicatedandimplementedinmany school andcommunitysanitation.Thisapproach total sanitationapproachwhichcontributedto In 2006,UNICEFNepaldevelopedtheschool-led programme (SSHE). the SchoolSanitationandHygieneEducation programme systematicallysince2000through Nepal hassupportedtheimplementationofWinS and UNICEFNationalCommittees. Department forInternationalDevelopment(DFID) donors including:theGovernmentofFinland, Nepal Fertility CareCenter;anditsdevelopment of DrinkingWater andSanitationUsersNepal International DevelopmentEnterprises,Federation of Education,NepalRedCrossSociety, Development andAgriculturalRoads,Department and Sewerage,DepartmentofLocalInfrastructure partners including:DepartmentofWater Supply a globalinitiativeofUNICEF; itsdevelopment programme inNepalispartof Schools (WinS) The Water, SanitationandHygiene(WASH) in THIS REPORT ABOUT in theeducationsystem,which inturnincreases the fullparticipationofgirlsand femaleteachers seeks toempowerallstudents andencourages Most ofthesewomenandgirlswillmenstruate at 47.79percent Census, thispercentageisslightlyhigher Nepal, accordingtothe2011NationalHousehold population isagedbetween15-44yearsold.In census Globally, accordingtothe2016mid-yearglobal encounter. and customsgirlswomencontinueto challenging prevailingnegativesocialpractices which inturncouldsignificantlycontributeto effectively managingmenstruationatschool, this shouldcreateaconduciveenvironmentfor introduction ofpracticalandeffectivemethods information, adviceandsupportwiththe promotes genderequality. Byprovidingaccurate their learningandachievementopportunities 2 1 change opportunities. for providinginformationandtheimpetuous the schoolsettingisanidealintervention being challenged,addressedandchanged communities. Howeverthesepracticesareslowly slowly beingchallengedbygirls,familiesand recently hasreceivedglobalmediaattention,is Court since2005.Thispractice,whichhas it hasbeenoutlawedbytheNepalSupreme of and learningopportunities.InNepalthepractice girl’s well-beingincludingherschoolattendance effectively, which canhaveanegativeeffecton girls andwomenisnotunderstoodormanaged exclusion. Asaresultmenstruationformany and girlsreinforcegenderinequalities on thelives,healthandsafetyofwomen that surroundmenstruationimpactnegatively scenarios prevailingnegativeculturalpractices ‘hidden’ andrarelydiscussed.Inworsecase world andNepal,itremainstaboo,stigmatized, reproductive cycle.However, inmanypartsofthe days. Menstruationisanaturalpartofthe regularly eachmonthforbetweentwo–seven chhaupadi Bureau ofStatistics,Kathmandu,Nepal. pop.php www.census.gov/population/international/data/idb/world National Population 2011,Central and HousingCensus World MidyearPopulation Sex for2016,https;// byAgeand 1 44.7percentoftheworld’sfemale , seclusion,continues,although 2 ofitsnationalpopulation. -

v ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 vi ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 3 focussed partofitsWASH Nepalprogramming UNICEF recognisesthisrequirementandhas used materialsoraplacetodrythemifreusable. used cloths;andfacilitiesforsafelydisposingof water andsoapforwashingtheirhandsthe their sanitarycloths,padsandclothes;clean require somewhereprivateandsafetochange convenient disposal/cleaningfacilities.They must haveaccesstowaterandsanitation menstruation hygienically, womenandgirls At apracticallevel,inordertomanage interventions. programme impact ofWASH inSchool(WinS) on agirl’sschoolattendanceandthepotential to fullyunderstandtheimpactofmenstruation menstruation, furtherexplorationwasnecessary response relatingtoschooling,attendanceand was nospecificquestionormultiplechoiceoption of girlsinthecategory‘Other’.Becausethere school’ wasself-reported byaverysmallnumber school attendanceduringmenstruation.‘Avoid questionnaires didnotaskspecificallyabout relating tomenstruationwerehigh,thereport’s and otherculturalnormstraditions this studyfoundtheprevalenceof regularly askedtoobserve the farandmid-westernregionsofNepalwere The reportfoundthat44percentofgirlsin particularly inthemidandfar-western districts’. girls havewide-rangingimplicationsinNepal, of pollutionassociatedwithmenstruationfor reported that‘restrictionsrelatingtonotions Participation (ADAP) BaselineStudy(2014) UNICEF’s AdolescentDevelopmentand ber 2014,p.42. (ADAP)–BaselineReport, and Participation UNICEF andPopulation Council, chhaupadi Adolescent Development chhaupadi Nepal,Novem 3 . While

- commissioned byUNICEFNepalincollaboration Programme forGirlsEducation2016,was Practices inNepal:TheRoleofWASH inSchools This report,AnalysisofMenstrualHygiene as attendanceisextremelyrelevant. measuring traditionaleducationalindicatorssuch resources andraisinghealthstandardsaswell tackling genderequalityissuesandaccessto on thewell-beingandempowermentofgirls, are imperative.Theeffectsoftheprogrammes into theroleandeffectivenessMHMinterventions and girls’empowerment,thusfurtherinvestigation UNICEF hasaclearmandateandfocusonwomen their educationopportunities. to girl’seducationattendanceandinturnenable facilities inschoolsshouldreduceinterruptions the provisionofsafe,clean,privateandhygienic programmeaimstoensure in Schools(WinS) communities andNGOsINGOstheWASH relevant GovernmentofNepaldepartments,local schools. Working withdevelopmentpartners,the to dealwiththisoftenoverlookedissuein including attendance. programme mayhavehadongirls’education, programmesinschoolsandtheimpactthis WinS Nepal, theroleandeffectivenessofWASH and in governmentschoolsthreeruraldistricts menstrual hygienepracticesandmanagement The research,analysisandthisreport,examines and consequencespertainingtogirls’education. practices relatedtomenstruation,itsmanagement Forum (HERD)toexplorethesocio-cultural with theHealthResearchandSocialDevelopment worked ontheanalysisandresults. the toolsfromNepalitoEnglishandthosethat transcribe data,thetranslatorswhotranslated researchers whoworkedhardtocollectand the HERDresearchteamincludingfield thanks andacknowledgementalsogoesto of Achham,BajuraandParsa districts.Special the supportofDistrictEducationOfficers participating inthestudy. We aregratefulfor girls andboys,theirmothersteachersfor of participatingschools,allthestudents– The teamwouldliketothanktheheadteachers ACKNOWLEDGEMENTS technical contributionsandsupportforthisstudy. School HealthandNutritionSectionfortheir support; andtheDepartmentofEducation, Dr. Tameez Ahmad,ChiefofWASH foroversight report; Dr. MarilynHoar, ChiefofEducationand tables forthedataanalysisandfinalizationof providing technicalsupportanddevelopmentof tools; Dr. NepaliSah,EducationSpecialistfor Officer fortechnicalsupportinfinalizationofthe Specialist; HomNathAcharya,WASH inInstitution Nepal including:MarianHodgkin,Education A mentionofthanksandsupportgoestoUNICEF

vii ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 viii ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 ACRONYMS WinS WASH SSI SSDP SRH SPSS SI PTA NHRC MHM HERD HDI GI FGD D-WASH-CC DEO CBS WASH inSchools Water, SanitationandHygiene Semi StructuredInterview School SectorDevelopmentPlan Sexual andReproductiveHealth Statistical Package fortheSocialSciences Structured Interview Parent/teacher Associations Nepal HealthResearchCouncil Menstrual HygieneManagement Health ResearchandSocialDevelopmentForum Human DevelopmentIndex Group Interview Focus GroupDiscussion District WASH CoordinationCommittee District EducationOffice Central BureauofStatistics 2. 1. questions: management inschools.Thestudyexaminedthree to addressingthechallengesofmenstrual programmesinNepalmaycontribute (WinS) Water SanitationandHygiene(WASH) inschools challenges facedinruralNepalandexplorehow Nepal in2016tobetterunderstandthescopeof This studywascommissionedbyUNICEF address thesebarriers. and relevantstakeholdersarebeginningto nationally andlocally;institutions,providers increasingly beingrecognisedinternationally, cultural andstructuralelementsofthisissueare the impetuousforchangeopportunitiesand intervention settingforprovidinginformationand and empowerment.Theschoolsettingisanideal opportunities andunderminesgenderequality in turncanimpactgirls’learningandeducation facilities inschoolenvironments sanitary products,sanitationandwastedisposal reasons including;shortageofsoapandwater, cultural restrictionsandpracticallogistical factors, aswellprevailingnegativesocio- effectively managetheirmenstruationduetothese in manygirlsbeingunabletoconfidentlyand with regardstotheirmenstruation.Thisresults lack ofaccurateinformation,adviceandsupport experience shame,fear, confusion,teasingand in schools.Researchhasshownthatmanygirls struggle tomanagetheirmenstruationhygiene due totheirgenderandschoolattendinggirlsoften Women andgirlscontinuetofacemanychallenges programming, educationandhealthpolicies. recognition thatitshouldbeincludedinresearch, low incomecountrieshoweverthereisincreasing school girlshaslongbeenaneglectedissuein Menstrual HygieneManagement(MHM)for EXECUTIVE SUMMARY 4 how do these meet girls’ needs? how dothesemeetgirls’needs? affecting attendance? girls andwhatistheroleofWASH facilitiesin What aretheWASH facilitiesinschoolsand How doesmenstruationaffectattendanceof PLoS Med 13.2(2016):e1001962. Girls’ MenstrualHygieneManagement Needs inSchools. Sommer, M.,etal., A Time Action:Addressing forGlobal 4 . These barriers . Thesebarriers and learning outcomes, minimizing the drop-out and learningoutcomes,minimizingthedrop-out students andteachers.To strengthenparticipation children, boysandgirlsdifferently-abled are environmentallysoundanduser-friendly for functional waterandsanitationfacilitiesthat aims:‘…forallschoolstohave Plan (SSDP) in schools.The2016SchoolSectorDevelopment government andcivilsocietytoimplementWASH learn andthrive.InNepal,UNICEFissupporting comfortable environmentwherechildrencangrow, and programmeis aim ofWiS and promotesgoodhealthoutcomes.Themain safe drinkingwater, improvessanitationfacilities programmeprovides The WASH-in-Schools (WinS) 3. menstrual hygienemanagementrelatedneeds’ rate ofadolescentgirlsbyfulfillingtheirprivacyand 5 twelve schoolsintheAchham,BajuraandParsa (6), headteachers(12)andmothers(6)from the students-girls(600)andboys(180),teachers a mixed-methodsapproachtocollectdatawith: Programme forGirlsEducation2016,employed Practices inNepal:TheRoleofWASH inSchools This study, AnalysisofMenstrualHygiene promoted. standards anduniformityfortheprogrammeare to minimalizeduplicationwhileensuringthat programme fortheirschoolguidelines,inorder The GovernmentisalsodevelopingtheWASH ahighpriority.programme inschools(WinS) The GovernmentofNepalhasgiventheWASH sensitization programmes. support programmesandwithtraining and hygienefacilitiesincludingconstruction Nepal supported977schoolswithwater, sanitation in 79.7percentoftheschools.In2016,UNICEF adequate drinkingwaterfacilitiesareavailable are foundin67.6percentoftheschools;and schools is81.3percent;separatetoiletsforgirls Current accesstotoiletfacilitiesingovernment al fully participateinschoolandcommunitylife? How does menstruation affect girls’ ability to How doesmenstruationaffectgirls’abilityto October 2016,p.x. Plan 2016-2023,MinistryofEducation(MoE), Kathmandu, Government of Nepal (GoN), School Sector Development Government ofNepal(GoN),School l schools provide a safe, healthy and l schoolsprovideasafe,healthyand

all children go to school childrengotoschool 5 .

1 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 2 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 o o o o Significant findings: Nepal HealthResearchCouncil(NHRC). used. Thestudyreceivedethicalapprovalfromthe observational checklistoftheschool’sfacilitieswas on thegirl’sattendancefromschoolsand periods. Aquestionnairewasusedtocollectdata their schoolattendanceduringmenstrual asked tomaintainaself-complete diarytorecord three districts.Thegirlstudents(600)werealso schools(six)weresampledineachofthe WinS schools(six)andnon- Equal numbersofWinS the study, inordertomeetanagreedsamplesize. districts werepurposivelysampledandusedfor districts ofNepal.Thelargerschoolsinthese restrictions andcustoms,including Girls wereexpectedtoobserve anumberof observe theculturalrestrictions(rules). and/or sourceofembarrassmentandhowto physically, abouttheaccompanyingteasing to effectivelymanagetheirmenstruation was happeningtothemphysically, how for mostgirls.Theyworriedaboutwhat was afrighteningandconfusingexperience As aresultmenarche(firstmenstruation) girls intheParsa district. menstruation -including76percentofthe did notknowthecauseorreasonfortheir ‘ schooldescribedmenstruationasa WinS schools and48percentofthegirlsinnon- Although 57percentofthegirlsfromWinS expected toobserve. expectations andrestrictionsthegirlswere or concentratedonthesocialandcultural had inadequateinformationthemselves main sourceofinformation,buttheyoften concerns. Thegirls’motherswereoftena were responsivetothegirls’questionsand cleanliness topreventdiseasesratherthan problematic. TheMHMclassesfocusedon self-study andthemixedgenderclasseswere information –teachersinstructedthegirlsto often theSRHclassesdidnotprovidethis many ofthegirlshadattendedclasses, including: menstruation, especiallythephysicalaspects; continued tohavemanyquestionsabout andnon-WinS,and schools–bothWinS All thegirlsinstudy, fromallthedistricts which despite being outlawed, 17 percent of which despitebeingoutlawed, 17percentof normal healthyprocess’ ’Why doesithappen?’ , many of the girls , manyofthegirls Although Although chhaupadi , o o o At school: o o o o o At homeinthecommunity: o o in non-WinS schoolswouldneverwriteonthe and43percent 32 percentofgirlsinWinS never raisetheirhandtoanswerquestionsand cent innon-WinS schools,reportedtheywould schoolsand21per Girls -15percentinWinS classroom whentheyhadtheirperiods; uncomfortable sittingnearthefrontof Less thanhalfofthegirls,45percent,felt home anddidnotreturntoschoolthatday; to gohomechangeusuallyremainedat toilets atschool;girlsthatleftschoolinorder girls didnotchangetheirproductsorusethe Toilets wereoftennotcleanorprivate so most community lifeincluding: girl’s abilitytofullyparticipateinschooland a ‘ Menstruation continuestoberegardedas seclusion. districts reportedobservingsomeformof the girlsinBajuraand60percentAchham concern; to embarrassmentandgossip wasstilla Fear ofleakageinschoolandathomeleading affecting cropsandlivestock; including othermalesandholymenor including worship,peopletheymayencounter for thegirls’safetyandculturaltaboos, attacks fromwildanimals,includingsnakes, vulnerability –fromviolenceincludingrapeand – inordernottooffend,duetheirincreased movements aroundthevillagewererestricted The practiseofchhaupadi;includingthegirl’s the typesoffoodpermitted; Cooking andfoodpreparationrestrictions retribution forthemselvesortheirfamilies; Few girlswouldworship–fearingdivine in classeswithboys. playing sportsandwereuncomfortablebeing in alldistrictsreportednotfeelingcomfortable The majorityofgirlsinbothtypesschoolsand discomfort, painandfearofleakage; to concentrateontheirclassesdue Half thegirlsreportedthatitwasdifficult board whenmenstruating; dirty pollutingprocess’ and limited the andlimitedthe cultural and traditional restrictions were more likely restrictionsweremorelikely traditional and cultural especially thosethatweremulti-generational,the source ofinformation.Inextendedhouseholds, schools otherfemalefriendswerethemain the girlswereexpectedtoobserve.Innon-Wins behaviour andtheculturaltraditions/restrictions they providedtendedtofocusontheexpected source ofinformation,althoughtheinformation schools,mothersweretheother main In WinS discuss questionsandconcernstheymayhave. taught inagirls-onlyclass–sotheycouldopenly with informationrelatingtomenstruationwere being teased.Girlspreferredthathealthclasses students, especiallyboys–andworriedabout uncomfortable abouttheirperiodsaroundother teacher. Girlsfeltespeciallyshy/embarrassed/ sanitary suppliesormedicinefromamale uncomfortable aboutaskingforinformation, Girls admittedfeelingshy, embarrassedand a fulltimefemalestaffmemberorteacher. and boys. Not alltheschoolsinstudyhad information aboutmenstruationforbothgirls Schools wereandareanimportantsourceof similar patternsofmenstrualclothutilization. other districts,despiteallthestudydistrictshaving missed schoolduetotheirmenstruationthanin research foundthatmoregirlsintheParsa district common reasongivenforschoolabsence.The less fearofleakage,whichwasthesecondmost sanitary padswereintroduced.Thesegirlsandhad a goodandconstantwatersupplyreusable toilets hadbeenbuiltandmaintained,therewas in theBajuradistrictwheregendersegregated significant andpositivecontributionsforthegirls programmemade The researchfoundthatWinS was duetopain,discomfortandleakage. gave formissingschoolduringtheirmenstruation dropped significantly. Themainreasonsthegirls school daysmissedbecauseoftheirmenstruation After agirl’sfirstperiodhowever, thenumberof three studydistricts:Achham,BajuraandParsa. most girlsmisseduptoaweekofschoolinallthe menarche, thefirstoccurrenceofmenstruation, T o example instead of sleeping outside in a separate example insteadofsleepingoutside inaseparate slowly changingornotasstrictly enforced.For customs), althoughmanyofthese restrictionswere to beenforcedincludingc he research found that typically at the onset of he researchfoundthattypicallyattheonsetof homes. disposing oftheirproductsawayfrom would haveresorttoburying,burningor feared othersseeingtheirmenstrualblood, and/or cleaningsanitaryproductsasgirls Difficulties werereportedwhendisposingof hhaupadi (segregation (segregation opportunity for generational change. opportunity forgenerationalchange. to intervenewitholderfamilymembersandthe feared divineretribution.Thisindicatestheneed only afewrestrictionswerefollowedbecausegirls the restrictionswasbecauseoftheirfamiliesand us thatthemainreasonstheyobservedmanyof and practiceswereslowlychanging.Girlstold by schoolsandcommunitieswereappreciated concerted effortstoaddressmenstrualrestrictions of water, notbeingcleanedormaintained.The toilets wereunavailabletothestudentsduelack these facilities.Theresearchfoundthatattimes and sustainedsothatgirlscanrelyonhaving it isimportantthattheyareaccessible,maintained made totheschools,includingsinglesextoilets; While girlsappreciatedinfrastructureimprovements degrees. prevailed insomeformallthedistrictstovarying sanitary products,washingandworshipthoughstill restricted foodandactivities,disposalofsoiled possible. Restrictionsaroundfoodpreparation, different bedorlocationwithinthehouseifthatwas hut, menstruatinggirlswouldnowsleepina wider community. students, teachers,schoolsand parentsand that thereisaclearpolicyunderstood bythe medications arecheckedand re-stockedand their suppliesofsanitaryitems,includingpain separated. Theschoolsneedtoensurethat provide adequateprivacyandshouldbegender and areaccessible.Thetoiletsalsoneedto soap, thetoiletsaremaintained,cleanedregularly water supply, suppliesarereplaced–including the facilities–ensuringthatthereisanadequate Schools needtoensurethattheycanmaintain management relatedclassestogirls. facilities wherenursescouldhelpteachmenstrual could explorecollaboratingwithlocalhealth management isrecommendedandschools menstrual of issues. Ageappropriateteaching more comfortabletoaskquestionsandexplore students) wouldbebeneficial,allowinggirlstofeel and reproductivehealthbygender(teachers ensure coverage.Segregatedteachingofsexual need tobeintroducedatanupperprimarylevel the onsetofmenarche,thusclassesmay it iscrucialthattheclassesareconducted Currently theclassesarebetween6-9but and MHMclassesareconductedisalsorequired. manner andareviewofwhatage(class)theSRH and causesofmenstruationinanunderstandable accurate informationaboutmaterials,symptoms schools. Thiswouldenablethemtoprovide More supportisrequiredfortheteachersand before

3 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 4 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 8 7 6 changes thathappenduringpuberty;andprovide girls tonegotiatethephysicalandpsychosocial intervention sitetoenableadolescentboysand The schoolenvironmentprovidesanexcellent management. pragmatic informationaboutmenstrualhygiene not tohaveaccessnorreceiveaccurateand community lifeandschool.Manygirlscontinue ability toequallyandfullyparticipateinfamily, and othersocialrestrictionsalsoaffectgirls’ cultural practices,including supply issuesinruralareas sanitary materialsbecauseoffinancialand/or Girls haveoftenbeenunabletoaccessadequate themselves duringtheirmenstruationatschool. girls tohygienicallyandconfidentlytakecareof facilities contributetothedifficultiesfacedby Limited accesstowater, sanitationandhygiene stated aspartofitsmissionstatement: (SSDP) Nepal’s 2016SchoolSectorDevelopmentPlan programming, educationandhealthpolicies recognition thatitshouldbeincludedinresearch, low incomecountrieshoweverthereisincreasing school girlshaslongbeenaneglectedissuein Menstrual HygieneManagement(MHM)for INTRODUCTION

Mason, L. etal., Mason, L. pp. 99-115. giene) programmes Asia: aneglectedissueforWASH (water, sanitationand hy Mahon, T. andM.Fernandes, 2016-2013, Government ofNepal, study. menstrual cupsandpadsinruralwesternKenya:aqualitative 7 includedrecognitionofthisissueand management relatedneeds.’ their privacyandmenstrualhygiene rate ofadolescentgirlsbyfulfilling outcomes, minimizingthedrop-out To strengthenparticipationandlearning differently-abled studentsandteachers. friendly forchildren,boysandgirls are environmentallysoundanduser- water andsanitationfacilitiesthat ‘…for allschoolstohavefunctional Waterlines 34.1, 2015,pp.15-30. 2016,p.x. Adolescent schoolgirls'experiencesof . GenderandDevelopment18(1),2010, School Sector Development Plan 8 Menstrual hygieneinSouth . Prevailingnegative chhaupadi (seclusion) 6 . - segregated facilities,lackofprivacy, inadequate of menstruation,throughabsencegender do notallowforcomfortablemanagement attendance ofgirlstudents.Ifschoolfacilities district menstrual taboos,althoughthismayvaryby suggests thatschoolattendanceisaffectedby Previously conductednationalresearch challenges whiletheyaremenstruating mean thatmanywomenandgirlsfacesignificant persist. Theideathatmenstruationis‘polluting’ In Nepal,culturalinterpretationsofmenstruation sanitation andhygieneneeds particularly iftheschooldoesnotmeettheirwater, participate inschoolwhentheyaremenstruating, girls finditevenmoredifficulttoattendand accurate information.Yet, thereisevidencethat 17 16 15 14 13 12 11 10 9 improve accesstocleanwatersuppliesin The GovernmentofNepalistakingstepsto of schoolsinNepaldonothaveatoilet better waterandsanitationfacilities,18.4percent of Nepalhasmadesomeprogresstoprovide likely tomissschool water supplyordisposalsystems,girlsaremore

Kathmandu, MinistryofEducation,Government ofNepal. Ministry ofEducation, Unit, InstituteofEducationUniversity London 6,2011. systematic reviewoftheevidence. secondary schoolenrolment,attendance andcompletion?A separate toiletsforgirlsatschoolshave ontheirprimaryand etal., Birdthistle, Isolde, Ibid pp.91-100. seminarpapers/dg10052010_1.pdf Economics 3.1, 2011,pp.91-100; domized evaluation products andschoolattendance:Evidencefromaran Oster, Emily, andRebeccaThornton, 4 (4),2014. tion cio-cultural practices:whatschoolgirlsdoduringmenstrua S.K.C., Hamal, M.and 2015, pp.785-95. Health ofWomeninNepal etal., Ranabhat, C., Health Sex16(4),2014,pp.426-39. natural process':managingmenstrualstigmainNepal. Kaufman, MengerandM.R. L.M. Crawford, M., and Ethiopia. education experiencesofgirlsinTanzania, Ghana,Cambodia Sommer, M.,etal., 2014, 14:p.1118. students inNortheastEthiopia. ment andschoolabsenteeismamongfemaleadolescent Tegegne, T.K. andM.M.Sisay, 15 . Theschoolcontextalsoaffectsthe ? InternationalJournalofHealthSciencesandResearch Compare45(4),2015,pp.589-609. . AmericanEconomicJournal:Applied A comparison of themenstruationand A comparisonof 16 Chhaupadi Culture andReproductive Chhaupadi Culture . AlthoughtheGovernment Consolidated FlashReport2015/16 Hygiene, Health Problems andSo Hygiene, Health What impact doestheprovisionof What impact . AsiaPac Health27(7), JPublic BMC Public Health(14), BMCPublic Menstrual hygienemanage 9 , SocialScienceResearch 10 http://sticerd.lse.ac.uk/ . . Menstruation, sanitary 11 17 14 , . This isa 12

, 13 . - Cult - , - - 19 18 of challengesstillfacedbyschoolattending UNICEF in2016tobetterunderstandthescope (MHM) inschoolswascommissionedby This studyonMenstrualHygieneManagement supportive nationalpolicy creating aconducivelearningenvironmentand the curriculum,providingteachertrainingand menstrual hygienemanagement,workingwithin training teachersonbasichygieneskillsand improving physicalWASH infrastructure, through theeducationsystem.Thisincludes investment forWASH programmesinschools Education (MoE)in2010,hasbeensupporting working group,approvedbytheMinistryof UNICEF, incoordinationwiththeWASH thematic water andsanitation. include accesstochild-gender-disabled friendly outlines nineaspectsofqualityeducation,which by UNICEF.and issupported in 2002 initiative This Friendly SchoolsInitiative’ communities andinschoolsaspartoftheir‘Child

Maldives, Nepal, Pakistan andSriLanka Maldives, Nepal,Pakistan Draft, StateofArtinAfghanistan,Bangladesh,Bhutan,India, UNICEF, ROSA, UNICEF. UNICEF, Child Friendly Schools Manual Child FriendlySchools WASH forSchoolChildren.Provisional 19 18 . , whichwaslaunched . 2009,NewYork: 3. 2. 1. answer threequestions: Specifically, themixed-methodsstudysoughtto three ruraldistricts;Achham,BajuraandParsa. management facedbythegirlsinschools the ongoingchallengesofmenstrualhygiene reusable sanitarypads.Thefindingsdiscuss management; includinghowtomakeanduse practical skillsinformationforeffectivemenstrual of basicawarenessonmenstrualhygieneand girls’ toilets.Thestudyalsoresearchedlevels appropriate disposalfacilitiesandprivacyin addressing adequatewaterandwashingfacilities, programmeshavecontributedto existing WinS girls inruralNepal.Thestudyexploredhow fully participateinschoolandcommunitylife? how dothesemeetgirls’needs? affecting attendance? girls andwhatistheroleofWASH facilitiesin How doesmenstruationaffectgirls’abilityto What aretheWASH facilitiesinschoolsand How doesmenstruationaffectattendanceof

5 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 6 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 21 20 Map 1:oftheresearchdistrictsinNepal 1. description ofthestudydistricts: some ofthedistricts’governmentschools.Abrief programmein UNICEF hasimplementedWinS Achham, BajuraandParsa, wherecurrently twelve governmentschoolsinthreeruraldistricts: The researchdatawascollectedin2016from Setting METHODS

Nepal the district71outof75onHDIscalein Development Index(HDI)of0.378,placing The districthasanational(Nepal)Human males -46percentandfemales37cent. three districtsusedinthestudy, forboth district hasthelowestliteracylevelsof between theages10to19years.The 257,477 with34,204adolescentgirls, The districthasapopulationofapproximately Nepal andiscoversanareaof1,680km The Achhamdistrictislocatedinfarwestern Programme, Nepal (2014). Government ofNepalandUnitedNations Development Unlocking HumanPotential. DevelopmentReport: Nepal Human 2014 Central BureauofStatistics, : NationalPlanningCommission,Government ofNepal. 20 , 21 .Achham ispredominantlyruralwith NationalPlanningCommission, Population MonographofNepal. Population Beyond Geography, 2 . 3. 2. 25 24 23 22

The Parsa districtislocatedincentralNepal, and Sanyasi per centandtheremainingfromThakuri Brahmin/Chhetri ethnicity71percent,Dalit23 majority ofthedistrict’spopulationisHindu; in NepalwiththelowestHDIof0.364 Bajura districtistheleastdeveloped cent forwomenand69permen.The old. Theliteracyratesinthisdistrictare43per adolescent girls,agedbetween10to19years and populationof134,912.Thereare16,768 western Nepalwithanareacovering2,188km The Bajuradistrictisalsolocatedinfar ethnicity and26percentDalit of thepopulationbeingBrahmin/Chhetri exclusively aHindudistrict,with68percent an agriculturalbasedeconomyandisalmost population ofthestudyareas601,017. with anareaof1,353km ing Census2011 Central BureauofStatistics, Unlocking HumanPotential. DevelopmentReport: Nepal Human 2014 Central BureauofStatistics, Nepal. Commission, CentralBureauofStatistics,Government Housing Census2011 Central BureauofStatistics, 25 castes. . 2012. . 2012,Kathmandu:NationalPlanning National Population andHous National Population MonographofNepal. Population and National Population 2 andhasthelargest Beyond Geography, 22 . 23 , 24 . The . The - 2 conducted November2006-January2008. included 198girlsfromgradessevenandeight another studyintheChitwandistrict,Nepalwhich chosen toallowacomparisonofthisstudywith participated inthestudy. Thissamplesizewas A totalof600girls,200girlsperdistrict,were Structured Interviews withgirls Quantitative MethodsandSampling sampled tomeetsamplesizerequirements. students inclasses7,8,9and10werepurposively Large schools,withclasssizerangeof114to571 supply andexistenceofahandwashingstation. being availableduringmenstruation,safewater room, medicine,sanitarypadsandproducts segregated toilets,availabilityofachanging their WASH infrastructure.Criteriaincludedsex programme,intermsof not receivedtheWinS paired matchedschoolsthathaveand For theschoolselection,UNICEFregionalteams Achham, BajuraandParsa –see in theirschoolprogrammefromallthreedistricts; programmes andsixschoolswithoutanyWASH incorporating WASH programmesintheirschool was conducted.Thisincludedsixschoolswith settings. Intwelveschoolspurposivesampling collect avastarrayofinformationinvariety and qualitativedatawaschoseninorderto variety ofmethodstocollectbothquantitative until August2016.Thismethodincludesa study overaperiodoffourmonths,fromMay A mixed-methodsapproachwasusedinthis Sampling andDataCollection 27 26

14 percent second largestreligiousgroupisMuslimat cent andBrahmin/Chhetri10percent.The 41 percent;Janajati16percent;Dalit14 population isHindu,83percent:Madhesi a HDIof0.464.Themajoritythedistricts’ 42 outof75amongstdistrictsinNepalwith cent andmen’s67percent.Parsa isranked Bajura district:withfemaleliteracyat44per the literacyratesfoundherearesimilarto between 10to19yearsoldinthedistrictand There are61,998adolescentgirlsaged ized evaluation products andschoolattendance:Evidence fromarandom Oster, Emily, andRebeccaThornton, Ibid. 26 , pp.91-100. . Menstruation, sanitary Table 1.

27 -

field researchersaskedthemtorecordwhether the study. Onthedaysthatgirlsmenstruated, they menstruateforthetwomonthspriorto also eachgivenapersonaldiarytorecordwhen seven, eight,nineandtenofeachschoolwere These fiftyrandomlyselectedgirlsfromgrades using theOpenDataKitsoftwareprogram. girls. DatawascollectedonSamsungtablets interviews wereconductedwithmenstruating In allthesampledschools,fiftystructured team, usingalotterysamplingselectionmethod. mixed upanddrawnatrandombytheresearch names onseparatepiecesofpaper, whichwere interested inparticipatingthestudywrotetheir who hadobtainedparentalconsentandwere of theparticipantswas15yearsold.Allgirls seven, eight,nineandtentheaverageage their menstruation.Thegirlswerefromtheclasses interested girlsingrades7-10whohadbegun distributed parentalconsentformstoalleligible of thestudyandhowitwouldbeconducted recruited inKathmandu,explainedthepurpose The fieldresearchers,allexperienced,femaleand the participantsandarranged forthepickup the datacollectionperiod,researchers called school andthereasonsforthis absence.After when theymenstruated,if wereabsentfrom make notesonablanksheets ofpaper, recording for thisthefieldresearchersaskedgirlsto systematically.information Inordertocompensate contain extrapagesinorderforthegirlstorecord recording problemsaroseasthediariesdidnot menstruation experiences.However, some briefed abouthowtocontinuerecordtheir to theresearchteam,theywerecontactedand to school.Ifgirlshadgiventheirphonenumbers one monthaftertheholidaywhentheyreturned continuation ofdiarymaintenanceforafurther closed. Teachers wereaskedtobriefthegirlson approximately onemonthandschoolswere there wasanationalschoolholidaywhichlasted after thefirstmonthofbeginningstudy, how tocorrectlyfillintheirdiaries.Unfortunately, demonstrated tothegirlsandtheirteachers the waytoschoolor‘other’.Thefieldresearchers presence ofteasing,templeintheschooloron sanitary pads/cloths,fearofleakage,or of adequateWASH facilitiesorwastedisposal including: schoolholiday, pain,tiredness,lack of reasonstochoosefromformissingschool days. Theresearchteamgavethegirlsalist reason(s) whytheymissedschoolduringthose they missedpartorafulldayofschoolandthe

7 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 8 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 safe andregularlymaintained. and/or alock),clean,haddisposal facilities,were accessible, private(including iftheyhadadoor The researchersalsonotedifthebathroomswere friendly watertapsandbinsforwastedisposal. disabled friendlytoilets,child including: availabilityofgenderseparatedtoilets, in theschoolsthathadbeen(ornot)implemented components ofthechildfriendlyschoolinitiative conducted. Fieldresearchersobservedthemain ( Structured observations,ofallthetoilets oftheschools Structured observations interviewed bythe in thestudy. Alltheboyswereindividually parents hadgiveninformedconsenttoparticipate from class9,atotal180boys,whose was usedtorandomlyselect15interestedboys participated in.In all 12schoolsthe lottery method the girls)thattheymayhaveobservedorhad additional knowledgeorinsightsintoteasing(of taboos, restrictionsandpracticesany menstruation, theirknowledgeofthecultural to gaininsightintotheboys’knowledgeof Structured interviewswereconductedinorder from thesameschoolsusedforstudy. Data wasalsocollectedfromadolescentboys Structured Interviews withboys diary) to Questionnaire9forexampleofanindividual total numberofdiariesusedinthestudy477( which 2diarieswereblank;thereforemakingthe diaries outofthe600whichweredistributed, diaries. Fieldresearcherscollectedatotalof479 concurrent withtheinformationinindividual days ofabsencewerecheckedandfoundtobe school, howevertheaccuracyofrecordingfull show ifagirlmissespartoftheschooldayorleft each district).Theschoolrecordsdidnotrecord/ the schoolrecords(atotalof60diariesfrom 15 randomlyselectedgirlsineachschoolwith researchers checkedthedatafromdiariesof involved infirstphaseofdatacollection.These collected bythesameresearcherswhowere homes orthroughfriends.Thediarieswere – includingcollectingfromtheparticipant’s looked forotherwaystoretrievetheinformation If thegirlswereabsentfromschool,researchers diaries andadditionalnotesfromgirlsatschool. Questionnaire 6) . on every school compound, were oneveryschoolcompound,were researchers (Questionnaire7). refer 28 emotion body part(s)concernedwiththatfeelingor participants markedonthepicturerelevant while menstruatingandattendingschool.The a pictureofgirlanddiscussinghowgirlsfeel The bodymappingexerciseinvolveddrawing to discussthefeelingsofafictionalcharacter. environment andway, astheywerebeingasked discuss theirfeelingsandexperienceina‘safe’ the reasonsforherfeelings.Thisenabledgirlsto experiences ofthegirl,howgirlmightfeeland then initiatedadiscussionbasedaroundthe with. Afterwatchingthesestoriestheresearchers scenarios thatstudyparticipantswouldbefamiliar presented thestoryofagirlindifferentsituations/ body mappingexercisewasused.Thevignettes communication, agame,vignettes(stories)and more ateasewithoneanother. To furtherenhance class weresampledastheylikelytofeel Whenever itwaspossible,girlsfromthesame issues withregardstomenstrualmanagement. to discusstheschoolandwidercommunity per district – one with a WinS programme, one programme,one per district–onewithaWinS addition,inthesixparticipatingschools(two In Focus groupdiscussionswithgirls experiences oftheirmenstruationmanagement. team couldgainfurtherinsightintotheirpersonal at-ease duringthediscussionandresearch friend, thiswouldenablethegirlstofeelmore using thismethodandhavingthesupportofa friend ( to participateinagroupinterviewwithclose participated instructuredinterviews,wereasked Two menstruatinggirlsperschool,whohadnot Group interviews withgirls qualitative andquantitativedata. These sixschoolswereusedtocollectfurtherthe number ofstudentsinclasses7,8,9and10. were identifiedbyUNICEFashavingthegreatest andonenon-WinS- oneWinS schoolperdistrict Of thetwelveschoolsinsample,two Qualitative MethodsandSampling group interviews( previously sampledforstructuredinterviewsor six toeightmenstruatinggirls,whohadnotbeen without), onefocusgroupdiscussioninvolving

Unlocking HumanPotential, DevelopmentReport: Nepal Human Questionnaire 3) 28 . Sanitary products including pads and . Sanitaryproductsincludingpadsand Questionnaire 2) . Itwashopedthatby 2014. Beyond Geography, , was conducted , wasconducted researchers throughoutdatacollection. Kathmandu, maintainedregularcontactwith at theimplementingorganization-HERD, in adapted accordingly. Adesk-monitoring unit quality oftranslation.Tools werepilotedand translated backintoEnglishtocheckthe in English,translatedintoNepaliandthen Topic guidesandquestionnairesweredeveloped study sample. schools wereexcludedfromtheactualresearch programme inParsa district.Thesetwopilot two schools;onewithandwithoutaWinS observed duringaone-daypilotofthetoolsin methods andtools.Theteamsthenwere the researchteamsfivedaystrainingon Forum (HERD),basedinKathmandu,provided The HealthResearchandSocialDevelopment qualitative andquantitativedatainruralareas. health. Allhadpriorexperienceofcollecting academic qualificationinsocialsciencesorpublic researchers withminimumofagraduatelevel Data wascollectedbythreeteamsoffourfemale Data Collection given in the schools.Anoverviewofdatacollectedis programmein the implementationofWinS the positivefacilitatorsandfurtherinsightsof programme,thecontinuingbarriers, WinS and furtherunderstandtheimplementationof schools werealsoconductedinordertodescribe interviews withheadteachersfromalltwelve also interviewed Health andPopulation’ subjectclasseswere and onenon-WinS, whotaughtthe‘Environment, 4) each district,atotalofsixmothers two motherschosenfromthestudyparticipantsin semi-structured interviewswereconductedwith barriers forconfidentmenstrualmanagement, collect furtherdataonschoolandcommunity To triangulateinformationfromthegirls and Interviews withteachers andmothers qualitative studyisdetailedin discussion. Adescriptionofgirlsparticipatinginthe were passedaroundtostimulateandfocusthe cloths whichareusedinmenstrualmanagement . Six teachers, two from each district; one WinS . Sixteachers,twofromeachdistrict;oneWinS Table 3 . (Questionnaire 1) Table 2. . Structured (Questionnaire Consistency andrangecheckswereperformed was ‘cleaned’,manuallycheckedandcoded. data fromthesewasenteredinExcel.The observation checklistswereshort,thecollected v6.0.Asthe management programCSpro and fielddiarieswereenteredintothedata paper questionnaires,headteacherinterviews throughout datacollection.Datafromtheboys’ then uploadedtoacentralserverinKathmandu The quantitativedatawascollectedontabletsand Data managementandanalysis research teamhadaccesstothedata. on password-protectedcomputersandonlythe anonymised foranalysis.Thedatawasstored collected inprivateandalltheparticipantswere Health ResearchCouncil(NHRC).Datawas study receivedethicalapprovalfromtheNepal written consenttoparticipateinthestudy. The parents, teachersandmothersgaveinformed All theparticipantsincludingstudentsandtheir Ethical concerns 29 as havingahighsocio-economicstatus and those eight scoring and above were classified considered ofmediumsocio-economicstatus if theyscoredbetweenfivetosevenwere categorised ashavinglowsocio-economicstatus, If ahouseholdscoredfourorlowertheywere point andthesepointswerethenaddedup. characteristic, participantswerescoreda water – materials, andtypeoftoiletmainsource household assets,roofandhouseconstruction analysis. Awealthindexwasgeneratedusing v20fordescriptive before exportingtoSPSS

dives, Nepal, Pakistan andSriLanka. dives, Nepal,Pakistan State ofArtinAfghanistan,Bangladesh,Bhutan,India,Mal UNICEF, ROSA, refer toFigure1 Wash forSchoolChildren.ProvisionalDraft, . For eachhousehold 29 . -

9 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 10 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 an initialcodingstructurebasedonthemain read thedata,madememosanddeveloped analysis usingtheNvivoV11program.Theteam data teamconductedadescriptivecontent quality, accuracyandconsistency. Thequalitative transcripts andprovidedfeedbacktoensure 30 percentoftranslationswiththeoriginalNepali qualitative datatranslation.Supervisorscompared in Kathmandu,whohadpriorexperienceof Nepali toEnglishbyateamoffourtranslators The transcriptswerethentranslatedfrom in theParsa, Bajura,andAchhamdistricts. in Nepalibytheresearcherswhiletheywere The qualitativedatawascollectedandtranscribed Figure 1:Variables usedinthewealthindexcalculation Bank account Livestock Computer Mobile phone Television Radio Solar Electricity Household Assets Cement dhalan fibre Calamine/cement Roof construction Cement block Stone andcement Brick andcement House construction data fromeachrespondenttype,beforereviewing This codingstructurewasappliedtoasampleof of menstruationforgirlsandotherrespondents. help elicitbroadermeaningtotheexperiences researchers makesenseofthedata,thosethat dataset. Emergentthemeswerethosethathelped These ‘themes’recurorwerecommoninthe natural structuresthatoccurredinthedata. between andwithintranscriptstoclassifythe data. Theteamusedaprocessofcomparison issues orcategoriesemergingfromthecollected transcripts. and thencompletingcodingofalltranslated Pit latrinewithslab Flush tosomewhereelse Flush toseptictank Toilet facility Pipe waterincompound Water supply Table A-WASH supportivestructuresinschools programme schoolshadslightlymoreactive school inParsa. TheheadteachersfelttheWinS existed inalltheschoolsexceptforonenon-WinS PTA meetings.Schoolmanagementcommittees schools (exceptfortwo)hadregularmonthly non-WinS schoolinParsa andalmostallofthese associations (PTAs) atallschools exceptforone in theBajuradistrict.Therewereparent/teacher nurse. Therewasanurseinnon-WinS school schoolshadaschool person; noneoftheWinS schoolinAchhamhadaWASH focal one WinS about theirschool’sprogramme.Whileallbut programmeand components oftheWinS in thestudywereinterviewedaboutkey All theheadteachersateachschoolinvolved Programme The WinS management inschools. provided beforediscussingmenstrualhygiene management inthehome.Thisinformationis of knowledgeandinformationmenstrual about menarche,culturaltraditions,sources quantitative sample.Thefindingspresentdata characteristics ofgirlsandboysinvolvedthe schools ispresentedaswelltheresultsand programmein implementation oftheWinS programme schools.Adescriptionofthe andnon-WinSdifferences betweentheWinS The dataispresentedbydistrictandthe RESULTS Moderately active Very active Activeness ofSMC Committee (SMC)) School Management meetings Regular monthlyPTA Association (PTA) Parent Teachers health personnel Nurse ortrained WASH focalPerson WinS (2) N=2 1 1 2 2 2 0 1 Achham N-WinS (2) N=2 0 1 1 2 2 2 0 WinS (2) N=2 1 1 2 1 2 0 2 Bajura N-WinS (2) pads conducted trainingonmakingre-usablesanitary schoolandtwonon-WinSone WinS schoolshad schools receivingthisadditionalsupport.Only (INGOs), comparedwithonlytwonon-WinS international non-governmentalorganizations nongovernmental organizations(NGOs)and support andfundingfromlocalgovernment, training onmenstrualmanagementwith schoolshadreceivedsupportand Six WinS very activeinthistopic. management andWASH -threeschoolswere children’s clubsaddressedissuesofmenstrual these, onlyhalfoftheseschools,thosewiththe Clubs, apartfromanon-WinS schoolinParsa. Of A. school managementcommittees,referto products) availableforgirlstouseonaregular Achham) hadsanitarypads(orequivalent Four schools (twoinParsa WinS andtwoin disposal facilitiesforthegirls. when requiredandnoneoftheschoolshadwaste changing rooms,oneschoolprovidedpainkillers the non-WinS schools:noneoftheseschoolshad disposal facilitiesinthegirl’swashrooms.Among pain andtwoschoolshaddesignatedwaste schools gavepainkillerswhenrequiredtomanage three schoolshadachangingroomforgirls,two N=2 ElevenoutofthetwelveschoolshadChildren's 1 1 2 2 2 1 0 - seeTable 4. WinS (2) N=2 0 2 2 2 2 0 2 Parsa Among the WinS schools; AmongtheWinS N-WinS (2) N=1 0 0 1 1 1 0 0 WinS (6) N=6 2 4 6 5 6 0 5 Total N-WinS (6) Table N=5 2 2 5 5 5 1 0

11 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 12 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 100 percentinnon-WinS districts and BhojpuriinParsa and 82percentinWinS and96percentinnon-WinS- 87percentinWinS Doteli wasthefirstlanguage intheBajuradistrict from AchhamspokeNepaliastheirfirstlanguage. 59 percentinnon-WinS schools. Allparticipants and schools andAchham69percentinWinS and79 percentinnon-WinS77 percentinWinS from Brahman/ChhetriethnicgroupsinBajura ethnic group.Thereweremorestudyparticipants district, Parsa wastheonlydistrictwithaMadhesi the dominantreligiousandethnicgroupsineach The samplereflecteddatafromthecensuson their families economic characteristicsofgirlsand Socio-demographic andsocio- communities. improvements werebeginningtohappenintheir challenge; theteachersfeltthatweresomeslow within thewidercommunity, theseremaineda practices andperceptionsofmenstruation there hadbeensomepositivechangestocultural be taughtatyoungerage/lowerclass.Although This maymeanthattheclassesbehaveto information beforetheonsetoftheirmenarche. and itwasimportantthatthegirlsreceived sexual andreproductivehealth(SRH)classes materials wererequestedandrequiredforthe staff werenotavailable.Moreinteractiveteaching talking aboutmenstrualhygienewhenfemale make thegirlsfeelcomfortabledealingwithor The teachersandheadssaiditwasdifficultto facilities. building andregularmaintenanceofappropriate need forskilledhumanresourcestosupervisethe teachers andheadsidentifiedthattherewasa leadership. Resourceshortageswerefeltandthe requires commitment,ownershipandsupportive or actiontorepair. Repairandresupplying pipe, theyfelttherewasalackofaccountability If thingsbroke,suchasawaterpumpor where andwhentherewasnotenoughwater. cleanliness oftoiletswasdifficult,particularly found support.Theysaidthatmaintainingthe improvements andwhereoriftheyhad challenges theyfacedinimplementingtheWinS Teachers andheadteacherswereasked what (see sanitary productsavailableforemergenciesonly basis andoneschoollocatedinAchhamhad Table 5). (see Table 6). some minordamageinthe2015earthquake, schools. Althoughsomehomeshadsuffered cent wereinthepoorestwealthquintileWinS in thepoorestwealthquintile.InAchham29per schools with34percentand30being schoolswerepoorerthanthoseinWinS WinS Girls’ familiesfromBajuraandParsa innon- cent offamiliesinthemediumwealthquintile. being inthelowestwealthquintileand64per and 26percentinnon-WinS schoolsoffamilies socio-economic scores,with22percentinWinS andnon-WinSfrom WinS schoolshadsimilar reached class10andabove.Thegirls’families schoolsinParsain WinS where39percenthad girls’ fatherswerebettereducated,particularly the mothershadnotreceivedanyeducation.The and61percentinnon-WinSper centinWinS of mothers washighestinParsa, butdespitethis,67 15 yearsold.Theeducationlevelofthegirls’ non-WinS schools.Themeanageofgirlswas and districts; lessthan10percentfromallWinS themselves ashavingadisabilityinallthree A smallproportionofthepopulationself-defined non-WinS schools orfriends-moresointheWinS information fromtheirmother -particularlyinthe menstruation andcare,they usually obtainedthis programme. Ifgirlsknew‘something’ about possible toattributethiswiththestartofWinS 95 percentconfidencelevel.However, itisnot of 0.027,indicatingasignificantdifference- of 4.920,1degreefreedomandapvalue Pearson’s chi-squaredtestrevealedavalue schools comparedwiththenon-WinS schools. before onsetoftheirmenarcheattheWinS girls knowing 2). menstruation beforemenarche cent innon-WinS schoolsknew‘something’about and17per Overall, 24.3percentofgirlsinWinS years andminimumwas10old. amongst theparticipantsinstudy, was17 years inParsa. Themaximumageofmenarche, 13 yearsoldinBajuraandAchham,12 The averageagefortheonsetofmenarchewas information Menarche -practices,knowledgeand similar tothegirls’households. status ofboysispresentedin The socio-economicandsocio-demographic houses werenotdamagedatall overall thevastmajority, 93percent,ofthe Therewasasignificantdifferencebetween something aboutmenstruation Table 7 (refer toFigure (see Table 6). andis Figure 3:Ageofmenarche–percentbydistrict from BajuraandAchhamreportedbeingteased their menstruationfromfamilyandfriends.Girls schoolinAchham.Somegirlstriedtohide Win first timeandIgotscared,”saidagirlfromnon- them: “Isuddenlysawmymenstrualbloodforthe and manydidn’tknowwhatwashappeningto embarrassed whentheirmenstruationstarted; Most girlsreportedfeelingscared,confusedand their menarche know whatthecauseofmenstruationwasbefore 66 percentofgirlsinnon-WinS schoolsdidnot schoolsand teachers. 57percentofgirlsinWinS only 8percentofgirlsreceivedinformationfrom schools,whereasinnon-WinSin WinS schools getting informationpre-menarchefromteachers schools. Interestingly, 27percentofgirlsreported Figure 2:Ageofmenarchebydistrict (see Table 8). they gavemenutritiousfoodtoeat, in thehouse.Onfourthdayofmenstruation also didnotletmegooutside.Ihadtostayalone brother oranyoneelse,eventhecattle.They inside thehouse.Theydidnotletmetouchmy her firstmenstruation:“Myfamilytoldmetostay than inParsa. OnegirlfromAchhamdescribed was stricterintheAchhamandBajuradistricts family inallthreedistricts,althoughtheseclusion of onset oftheirmenarche,girlsreportedsomesort stains andbackbite[gossip]aboutit.”Atthe carefully asneighboursmightnoticeiftheblood Bajura said“Ihavetoldmydaughtertowalkorsit when theystartedmenstruating.Onemotherfrom by neighboursandothercommunitymembers chhaupadi (seclusion)practicefollowedbytheir

13 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 14 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Figure 4:Girlsknowingsomethingaboutmenstruationbeforemenarche did youknowaboutmenstruation apartfrom For example:whenaresearcherasked:‘What or practicalphysicalmenstrual management. about thephysicalprocessof menstruation as opposedtoaccurateexplanatoryinformation they shouldbehaveandwhatavoid, observe whilemenstruating.Theseincludedhow that theyshould,andareexpectedto,follow detailed informationontheculturalrestrictions At theonsetofmenarche,girlstendedtobegiven Cultural PracticesandRestrictions taunt/question accordingtothegirls. asking ‘whowillshemarry?’”wasacommon of theteasingwasrelatedtothis“friendstease girls wouldgetmarriedandleavehomesome historically/traditionally signifiedthetimewhen informed theteam.Inallthreedistricts,menarche schoolinBajura to eightdays,”agirlfromWinS not allowedtocomeschoolforaroundseven they menstruated:“At first,menstruatinggirlsare Girls oftenmissedaweekofschoolthefirsttime tradition. if possible,ratherthanoutside,whichwasthe girls mightsleepsomewhereelseintheirhome, how although thereweresomesubtlechangeson girls orfamilieschallengingthesetraditions, to bechangingnorwerethereanyreportsof widely practicedandthiscustomdidnotappear at theonsetofagirl’sfirstmenstruation,wasstill 12 days.”Thepracticeofseclusion,especially had totakeearlymorningbathsthroughoutthose main houseonlyafter12daysofmenstruation.I me fruitsandotherfoods.Theyletenterthe chhaupadi was practiced.For example:the to usecloths,orhowsit‘properly’avoid from theirmothersorfemalerelativesabouthow Girls were from thebodycomingoutduringmenstruation’. response was:‘Iknewthatitwasimpureblood not beingallowedtotouchplants?’acommon and extent of restrictions. The data has been and extentofrestrictions.The datahasbeen in termsofreasonsgivenforthe restrictions Differences wereobservedbetween thedistricts (questionnaire 8) response categorieswerenotmutuallyexclusive reason, butitisimportanttonotethatthe Girls identifiedwhattheyfeltwasthe‘main’ reasons forrestrictionsandtheirconsequences. and womenmultiplebeliefsexistedaboutthe shows thatthereweremultiplerestrictionsongirls restrictions werequantified.Thequalitativedata were quantifiednorallthereasonsfor concurrently. Thismeantthatnotallrestrictions questionnaire, asthedatawascollected not abletoinformthedevelopmentof however thecollectedqualitativedatawas restrictions duringthestructuredinterviews, Girls werefurtheraskedaboutmenstrual and discussionstotheresearchteam. commonly askedbythegirlsduringinterviews of information:‘ and wouldoftenasktheresearchersforthistype they menstruate,orwhymenstrualcrampsoccur did notactuallyreceiveinformationaboutwhy stained onthebedding.”Girlsreportedthatthey to sitcarefullysothattheblooddoesnotget anything. TheonlythingwhichItaughtherwas school inBajuraexplained:“Ididnotteachher staining wheretheysat.OnemotherfromaWin sometimes Why dowemenstruate? . givenpracticalinformation ’ was 30 wash alltheclothesandlater, aftermakingit to paintthefloorofthatroom(withredmud), here isthebed.Aftersleepinginbedwehave finishes menstruating:“Saythisisourhouse-like still havetotakeplaceinsidethehouseaftershe Bajura districtdiscussedthepurifyingritualsthat schoolexplained.Onegirlfromthe Bajura WinS in asafeplace Although theystayinaseparateroom,are are allowedtostayinaroominsidetheirhome. of thehouse.Butnowwehavefoundthatthey made tostayinashedorseparateplaceout chhaupadi instead ofashedoutsidethehome:“Earlier, when a differentpartofthehouse,orbed, were changingandsomereportedsleepingin and Achham,girlsreportedthesepractices During theinterviewsandfocusgroupsinBajura same houseasherfamilywhilemenstruating. in Parsa reportednotbeingabletosleepinthe family - were notabletosleepinthesamehouseastheir and 11percentinnon-WinS schools inBajura schools family and23percentofgirlsinWinS being abletosleepinthesamehouseastheir non-WinS schools-60percent,reportednot family. and ThemajorityofgirlsfrombothWinS illness forthemenstruatingwomanand/orher menstruating woman,leadingtomisfortunesor of spiritpossessionfamilymembersorthe angered, thenitwasbelievedtheretherisk were worshippedinthehome.Ifgods house pureandpreventangeringthegodsthat was tocontainmenstrualpollution,keepingthe outside indesignatedshed.Thisseclusion they weremenstruating,wouldstayinstead were notpermittedtoliveintheirhomewhile by girlsandtheirmothers,beingwhenwomen Menstrual seclusionatitsstrictest,wasdescribed the In BajuraandAchhamdistrictsgirlsdiscussed Menstrual seclusion and non-WinS schoolsandisshowninTables 9-14 schools disaggregated bydistrict,andWinS

chhaupadi struation/ statnews.com/2017/02/17/nepal-tradition-chaupadi-men struating-women-banished-cattle-sheds al-development/2016/apr/01/nepal-bleeding-shame-men See recentarticles: go, andwhomshecantouchwhile ismenstruating. she cansleep,withwhominteract,where of Nepalin2005,dictateswhatawomancaneat,where The practice of The practiceof see Tables 9,10,11and12. waspracticed,menstruatinggirlswere 30 , ” oneoftheheadteachersina traditionofmenstrualseclusion. chhaupadi https://www.theguardian.com/glob , outlawedbytheSupremeCourt ; andhttps://www. Onlyonegirl - - - . prestige will go down,” a girl in Achham explained. follow restrictionsduringmenstruation,thenour prestige: “Ifwe-thehighclassfamilydonot restrictions toprotecttheirfamilies’honourand class, theyweremorelikelytomaintainstricter was moretraditional outside thehome.Girlsreportedthatifafamily more likelytohavesleepinashedawayand were morestrictlyadheredto,forexamplegirls extended familyhouseholdmeantthatcustoms explained. Thepresenceofeldersandlivinginan school of thegirlsinAchhamattendingaWinS saying thattheyhadtofollowrestrictions,”one us moreduringmenstruation[thanparents], people livinginjointfamiliesandtheycontrol followed andadheredto:“Therearemoreold meant thattraditionstendedtobemorestrictly As well,thepresenceofeldersinhousehold women withinthehouseduetospacelimitations. Achham hadfewerplacestosecludegirlsand Girls livinginextendedfamiliesBajuraand normal.” pure bysprinklingcow’surinewecansleeplike 32 31 in Bajuratoldtheteam:“[thecampaign]has stay onthegroundflooroftheirhouse.”Agirl and nowpeopleallowmenstruatingwomento chhaupadi before. BecauseofvariousINGOsandNGOs,the “Nowadays, thingsaredifferentcomparedto in thispracticeasrecentlytwoyearsago: schoolinAchhamreportedachange at aWinS the press years fromnon-governmentalorganizationsand of Nepalhasreceivedalotattentioninrecent Menstrual seclusion– non-WinS school. obey therestrictions],”saidanAchhamgirlfroma of thepeopleinvillagegetangry[ifIdonot have agrandfatherorgrandmother, buttherest (enforcing) thatthetraditionswereupheld:“Idon’t spoke abouttheroleofcommunityinensuring The girlsintheAchhamandBajuradistrictsalso in enforcingrestrictionsthanmalemembers. Girls feltthatfemalefamilymemberswerestricter

rounding-periods-in-nepal-video opment/video/2017/may/27/girls-challenge-the-stigma-sur b08pnszp here world article BBC this isunlikelytorefereducationlevelsalone. of educationinmostfamiliesthesedistrictsthisstudy Often expressedas‘ 32 traditionhasbeennearlyeliminated andsomegirlsthehealthteacher ; andhttps://www.theguardian.com/global-devel 31 uneducated and/orwasofahighsocial chhaupadi, http://www.bbc.co.uk/programmes/ ’ –butgiventhelowlevels in thefarwest - -

15 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 16 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 33 Note: n=200ineachdistrict. Table B.Menstrualrestrictionsbydistrict Bajura saiditwasbecausetheyfearedtheperson touch malefamilymembersinbothAchhamand B compared toonly16percentinParsa touch malefamilymemberswhilemenstruating 62 percentofgirlsinBajuracould/wouldnot woman be changedaftercontactwithamenstruating wearer mustnotbedefiledandthethreadshould is asymbolofspiritualpurity. Thethreadand and thethreadsignifieslineagemembership their casteand wearing sacredthreadshavebeeninitiatedinto family memberswhowearholythreads.Men specific, sayingthattheyshouldnottouchmale The qualitativedatarevealedgirlsweremore to inalldistricts,especiallyBajuraandAchham. with malefamilymemberswasenforced/adhered Girls saidthatthepracticeofcurtailingcontact Restrictions onphysical contact representation ofthepractice. practices, thereforedatamightshowanunder- or admittotheirownexperienceswith girls feellesscomfortableandabletoreport focus oneradicating the researchteambelievesthatincreased being okaytotouchmenstruatinggirls.”However menstruating]. Italsomadepeopleawareaboutit separately. Itisnowalrighttogoschool[while made peopleawarethatgirlsshouldnotbekept Cannot liftheavyloads Cannot sleepinthesamebedasothers Cannot sleepinthesamehouseasrestoffamily Cannot eat Cannot gooutsideasmuchnormal Cannot cook/enterthekitchen Cannot touchmalefamilymembers Cannot dohouseholdpuja Cannot attendreligiousoccasions Cannot visitreligiousplaces ). Thegirlswhoreportedtakingcarenotto

and AfricanStudies University Press,1989.and in Nepal cred sisters:socialandsymbolicrolesof high-castewomen Gellner, DavidN."Lynn Bennett, 33 . 60percentofgirlsinAchhamand . xiv, 353pp.NewYork andOxford:Columbia any gotra foods ordrinkswithoutanyrestrictions 54.02, 1991,pp.397-398. (ancestral)membership, chhaupadi Restrictions Bulletin oftheSchoolOriental Dangerous wivesandsa mayhavemade chhaupadi (see Table -

In Achham96percentofgirlsand98 cooking andeating Restrictions inentering thekitchen, possession. - perhapsduetotheirvulnerabilityspirit touch youngbabieswhowerestillbreastfeeding also specificallymentionednotbeingableto vulnerable ifthesepersonsweretouched.Girls therefore girlsandtheirfamilieswereparticularly Healers wereclosertothespiritworldand schoolinBajuraexplained. attending aWinS we touchedthem[whilemenstruating],”agirl “ scared ofspiritpossessionandbecause: touching healers- Menstruating girlswerealsorestrictedfrom family didnotallowthemto. touch malefamilymemberswasbecausetheir infected.” InParsa themainreasontheywouldnot they touchedwouldbecomeunwell:“menget or cookingfood;22percentofgirlsinAchham, house.” Manygirlswererestrictedfrompreparing the godsthatareplacedandworshippedinour then youwillbepossessedbythegodsthere, team: “Ifyougointothekitchentoeatsomefood, girls inParsa and cookfood,comparedwith28percentof of girlsinBajurawereunabletoenterthekitchen Those peoplewhoare 110 (55.0) 120 (60.0) 159 (79.5) 191 (95.5) 119 (59.5) 199 (99.5) 191 (95.5) 200 (100) 94 (47.0) 58 (29.0) Achham N (%) (see Table B) dhami 165 (82.5) 179 (89.5) 195 (97.5) 123 (61.5) 198 (99.0) 172 (86.0) 198 (99.0) 86 (43.0) 34 (17.0) 46 (23.0) dhami Bajura , becausetheywere N (%) . GirlsinBajuratoldthe wouldfallsickif 109 (54.5) 195 (97.5) 121 (60.5) 194 (97.0) 94 (47.0) 55 (27.5) 32 (16.0) 11(5.5) 12 (6.0) 1 (.5) Parsa N (%) and Iworshipped,”agirlinParsa ataWinS worshipped: “OnceIforgotwasmenstruating family membersand/orspiritpossessionifthey infertility, failingtheirexams,illness,illnessof retribution thaninotherdistricts.Girlsfeared this restrictionwasthattheyfeareddivine More girlsinBajurasaidthemainreasonfor divine retributionandtheirfamilies’restrictions. main reasonsgivenforthiswereafearof the templewhiletheyweremenstruating.The participate inreligiousceremoniesorgoto not beingabletoworship,receiveblessings, Almost allgirlsinthreedistrictsreported Religious restrictions was themorecommonreasongiven. Achham andParsa. InBajurafamilyrestrictions if restrictedfoodswereeaten,particularlyin feared havingheavybleedingorbecomingunwell main reasonfortheserestrictionswasthatgirls The quantitativedataanalysisshowedthatthe will beruinedifamenstruatinggirltouchesthem. from touchingpicklesandricebecausethese to preventheavybleeding,aswellrefraining reported restrictingtheirsourfoodintakeinorder will graduallystopproducing.”GirlsinParsa impure andproducelessmilkthey gods willbefurious,”andthe“Cowsbecome cows andbuffaloswillbecomeimpurethe explained: “Ifweeatyoghurtormilkthenthe products. Two schoolsinBajura girlsfromWinS foods inBajuraandAchhamincludeddairy menstruation period any foodordrinkoftheirchoiceduring in Parsa reportedthattheywerenotpermitted Achham, 89.5percentinBajuraand47 Table B). compared with47percentofgirlsinParsa eating certaintypesoffoodwhilemenstruating, per centofgirlsinBajurawerepreventedfrom as well;80percentofgirlsinAchham,and90 The girlsreportednumerousfoodrestrictions was alsoslowlychanging. touching cookingutensils,althoughthispractice girls alsotalkedaboutbeingrestrictedfrom restrictions. Ingroupinterviewsandfocusgroups, given werefearofdivineretributionandfamily food (referto because itwasbelievedtheywouldspoilthe 5 percentinBajuraand7(2)Parsa, 34

It was not clear for how many days or longaperiod. forhowmanydays It wasnotclear Alarmingly79.5percentofthegirlsin Tables 9,11and14 34 ( see Table B ). Otherreasons ). Restricted (see by thecommunityorfamilythereisbelief/ explained becausethetoiletisabuildingused the river,” agirlfromAchham non-WinS school to usethetoilet.We gototheforest,towards or thecommonwatertap:“We arenotallowed Girls werealsorestrictedfromusingthetoilet grass whilemenstruating. touch andthereforetheyshouldonlyfeeddry grass couldbepollutedbyamenstruatinggirls’ were menstruating.Itwasbelievedthatthis‘wet’ grass thathadbeencutsamedaywhilethey reported notbeingabletofeedcowsandbuffalos them barrenorruiningacrop.GirlsinBajura animals andkitchengardensforfearofmaking livestock, particularlycowsandmilkproducing Girls alsoreportedbeingkeptawayfrom traditions andrestrictions. demonstrated bytheirfollowingandobserving be respectfultotheirfamilymembers–thisthey me alotwhenIreturnedhome.”Girlswantedto exam!’ Istoppedthenandmymotherscolded worship asgodwillbeangryandyoufailyour school recounted,“mymothersaid–‘donot 35 fear ofheavybleeding studies haveindicatedthatthereasonforthisis Bajura andAchhamcomparedtoParsa. Previous reflecting thedifferencesinlifestylefamilies qualitative datacollectioninParsa, perhaps was onlyspontaneouslymentionedduringthe them toliftheavyloadswhilemenstruating.This Achham, girlssaidthattheirfamilydidnotallow well ortheydidn’tfeelphysicallyable,wherein and Bajurathiswasbecausetheydidn’tfeel lifting heavyloadswhilemenstruating.InParsa Around halfofgirlsinalldistrictsreportednot infecting orpollutingothers. fourth dayandbathetobecomepureavoid us thattheyaremeanttodrinkcowurineonthe the fourthdayoftheirperiod.InBajura,girlstold mothers usedtoobservewasnotbatheuntil spirit.” Anotherculturalrestrictiongirlsandtheir sees itthen[thegirl]willbepossessedbyanevil toilet. Ifbloodgetsinanything,ifanotherperson menstruation defecatesandurinatesoutsidethe in theopen:“Itisquitebadifagirlhaving was alsoriskyforgirlsiftheyrelievedthemselves fear thatshemightpolluteitandaffectothers.It

Commons, Toronto, 2012. undocumented workersthroughbodymapping Methodological considerationsfortelling thestoriesof etal., Gastaldo, Denise, 35 . Body-mapstorytelling asresearch: , Creative

17 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 18 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 currently knewaboutthecause ofmenstruation; The participatinggirlswereasked ifthey menstruation Girls' currentknowledgeof Parsa explained. that somethingbadwillhappen,”aMuslimgirlin to touchtheQur’anasourfamilymemberssay vegetable orfruitgardenbutwearenotallowed Muslim religiongirlsareallowedtogothe girls hadslightlydifferentrestrictions:“Inour they wererestrictedfromworshipping.Muslim the girlsfromAchhamandBajuradistricts to live/stayintheirhomeswhilemenstruating.Like movement wasalsopracticed,butgirlswereable In Parsa menstrualrestrictionsonagirls’ not letyougothere.” get angryifyouwalkintheseroads,sotheydo roads mightleadtoawatersourceandpeople are temples.Theroadsmayleadtotemples,the nearby. Ifwegooutthenareworried.There in ourrooms.We cannotgoanywhere,even at homewhilemenstruating.We havetositstill school inAchhamexplained:“We havetostay themselves ortheirfamily. AgirlfromaWinS the gods,beingcursedorcausingillhealthto weren’t meanttotouchandthereforeangering a watersource,ortouchingsomeonewhothey taking roadswheretheremaybeatemple,or Bajura andAchhamwereparticularlyafraidof because ofdiscomfortorfeelingunwell,girlsin while somegirlsreportednotwantingtogoout The qualitativedataresponsesindicatedthat family memberstomovearoundasnormal. divine retribution,ortheywereforbiddenbytheir responses includedthatthegirlseitherfeared answer questionfrompredefinedcategories; were askedforthereasonsthisinamultiple normal whilemenstruating not beingabletomovearoundasmuch cent andfewergirlsinParsa, 6percent,reported the girlsinAchham29percentandBajura23 as muchnormalwhiletheyweremenstruating researchers askedgirlswhethertheycouldgoout say wearecarelesslyroamingaround.”The our societyfrownonusgoingoutalone.They us togooutsidethehousethatoften.People in girl inAchhamexplained:“Here,theydonotallow reason, evenwhentheywerenotmenstruating.A not gooutsideofthehomewithoutapurposeor Most girlsandmothersreportedthattheydid Restrictions onmovement (see Table B). Thegirls menstruation Boys currentknowledgeof survey. qualitative datawascollectedpriortothe could bepreventedinanyfuturestudies,if be atruerepresentationoftheirbeliefs.This able tochooseoneanswer, thedatamightnot However, becausetheparticipantswereonly blood beingshed’and/or‘tohavechildren’. described as‘anormalhealthyprocess’,‘bad exclusive. For example,menstruationcouldbe was thecauseofmenstruationnotmutually questionnaire toelicitwhatgirlsandboysthink shows thatthecategoriesusedinstructured menstruation Parsa districtstilldidn’tknowthecauseof the majorityofgirls,76percent,in about menstruationaftertheirmenarche,but schools reportedreceivingmoreinformation andnon-WinSmenstruation. GirlsfromallWinS knowing thecauseorphysicalreasonfor per centinnon-WinS schoolsreportednot schoolsand32.7 24.3 percentinWinS because the study did not collect qualitative data because thestudydidnotcollect qualitativedata It isnotpossibletoknowthenature ofthissupport and Parsa than inthedistricts’non-WinS schools. schoolsinBajura Achham andmoresoinWinS data showsthatboyswereequallysupportivein andnon-WinSWhen comparingWinS schools, the manage theirmenstruationinallthreedistricts. also saidtheyhadsupportedfamilymembersto sanitary productswerenoteasilyavailable.Boys of littlerelevanceinBajuraandAchhamwhere sanitary padsifaskedto,butthisquestionis in pain.Mostreportedtheywouldbeabletobuy when theyweremenstruatingorthat boys saidthattheirfemalerelativestoldthem the Parsa schools, district,particularlyintheWinS women wereexpectedtofollowintheirhome.In menstruating becauseofrestrictionsthegirlsand boysusuallyknewwhenwomenwere The cent confidencelevel( indicating anon-significantdifferenceat95per degree offreedomanda chi-square testrevealedavalueof0.035,1 between thetwotypesofschool.ThePearson’s significant differencebetweenknowledgeofboys knowledge aboutmenstruation,andtherewasno andnon-WinSWinS schoolshadsimilarextentof with womenwhoweremenstruating.Boysinboth menstruation inalldistrictsandalmostlived Most boysreportedknowingsomethingabout (seeTable 8). see Figure3 p valueof0.851, Thequalitativedata ). in the WinS schools.Teachersin theWinS alsofocused on how tomakereusablesanitarypads,particularly and preventingdisease.Thegirlswere also taught was mainlyaboutsexualandreproductivehealth findings suggestthatinformationfromteachers Non-WinS schools schoolsandmothersin friends intheWinS information tendedtobefromteachersand The mainsourcesforreceivingmenstrual Girls’ sourcesofinformation Table 18). by genderwhenteachingthissubject boys felttheclassshouldnotbedisaggregated found theclassembarrassing.Despitethis,most found theclassinteresting,moreboysinParsa and reproductivehealthatschool.Althoughboys per centofboyshadreceivedaclassonsexual received informationfromhealthworkers.Over80 members aboutmenstruation,whileafewhad Most receivedinformationfromteachersorfamily cause ofmenstruationwasinternalbleeding. Achham andParsa, someboysthoughtthemain to boysinterviewedintheParsa district.In menstruation wassheddingbadbloodcompared districts weremorelikelytobelievethecauseof (see Table 17). menstruation was‘anormalhealthyprocess’ schoolsthoughtthatthemaincauseof WinS compared to56percentofboysinnon- Fewer schools,39percent boysintheWinS schools WinS menstruation, comparedtoonly13percentinnon- Bajura hadspokentoafamilymemberabouttheir schoolsin from boys.60percentofboysinWinS Figure 5:Boysknowingsomethingaboutmenstruation taught usthatweshouldregularly takeabath, and careduringmenstruation: “He[theteacher] the importanceofcleanliness, goodnutrition,rest (see Table 16). BoysintheAchhamandBajura (see Table 8).The

qualitative (see

movements shouldberestrictedandthatwomen care duringmenstruationreinforcesideasthat polluting ordirtyprocessandthefocusontaking further reinforceideasaboutmenstruationbeinga focus oncleanlinessduringmenstruationmay While goodhygieneisimportanttoteach,this research team,rememberingherclasslessons. get infected,”agirlfromAchhaminformedthe otherwise therewouldbegermsandwe the classembarrassing,however, theywerealso were notmutuallyexclusive, as girlsoftenfound data analysisshowsthatquestionnaire categories from Bajuraschoolsreported. Thequalitative about things.We couldn’tsayanything,”students ask questions;“We didn’task,weonly thought the qualitativedatashowsthattheydidn’tusually invited toaskquestionsduringtheseclasses, schools reportedtheywere 33 percentinWinS Although 25percentofgirlsinnon-WinS and menstruation. girls] feltitimportantthatboysalsolearnabout classes. Thismayreflectthefactthatthey[the prefer theclasstobetaughtinmixedgender around 60percentofgirlssaidtheywould these qualitativefindings,instructuredinterviews and preventedthemfromlearning.Despite non-WinS schoolsfeltthatboysweredisruptive classes whenteachingthistopicandgirlsinthe was difficultforteacherstomanagemixedgender ‘ embarrassed andsometimesaskedthemto health (SRH)weretaught.Teachers oftengot their classesaboutsexualandreproductive Many girlsweredissatisfiedwiththeway physical attacksincludingrape. snake bitesandotheranimalattacks,violent included healthrisks–includinginfections, are vulnerableduringthistime.‘Beingvulnerable’ self-study ’ orstudyforthemselvesfrombooks.It

19 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 20 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Table B.1Materialsusuallyusedtomanagemenstruation sanitary productsthatcanbeused:“We doknow menstrual flow, physicalsymptoms anddifferent girls learntabouthowtherearedifferencesin talking totheirmothers.Throughfriends Parsa district,wheregirlsfeltmorecomfortable menstruation, exceptinthenon-WinS schoolsin most comfortabletalkingtotheirfriendsabout practical guidance.Girlssaidthattheyfelt and moreaboutsharingofexperiencesor from friendswaslessbiologicalortechnical from teachers,theinformationthatgirlsreceived In comparisonwiththeinformationreceived less teasing. management andencounterorhavetodealwith enable thegirlsmoreconfidentmenstruation before age(onset)oftheirmenarche,to the girls(andboys)learnedaboutmenstruation old. Theheadteachersfeltitisimportantthat in thesegradeswerebetween11and14years grades sixandnine.Headteacherssaidthatgirls and intheBajuraAchhamdistrictsbetween school: inParsa, betweengradessixandseven; menstruation relatededucationwastaughtattheir teachers wereaskedatwhatage/classthe classes thatgirlsweresatisfiedwith.Head teachers, bothmaleandfemaleteacherstaught ask questionsaboutmenstruationwithfemale Although girlspreferredtogetsupportand health teacher reproductive healthclassesweretaughtbythe for learningabouttheseissues.Mostsexualand and girlsalsomentionedthesupportofaNGO subjects suchasconsentforsexualintercourse In afewschools,someteachersweretackling such ascancer, orsexuallytransmitteddiseases. the needtokeepcleanpreventdiseases, more information.Girlsreportedlearningabout interested intheseclassesandwantedtolearn Other (nothing) trousers Wears twoorthree Sanitary pads(reusable) able) Sanitary pads(dispos Cloth (reusable) Materials (see Table 19). - 94(94.0) N=100 5(5.0) 1(1.0) N (%) WinS 0(.0) 0(.0) Achham 94(94.0) N-WinS N=100 4(4.0) 1(1.0) 1(1.0) N (%) 0(.0) 53 (53.0) 42 (42.0) N=100 3(3.0) 2(2.0) N (%) WinS 0(.0) Bajura at thesametime menstruation bywearingseveralpairsoftrousers Achham 4percentofthegirlsmanagedtheir anything atalltomanagetheirmenstruation.In time and6percentstatedthattheydidn’tuse by wearingseveralpairsoftrousersatthesame in non-WinS schoolsmanagedtheirmenstruation non-WinS schools.InBajura,20percentofgirls sanitary padscomparedtoonly2percentin schools-53percentusedreusable girls inWinS used reusablesanitarypads.Themajorityof of girlsintheBajuradistrict,wheremany manage theirmenstruation,withtheexception Most girlsusedreusable,used,dryclothsto Materials formanagingmenstruation explained. school among friends,”agirlinBajuraWinS problems?’ Thesethingsarediscussed[freely] are menstruating?Dotheyalsohavethesame Why doesourstomachhurtsomuchwhilewe our friends.Whyistheresomuchbleeding? about menstruation.We discusseditamong schools and17.9percentinnon-WinS schools their home,only11.4percentofthegirlsinWinS schools inParsa hadashopsellingpadsnear schoolsand16percentin non-WinSgirls inWinS Interestingly, despitethefactthat37percentof schools. schools useddisposablepadsmorethanatWinS by girlsinParsa District,wheregirlsatnon-WinS per centconfidencelevel.Thisdifferenceisdriven and apvalueof0.047whichissignificantat95 revealed avalueof3.938,1degreefreedom schoolswhenPearson’sWinS chi-squaredtest andnon- using disposablesanitarypadsinWinS revealed used disposablesanitarypads;theanalysis 20(20.0) 68(68.0) N-WinS N=100 6(6.0) 2(2.0) 4(4.0) N (%)

a significantdifferencebetweengirls 87(87.0) N=100 7(7.0) 6(6.0) N (%) WinS 0(.0) 0(.0) (see Table B.1). Parsa N-WinS 13(13) 87(87) N=100 N (%) 0(.0) 0(.0) 0(.0) 223(74.3) 65(21.7) N=300 3(1.0) 9(3.0) N (%) WinS 0(.0) Very fewgirls Total 249(83) N-WinS 24(8.0) 18(6.0) N=300 6(2.0) 3(1.0) N (%) Table B.1Materialsusuallyusedtomanagemenstruation Other (nothing) trousers Wears twoorthree Sanitary pads(reusable) able) Sanitary pads(dispos Cloth (reusable) Materials - 94(94.0) N=100 5(5.0) 1(1.0) N (%) WinS 0(.0) 0(.0) Achham 94(94.0) N-WinS N=100 4(4.0) 1(1.0) 1(1.0) N (%) 0(.0) 53 (53.0) 42 (42.0) N=100 3(3.0) 2(2.0) N (%) WinS 0(.0) Bajura 20(20.0) 68(68.0) N-WinS N=100 6(6.0) 2(2.0) 4(4.0) N (%) 87(87.0) N=100 7(7.0) 6(6.0) N (%) WinS 0(.0) 0(.0) Parsa N-WinS 13(13) 87(87) N=100 N (%) 0(.0) 0(.0) 0(.0) 223(74.3) 65(21.7) N=300 3(1.0) 9(3.0) N (%) WinS 0(.0) Total 249(83) N-WinS 24(8.0) 18(6.0) N=300 6(2.0) 3(1.0) N (%) Table Reasonsfornotusingdisposablesanitarypads C: and clothfromshopkeepers,theirmothers effects ofusingdisposablepads,reusablepads (and perhapsincorrect)messagesaboutthe caused cancerandinfections.Girlsheardmixed that sanitarypadscontainedchemicals causing cancerandinfectionsafewthought germs couldgatherandenterintotheuterus cloth wasnotgoodfortheirhealth,because dance performances.”Somegirlsfeltthatusing not falloffandIcandoanythingfreelyduringmy and I feel relaxed and confident that it [pad] would school explained:“Therearedanceprogrammes around andsitwithfriends.AgirlataBajuraWinS cloth, whichmadethemmoreconfidenttomove felt thatsanitarypadswerelesslikelytoleakthan them anddidnotwanttouseanythingelse.Girls who wereusingreusablepadssatisfiedwith like tousedisposablesanitarypads.Thosegirls half ofthegirlsusingclothinalldistrictswould wear tomanagetheirmenstruation,approximately When girlswereaskedwhattheywouldliketo (see Table C). to haveneverheardofdisposablesanitarypads districts 49percentofthegirlsweremostlikely In thenon-WinS schoolsBajuraandParsa, inboth easily availableortheyhadneverheardofthem. sanitary pads,thiswasbecausetheywerenot Of thosegirlswhodidn’tusuallyusedisposable from ashopintown(asopposedtolocalshop). sanitary padsreportedthatarelativeboughtthem Over 70percentofgirlswhouseddisposable used disposablepadsregularly. Others Not likelytousepad Due toeasilyavailabilityofcloths Difficult todisposeof Embarrassed togoandbuythem Expensive Unsure ofhowtousethem Never heardofthem Not easilyavailable Reasons

9 (11.7) 9 (11.7) 57 (74) 5 (6.5) 1 (1.3) 3 (3.9) 1 (1.3) 4 (5.2) 4 (5.2) N (%) N=77 WinS Achham 16 (18.2) 59 (67.0) 9 (10.2) N-WinS 5 (5.7) 1 (1.1) 8 (9.1) 3 (3.4) 6 (6.8) N (%) 0 (.0) N=88 13 (15.9) 21 (25.6) 14 (17.1) 32 (39.0) 33 (40.2) 6 (7.3) 8 (9.8) N (%) 0 (.0) 0 (.0) N=82 WinS Girls inParsa alsomentionednotwashingtheir to prevailingsuperstitionsandfearof‘polluting’. than normaltowashtheirreusablematerials,due reported havingtouseadifferentwatersource they managed.Afewgirls,inBajuraandParsa, a privateplacetowashtheirreusablematerials, dry them.Althoughgirlsdidn’tnecessarilyhave and likedthefacttheydidn’thavetowash However girlsfeltdisposablepadswerecleaner locations wheretheywerenoteasilyavailable. unsustainable productoption,particularlyinthe Using disposablepadswasanexpensiveand that theyhadtobethrownawayafteruse. to disposablepadsformanygirlswasthefact A simultaneousadvantageanddisadvantage schools. ornon-WinSmisinformation bydistrictorWinS no clearpatternofopinionorhearsay/rumour/ are mixedinthosedisposablepads.”Therewas madam [theteacher]thathazardouschemicals a Parsa whoreported:“We aretaughtby WinS those givingreusablepadtraining.Astudentfrom didn’t seetheirmenstrualblood,sothey, the while disposingofusedmaterialssothatothers and girlssaidthatitwasimportanttheytookcare Cloths wereusuallywashedbeforedisposing the riveror‘ a combinationofburning,buryingorthrowingin districts disposing ofpadsoroldclothsinanythe There werenoclearpracticesorrestrictionson cloths atnightduetoafearofbecominginfertile. Bajura 15 (17.2) 14 (16.1) 24 (27.6) 43 (49.4) 31 (35.6) N-WinS 1 (1.1) 1 (1.1) 1 (1.1) N (%) 0 (.0) N=87 (see Table 23). a placewhereno-onegoes 15 (26.8) 12 (21.4) 12 (21.4) 8 (14.3) 6 (10.7) 7 (12.5) 1 (1.8) 5 (8.9) N (%) 0 (.0) N=56 WinS Parsa Girlsinalldistrictsused 18 (29.5) 30 (49.2) 16 (26.2) N-WinS 2 (3.3) 2 (3.3) 2 (3.3) N (%) 0 (.0) 0 (.0) 0 (.0) N=61 102 (47.4) 22 (10.2) 37 (17.2) 38 (17.7) 48 (22.3) 13 (6.0) 10 (4.7) 7 (3.3) 9 (4.2) N=215 N (%) WinS Total ’ afteruse. 58 (24.6) 82 (34.7) 106 (45) 20 (8.5) 22 (9.3) N-WinS 8 (3.4) 9 (3.8) N=236 N (%) 1 (.4) 1 (.4)

21 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 22 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 the highestnumbersofgirls making andusing schoolsinBajurahad reusable pads.TheWinS for themselvesand50percent hadusedthe pads and49percenthadgone ontomakethem cent ofgirlshadlearnedhowtomakereusable schools62per of reusablepads.InalltheWinS schools. Onlyonemotherinterviewedhadheard in makingreusablesanitarypadsonlyafew only afewheadteachersreportedtraininggirls reusable sanitarypads,despitethefactthat In thequalitativeinterviews,manygirlshadused away frompublicview. them underneathclothesordriedinplace where theclothesaredried.Otherseitherhid the normalplacethatwholehouseholdused, of girlswhousedclothsdriedoutsidein school explainedherroutine.Only21percent no-one notices,”agirlatParsa non-WinS pads inpublic:“We drythemataplacewhere drying theirmenstrualclothsorreusablesanitary Some girlsinalldistrictsfeltembarrassedabout and theywouldtalkaboutit. of us.Theywouldknowweweremenstruating see [theused/soiledcloth]theywouldmakefun or beingteased:“We feelembarrassed.Ifpeople being scoldedbyothersformakingtheareadirty other peopleseeingtheirpadsorusedclothand mothers inParsa weremoreconcerned about them inarubbishpitorburnthem.Girlsand They tendedtothrowtheminastream,bury their sanitaryproductsactionsandbehaviours. illness intheirwashing,dryinganddisposingof were morefocusedonpreventingdiseaseand their home.GirlsinBajuraandAchhamdistricts schools buriedtheirusedclothsinlandawayfrom schoolsand84percentofgirlsinnon-WinSWinS stained menstrualclothand53percentofgirlsin if someonesawtheirmenstrualbloodor girls wereconcernedaboutspiritpossession a chanceofcausingtheirinfertility. InParsa some mentioned thatifclothisburned,thentherewas of spreadingdiseases.”SomegirlsinParsa also air willmixwithwater, andtherewillbehighrisk polluted iftheyareburned,andthenthe person shouldnotbeburnedandtheairwill because: Bajura, somewereconcernedwiththispractice to theteam.Althoughgirlsburntusedmaterialsin schoolgirlexplained transmit diseases,”aWinS used padisthrownanywherethenthefliescan germs intheusedpadcanaffectpeople…ifthat girls, weren’tthecauseofother’sillhealth:“The “ It issaidthattheclothofaliving ”

them whenweareatschool.We donotgenerally “We donotusethoseineveryhouse.We use them butadmittedtonotusingfrequently: reusable pads.Theywereenthusiasticabout and womeninthecommunityhowtomake reported receivingtrainingandothergirls the reusablesanitarypad.SomegirlsinAchham used theclothinsidebutnotoutermaterialof schoolgirlinAchham.Anothersaidshe WinS it mightfallout,”wasoneoftheconcernsfroma did notfeelsecure:“Thebuttonmightbreakand explained. Orthebuttonsbreakandthengirls girls donotusethem,”theataParsa WinS pads madethemfeeluncomfortable,somost them: “Everybodysaidthatreusablesanitary girls complainedoffeelinguncomfortableusing once andthenleftit.Therewasnotime.”Other schoolgirl:“Imadeit them, includingaWinS complained aboutthetimeittooktomake Achham andParsa. Somewomenandgirls making andusingreusablesanitarypadsin However, thereweremixedresponsesabout reusable pads was sporadicandstudentswere expectedto Parsa districtthe resupplyofpadsinoneschool Table D) in Bajuradistrictandnon-WinS schools sanitary materials.Whereasthisrarelyhappened answered thattheywouldasktheirteachersfor cent andParsa -40percentoftheparticipants do? menstruating suddenlyatschool,whatdoyou Girls wereaskedthequestion:‘ school day Menstrual managementduringthe School inBajurasympathised. of themdonotbringcloths,”astudentatWinS embarrassed bringingthesecottonclothes.Some shy, their familiesarepoorandtheyfeelextremely difficult forsomegirls:“Ourfriendsstillfeelvery put insidethereusablepadandthatthiswas sometimes askedtobringclothfromhome When girlsreceivedthetrainingtheywere we like.No-onewillknowaremenstruating.” and stainourclothes,wecangowherever and mostimportantly:“Bloodwillnotleakoutside absorb alotofblood,theycanusethemagain enthusiastic aboutreusablepadssayingthatthey schoolsinBajura,girlsweremore In theWinS Achham explained. schoolin use itthatmuch,”thegirlsataWinS ’ In the WinS schools inAchham-47per ’ IntheWinS . Thequalitativedatashows that inthe (see Table 24). If youstart (see Table D:Menstrualmanagementatschool embarrassed asking‘sir’[maleteacher],”agirls difficult formetoaskonefrom’sir‘.Ifeelvery there oronthedayssheisleave,itvery I needasanitarypadwhenour’mam‘isnot When Ihavetosaythatammenstruatingand their menstruation:“SometimesIfeelalittleshy. they requiredpadsorarehavingdifficultieswith prefer toaskafemaleteacherforassistanceif asking forpadsfrommaleteachersandwould in AchhamandParsa saidthattheyfeltuneasy girls areprovidedbythiscommittee Pads andmedicineneededformenstruating the madamandsirwhoformedthiscommittee. raised anddepositedontheaccountofone adolescent reproductivehealthwherefundsare formed aseparatecommitteeformanagementof and medicinesfromthisschoolwehavealso offered thisfacility:“We providesanitarypads the schoolandteacherswereproudtotellusthey were verypleasedwiththeavailabilityofpadsin schoolinAchham,thegirls provided, oneWinS However intheschoolsweresupplies not providedbytheschool.” cotton fromtheschoolbutnowitisfinishedsoit’s this saying:“Earlierweusedtoprovidepad/ The district head teachers corroborated/confirmed Parsa healthTeacher schoolexplained. ataWinS separate fundfromtheschoolforbuyingpads,”a provide thesetoeveryone.Thereisalsono then everyonecomestoaskforitandwecannot time ofemergency’…Ifwe[theschool]keepthem and buykeepitsothatyouallcanuseatthe them; ‘You allyourselfcollectfiverupeeseach the schoolkeepssomebyaskingstudentstelling contribute (financially)toresupply:“Sometimes, Note: n=100 each in WinS andN-WinSNote: n=100eachinWinS in eachdistrict. Other (don'tknow) materials Go toanearbyschoolshopandbuy Ask friendsformaterials Use materialsthatyoubroughtwith Go homechangeandcomeback You donothing Go homechangeandstay Ask teacherformaterials When you start menstruating and you are at school,how do you usuallymanage? Management 14 (14.0) 11 (11.0) 23 (23.0) 47 (47.0) . ” Mostgirls 1 (1.0) 3 (3.0) 1 (1.0) N (%) 0 (.0) WinS Achham 10 (10.0) 27 (27.0) 53 (53.0) N-WinS 1 (1.0) 1 (1.0) 4 (4.0) 4 (4.0) N (%) 0 (.0) 11 (11.0) 10 (10.0) 24 (24.0) 17 (17.0) 33 (33.0) 3 (3.0) 2 (2.0) and then the sandal gets stained with blood,” a girl and thenthesandalgetsstainedwithblood,”agirl bench: “Ifwefeeldifficultputasandaldown their sandals-sothattheblooddidnotstain started menstruatinginschooltheywouldsiton inBajuratoldtheresearchteamthatifthey Girls home andstayedthere available atschools8.4percentofgirlsstillwent (see Table D). ‘ non-WinS schoolsinBajura58percentofgirls home ortheychangedandreturnedtoschool.In schoolsgirlseitherwenthomeandstayed WinS tended togohomeandremainthere.InBajurain who didnottakepadsfromteachersatschool, districts whostartmenstruatingsuddenlyand Girls innon-WinS schoolsinParsa andAchham distribution offemaleteachersinschools. friends, howeverthismaybebecauseofthe teachers; whereasinnon-WinS schoolitwas schoolsittendedtobefemale from: intheWinS felt mostcomfortableaskingforsanitarymaterials structured interviewsgirlswereaskedwhothey schoolexplained.Inthe from anAchhamWinS not routinely taught by a female teacher in any of not routinelytaughtbyafemaleteacherinanyof 74 percentofgirlssaidtheywouldtell.Girlswere schoolsinParsa school, apartfrominWinS were that theydon’ttellthereasonneedtoleave school duringtheirmenstruation.Mostgirlssaid (not theirclassteacher),iftheyhadtoleavethe there. Girlsreportedusuallytellinganotherteacher cent, reportedthattheygohome,changeandstay all thenon-WinS schoolsinallthedistricts,52per to preventastainfrombeingseen.Thegirls or theywouldfoldtheirtrousersasbestcould from aBajuranon-WinS schoolinformedtheteam; N (%) 0 (.0) WinS did nothing Bajura 58 (58.0) 17 (17.0) N-WinS 1 (1.0) 9 (9.0) 9 (9.0) 6 (6.0) N (%) 0 (.0) 0 (.0) ’ iftheystartedmenstruatinginschool Evenwhensanitarypadswere 21 (21.0) 25 (25.0) 40 (40.0) 2 (2.0) 5 (5.0) 5 (5.0) 2 (2.0) N (%) 0 (.0) WinS Parsa (see Table 25a). 86 (86.0) N-WinS 4 (4.0) 1 (1.0) 1 (1.0) 8 (8.0) N (%) 0 (.0) 0 (.0) 0 (.0) 59 (19.7) 81 (27.0) 89 (29.7) 19 (6.3) 13 (4.3) 28 (9.3) 8 (2.7) N (%) WinS 3 (1) Total 156 (52.0) 85 (28.3) 11 (3.7) 14 (4.7) 24 (8.0) N-WinS 5 (1.7) 4 (1.3) N (%) 1 (.3)

23 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 24 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Table D.1 Wholedaysmissedatschoolinthepast3monthsduetomenstruation schools inParsa 49 percentofgirlshadmissed in otherdistricts( the dayofschoolwhilemenstruating-morethan Parsa whoreportedmissingwholedaysor partof Table D.1 significant at95percentconfidencelevel( degree offreedomandpvalue0.036whichis chi-squared testrevealedavalueof4.391,1 non-WinS schoolsmissingschool.Pearson’s WinS and significant differencebetweengirlsin day becauseoftheirmenstruation.Therewasa how manydaystheywereabsentforpartofthe from schoolbecauseoftheirmenstruationandfor three monthshowmanydaystheywereabsent interviews, girlswereaskedtorecallfromthelast through thestructuredinterviews.In school absencesbygivingdiariestogirlsand difficult tocapture.Thisstudytriedmeasure School absencesattributedtomenstruationwere Absence fromschool pads or otherfacilities friends toaskforpermissionleaveor explain theirresponses.Oftentheywouldask the schoolsresearchteamvisited,whichmay Figure 6:Sanitarymaterialsavailableatschoolwhenstudentsneeded Days (1to15) 0 days Days ). Thisdifferencewasdrivenbygirlsin see Table 26) (seeTable D). 96 (96) 4 (4.0) N=100 N (%) WinS Achham . Inthenon-WinS 91 (91.0) N-WinS 9 (9.0) N=100 N (%) see 92 (92.0) 8 (8.0) N=100 N (%) WinS Bajura had missedawholedayofschoolwere15.3per pain andfearofleakage reasons givenformissingpartofthedaywere and non-WinS schoolsofthreedistricts,themain schools in WinS menstruation, while34percenthadmissedaday at leastonedayinthepastthreemonthsdueto part oftheday(see report missingschoolforeitherthewholedayor menstruation withclothswhoweremorelikelyto part oftheday. Itwasthegirlswhomanagedtheir reported missingschoolforawholedayoreven wearing severalpairsoftrousers,nonethegirls Of those districts thaninParsa. districts; fewergirlsmissedschoolinthese given forabsencesintheBajuraandAchham While fearofleakagewasamostcommonreason Table 26). andnon-WinScent inWinS schools and fearofleakage21.7percent15.2 cent andinthenon-WinS schools75.8percent; schools71.7per their absenceswere:pain-WinS schools.Thetwomainreasonsgivenfor WinS schoolsand22percentnon- cent intheWinS 92 (92.0) N-WinS 8 (8.0) N=100 N (%)

girls whomanagedtheirmenstruationby 34 (34.0) 66 (66.0) N=100 N (%) WinS (seeFigure5 Parsa Tables 21and22). 49 (49.0) 51 (51.0) N-WinS N=100 N (%) (see Table 26). ). In all the WinS ). InalltheWinS 46 (15.3) N=300 (84.7) N (%) WinS 254 (see Total Mostgirls Girlswho

66 (22.0) 234 (78) N-WinS N=300 N (%) month period Table E:Schoolabsenteeismduringaone in allthestudydistrictsandschools. girls weremenstruatingreportedfromallthe 71 percentattendancerateonthedayswhen In monthone,therewasbetween63percentto as inmonthone,buttheresponseratewaslower. month. Datafrommonthtwoshowssimilartrends accurate representationofa‘normal’school one, wheretherewasbetterreportingandamore month two,thediscussionisfocusedon data collectionduetotheschoolholidaysin whole dayofschool,duetothedifficultieswith The findingsarepresentedaboutgirlsmissinga school. school; 52hadlosttheirdiary;and9left went tocollectdiaries;18hadmarriedandleft diaries: 42absentfromschoolwhenresearchers from allthedistricts,thosewhodidnotreturntheir Amongst allthegirlsparticipatinginstudy, 88 percentinBajuraand79Parsa. and collected:73percentofdiariesinAchham, 80 percent,atotalof479,ofdiarieswerefilled this forthetwomonthspriortostudy. Intotal they wereabsentfromschoolandthereasonsfor Girls wereaskedtorecordintheirdiarieswhen per centmissedschoolduringtheirmenstruation. the girlswhousedreusablesanitarypadsonly7 used clothstomanagetheir Figure 7:Wholeschooldaysmissedinthepastthreemonthsduetomenstruation Menstruation Day 2 Day 1 Absent 31.4% 34.1% Part oftheday

Month1 menstruation. 2.5% 3.2% Total number

472 475 Among Among thegirlswhoprovidedreasonsforbeing because oftheearlierpractices, somemaynot told theresearchteam:“Some girlsmissschool school they come.”AmotherfromAchham WinS when theyweremenstruating, butnowadays explained: “Inthepastgirlsdidn’tcometoschool schoolgirl they weremenstruating.AWinS school andthatgirlsshouldattendevenwhen was anawarenessthatitnotgoodtomiss The girls,mothersandteachersfeltthatthere whole dayorpartoftheday. several pairsoftrousersmissedschoolfora girls whomanagedtheirmenstruationbywearing report missingschool( cent girlswhousedclothsweremorelikelyto related reasons,fromatotalof53girls,83per girls whowereabsentbecauseofmenstruation common ondaythreeofmenstruation.Ofthose cent). Absenceduetofearofleakagewasmost cent to20percent)orfearofleakage(7-27 (14 percentto60cent),tiredness(13 half (orpartofthe)dayschoolbecausepain of leakage,or‘other’reasons.Afewgirlsmissed whole dayofschoolbecausetiredness,fear days ofmenstruation.Onlyafewgirlsmissed This wasalsomorecommonduringthefirstfour missed awholedayofschool(25-49percent). most commonreasongivenfromthegirlswho month (see absent duetomenstruationonfirstdayof Menstruation Day 5 Day 4 Day 3 Table 27 Absent 26.6% 33.0% 30.2% ), menstrualpainwasthe see Table 28 Part oftheday Month1 1.5% 1.5% 2.3% ). Noneofthe Total number 263 412 470

25 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 26 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Figure 8:Sometimeshaveleakageduringschoolhours their houseswerelocatedfarfromtheschool,it and stayathome.Thiscouldoftenbethecaseif schools statedthattheywouldgohome,change happened. 64percentofgirlsinBajuraWinS per centsaidthattheywouldstayatschoolifthis sometimes hadleakageissuesandofthose,78 schools where43percentofgirlsreportedhave more commonlycitedinBajuranon-WinS their menstrualbloodwhileatschool.Thiswas sometimes hadtheproblemofleakage Over athirdofgirlsinthestudysaidthey health teacherinanAchhamnon-WinS school. difficulty room here-thatiswhyitcausingabitof medicines forthemintime.Thereisnoresting suffer frommenstrualcramps,wecouldnotget to havetheseavailable:“Sometimeswhenthey of thesefacilitiesinotherschoolsandwerekeen available. Teachers andgirlsnotedtheabsence and onenon-WinS schoolpainkillerswere schools Head teacherstoldusthatintwoWinS to schoolbecausetheyhavenottakenabath.” some donottakeabath,mostgirlscome “Some girlshaveheavybleeding,itsmellsfoul… schoolgirlinAchhamtoldtheteamthat: A WinS other reasonsgirlsgavefornotattendingschool. Heavy bleedingandnotbeingabletobathewere schoolsaid. school,” agirlinanAchhamWinS if theyareverybadthenthereisnoneedtogo what sirissayingbecauseofmenstrualcramps… attending school:“We cannotconcentrateon discomfort sometimespreventedthemfrom with quantitativedata,asgirlssaidthatpainand not donethis.”Thequalitativedataconcurred have beenallowedtogoschool,butwe

[for girlstoattendschool],”confirmeda menstruating. Ifeelreallyembarrassedsitting then theboyswillmakefunofmethatIam use pads,thentherewillbeleakageofblood, girl fromanon-WinS inBajurasaid:“Ifwedonot clothes andtheboysmightteaseus.”Another the mostisthatbloodmightgetstainedonour underwear. Thethingthatmakesusscared school inBajuraexplained“We don’twear classmates, particularlyboys.AgirlataWinS girls inalldistrictswerescaredofridiculefrom The qualitativedatacollectedshowedthat Teasing fear ofteasingwhentheyreturned would stayathomeiftheyhadleakagecouldbe stay home.Onereasonforthehighnumbersthat schools saidtheywouldgohomechangeand schoolsand93percentinthenon-WinSthe WinS they hadaleakage.WhileinParsa 56percentin they wouldgohome,changeandstayathomeif andnon-WinScent ofgirlsinWinS schoolssaid to schoolafterchanging.InAchhamover80per was notconsideredfeasibleorpracticaltoreturn me, pointingoutmymenstruation,tellingme I don’tdrinkwaterandthentheystartteasing go alittlebitfurtheraway. Thentheywonderwhy teasing: “Ifweneedtodrinkwater menstruating, makinghermorevulnerableto also broughtattentiontothefactthatagirlis by alltheboys.”Culturalmenstrualrestrictions a lot.Isawhercryingaftershewasteasedlot blood onherbench.Theboysmadefunof her friendhadexperienced:“Everyonesawthe schoolrecalledanembarrassingincident WinS in frontofmyfriends.”OnegirlfromAchham (see Table 30). Table F: Teasing Practices andnon-WinSgirls inbothWinS schools,44per once amonth schoolsatleast they hadseenteasinginWinS uncomfortable; 21percentofgirlssaidthat experience andsomethingthatmadethem less confident,teasingwasaveryunpleasant to thosewhoteased,butforthegirlswere Some girlshandledtheteasingbytalkingback first menstruationwerestilllikelytobeteased. amount ofteasinghadreduced,girlshavingtheir perpetrators. Girlsconfirmedthatalthoughthe schools andpunishmentswerementionedforthe took teasingissuesmoreseriouslythannon-WinS schools collected revealedthatgenerallyWinS school inBajurapointedout.Thequalitativedata felt veryuncomfortable,”agirlfromnon-WinS they canseethebloodstainatback.ThenI that Ishouldhavestayedbackhomeand *percentage mayexceed100dueto multipleresponses; Boys Girls If you have ever seenteasing ,whohasdoneteasing* served inpast3months Not experiencedorob Once in3months Once in2months Once amonth Once aweek How often have you experienced orobserved teasing ofgirlsaboutmenstruation inthepast 3months Experienced orobserved teasing ofgirlsaboutmenstruation Female Teachers Boys Girls Who are you worried willtease you Not worry Worry When you have your periodinschooldoyou worry aboutbeingteased? because ofmenstruation Ever challenged teasing Teasing (see Table F) - 30(81.1) 13(35.1) 14(14.0) N=100 9(90.0) 4(40.0) 2(18.2) 3(27.3) 5(45.5) 11(11) 63(63) 37(37) 1(9.1) n=10 n=11 n=37 N (%) WinS 0(.0) 0(.0) . Equalnumbersof Achham N=100 N-WinS 3(50.0) 3(50.0) 8(57.1) 4(28.6) 14(14) 11(11) 1(7.1) 1(7.1) n=14 N (%) 0(.0) n=6 31(72.1) 23(53.5) 57(57) 43(43) 1(2.3) n=43 n=100 each in WinS andN-WinSn=100 eachinWinS ineachdistrict. 10(66.7) 12(44.4) N=100 6(40.0) 7(25.9) 5(18.5) 27(27) 20(20) 2(7.4) 1(3.7) n=15 n=27 N (%) WinS 44(86) 20(39) 49(49) 51(51) Bajura n=51 0(.0) schools. Alockedtoiletinonenon-WinS school toilets andhandwashingfacilitiesin11outof12 The researchersmadeobservationsofthe Toilet facilitiesinschools witnessed. reported challengingthosewhowereteasingthey menstruation relatedteasingofgirls,most of girls.Whileafewboysadmittedwitnessing The researchteamaskedtheboysaboutteasing schools. responsible forteasinginWinS data showedthatgirlsandboyswereequally and complainedaboutteasingfromboys,the qualitative datashowedthatgirlsfearedteasing to 12percentinnon-WinS schools.Although schools hadbeenteased20percentcompared cent, worriedaboutteasing.MoregirlsinWinS N=100 N-WinS 7(87.5) 1(12.5) 8(50.0) 4(25.0) 3(18.8) 9(25.7) 16(16) 33(94) 65(65) 35(35) 14(14) 1(6.3) n=16 n=35 N (%) 0(.0) 0(.0) n=8 12(52.2) 25(56.8) 28(63.6) N=100 4(36.4) 8(72.7) 4(17.4) 3(13.0) 23(23) 56(56) 44(44) 19(19) 2(8.7) 2(8.7) n=11 n=23 n=44 N (%) WinS 0(.0) Parsa 34(65.4) 31(59.6) N=100 N-WinS 1(33.3) 2(66.7) 4(57.1) 2(28.6) 1(14.3) 48(48) 52(52) n=52 N (%) 0(.0) 0(.0) 0(.0) n=3 n=7 7(7) 5(5) 23(63.9) 18(50.0) 25(41.0) 12(19.7) 13(21.3) 61(20.3) 99(75.0) 61(46.2) 53(17.7) 168(56) 132(44) N=300 8(13.1) n=132 3(4.9) n=36 n=61 N (%) WinS 0(.0) Total 170(56.7) 130(43.3) 11(64.7) 20(54.1) 10(27.0) 37(12.3) 98(75.4) 63(48.5) 30(10.0) N=300 N-WinS 6(35.3) 5(13.5) n=130 2(5.4) n=17 n=37 N (%) 0(.0) 1(.8)

27 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 28 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 36 Parsa withthederogatorygraffitiwasaware of schoolin private. TheheadteacherintheWinS school compound,andthereforenotconsidered in non-WinS schoolswereinwardfacingonthe WinS schoolsandthree but onlyfivetoiletsin school, alltoiletswerewithoutderogatorygraffiti, had enoughlight.ApartfromonetoiletinaWinS schools therewerenocleantoiletsandnone were observedtobeclean.IntheAchhamdistrict toilets schoolsandfourinthenonWinS the WinS age appropriateheightforchildren).Fivetoiletsin had achild-friendlywatertap(onethatisatan schoolsandtwointhenon-WinSWinS schools facilities forhandwashing.Onlythreetoiletsinthe None ofthetoiletshadnearbysoapandwater address andminimizetheproblem and maintenancefundthatshouldpositively ensured thecompulsoryprovisionofanoperation programmehave partners supportingtheWinS At presenttheGovernmentanddevelopment an operationormaintenancefundforthiswork. did nothavedoorsreportedthatthey ensure thatthetoiletshavedoors;schools schools theWASH programmewastryingto toilets hadafunctioninglockonthedoor. InWinS to use.Oftheenclosedtoilets,onlyhalf enclosed andfouropenpantoiletswereavailable whereas inthenon-WinS schoolsatotalofsix enclosed toiletsand29openpan schools,therewereatotalof13 In theWinS had adisabledfriendlytoilet school child friendlywatertapandonlyoneWinS schoolsandoneinnon-WinSWinS schoolhada non-WinS schoolshadaseparategirls’toilet,two and compound. FiveschoolsinboththeWinS all schoolshadatoiletfacilityintheschool in Parsa wasnotabletobeobserved.Insummary Table G:Observationofschoolfacilities Separate toiletforsecondaryschoolgirls Disabled friendlytoilets Child friendlyWater tap Separate girls’onlytoilet Toilet intheschool

door; openpantoiletmeanswithoutdoor. lockingsystemanda meanshavingproper Enclosedtoilets Observation (see Table F). (see Table 31) WinS N=2 36 1 0 0 2 2 ; Achham

N-WinS N=2 0 0 0 2 2 . Most girlsdon’tchangetheirsanitarymaterials constructed after2009dofulfilthecriteria. fulfil thiscriteria;almostallthenewtoiletblocks toilets thatwereconstructedbefore2009donot and environmentallyfriendly. Howevermostofthe school toiletsshouldbechild,gender, disabled and developmentpartnersclearlystatesthat Table 32). schools inthestudyhaddisabledaccess rid ofit.OnlyonetoiletinParsa amongstallthe the offensivegraffitiandhadtakenactionstoget interviews withmothers,theresearch teamfound a non-WinS schoolinAchhamexplained.Inthe there wasnowatertodoso,”ahealthteacherin We requestedhimtocleanthem,buthesaid refused sayingthatthetoiletswereverydirty. also requestedhimtoopenthetoilets,buthe We talkedaboutitwiththeofficeassistantand they justgotowardstheforesttochange… pads asthetoiletswereverydirty. Soinstead of girls.Theyarehavingtroublechangingtheir got dirty:“Thetoilethasnotfulfilledtheneeds Toile it wasdifficultfortheschooltokeepthemclean. water supplyproblem.Whentherewasnowater, Many toiletsintheschoolsreportedtheyhada Table 33). the toiletduringbreakmostoftime non-WinS schoolsreportedbeingabletouse schoolsand94percentin cent ofgirlsinWinS school morethanotherschools.Intotal98per schoolsinBajurareportchangingat in theWinS schoolinAchhamGirls reported agirlatWinS change andthrowtheusedclothatschool,” to changeatschool...thereisnofacility change sanitarymaterials.Therewillbe‘tension’ at school: “If we gotoschoolthendonot WinS N=2 0 0 1 1 2 ts wereeitherlockedornotusedwhenthey Bajura N-WinS ThepolicysetoutbytheGovernment N=2 0 0 1 2 2 WinS N=2 0 1 1 2 2 Parsa N-WinS N=1 0 0 0 1 1 WinS N=6 1 1 2 5 6 Total* (see N-WinS (see N=5 0 0 1 5 5 Table H:Comfortlevelinschoolduringmenstruation there attheside…thereisaholeingroundso is adoorbutitcannotbelocked.Boysgather “We feelitisdifficulttogoinsidethattoilet.There the difficultyofnothavingaseparategirl’stoilet: Girls inanon-WinS schoolinBajuramentioned because thetoiletsmelled. toilet andrestroomshouldbenotadjoining completely private.Theyalsomentionedthatthe was appreciatedbygirls,theysaiditwasn’t with permissionfromtheteacher. Althoughthis menstruating girls.Thiswaslockedandopened there wasachangingroomlinkedtothetoiletfor schoolinParsa, schoolinBajura.InaWinS WinS happening,” pointedoutahealthteacherat if thatfacilitywillbetherethoughisnot menstruation iftheyfeelodd.Ifwouldbebetter change theirclothsandattendtheclassduring “There shouldbethefacilitythatgirlscan this requestwasacknowledgedbyteachers: wanted aseparateprivateplacetochangeand other girlsfeelbadseeingthis.”Alltheall blood therethatisdifficulttotakecareof. The right aftersomeoneusesit,thentherewillbe told theteam:“Ifamenstruatinggirlgoesin schoolinAchham usable. OnegirlfromaWinS to keepthemcleanandensuretheyremain state ofthetoilets,wasaregularwatersupply main factorthatwouldmakeadifferencetothe and keep cleanatschool.Girlssaidthatthe possibility tochangetheirsanitarymaterials These separatetoiletsalsoallowedthegirls good thattherewereseparatetoiletsforgirls. been made,girlsappreciatedtheseandfelt Where recentchangesintoiletfacilitieshad state ofthetoiletfacilitiesinschool. that theywereoftenunawareofthepoor/unusable Not comfortable Comfortable When you are menstruating, how comfortable do you feel beingin theclasswithboys? play sports No sportsatschool/don’t Not comfortable Comfortable When you are menstruating, how comfortable do you feel playing sports? Comfort Level 82(82.0) 18(18.0) 11(11.0) 73(73.0) 16(16.0) N=100 N (%) WinS Achham 96(96.0) 75(75.0) 16(16.0) N-WinS N=100 4(4.0) 9(9.0) N (%) 80(80.0) 20(20.0) 64(64.0) 35(35.0) N=100 1(1.0) N (%) WinS Bajura materials homeorthrowingtheminthejungle facilities, butmanagedbyeithertakingtheir or pads.Girlswouldhavepreferreddisposal had adequatedisposalfacilitiesforusedcloths schoolshad cloths atschool.OnlytwoWinS mentioned beingtooembarrassedtowashtheir in mostschools dry thematerialswhichpreventedthisactivity of water, soapandavailableplacetowash sanitary materialsatschool.Therewasalack where 22percentreportedwashingtheir schoolsinBajura at school,exceptforinWinS Most girlsdidn’twashtheirreusablematerials Parsa asked. how canwego?”thegirlsatanon-WinS schoolin the toiletwithoutalock:“Thereisnolockthere,so schoolalsomentionedthedifficultyofusing WinS make thetoiletsdirtyinotherschools.Girlsa usable.” Younger childrenwerealsoreportedto and thenwefeeldirty. Thatiswhythetoiletnot children defecatemoreandmakethetoiletdirty, boys sitthereandkeepseeing.Inthistoiletsmall disposal facilities. for girlswhentheywereunabletoeasilyfind place fordisposalandmadeitmorestressful made itmoreimportanttofindanappropriate be cursedifanotherpersonseesthecloth.This that usedmaterialsspreaddisease,oragirlcan felt embarrassed,buttherewasalsoabelief school inAchhamtoldtheresearchteam.Girls polythene bagandwashit,”agirlfromWinS then wefeelembarrassed.We takeithomeina the usedclothatourschool.Ifanyoneseesit or river:“Thereisnofacilitytochangeandthrow 73(73.0) 27(27.0) 66(66.0) 31(31.0) N-WinS N=100 3(3.0) N (%) 82(82.0) 18(18.0) 11(11.0) 69(69.0) 20(20.0) N=100 N (%) WinS (see Table 30). Parsa 93(93.0) 17(17.0) 66(66.0) 17(17.0) N-WinS N=100 7(7.0) N (%) 244(81.3) 206(68.7) Afewgirlsalso 56(18.7) 71(23.7) 23(7.7) N=100 N (%) WinS Total 262(87.3) 207(69.0) 38(12.7) 64(21.3) N-WinS 29(9.7) N=100 N (%)

29 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 30 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 while theyweremenstruatingand15percentin never writeontheboardiftheywereaskedto cent innon-WinS schoolsfeltthattheycould schoolsand43per saying. 32percentinWinS could alwaysfocusonwhattheteacherwas to sitinfrontoftheclassroomandaroundhalf Only 45percentofallthegirlsalwaysfeltable when theyweremenstruating not feelcomfortablebeinginaclasswithboys schools and87percentinnon-WinS schools,did while menstruatingandgirls81percentinWinS districts didn’tfeelcomfortableplayingsports girls 69percent,inallthestudyschools school whiletheyweremenstruating.Mostofthe felt doingorparticipatinginspecificactivities Girls wereaskedabouthowcomfortablethey Participation inschool * Percentage mayexceed100duetomultipleresponses Table I:Boys’opinionaboutactivitiesthatcan'tbedonebygirlsduringmenstruation* They candoanything Don't know Others Cannot gotocollectfirewood Cannot liftheavyloads answer aquestion Cannot sandupinclassto answer aquestion Cannot gototheboard Cannot playsports Opinion 16(53.3) 11(36.7) 6(20.0) (N=30) 1(3.3) 2(6.7) N (%) WinS 0(.0) 0(.0) 0(.0) (see Table G). Achham 12(46.7) 10(35.0) N-Wins 5(11.7) 2(13.3) (N=30) 1(3.3) 1(1.7) N (%) 0(.0) 0(.0)

17(56.7) 12(40.0) 6(20.0) 6(20.0) (N=30) 1(3.3) N (%) WinS 0(.0) 0(.0) 0(.0) Bajura majority of the girls, 78 per cent in WinS and68 majority ofthegirls,78percentinWinS a questionwhiletheyweremenstruating.The their handtoanswerwhentheteacherasked and21percentsaidtheycouldneverraise WinS answer aquestion couldn’t gototheboardinclass,orstandup Some boysintheParsa districtalsofeltthatgirls could notdosportswhiletheyweremenstruating. Parsa mostboys,over70percent,feltthat girls thought thatgirlscoulddoeverything,howeverin half theboysinBajuraandAchhamschools girls coulddowhilemenstruating.Approximately The researchteamaskedtheboyswhatactivities Table 34). school whiletheyweremenstruating homework and70percentfelttheycouldattend per centinnon-WinS schools,feltabletodotheir 21(63.3) N-Wins 0(10.0) 3(15.0) 7(31.7) (N=30) 0(1.7) N (%) 0(.0) 0(.0) 0(.0) 22(73.3) 3(10.0) 3(10.0) 3(10.0) 9(30.0) (N=30) 2(6.7) 2(6.7) N (%) WinS 0(.0) Parsa (see Table H). 10(33.3) 21(70.0) N-Wins 4(13.3) (N=30) 1(3.3) 1(3.3) N (%) 0(.0) 0(.0) 0(.0) 35(38.9) 11(12.2) 21(23.3) 45(50.0) (N=90) 2(2.2) 5(5.6) 3(3.3) N (%) WinS 0(.0) (see Total 34(37.8) 15(16.7) 38(42.2) N-Wins 9(10.0) (N=90)

2(2.2) 1(1.1) N (%) 0(.0) 0(.0) sampled. Itwouldhavebeenbeneficialtospeak health andpopulationteacherswereuniformly predefined, clearandconsistent.Thereforethe they visitedasthesamplingcriteriahadtobe there wasafemaleteacherintheschoolbefore team wasunabletoknowinadvancewhether numbers offull-timefemalestaff. Theresearch presence ofafemaleteacherintheschool,or a cleanertoilet.Datawasnotcollectedonthe was water, thenitwasmorelikelytoencounter menstruation. Ifschoolswerevisitedwhilethere the contextinwhichgirlsweremanagingtheir have enabledamorenuancedexaminationof regularity ofwatersupplyinschoolswould to school.Systematicdatacollectiononthe they wenthometochangeanddidnotreturn sudden menstruationorleakage,includingif influenced theirabsencewhileexperiencing from girls’hometotheschoolwhichmayhave Information wasnotcollectedaboutthedistance were notmenstruating. with thegirls’usualattendanceratewhenthey compare thegirls’attendancewhilemenstruating menstruated. Thereforeitwasnotpossibleto or presentatschoolforthedayswhenthey asked tojustrecordwhethertheywereabsent information forthewholemonth,rathertheywere attendance. Girlswerenotaskedtorecord first monthofthestudywasusedtoexamine the report.Thereforedatacollectedfrom the ‘additional’month,asexplainedearlierin problems withtherecordingandcollectingfor in thesecondmonthofstudyandsome unreliable duetotherebeinganextendedholiday The dataonattendancefromdiarieswas LIMITATIONS options andstyle.For example,severalquestions lack ofqualitativeresearchtoinformquestion The questionnairequestionswerelimitedbythe of thisstudy. also beconsideredwheninterpretingtheresults availability andremoteness.Thisfactorshould from smallerschoolsintermsoffacilities,teacher experiences inlargerschoolsmightbedifferent to satisfytheresearchteam’ssamplesize.The Data wascollectedinlargerschoolsorder out ofschoolwereexcluded. participants ofthisstudyandchildrenwhowere Students attendingschoolweretheonly for thegirlswhentheyweremenstruating. as theywereusuallythemainsourceofsupport t challenge negativeculturalpractices. menstrual hygienefacilities,knowledgeand and abletoattendschoolimproveupon further actiontomakegirlsfeelmorecomfortable are sufficienttodemonstratethene Despite theselimitations,thestudyconclusions was notpossiblewithinthescopeofthisstudy. a girlfeelsduringherperiod.Unfortunatelythis menstruating, inordertoestimatehowdifferent attendance (andperformance)whentheyweren’t useful toaskgirlsaboutdaysandtheirschool levels whilemenstruatingitwouldhavebeen When consideringattendanceandcomfort answers. that apply and couldhavebeenbetterframedas did nothavemutuallyexclusivecategories o afemaleteacher, insteadofthehealthteacher ’ insteadofsingleanswerquestions/ ed totake ‘tick all

31 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 32 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 RECOMMENDATIONS AND DISCUSSION was low-indicatingthatgirls didnotmissmany for therestofday. Theincidenceofleakage and stayedathomedid not returntoschool menstruation, 8.4percentofgirlsstillwenthome at schoolswhenstudentsneededtomanagetheir leakage. Evenwhensanitarypadswereavailable if theystartedmenstruatingsuddenlyorhada said thattheywouldgohomeandstayat and 52percentofgirlsinnon-WinS schoolsstill schools however 27percentofgirlsinWinS school iftheystartedmenstruatingsuddenly, beneficial topreventgirlsfromhavingleave school. Theprovisionofpadsinschoolswas schoolsandonenon-WinSschools -twoWinS leakage. Painkillers wereonlyprovidedinthree girls missedschoolbecausetheywereafraidof due topain,discomfortandtiredness.Fewer absent fromschool,themainreasonsgivenwere concerns thantheotherdistricts.Whengirlswere of disposablepadsandreportedlessleakage Achham andBajura.Parsa alsohadahigheruse fewer menstrualculturalrestrictionsthangirlsin of menstrual girls. GirlsinParsa didnot reportashighlevels fewer social/culturalrestrictionsonmenstruating when comparedwithotherdistricts,despite menstruating. AttendancewaslowerinParsa 63 -71percent,didnotmissanyschoolwhen three districtsshowedthatthemajorityofgirls of thepersonaldiarydatacollectionfromall The analysisoftheresponsesfromonemonth attendance? role ofWASH facilitiesininfluencing girls’ attendanceandwhatarethe 1. Howdoesmenstruationaffect are offered: main researchquestionsandrecommendations Conclusions arepresentedaccordingtothethree to non-WinS schoolsintheselecteddistricts. school programmeineachdistrict,compared Parsa andconsideredtheeffectofWinS girls intheruraldistricts:Achham,Bajuraand This reportdescribedthesituationofmenstruating chhaupadi seclusionandhad lack offacilitiesforgirls,theywerethemajority inadequate watersupply. However, despitethe especially duringtimeswhentherewasan dirty. Dirty/unclean toiletswereoftenlocked, important andtheydidnotusetoiletsthatwere identified bythegirlsinstudyasbeingvery disaggregated toiletswithlockswereconditions supply. Aregularsupplyofwaterandgender to change;lackofprivacy;andirregularwater at schooldueto:thelackofanappropriateplace Most girlsdidnotchangetheirsanitaryproducts for girlstoreturnschool. discovered, particularlybyboys,madeitdifficult However, theteasingthatoccurredifleakagewas days ofschoolbecauseduetoleakageconcerns. female teachersorstaff. felt muchmorecomfortableasking forhelpfrom and they having sanitarypadsavailable inschools study metallofthesecriteria.Girlsappreciated water, soapandwastedisposal.Noschoolinthe be comprehensive,clean,privateandsafe,with The WASH facilitiesformenstruatinggirlsneedto girls’ needs? in schoolsandhowdothesemeet 2. WhataretheexistingWASH facilities • • • • Recommendations: of thetime,attendingschool. practices. challenges negativeassociationsandsocial that providesaccurateinformationand A consistent,empoweringprogramme available forgirlswhenrequired; Pain managementandprivatespacetorest regularly re-stocked; supplies, tobeavailableatalltimesand Availability ofmenstrual management disposal; soap andhandwashingfacilitieswaste specific toiletswithaconsistentwatersupply, Accessible, clean,lockable,ageandgender Recommendations: disposable sanitarypads. were moreambivalentandwouldprefertouse had receivedtrainingonreusablepadmaking, them; whereasgirlsinAchhamandParsa who reusable padsinBajurawereverysatisfiedwith their menstruation. or partoftheschooldayusedclothstomanage day. 84percentofgirlswhomissedawholeday missing schoolforawholedayorevenpartofthe with severalpairsoftrousers,nonereported whomanagedtheirmenstruation about thosegirls in thesesituations.Whenexaminingdiarydata reusable padtrainingcouldbeeffectivelyused wore underwearanditwasunclearwhetherthe did notuseanythingatall.NotallgirlsinBajura wearing severalpairsoftrousersand6percent cent ofgirlsmanagedtheirmenstruationby pads. Inthenon-WinS schoolsinBajura20per used reusablesanitary schools in theWinS of girls menstruation, exceptinBajurawhere53percent on makingreusablesanitarypadtomanagetheir because notallthegirlshadbeengiventraining Most girlsusedreusable,used,drycloths differences inmenstrualflow. reasons formenstruatingandinformationon information onmaterials,reasonsforpain, to askquestions.Girlssoughtandwanted and reproductivehealthgirlsfeltunable Boys frequentlydisruptedclassesaboutsexual menstruation beingadirty, pollutingprocess. hygiene focusoftrainingreinforcedideasabout technicalities and(cultural)restrictionsthe for andmanagementof. Informationfocusedon menstruation –includingthephysicalreasons receive enoughadequateinformationabouttheir reported thatevenaftertheclasstheydidnot classes wereinterestingbutembarrassingand that thesexualandreproductivehealth(SRH) their mothers.Around50percentofgirlsfelt 42 percentfromfriendsand58 information aboutmenstrualhealthfromteachers, schoolsreceivedmostoftheir girls inWinS when required.InParsa, only25percentof member ofstafftobeavailablehelpgirls indicates theneedforapermanentfemale this wasfeltbythegirlstobenotenoughand beneficial forprovidinginformationhowever, Interaction withNGOsandhealthfacilitieswas • disaggregated andageappropriate classes, Responsive teaching,ingender

Girls usingandwearing • • • cooking andworshipping.Teasing andridiculeof girls wererestrictedfromentering thekitchen, school foruptoaweek.Inall threedistricts all districtsandcausedgirls to beabsentfrom first menstruation(menarche)wascommonin illness, misfortuneandinfertility. Seclusionat to themortheirfamilymembers,including which wouldthenbringmisfortuneorshame someone elseorbeingthecauseofsomething and activitiesduetothefearofpolluting were stillrestrictedintheirphysicalmovements felt thatpracticeswereslowlychanging,they house astherestoffamily. Althoughgirls girls inBajurawerenotabletosleepthesame per centofgirlsinAchhamand17 chhaupadi In BajuraandAchhammenstrualseclusion- community life? ability tofullyparticipateinschooland 3. Howdoesmenstruationaffectgirls’ • not oftenthebest,appropriateorpreferred For examplere-useablesanitarypadswere appropriate menstrualhygieneproducts. Greater awarenessandsupportfor upper primaryleveltoensurecoverage; classes mayneedtobeintroducedatan before theonsetofmenarche,thus but itiscrucialthatthe classes are conducted classes areconductedbetween6-9 MHM classesareconducted.Currentlythe Review ofwhatage(class)theSRHand the girlsatschool; member, inordertoprovidefurthersupport permanent trainedfull-timedfemalestaff More femaleteachers,oratleasta required; providing accurateinformationwasalso and confidentinansweringquestions to theteacherssothattheyfeelequipped discussions. Further supportandresources girls toaskquestionsandcontributethe in ordertocreatea‘safe’environmentfor schools. adequate wastedisposalarerequiredinall private, genderandagesegregated,with consistent watersupply, whichwereclean, Regularly maintainedtoiletfacilitieswitha required andgreatlyappreciated; and regularlyre-stockedsupplieswere choice. Howeveraconsistent,easilyavailable wasstillcommonlypracticedand60

33 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 34 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 • Recommendations: also bethecasewhentheyarenotmenstruating. on theteacherandtheirlessons,butthismay difficult forthemtodoclassworkandconcentrate discomfort orfearofembarrassment,makingit sometimes beingaffectedbytheirmenstruation activities andplaysports.Thegirlsreported write ontheboard,participateinlessonsor feeling ‘well’atschool,affectedgirls’abilityto in policingrestrictions.Fear ofleakageandnot members, particularlywomen,wereinfluential boys. Communitymembersandolderhousehold menstruating girlswascommon,particularlyby engagement opportunitiesformothers; and processes.Providelearningfurther especially onesinvolvingphysicalchanges unable toadequatelyanswerquestions, the mainsourceofinformation–yetareoften More involvementofmothers,whoareoften • • awareness. encourage andfostergreatersensitivity health informationgiveninclassesand accurate genderempowermentandsexual Continued engagementwithboysand promote empoweringknowledge; the practiceof change negativesocialcustoms,including and thecommunityinordertochallenge Greater involvementofoldergenerations chhaupadi, and provide would bealsobeneficial,allowinggirlstofeel health classesbygender(teachersandstudents) Segregating teachingofsexualandreproductive and taughtsooner, inlowerclasses/grades. is required.Thesemayneedtobereviewed and ReproductiveHealthclassesaretaught Hygiene ManagementclassesandSexual review ofwhen(whatclass/grade)theMenstrual before theonsetoftheirmenarche,thereforea management informationreachesthegirls manner. Itisalsoimportantthatthemenstrual causes ofmenstruationinanunderstandable information aboutmaterials,symptomsand beneficial toenablethemprovideaccurate More supporttoteachersandschoolswouldbe about menstruationforbothgirlsandboys. Schools wereanimportantsourceofinformation confidence, particularlyin Parsa andAchham. materials, thattheyareabletodisposeofwith with comfortable,securemenstrualmanagement However, morecouldbedonetoprovidegirls were lessworriedaboutofleakageasaresult. this districtwereusingreusablesanitarypadsand with agoodandregularwatersupply. Thegirlsin where gendersegregatedtoiletshadbeenbuilt positive contributiontogirlsintheBajuradistrict programmehasmadeasignificantand The WinS missed themostdaysofschool. revealed thatitwasaftertheirfirstperiodgirls and discomfort,fearofleakage.Theresearch absence duringmenstruationwasduetopain data sourcesindicatedthatthemaincauseof Despite this,thetriangulationfrommultiple contexts whichmakesdirectcomparisondifficult. non-WinS schoolsinthisstudyweredifferent and differently indifferentplacesandWinS programmewasimplemented The WinS CONCLUSION are replaced–includingsoap,thetoilets that thereisanadequatewatersupply, supplies that theycanmaintainthefacilities–ensuring or maintained.Schoolsalsoneededtoensure the studentsduetolackofwater, beingcleaned found thatattimestoiletswereunavailableto to thesefacilitiesandproducts.Theresearch maintained sothatgirlscanrelyonhavingaccess but itisimportantthattheyaresustainedand Girls appreciatedinfrastructureimprovements related classestogirls. nurses couldhelpteachmenstrualmanagement collaborating withlocalhealthfacilitieswhere is recommendedandschoolscouldexplore appropriate teachingofmenstrualmanagement order toaskquestionsandexploreissues.Age more comfortableinasinglesexsetting interventions tofocusonoldergenerations. for generationalchangeandtheneedfurther families. Thisindicatesthatthereisopportunity retribution, eitherforthemselvesortheir were followedbecausegirlsfeareddivine practices aroundvisitingtemplesorworshipping practices wereactuallybeing‘keptup’.Those because oftheirfamilyandonlyafewthe practiced orobservedtheserestrictionswere Girls toldusthatthemainreasonsthey appreciated andpracticeswereslowlychanging. restrictions byschoolsandcommunitieswere Concerted effortstoaddressmenstrual and parentswidercommunity. understood bythestudents,teachers,schools and re-stockedthatthereisaclearpolicy items, includingpainmedicationsarechecked need toensurethattheirsuppliesofsanitary need toprovideadequateprivacy. Theschools maintained andareaccessible.Thetoiletsalso

35 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 36 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

ANNEXES

Table 1. List of Schools

Intervention Achham Bajura Parsa Type of data collected

Surya Chandra Higher Secondary Thuma Higher Secondary School Shree Nepal Rastriya Higher Qualitative and Quantitative School Secondary School WinS Ambika High School Nepal Rastriya High School Mahananda Prashad Upadhaya Quantitative Higher secondary school

Non-WinS Mangala Nera Higher Secondary Mastishweri Higer Sec. School Ram Charita Bhagat Higher sec- Qualitative and Quantitative School ondary School Katyani Higher Secondary School Dhuralsain High School Naugawa Higher secondary Quantitative school

Table 2. Characteristics of participants in the qualitative study

Parsa Participants Bajura Participants Achham Participants Characteristics FGD GI (N=4) Mother Teacher FGD GI (N=4) Mother Teacher FGD GI (N=4) Mother Teacher (N=2) (N=2) (N=2) (N=2) (N=2) (N=2) (N=2) (N=2) (N=2) Caste/ethnicity Brahmin/Chhetri 2 - 1 - 9 7 2 2 6 6 2 1 Hill Janajati ------2 - - - Parsa Participants Bajura Participants Achham Participants Characteristics FGD GI (N=4) Mother Teacher FGD GI (N=4) Mother Teacher FGD GI (N=4) Mother Teacher (N=2) (N=2) (N=2) (N=2) (N=2) (N=2) (N=2) (N=2) (N=2) Madeshi 7 5 1 ------Terai Dalit ------Terai Janajati 2 3 - 1 ------Muslim 1 ------Hill Dalit 1 - - 1 3 1 - - 3 1 - - Others (Thakuri, ------1 1 - 1 Sanyasi) Total participants 13 8 2 12 8 2 2 12 8 2 2 Class 9,10 9 - - 10 9,10 - - 10 8,9 - - Mean Age 15 14 39 31 15 15 - - 15 14 39 36 N=Total number of event

Table 3. Data collected

Methodology and Method N units of data Total number of participants Qualitative Group interviews with girls 12 (Groups) 24 Focus group discussion with girls 6 37 Semi structured interview (SSI) with Health teacher 6 6 Semi structured interview (SSI) with Mothers 6 6 Total qualitative data 30 73 Quantitative Observation 12

37 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 38 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Methodology and Method N units of data Total number of participants Structured interview girls 600 (~50 per school) 600 Self-Completed Diary 600 600 Structured interview boys 180(15 per school) 180 Semi structured interview (SSI) with Head Teachers 12 12 Total quantitative data 1404 792 *same participants for structured interview and self-completed diary

Table 4. Support for WASH in schools

Achham Bajura Parsa Total Support Wins N-wins Wins N-wins Wins N-wins Wins N-wins N=2 N=2 N=2 N=2 N=2 N=2 N=6 N=6 School has WASH in the school improvement plan 0 2 1 0 2 1 3 3 School has a fund to manage the cleanliness of the 0 0 1 0 0 0 1 0 compound and toilet School received support to teach menstruation related edu- 2 1 2 0 2 1 6 2 cation Types of support N=2 n=1 N=2 n=0 n=2 n=1 N=6 n=2 WinS training 1 0 2 0 2 0 5 0 Training on making re-usable sanitary pad 1 1 0 0 0 1 1 2 Menstrual hygiene was included in the WASH training 2 1 2 0 2 1 6 2 Source of the support District Education Office 2 0 1 0 0 0 3 0 Red Cross 0 0 0 0 0 1 0 1 Achham Bajura Parsa Total Support Wins N-wins Wins N-wins Wins N-wins Wins N-wins N=2 N=2 N=2 N=2 N=2 N=2 N=6 N=6 Drinking Water and Sanitation Committee 1 0 0 0 0 0 1 0 Women Development Committee 0 1 0 0 0 0 0 1 District WASH Community Committee 0 0 1 0 0 0 1 0 Beyond Nepal 0 0 0 0 1 0 1 0 UNICEF 0 0 0 0 1 0 1 0

Table 5. Menstrual education and Facilities provided by schools to manage menstruation at school

Achham Bajura Parsa Total Menstrual education and Facilities WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS N=2 N=2 N=2 N=2 N=2 N=2 N=6 N=6 How do girls receive menstruation related education at school? As part of the curriculum 2 2 2 2 2 2 6 6 As part of a specific training 0 0 0 1 2 0 2 1 From NGOS 1 0 0 0 0 0 1 0 From Health workers 1 0 0 0 0 0 1 0 From Extra-Curricular Activities 0 0 1 0 0 0 1 0 Friends 0 0 0 0 1 0 1 0 Who teaches menstruation related curriculum at school? Teachers 2 2 2 2 2 2 6 6 Health workers 1 0 0 0 0 0 1 0 Facilities provided by schools to make girls feel more comfortable to manage their menstruation Education 1 2 2 2 2 1 5 5 Medicine (painkillers) and/or hot water bags 1 0 1 1 0 0 2 1

39 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 40 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Achham Bajura Parsa Total Menstrual education and Facilities WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS N=2 N=2 N=2 N=2 N=2 N=2 N=6 N=6 Changing room 1 0 0 0 2 0 3 0 Giving sanitary pad training to girls 0 0 0 1 2 0 2 1 Waste disposal facility 0 0 1 0 1 0 2 0 No services provided 1 0 0 0 0 1 1 1 Available sanitary pads (or equivalent materials) for girls at 2 0 0 0 2 1 4 1 school on a regular basis Available sanitary napkins for girls at the school in an emer- 1 0 0 0 0 0 1 0 gency

Table 6. Socio-demographic characteristics of girls

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Characteristics N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Mean age 15 15 14 14.6 Ethnicity Dalit 26 (26) 22 (22) 17 (17.0) 18(18) 6 (6.0) 6 (6.0) 49 (16.3) 46 (15.3) Janajati 1 (1.0) 2 (2.0) 0 (.0) 3 (3) 27 (27.0) 1 (1.0) 28 (9.3) 6 (2.0) Madhesi 0 (.0) 0 (.0) 0 (.0) 0 (.0) 51 (51) 89 (89) 51 (17) 89 (29.7) Brahmin/Chettri 69 (69) 59 (59) 77 (77) 79(79) 9 (9.0) 0 (.0) 155 (51.7) 138 (46) Sanyasi/ Thakuri 4 (4.0) 17 (17) 6 (6) 0 (.0) 0 (.0) 0 (.0) 10 (3.3) 17 (5.7) Others 0 (.0) 0 (.0) 0 (.0) 0 (.0) 7 (7.0) 4 (4.0) 7 (2.3) 4 (1.3) Religion Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Characteristics N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Mean age 15 15 14 14.6 Hindu 100 (100) 100(100) 100(100) 99(99) 90 (90.0) 97 (97) 290 (96.7) 296 (99) Muslim 0 (.0) 0 (.0) 0 (.0) 0 (.0) 7 (7.0) 3 (3.0) 7 (2.3) 3 (1.0) Christian 0 (.0) 0 (.0) 0 (.0) 1 (1) 3 (3) 0 (.0) 3 (1.0) 1 (.3) Primary language Nepali 100 (100) 100 (100) 13 (13.0) 4 (4.0) 14 (14.0) 0 (.0) 127 (42.3) 104(35) Bhojpuri 0 (.0) 0 (.0) 0 (.0) 0 (.0) 82 (82.0) 100 (100) 82 (27.3) 100 (33) Doteli 0 (.0) 0 (.0) 87 (87) 96(96) 0 (.0) 0 (.0) 87 (29.0) 96 (32) Others 0 (.0) 0 (.0) 0 (.0) 0 (.0) 4 (4.0) 0 (.0) 4 (1.3) 0 (.0) Describe themselves as disabled 9 (9.0) 7 (7.0) 4 (4.0) 8 (8.0) 20 (20.0) 10 (10) 33 (11.0) 25 (8.3) Education level of mother None 86 (86) 80 (80.0) 85 (85.0) 88 (88) 67 (67.0) 61 (61.0) 238 (79.3) 229 (76.3) Below class 10 12 (12.0) 18 (18.0) 14 (14.0) 11 (11) 30 (30.0) 34 (34.0) 56 (18.7) 63 (21.0) Class 10 and above 1 (1.0) 0 (.0) 1 (1.0) 1 (1.0) 2 (2.0) 5 (5.0) 4 (1.3) 6 (2.0) University 0 (.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) Don’t know 1 (1.0) 2 (2.0) 0 (.0) 0 (.0) 1 (1.0) 0 (.0) 2 (.7) 2 (.7) Education level of father None 26 (26) 28 (28.0) 30 (30.0) 40 (40) 27 (27.0) 23 (23.0) 83 (27.7) 91 (30.3) Below class 10 57 (57) 59 (59.0) 62 (62.0) 39 (39) 51 (51.0) 38 (38.0) 170 (56.7) 136 (45.3) Class 10 and above 12 (12) 10 (10.0) 6 (6.0) 19 (19) 15 (15.0) 37 (37.0) 33 (11.0) 66 (22.0) University 2 (2.0) 0 (.0) 1 (1.0) 1 (1.0) 1 (1.0) 2 (2.0) 4 (1.3) 3 (1.0) Don’t know 3 (3.0) 3 (3.0) 1 (1.0) 1 (1.0) 6 (6.0) 0 (.0) 10 (3.3) 4 (1.3) Wealth index

41 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 42 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Characteristics N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Mean age 15 15 14 14.6 Low 29 (29) 13 (13.0) 19 (19.0) 34 (34) 18 (18.0) 30 (30.0) 66 (22.0) 77 (25.7) Medium 66 (66) 82 (82.0) 71 (71.0) 63 (63) 56 (56.0) 47 (47.0) 193 (64.3) 192 (64.0) High 5 (5) 5 (5.0) 10 (10.0) 3 (3.0) 26 (26.0) 23 (23.0) 41 (13.7) 31 (10.3) How has the earthquake affected your home? No effect of earthquake 99 (99) 100(100) 97 (97.0) 97 (97) 82 (82.0) 83 (83.0) 278 (92.7) 280 (93.3) Minor cracks to home 1 (1) 0 (.0) 3 (3.0) 3 (3.0) 16 (16.0) 14 (14.0) 20 (6.7) 17 (5.7) Major damage to home 0 (.0) 0 (.0) 0 (.0) 0 (.0) 2 (2.0) 3 (3.0) 2 (.7) 3 (1.0)

Table 7. Socio-demographic characteristics of boys

Achham Bajura Parsa Total WinS N-Wins WinS N-Wins WinS N-Wins WinS N-Wins Characteristics (N=30) (N=30) (N=30) (N=30) (N=30) (N=30) (N=90) (N=90) N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Mean Age of Boys 14 15 15 14 14 14 14 14 Caste/Ethnicity Brahmin/Chettri 18 (60) 24 (80.0) 20 (66.7) 23 (76.7) 4 (13.3) 0 (0) 42(46.7) 47(52.2) Dalit 12 (40) 6 (20) 10 (33.3) 7 (23.3) 3 (10) 2 (6.7) 25(27.8) 15(16.7) Madhesi 0 (0) 0 (0) 0 (0) 0 (0) 11 (36.7) 24 (80) 11(12.2) 24(26.7) Muslim 0 (0) 0 (0) 0 (0) 0 (0) 7 (23.3) 4 (13.3) 7(7.8) 4(4.4) Terai Janajati 0 (0) 0 (0) 0 (0) 0 (0) 5 (16.7) 0 (0) 5(5.6) 0(.0) Religion Hindu 30 (100) 30 (100) 27 (90) 30 (100) 23 (76.7) 26 (86.7) 80(88.9) 86(95.6) Achham Bajura Parsa Total WinS N-Wins WinS N-Wins WinS N-Wins WinS N-Wins Characteristics (N=30) (N=30) (N=30) (N=30) (N=30) (N=30) (N=90) (N=90) N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Mean Age of Boys 14 15 15 14 14 14 14 14 Muslim (Islam) 0 (0) 0 (0) 0 (0) 0 (0) 7 (23.3) 3 (10) 7(7.8) 3(3.3) Christian 0 (0) 0 (0) 2 (6.7) 0 (0) 0 (0) 1 (3.3) 2(2.2) 1(1.1) Buddhist 0 (0) 0 (0) 1 (3.3) 0 (0) 0 (0) 0 (0) 1(1.1) 0(.0) Primary language Nepali 30 (100) 30 (100) 0 (0) 0 (0) 3 (10) 0 (0) 33(36.7) 30(33.3) Doteli 0 (0) 0 (0) 30 (100) 30 (100) 0 (0) 0 (0) 30(33.3) 30(33.3) Bhojpuri 0 (0) 0 (0) 0 (0) 0 (0) 24 (80) 30 (100) 24(26.7) 30(33.3) Hindi 0 (0) 0 (0) 0 (0) 0 (0) 3 (10) 0 (0) 3(3.3) 0(.0) Disabled 2 (6.7) 4 (13.3) 3 (10) 0 (0) 2 (6.7) 0 (0) 7(7.8) 4(4.4) Education level of mother None 26 (86.7) 25 (83.3) 27 (90) 28 (93.3) 19 (63.3) 18 (60) 72(80.0) 71(78.9) Below class 10 3 (10) 4 (13.3) 2 (6.7) 2 (6.7) 9 (30) 11 (36.7) 14(15.6) 17(18.9) Class 10 and above 1 (3.3) 0 (0) 0 (0) 0 (0) 1 (3.3) 0 (0) 2(2.2) 0(.0) Don’t know 0 (0) 1 (3.3) 1 (3.3) 0 (0) 1 (3.3) 1 (3.3) 2(2.2) 2(2.2) Education level of father None 8 (26.7) 9 (30) 9 (30) 12 (40) 11 (36.7) 4 (13.3) 28(31.1) 25(27.8) Below class 10 9 (30.0) 16 (53.3) 17 (56.7) 13 (43.3) 16 (53.3) 21 (70) 42(46.7) 50(55.6) Class 10 and above 10 (33.3) 3 (10.0) 3 (10.0) 4 (13.3) 3 (10.0) 4 (13.3) 16(17.8) 11(12.2) University 3 (10) 1 (3.3) 1 (3.3) 1 (3.3) 0 (0) 0 (0) 4(4.4) 2(2.2) Don’t know 0 (0) 1 (3.3) 0 (0) 0 (0) 0 (0) 1 (3.3) 0(.0) 2(2.2) Wealth Index Low 7(23.3) 3(10.0) 3(10.0) 13(43.3) 7(23.3) 6(20.0) 17(18.9) 22(24.4) Medium 21(70.0) 24(80.0) 23(76.7) 17(56.7) 19(63.3) 17(56.7) 63(70.0) 58(64.4) High 2(6.7) 3(10.0) 4(13.3) 0(.0) 4(13.3) 7(23.3) 10(11.1) 10(11.1)

43 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 44 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Table 8. Knowledge of Menstruation

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300

Know about menstruation before men- 22 (22.0) 17 (17.0) 27 (27.0) 18 (18.0) 24 (24.0) 16 (16.0) 73 (24.3) 51 (17.0) arche Source of information* n=22 n=17 n=27 n=18 n=24 n=16 n=73 n=51 Mother 10 (45.5) 10 (58.8) 13 (48.1) 10 (55.6) 14 (58.3) 13 (81.3) 37 (50.7) 33 (64.7) Older Sister 11 (50.0) 6 (35.3) 14 (51.9) 9 (50.0) 11 (45.8) 8 (50.0) 36 (49.3) 23 (45.1) Friend 11 (50.0) 3 (17.6) 18 (66.7) 9 (50.0) 10 (41.7) 2 (12.5) 39 (53.4) 14 (27.5) Teacher 5 (22.7) 0 (.0) 9 (33.3) 3 (16.7) 6 (25.0) 1 (6.3) 20 (27.4) 4 (7.8) Older Sister in law 0 (.0) 0 (.0) 2 (7.4) 4 (22.2) 2 (8.3) 0 (.0) 4 (5.5) 4 (7.8) Book/magazine 1 (4.5) 1 (5.9) 2 (7.4) 2 (11.1) 3 (12.5) 0 (.0) 6 (8.2) 3 (5.9) Others 4 (18.2) 2 (11.8) 5 (18.5) 2 (11.1) 2 (8.3) 0 (.0) 11 (15.1) 4 (7.8) * Percentage may exceed 100 due to multiple response Information was useful 20 (90.9) 16 (94.1) 26 (96.3) 18 (100) 24 (100) 16 (100) 70 (95.9) 50 (98.0) When you first started menstruating, what did you believe was the cause of your menstruation? N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 Normal healthy process 35 (35.0) 27 (27.0) 23 (23.0) 14 (14.0) 4 (4.0) 6 (6.0) 62 (20.7) 47 (15.7) Any type of illness 11 (11.0) 10 (10.0) 12 (12.0) 9 (9.0) 7 (7.0) 10 (10.0) 30 (10.0) 29 (9.7) Bad blood being shed 9 (9.0) 6 (6.0) 8 (8.0) 2 (2.0) 2 (2.0) 2 (2.0) 19 (6.3) 10 (3.3) Internal bleeding 0 (.0) 0 (.0) 5 (5.0) 7 (7.0) 1 (1.0) 2 (2.0) 6 (2.0) 9 (3.0) Others 2 (2.0) 2 (2.0) 1 (1.0) 0 (.0) 10 (10.0) 4 (4.0) 13 (4.3) 6 (2.0) Don’t know 43 (43.0) 55 (55.0) 51 (51.0) 68 (68.0) 76 (76.0) 76 (76.0) 170 (56.7) 199(66.3) Now, what do you believe is the cause of your menstruation? Normal healthy 67 (67.0) 64 (64.0) 68 (68.0) 62 (62.0) 32 (32.0) 19 (19.0) 167 (55.7) 145(48.3) processes Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 Bad blood being 27 (27.0) 20 (20.0) 9 (9.0) 5 (5.0) 6 (6.0) 9 (9.0) 42 (14.0) 34 (11.3) shed Supernatural 0 (.0) 1 (1.0) 1 (1.0) 0 (.0) 3 (3.0) 8 (8.0) 4 (1.3) 9 (3.0) reason To give birth 0 (.0) 0 (.0) 0 (.0) 0 (.0) 8 (8.0) 4 (4.0) 8 (2.7) 4 (1.3) Others 0 (.0) 2 (2.0) 1 (1.0) 2 (2.0) 5 (5.0) 6 (6.0) 6 (2.0) 10 (3.3) Don’t know 6 (6.0) 13 (13.0) 21 (21.0) 31 (31.0) 46 (46.0) 54 (54.0) 73 (24.3) 98 (32.7) Received more information about 66 (66.0) 48 (48.0) 77 (77.0) 74 (74.0) 85 (85.0) 82 (82.0) 228 (76) 204 (68) menstruation

Source of addi- tional information n=66 n=48 n=77 n=74 n=85 n=82 n=228 n=204 from* Mother 33 (50.0) 24 (50.0) 32 (41.6) 31 (41.9) 55 (64.7) 74 (90.2) 120 (52.6) 129(63.2) Older Sister 24 (36.4) 18 (37.5) 33 (42.9) 34 (45.9) 27 (31.8) 38 (46.3) 84 (36.8) 90 (44.1) Older Sister in 10 (15.2) 3 (6.3) 8 (10.4) 16 (21.6) 9 (10.6) 9 (11.0) 27 (11.8) 28 (13.7) law female relative 7 (10.6) 2 (4.2) 8 (10.4) 6 (8.1) 8 (9.4) 10 (12.2) 23 (10.1) 18 (8.8) Friend 41 (62.1) 25 (52.1) 57 (74.0) 57 (77.0) 43 (50.6) 35 (42.7) 141 (61.8) 117(57.4) Teacher 54 (81.8) 26 (54.2) 64 (83.1) 61 (82.4) 60 (70.6) 39 (47.6) 178 (78.1) 126(61.8) Book/magazine 23 (34.8) 4 (8.3) 61 (79.2) 59 (79.7) 10 (11.8) 2 (2.4) 94 (41.2) 65 (31.9) Radio 5 (7.6) 4 (8.3) 17 (22.1) 13 (17.6) 1 (1.2) 0 (.0) 23 (10.1) 17 (8.3) Child club/Young 3 (4.5) 1 (2.1) 18 (23.4) 3 (4.1) 4 (4.7) 0 (.0) 25 (11.0) 4 (2.0) Champion Others 3 (4.5) 5 (10.4) 7 (9.1) 2 (2.7) 3 (3.5) 2 (2.4) 13 (5.7) 9 (4.4) * Percentage may exceed 100 due to multiple response

45 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 46 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Table 9. Social Taboos and their reasons by WinS schools and non-WinS schools

Achham (WinS) Reasons for restriction Make the Food/ Restrictions Family Girls Don't feel Divine Don’t people Spoil the drink will Heavy Difficult to don’t Others (N=200) well retribution want to you touch food make you bleedings lift load allow you unwell feel unwell n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) Cannot visit religious place 100(100.0) 0(.0) 47(47.0) 52(52.0) 1(1.0) 0(.0) Cannot attend religious occasion 95(95.0) 0(.0) 39(41.1) 56(58.9) 0(.0) 0(.0) Cannot do household puja (bless- 99(99.0) 0(.0) 53(53.5) 43(43.4) 2(2.0) 1(1.0) ing) Cannot touch male family mem- 58(58.0) 0(.0) 24(41.4) 0(.0) 32(55.2) 2(3.4) bers Cannot cook food or enter inside 95(95.0) 2(2.1) 2(2.1) 69(72.6) 0(.0) 20(21.1) 2(2.1) kitchen Cannot go outside as much as 31(31.0) 3(9.7) 1(3.2) 25(80.6) 1(3.2) 1(3.2) normal Cannot eat any foods or drinks of 75(75.0) 3(4.0) 42(56.0) 0(.0) 25(33.3) 1(1.3) 4(5.3) their choice Cannot sleep in the same house- 60(60.0) 0(.0) 7(11.7) 53(88.3) 0(.0) hold as others Cannot sleep in the same bed as 50(50.0) 0(.0) 4(8.0) 36(72.0) 6(12.0) 4(8.0) others Cannot lift heavy loads 55(55.0) 5(9.1) 15(27.3) 3(5.5) 28(50.9) 4(7.3) Table 10. Social Taboos and their reasons by Wins and non-WinS

Achham (Non-WinS) Reasons for restriction

Family Make the Food/drink Till now not Divine Difficult Restrictions Girls Don't don’t Don’t people Spoil the will make necessary retribu- to lift Others (N=200) feel well allow want to you touch food you feel to lift heavy tion load you unwell unwell loads

n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) Cannot visit religious place 100(100.0) 1(1.0) 31(31.0) 68(68.0) 0(.0) 0(.0) Cannot attend religious occasion 96(96.0) 1(1.0) 26(27.1) 69(71.9) 0(.0) 0(.0) Cannot do household puja (blessing) 100(100.0) 0(.0) 36(36.0) 60(60.0) 0(.0) 4(4.0) Cannot touch male family members 61(61.0) 1(1.6) 14(23.0) 0(.0) 45(73.8) 1(1.6) Cannot cook food or enter inside kitchen 96(96.0) 2(2.1) 4(4.2) 68(70.8) 0(.0) 21(21.9) 1(1.0) Cannot go outside as much as normal 27(27.0) 5(18.5) 0(.0) 16(59.3) 3(11.1) 3(11.1) Cannot eat any foods or drinks of their 84(84.0) 3(3.6) 52(61.9) 0(.0) 23(27.4) 6(7.1) choice Cannot sleep in the same household as 60(60.0) 2(3.3) 5(8.3) 48(80.0) 5(8.3) others Cannot sleep in the same bed as others 44(44.0) 0(.0) 1(2.3) 34(77.3) 7(15.9) 2(4.5) Cannot lift heavy loads 55(55.0) 5(9.1) 20(36.4) 4(7.3) 18(32.7) 4(7.3) 4(7.3)

47 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 48 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Table 11. Social Taboos and their reasons by Wins and non-WinS

Bajura (WinS) Reasons for restriction Make the Food/ Restrictions Family Girls Don't feel Divine Don’t people Spoil the drink will Difficult to don’t Others (N=200) well retribution want to you touch food make you lift load allow you unwell feel unwell n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) Cannot visit religious place 100(100.0) 1(1.0) 80(80.0) 15(15.0) 0(.0) 4(4.0) Cannot attend religious occasion 85(85.0) 0(.0) 56(65.9) 25(29.4) 0(.0) 4(4.7) Cannot do household puja (blessing) 100(100.0) 1(1.0) 80(80.0) 15(15.0) 0(.0) 4(4.0) Cannot touch male family members 62(62.0) 7(11.3) 29(46.8) 0(.0) 26(41.9) 0(.0) Cannot cook food or enter inside kitchen 98(98.0) 13(13.3) 13(13.3) 65(66.3) 0(.0) 5(5.1) 2(2.0) Cannot go outside as much as normal 19(19.0) 1(5.3) 4(21.1) 9(47.4) 5(26.3) 0(.0) Cannot eat any foods or drinks of their choice 88(88.0) 17(19.3) 62(70.5) 1(1.1) 2(2.3) 6(6.8) Cannot sleep in the same household as others 23(23.0) 0(.0) 5(21.7) 17(73.9) 1(4.3) Cannot sleep in the same bed as others 80(80.0) 2(2.5) 9(11.3) 62(77.5) 2(2.5) 5(6.3) Cannot lift the heavy loads 54(54.0) 11(20.4) 11(20.4) 0(.0) 29(53.7) 3(5.6) Table 12. Social Taboos and their reasons by Wins and non-WinS

Bajura (N-WinS) Reasons for restriction Food/ Till now make the Restrictions Family drink will not nec- Girls Don't feel Divine Don’t people Spoil the Difficult to don’t make essary to Others (N=200) well retribution want to you touch food lift load allow you you feel lift heavy unwell unwell loads n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) Cannot visit religious place 98(98) 1(1.) 78(79.6) 14(14.3) 0(.0) 5(5.1) Cannot attend religious occasion 87(87) 0(.0) 55(63.2) 29(33.3) 0(.0) 3(3.4) Cannot do household puja (blessing) 98(98) 0(.0) 77(78.6) 18(18.4) 0(.0) 3(3.1) Cannot touch male family members 61(61) 15(24.6) 21(34.4) 0(.0) 25(41.0) 0(.0) Cannot cook food or enter inside kitchen 97(97) 6(6.2) 30(30.9) 56(57.7) 0(.0) 5(5.2) 0(.0) Cannot go outside as much as normal 27(27) 0(.0) 12(44.4) 15(55.6) 0(.0) 0(.0) Cannot eat any foods or drinks of their 91(91) 33(36.3) 54(59.3) 0(.0) 1(1.1) 3(3.3) choice Cannot sleep in the same household as 11(11) 0(.0) 3(27.3) 8(72.7) 0(.0) others Cannot sleep in the same bed as others 85(85) 2(2.4) 25(29.4) 55(64.7) 0(.0) 3(3.5) Cannot lift the heavy loads 32(32) 7(22) 4(12.5) 0(.0) 17(53.1) 2(6.3) 2(6.3)

49 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 50 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Table 13. Social Taboos and their reasons by Wins and non-WinS

Parsa (WinS) Reasons for restriction make the Food/ Restrictions Divine Family people drink will Heavy Difficult Girls Don't feel Don’t Spoil the retribu- don’t you make bleed- to lift Others (N=200) well want to food tion allow you touch you feel ings load unwell unwell n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) Cannot visit religious place 96(96.0) 0(.0) 44(45.8) 51(53.1) 1(1.0) 0(.0) Cannot attend religious occasion 61(61.0) 2(3.3) 33(54.1) 22(36.1) 3(4.9) 1(1.6) Cannot do household puja (blessing) 96(96.0) 0(.0) 43(44.8) 52(54.2) 1(1.0) 0(.0) Cannot touch male family members 13(13.0) 4(30.8) 6(46.2) 1(7.7) 1(7.7) 1(7.7) Cannot cook food or enter inside kitchen 27(27.0) 1(3.7) 2(7.4) 19(70.4) 2(7.4) 2(7.4) 1(3.7) Cannot go outside as much as normal 6(6.0) 2(33.3) 0(.0) 1(16.7) 3(50.0) 0(.0) Cannot eat any foods or drinks of their choice 46(46.0) 0(.0) 6(13.0) 3(6.5) 9(19.6) 28(60.9) 0(.0) Cannot sleep in the same household as others 0(.0) 0(.0) 0(.0) 0(.0) 0(.0) Cannot sleep in the same bed as others 7(7.0) 0(.0) 0(.0) 6(85.7) 1(14.3) 0(.0) Cannot lift the heavy loads 55(55.0) 22(40.0) 19(34.5) 2(3.6) 10(18.2) 2(3.6) Table 14. Social Taboos and their reasons by Wins and non-WinS

Parsa (N-WinS) Reasons for restriction

Restrictions make the Food/ Girls Don't feel Divine Family don’t Don’t people drink will Heavy Difficult to Others (N=200) well retribution allow you want to you touch make you bleedings lift load unwell feel unwell n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) Cannot visit religious place 98(98.0) 0(.0) 46(46.9) 52(53.1) 0(.0) 0(.0) Cannot attend religious occasion 60(60.0) 1(1.7) 27(45.0) 28(46.7) 3(5.0) 1(1.7) Cannot do household puja (blessing) 99(99.0) 0(.0) 39(39.4) 60(60.6) 0(.0) 0(.0) Cannot touch male family members 19(19.0) 2(10.5) 14(73.7) 2(10.5) 1(5.3) 0(.0) Cannot cook food or enter inside kitchen 28(28.0) 0(.0) 3(10.7) 24(85.7) 0(.0) 1(3.6) Cannot go outside as much as normal 6(6.0) 3(50.0) 0(.0) 1(16.7) 2(33.3) 0(.0) Cannot eat any foods or drinks of their choice 48(48.0) 0(.0) 6(12.5) 4(8.3) 2(4.2) 36(75.0) 0(.0) Cannot sleep in the same household as others 1(1.0) 0(.0) 0(.0) 1(100.0) 0(.0) Cannot sleep in the same bed as others 4(4.0) 0(.0) 0(.0) 4(100.0) 0(.0) 0(.0) Cannot lift the heavy loads 54(54.0) 22(40.7) 14(25.9) 11(20.4) 6(11.1) 1(1.9)

51 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 52 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Table 15. Old and existing restriction in each district from qualitative data

Achham Bajura Parsa Old restrictions Existing restrictions Old restrictions Existing restrictions Old restrictions Existing restrictions Not allowed to stay at Some families allow girl to Girls must paint the floor - Not allowed to touch water Everything can be touched home /construct shed stay at home daily during menstruation tap and utensils can be nearby home and stay cleaned there Not allowed going in front Allowed to go in the front Wet utensils are kept out- Allowed to keep utensils Not allowed to touch male Not allowed to touch male yard yard side the house for 4 days inside after they are dry family members family members in some family Not allowed to use toilet Allowed to use public toilet Not allowed to use the Use the toilet by hiding Not allowed to workshop Not allowed to worship or toilet from elder people in the or enter the temple enter the temple family Not allowed to wash Allow to bathe at a public Stay in a separate house Stay in the same house Not allowed to touch - cloths and also bathe at tap or shed as others and stay in own anything must sit quietly at a tap room but sleep separately the side from others

Not allowed to go upstairs - Not allowed to touch male Not allowed to touch male Not allowed to sit together Allowed to touch others in house and use chulo family members family members with other people and sit together if they (clay stove) bath daily Allowed home on 7th day Allowed home on 5th day Girls not allowed to go to Girls are going to school Others not allowed to eat Allowed to eat food of menstruation of menstruation school or touch text books and touching text books food cooked by menstru- cooked by menstruating ating woman woman Not allowed to have milk, Allowed to have milk, yo- Not allowed to worship Not allowed to worship Wash all clothes and clean No need to wash and yogurt, and ghee of cattle gurt and ghee of cattle god or enter temple god or enter temple house after menstruation clean everything after stopped menstruation stopped Not allowed to enter tem- Not allowed to enter tem- Breastfeeding child should Mother feed their child as Not allowed to cook or - ple/ worship god ple/ worship god be naked before feeding normal have to cook separately so that the child’s clothes for yourself during men- are not touched by men- struation struating mother Not allowed to walk in the Allowed to walk the same Not allowed to have yogurt Not allowed to have yogurt Not allowed to touch Allowed to touch pickle same path as others path as others or milk or milk pickle Achham Bajura Parsa Old restrictions Existing restrictions Old restrictions Existing restrictions Old restrictions Existing restrictions Not allowed to touch other Stay in one of the rooms Not allowed to walk the Not allowed to walk the Hide menstrual clothes in Dry menstrual cloths in people within the house same path as others same path as others corners to dry sunlight Not allowed to light a fire Allowed to light a fire as Girls go to school without Girls go to school with Not allowed to sleep in the Allowed to sleep together per need combing hair combed hair same bed as others in a same bed as other family members Not allowed to enter in the Not allowed to enter the Not allowed to enter the Not allowed enter the Stay alone, and eat alone, - kitchen kitchen kitchen kitchen outside in a separate room for 4-5 days Not allowed to touch male - Not allowed to walk in the - - family members same path as others - Allowed to cook food Allowed to do household Wet utensils are kept out- - - - when they are alone work if they live in a nucle- side the house for 4 days ar family, but those who are in an extended family are not allowed to do any household work Not allowed to go to school

53 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 54 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Table 16. Boys’ current knowledge and experience of menstruation

Achham Bajura Parsa Total WinS N-Wins WinS N-Wins WinS N-Wins WinS N-Wins Knowledge (N=30) (N=30) (N=30) (N=30) (N=30) (N=30) (N=90) (N=90) N(%) N(%) N(%) N(%) N(%) N(%) N(%) N(%) Heard about menstruation 22 (73.3) 22 (73.3) 30 (100) 26 (86.7) 21 (70) 24 (80) 73 (81.1) 72 (80.0) Have female members aged 30 (100) 29 (96.7) 28 (93.3) 29 (96.7) 30 (100) 30 (100) 88(97.8) 88 (97.8) 12 to 60 If yes, how do you know they are menstruating? (n=30) (n=29) (n=28) (n=29) (n=30) (n=30) (n=88) (n=88) Restriction at home 19 (63.3) 18 (62.1) 27 (96.4) 29 (100) 15 (50) 14 (46.7) 61(69.3) 61 (69.3) When they dry used cloths 8 (26.7) 6 (20.7) 1 (3.6) 0 (0) 2 (6.7) 4 (13.3) 11 (12.5) 10 (11.4) When they have stomach pain 1 (3.3) 1 (3.4) 0 (0) 0 (0) 3 (10) 8 (26.7) 4(4.5) 9(10.2) Tell themselves 1 (3.3) 1 (3.4) 0 (0) 0 (0) 7 (23.3) 3 (10) 8(9.1) 4(4.5) Others (Leakage, do not go to temples or do religious 1 (3.3) 3 (10.3) 0 (0) 0 (0) 3 (10.0) 1 (3.3) 4(4.5) 4(4.5) activities) (N=30) (N=30) (N=30) (N=30) (N=30) (N=30) (N=90) (N=90) Feel able to buy sanitary pads if a friend or family member 14 (46.7) 22 (73.3) 23 (76.7) 27 (90) 29 (96.7) 24 (80) 66 (73.3) 73 (81.1) needed them Helped a family member or a female friend to manage their 13 (43.3) 14 (46.7) 28 (93.3) 16 (53.3) 11 (36.7) 1 (3.3) 52 (57.8) 31 (34.4) menstruation Talked to other family members 7 (23.3) 10 (33.3) 18 (60) 4 (13.3) 0 (0) 3 (10) 25 (27.8) 17 (18.9) about menstruation Table 17. Boys’ Attitude towards menstruation

Achham Bajura Parsa Total WinS N-Wins WinS N-Wins WinS N-Wins WinS N-Wins Attitude (N=30) (N=30) (N=30) (N=30) (N=30) (N=30) (N=90) (N=90) N(%) N(%) N(%) N(%) N(%) N(%) N(%) N(%) Cause of menstruation Normal healthy process 9(30.0) 16(41.7) 13 (43.3) 20 (55.0) 13 (43.3) 14 (46.7) 35(38.9) 50 (55.6) Bad blood being shed 13 (43.3) 8(35.0) 14 (46.7) 7(35.0) 5(16.7) 1(3.3) 32(35.6) 16 (17.8) Internal bleeding 7 (23.3) 6(21.7) 1(3.3) 3(6.7) 4(13.3) 6(20.0) 12(13.3) 15(16.7) Curse 0 (.0) 0(.0) 1(3.3) 0(1.7) 0(.0) 2(6.7) 1(1.1) 2(2.2) Others (Supernatural reason, due to 1 (3.3) 0(1.7) 1(3.3) 0(1.7) 1(3.3) 1(3.3) 3(3.3) 1(1.1) increasing in age Don't know 0 (.0) 0(.0) 0(.0) 0(.0) 7(23.3) 6(20.0) 7(7.8) 6(6.7) Source of information Teacher 16 (53.3) 18(56.7) 23 (76.7) 16 (65.0) 18 (60.0) 29 (96.7) 57(63.3) 63 (70.0) Female family members 7(23.3) 6(21.7) 1(3.3) 8(15.0) 4(13.3) 1(3.3) 12(13.3) 15 (16.7) Health workers 6(20.0) 5(18.3) 2(6.7) 5(11.7) 1(3.3) 0(.0) 9(10.0) 10 (11.1) Friends 0(.0) 1(1.7) 0(.0) 0(.0) 4(13.3) 0(.0) 4(4.4) 1(1.1) Child clubs/ Mentors/Young Champions 0(.0) 0(.0) 3(10.0) 1(6.7) 0(.0) 0(.0) 3(3.3) 1(1.1) Others (radio/book) 1(3.3) 0(1.7) 1(3.3) 0(1.7) 3(10.0) 0(.0) 5(5.6) 0(.0) How useful was this information? Useful 24 (80.0) 25(81.7) 28 (93.3) 24 (86.7) 25 (83.3) 29 (96.7) 77(85.6) 78 (86.7) Not very useful 6(20.0) 5(18.3) 0(.0) 5(8.3) 1(3.3) 1(3.3) 7(7.8) 11 (12.2) No use at all 0(.0) 0(.0) 2(6.7) 1(5.0) 4(13.3) 0(.0) 6(6.7) 1(1.1) * Percentage may exceed 100 due to multiple responses

55 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 56 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Table 18. Boys’ experience of sexual reproductive health and menstruation (SRHM) education

Achham Bajura Parsa Total WinS N-Wins WinS N-Wins WinS N-Wins WinS N-Wins Experience (N=30) (N=30) (N=30) (N=30) (N=30) (N=30) (N=90) (N=90) N(%) N(%) N(%) N(%) N(%) N(%) N(%) N(%) Received a class on SRHM 19 (63.3) 23 (76.7) 30 (100) 30 (100) 27 (90) 30 (100) 76 (84.4) 83 (92.2) (n=19) (n=23) (n=30) (n=30) (n=27) (n=30) (n=76) (n=83) Able to ask questions 15 (78.9) 18 (78.3) 29 (96.7) 21 (70) 17 (63) 24 (80) 61 (80.3) 63 (75.9) How do you find the class? Interesting 18 (94.7) 19 (82.6) 28 (93.3) 25 (83.3) 14 (51.9) 20 (66.7) 60 (78.9) 64 (77.1) Embarrassing 1 (5.3) 4 (17.4) 1 (3.3) 3 (10) 12 (44.4) 9 (30) 14 (18.4) 16 (19.3) Others 0 (0) 0 (0) 1 (3.3) 2 (6.7) 1 (3.7) 1 (3.3) 2(2.6) 3(3.6) How would you prefer to be taught this class? Class not disaggregated by gender 17 (89.5) 16 (69.6) 28 (93.3) 20 (66.7) 18 (66.7) 20 (66.7) 63 (82.9) 56 (67.5) Class disaggregated by gender 2 (10.5) 7 (30.4) 2 (6.7) 10 (33.3) 9 (33.3) 10 (33.3) 13 (17.1) 27 (32.5)

Table 19. Girls experience of Sexual and Reproductive Health and Menstruation (SHRM) education

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Experience N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Received a class SRHM 90 (90) 74 (74.0) 94 (94.0) 98 (98.0) 83 (83.0) 90 (90.0) 267 (89.0) 262 (87.3) Who taught this class? n=90 n=74 n=94 n=98 n=83 n=90 n=267 n=262 Health teacher 77 (85.6) 64 (86.5) 56 (59.6) 83 (84.7) 75 (90.4) 74 (82.2) 208 (77.9) 221 (84.4) Other teacher 5(5.6) 7(9.5) 37 (39.4) 15 (15.3) 8(9.6) 16 (17.8) 50(18.7) 38(14.5) Health worker 4(4.4) 2(2.7) 1(1.1) 0(.0) 0(.0) 0(.0) 5(1.9) 2(.8) Staffs from some NGOs 4(4.4) 1(1.4) 0(.0) 0(.0) 0(.0) 0(.0) 4(1.5) 1(.4) Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Experience N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Were you able to ask questions? 29 (32.2) 16 (21.6) 22 (23.4) 24 (24.5) 38 (45.8) 25 (27.8) 89(33.3) 65(24.8) How did you find this class? Embarrassing 39 (43.3) 32 (43.2) 3(40.4) 55 (56.1) 33(39.8) 39 (43.3) 110 (41.2) 126 (48.1) Interesting 50 (55.6) 40 (54.1) 49 (52.1) 43 (43.9) 47 (56.6) 50 (55.6) 146(54.7) 133(50.8) Dull 1(1.1) 1(1.4) 2(2.1) 0(.0) 0(.0) 0(.0) 3(1.1) 1(.4) Not useful 0(.0) 0(.0) 0(.0) 0(.0) 3(3.6) 1(1.1) 3(1.1) 1(.4) Good 0(.0) 1(1.4) 2(2.1) 0(.0) 0(.0) 0(.0) 2(.7) 1(.4) Very good 0(.0) 0(.0) 3(3.2) 0(.0) 0(.0) 0(.0) 3(1.1) 0(.0) How would you prefer to be taught this class? Class disaggregated by gender 31 (34.4) 30 (40.5) 44 (46.8) 55 (56.1) 29 (34.9) 26 (28.9) 104 (39.0) 111 (42.4) 54 Class not disaggregated by gender 59 (65.6) 44 (59.5) 50 (53.2) 43 (43.9) 64 (71.1) 163 (61.0) 151 (57.6) (65.1)

Table 20. Menstrual Management

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Management N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Material usually used to manage menstruation Cloth (reusable) 94 68 94(94.0) 42 (42.0) 87(87.0) 87(87) 223(74.3) 249(83) (94.0) (68.0) Sanitary pads (disposable) 1(1.0) 1(1.0) 2(2.0) 4(4.0) 6(6.0) 13(13) 9(3.0) 18(6.0) Sanitary pads (reusable) 5(5.0) 1(1.0) 53 (53.0) 2(2.0) 7(7.0) 0(.0) 65(21.7) 3(1.0)

57 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 58 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Management N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Wears two or three trousers 0(.0) 4(4.0) 0(.0) 20(20.0) 0(.0) 0(.0) 0(.0) 24(8.0) Other (nothing) 0(.0) 0(.0) 3(3.0) 6(6.0) 0(.0) 0(.0) 3(1.0) 6(2.0) If you could choose one thing, what would you like best to manage your menstruation Cloth (reusable) 57(57.0) 66(66.0) 15 (15.0) 47(47.0) 46(46.0) 66(66) 118(39.3) 179 (59.7) Sanitary pads (dis) 35(35.0) 31(31.0) 28 (28.0) 48(48.0) 39(39.0) 31(31) 102(34.0) 110 (36.7) Sanitary pads (re) 8(8.0) 2(2.0) 56 (56.0) 4(4.0) 15(15.0) 3(3.0) 79(26.3) 9(3.0) Nothing 0(.0) 1(1.0) 1(1.0) 1(1.0) 0(.0) 0(.0) 1(.3) 2(.7) Shop within 20 minutes walking distance of home to buy sanitary pads Yes 4(4.0) 0(.0) 9(9.0) 9(9.0) 37(37.0) 16(16) 50(16.7) 25(8.3) *Have ever used sanitary pads 18 23(23.0) 12(12.0) 13(13.0) 44(44.0) 39(39) 85(28.3) 64(21.3) (18.0) How often do you use sanitary pads? n=23 n=12 n=18 n=13 n=44 n=39 n=85 n=64 Always 0(.0) 1(8.3) 4(22.2) 3(23.1) 5(11.4) 7(17.9) 9(10.6) 11(17.2) Usually 1(4.3) 0(.0) 2(11.1) 1(7.7) 1(2.3) 8(20.5) 4(4.7) 9(14.1) Sometimes 11(47.8) 7(58.3) 3(16.7) 3(23.1) 19(43.2) 14(35.9) 33(38.8) 24(37.5) Rarely 11(47.8) 4(33.3) 9(50.0) 6(46.2) 19(43.2) 10(25.6) 39(45.9) 20(31.3) How did you get them? Self-bought 6(26.1) 3(25.0) 8(44.4) 3(23.1) 7(15.9) 4(10.3) 21(24.7) 10(15.6) Relative bought 17(73.9) 8(66.7) 9(50.0) 10(76.9) 36(81.8) 35(89.7) 62(72.9) 53(82.8) Others 0(.0) 1(8.3) 1(5.6) 0(.0) 1(2.3) 0(.0) 2(2.4) 1(1.6) Where they were they from? Retail shop 0(.0) 0(.0) 4(22.2) 1(7.7) 8(18.2) 7(17.9) 12(14.1) 8(12.5) Bazaar (town) shop 22(95.7) 10(83.3) 12(66.7) 12(92.3) 27(61.4) 26(66.7) 61(71.8) 48(75.0) Medical shop 1(4.3) 2(16.7) 1(5.6) 0(.0) 7(15.9) 6(15.4) 9(10.6) 8(12.5) Others 0(.0) 0(.0) 1(5.6) 0(.0) 2(4.5) 0(.0) 3(3.5) 0(.0) Table 21. Menstrual materials and school absence for a whole day in the past 3 months

Not absent 1 to 15 days absent Materials usually used Materials (N=488) (N=112) (N=600) N (%) N (%) N (%) Cloth (reusable) 378(77.5) 94(83.9) 472(78.7) Sanitary pads (disposable) 17(3.5) 10(8.9) 27(4.5) Sanitary pads (reusable) 60(12.3) 8(7.1) 68(11.3) Wears extra trousers 24(4.9) 0(0) 24(4) Other (nothing) 9(1.8) 0(0) 9(1.5)

Table 22. Menstrual materials and school absence for part of the day in past 3 months

Not absent 1 to 15 days absent Materials usually used Materials (N=508) (N=92) (N=600) N (%) N (%) N (%) Cloth (reusable) 395(77.8) 77(83.7) 472(78.7) Sanitary pads (disposable) 18(3.5) 9(9.8) 27(4.5) Sanitary pads (reusable) 62(12.2) 6(6.5) 68(11.3) Wears extra trousers 24(4.7) 0(0) 24(4) others(nothing) 9(1.8) 0(0) 9(1.5)

59 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 60 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Table 23. Disposal of Menstrual Materials

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Materials N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Burn them 6(6.0) 3(3.0) 42(42.0) 4(4.0) 2(2.0) 0(.0) 50(16.7) 7(2.3) Throw away far from home 3(3.0) 17(17.0) 8(8.0) 8(8.0) 8(8.0) 1(1.0) 19(6.3) 26(8.7) Bury them in rubbish pit 26(26.0) 10(10.0) 7(7.0) 13(13.0) 6(6.0) 5(5.0) 39(13.0) 28(9.3) Bury them on land away from home 9(9.0) 5(5.0) 23(23.0) 7(7.0) 53(53.0) 84(84) 85(28.3) 96(32.0) Throw them in a stream 51(51.0) 57(57.0) 17(17.0) 42(42.0) 18(18.0) 1(1.0) 86(28.7) 100(33.3) use of cloths and re-use it after washing 3(3.0) 4(4.0) 2(2.0) 25(25.0) 4(4.0) 1(1.0) 9(3.0) 30(10.0) Others 2(2.0) 4(4.0) 1(1.0) 1(1.0) 9(9.0) 8(8.0) 12(4.0) 13(4.3)

Table 24. Use of re-usable sanitary pads

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Materials N=100 N=100 N=100 N=100 N=100 N=100 N=100 N=100 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Ever heard about reusable sanitary pads 83 (83.0) 29 (29.0) 77 (77.0) 6 (6.0) 74 (74.0) 32 (32.0) 234 (78) 67 (22.3) n=83 n=29 n=77 n=6 n=74 n=32 n=234 n=67 Learned to make reusable pads 35 (42.2) 6 (20.7) 67 (87.0) 2 (33.3) 44 (59.5) 20 (62.5) 146 (62.4) 28 (41.8) Made reusable pads 25 (30.1) 5 (17.2) 54 (70.1) 2 (33.3) 36 (48.6) 12 (37.5) 115 (49.1) 19 (28.4) Used reusable pad 27 (32.5) 4 (13.8) 64 (83.1) 2 (33.3) 27 (36.5) 3 (9.4) 118 (50.4) 9 (13.4) Bought reusable sanitary pads 1 (1.2) 0 (.0) 4 (5.2) 0 (.0) 1 (1.4) 0 (.0) 6 (2.6) 0 (.0) Bought from: n=1 n=0 n=4 n=0 n=1 n=0 n=6 n=0 Medical shop 1 (100.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) 1 (16.7) 0 (.0) Town market 0 (.0) 0 (.0) 4 (100.0) 0 (.0) 0 (.0) 0 (.0) 4 (66.7) 0 (.0) Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Materials N=100 N=100 N=100 N=100 N=100 N=100 N=100 N=100 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Friends 0 (.0) 0 (.0) 0 (.0) 0 (.0) 1 (100.0) 0 (.0) 1 (16.7) 0 (.0) n=27 n=4 n=64 n=2 n=27 n=3 n=118 n=9 Have private to wash pad 3 (11.1) 1 (25.0) 33 (51.6) 1 (50.0) 15 (55.6) 3 (100.0) 51 (43.2) 5 (55.6) Where do you dry reusable pads? Outside home in where clothes are dried 11 (40.7) 1 (25.0) 21 (32.8) 1 (50.0) 6 (22.2) 1 (33.3) 38 (32.2) 3 (33.3) Outside home in a place away from view 10 (37.0) 1 (25.0) 14 (21.9) 1 (50.0) 13 (48.1) 2 (66.7) 37 (31.4) 4 (44.4) Outside home covered by other clothes 5 (18.5) 2 (50.0) 27 (42.2) 0 (.0) 2 (7.4) 0 (.0) 34 (28.8) 2 (22.2) Others 1 (3.7) 0 (.0) 2 (3.1) 0 (.0) 6 (22.2) 0 (.0) 9 (7.6) 0 (.0)

Table 25. Managing menstruation at school

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Management N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) When you start menstruating and you are at school, how do you usually manage? Ask teacher for materials 47 (47.0) 4 (4.0) 2 (2.0) 0 (.0) 40 (40.0) 0 (.0) 89 (29.7) 4 (1.3) Go home change and stay at home 23 (23.0) 53 (53.0) 33 (33.0) 17 (17.0) 25 (25.0) 86 (86.0) 81 (27.0) 156 (52.0) You do nothing 11 (11.0) 27 (27.0) 17 (17.0) 58 (58.0) 0 (.0) 0 (.0) 28 (9.3) 85 (28.3) Go home change and come back 14 (14.0) 10 (10.0) 24 (24.0) 6 (6.0) 21 (21.0) 8 (8.0) 59 (19.7) 24 (8.0) Use materials that you brought with you 1 (1.0) 4 (4.0) 10 (10.0) 9 (9.0) 2 (2.0) 1 (1.0) 13 (4.3) 14 (4.7) Ask friends for materials 3 (3.0) 1 (1.0) 11 (11.0) 9 (9.0) 5 (5.0) 1 (1.0) 19 (6.3) 11 (3.7) Go to a nearby school shop and buy materials 0 (.0) 0 (.0) 3 (3.0) 1 (1.0) 5 (5.0) 4 (4.0) 8 (2.7) 5 (1.7) Others (don't know) 1 (1.0) 1 (1.0) 0 (.0) 0 (.0) 2 (2.0) 0 (.0) 3 (1) 1 (.3)

61 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 62 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Management N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Menstrual materials available at school 61 (61.0) 11 (11.0) 3 (3.0) 1 (1.0) 52 (52.0) 0 (.0) 116 (38.7) 12 (4.0) Who do you feel comfortable asking for materials to manage your menstruation? Male teacher 0 (.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) 6 (6.0) 0 (.0) 6 (2.0) Female teacher 76 (76.0) 45 (45.0) 25 (25.0) 9 (9.0) 60 (60.0) 9 (9.0) 161 (53.7) 63 (21.0) Friends 18 (18.0) 39 (39.0) 54 (54.0) 57 (57.0) 37 (37.0) 79 (79.0) 109 (36.3) 175 (58.3) Not comfortable / no-one 6 (6.0) 16 (16.0) 15 (15.0) 29 (29.0) 3 (3.0) 4 (4.0) 24 (8.0) 49 (16.3) Elder sister 0 (.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) 2 (2.0) 0 (.0) 2 (.7) Sanitary pad is not available at school 0 (.0) 0 (.0) 6 (6.0) 5 (5.0) 0 (.0) 0 (.0) 6 (2.0) 5 (1.7) If you have to leave the school compound during your menstruation who do you ask? No-one 9 (9.0) 34 (34.0) 14 (14.0) 28 (28.0) 2 (2.0) 3 (3.0) 25 (8.3) 65 (21.7) Male /Female Class teacher 26 (26.0) 20 (20.0) 20 (20.0) 5 (5.0) 54 (54.0) 54 (54.0) 100 (33.3) 79 (26.3) Other teacher (including head teacher) 46 (46.0) 39 (39.0) 54 (54.0) 40 (40.0) 42 (42.0) 43 (43.0) 142 (47.3) 122 (40.7) Male/Female Class representative 13 (13.0) 5 (5.0) 12 (12.0) 26 (26.0) 2 (2.0) 0 (.0) 27 (9.0) 31 (10.3) Friends 6 (6.0) 2 (2.0) 0 (.0) 1 (1.0) 0 (.0) 0 (.0) 6 (2.0) 3 (1.0) Do you tell the reason for leaving school? n=91 n=66 n=86 n=72 n=98 n=97 n=275 n=235 Yes 20 (22.0) 10 (15.2) 25 (29.1) 6 (8.3) 72 (73.5) 17 (17.5) 117 (42.5) 33 (14.0) No 71 (78.0) 56 (84.8) 61 (70.9) 66 (91.7) 26 (26.5) 80 (82.5) 158 (57.5) 202 (86.0) Table 25.a Managing menstruation at school by availability of sanitary pads at school when needed

Availability of sanitary pad at school when needed When you start menstruating and you are at school, how do you usually manage? No Yes Don’t know Total N (%) N (%) N (%) N (%) You do nothing 98(86.7) 5(4.4) 10(8.8) 113(100.0) Use materials that you brought with you 22(81.5) 1(3.7) 4(14.8) 27(100.0) Ask friends for materials 23(76.7) 5(16.7) 2(6.7) 30(100.0) Ask teacher for materials 8(8.6) 83(89.2) 2(2.2) 93(100.0) Go to a nearby school shop and buy materials 13(100.0) 0(.0) 0(.0) 13(100.0) Go home change and come back 61(73.5) 14(16.9) 8(9.6) 83(100.0) Go home change and stay at home 183(77.2) 20(8.4) 34(14.3) 237(100.0) Till now it has not happened 1(33.3) 0(.0) 2(66.7) 3(100.0) Don't know 1(100.0) 0(.0) 0(.0) 1(100.0) Total 410(68.3) 128(21.3) 62(10.3) 600(100.0)

Table 26 Absence due to menstruation

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Absence N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Whole days missed at school in past 3 months due to menstruation * 0 days 96 (96) 91 (91.0) 92 (92.0) 92 (92.0) 66 (66.0) 51 (51.0) 254 (84.7) 234 (78) Days (1 to 15) 4 (4.0) 9 (9.0) 8 (8.0) 8 (8.0) 34 (34.0) 49 (49.0) 46 (15.3) 66 (22.0)

Main reason for missing a whole day at school n=4 n=9 n=8 n=8 n=34 n=49 n=46 n=66 Pain 1 (25.0) 5 (55.6) 5 (62.5) 4 (50.0) 27 (79.4) 41 (83.7) 33 (71.7) 50 (75.8)

63 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 64 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Absence N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Fear of leakage 3 (75.0) 4 (44.4) 2 (25.0) 3 (37.5) 5 (14.7) 3 (6.1) 10 (21.7) 10 (15.2) Family advise not to go to school 0 (.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) 2 (4.1) 0 (.0) 2 (3.0) Family prevent from going to school 0 (.0) 0 (.0) 0 (.0) 0 (.0) 1 (2.9) 1 (2.0) 1 (2.2) 1 (1.5) Had to go and get sanitary materials 0 (.0) 0 (.0) 0 (.0) 1 (12.5) 1 (2.9) 0 (.0) 1 (2.2) 1 (1.5) Fear that books might be touched 0 (.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) 2 (4.1) 0 (.0) 2 (3.0) Due to first menstruation 0 (.0) 0 (.0) 1 (12.5) 0 (.0) 0 (.0) 0 (.0) 1 (2.2) 0 (.0) Part of day missed at school in past 3 months due to menstruation N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 0 days 95 (95) 95 (95.0) 90 (90.0) 95 (95.0) 71 (71.0) 62 (62.0) 256 (85.3) 252 (84) No. of days (1-15) 5 (5.0) 5 (5.0) 10 (10.0) 5 (5.0) 29 (29.0) 38 (38.0) 44 (14.7) 48 (16.0) Reason for missing the part of day at school in past 3 months due to menstruation n=5 n=5 n=10 n=5 n=29 n=38 n=44 n=48 Pain 2 (40.0) 2 (40.0) 2 (20.0) 4 (80.0) 23 (79.3) 24 (63.2) 27 (61.4) 30 (62.5) Fear of leakage 3 (60.0) 3 (60.0) 2 (20.0) 0 (.0) 4 (13.8) 8 (21.1) 9 (20.5) 11 (22.9) Had to go and get sanitary materials 0 (.0) 0 (.0) 5 (50.0) 0 (.0) 2 (6.9) 4 (10.5) 7 (15.9) 4 (8.3) Tiredness 0 (.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) 2 (5.3) 0 (.0) 2 (4.2) Family prevent from going to school 0 (.0) 0 (.0) 0 (.0) 1 (20.0) 0 (.0) 0 (.0) 0 (.0) 1 (2.1) Inadequate toilets facilities 0 (.0) 0 (.0) 1 (10.0) 0 (.0) 0 (.0) 0 (.0) 1 (2.3) 0 (.0) Table 27. Reasons for being absent because of menstruation during first month

Month1 Whole day absent Partial day absent

Reasons No facil- Other No facil- Other Tired- Fear of No re- Tired- Fear of No re- Total for being Pain ities in (mens. Total (N) Pain ities in (mens. ness leakage sponse ness leakage sponse (N) absent school related) school related)

Day 1 43.3 (26) 6.7 (4) 11.7 (7) 8.3 (5) 8.3(5) 21.7 (13) 53 60.0 (9) 20.0 (3) 6.7 (1) 0.0 (0) 6.7 (1) 6.7 (1) 13 Day 2 48.9 (22) 6.7 (3) 11.1 (5) 6.7 (3) 4.4 (2) 22.2 (10) 46 40.0 (6) 20.0 (3) 6.7 (1) 0.0 (0) 13.3 (2) 20.0 (3) 12 Day 3 41.5 (17) 9.8 (4) 4.9 (2) 2.4 (1) 9.8 (4) 31.7 (13) 39 20.0 (3) 20.0 (3) 26.7 (4) 13.3 (2) 6.7 (1) 13.3 (2) 11 Day 4 39.3 (11) 10.7 (3) 17.9 (5) 3.6 (1) 7.1 (2) 21.4 (6) 28 25.0 (2) 12.5 (1) 0.0 (0) 12.5 (1) 25.0 (2) 25.0 (2) 5 Day 5 25.0 (4) 12.5 (2) 6.3 (1) 6.3 (1) 0.0 (0) 50.8 (8) 16 14.3 (1) 14.3 (1) 0.0 (0) 14.3 (1) 28.6 (2) 28.6 (2) 4 * Percentage may exceed 100 due to multiple responses

Table 28. Materials usually used by girls absent on first day during menstruation

Students absent on first day of first month during menstruation** Absent Materials usually used * n=53 n (%) Cloth (reusable) 44(83.0) Sanitary pads (disposable) 7(13.2) Sanitary pads (reusable) 1(1.9) Does not use any material instead wears two to three suruwal (pants) 1(1.9) Others (nothing) 0(.0) *Data was taken from interview with girls; and **data was taken from diary data

65 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 66 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Table 29. materials usually used by absent girls on first day of first month (including holidays)

Absent on first day of first month including holiday ** H (Part of the day Materials usually used * P(Present) A(Absent) Total absent) n=298 n=162 n=15 n=475 n(%) n(%) n(%) n(%) Cloth (reusable) 220(60.1) 134(36.6) 12(3.3) 366(100.0) Sanitary pads (disposable) 14(60.9) 8(34.8) 1(4.3) 23(100.0) Sanitary pads (reusable) 43(72.9) 14(23.7) 2(3.4) 59(100.0) Wears extra trousers 14(70.0) 6(30.0) 0(.0) 20(100.0) Others(nothing) 7(100.0) 0(.0) 0(.0) 7(100.0) *Data was taken from interview with girls; and **data was taken from diary data

Table 29.a Girls describe themselves as disabled by reasons for missing school on first day of school on first month

Reason for missing school on first day school on first month Describe themselves as disabled Girls (n=53) pain Tiredness Fear of staining in cloth Total N (%) N (%) N (%) N (%) N (%) Yes 7 (13.2) 4 (57.1 1(14.3) 2(28.6) 7(100.0)

Table 30. Leakage and washing menstrual cloths in schools

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Leakage and washing menstrual cloths N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) When you have your period in school, how often do you have leaks Always 0(.0) 0(.0) 4(4.0) 2(2.0) 0(.0) 1(1.0) 4(1.3) 3(1.0) Sometimes 27(27.0) 33(33.0) 29(29.0) 43(43.0) 36(36.0) 27(27.0) 92(30.7) 103(34.3) Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Leakage and washing menstrual cloths N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Never 73(73.0) 67(67.0) 67(67.0) 55(55.0) 64(64.0) 72(72.0) 204(68.0) 194(64.7) If you have leakage when you are at school, what do you do? n=27 n=33 n=33 n=45 n=36 n=28 n=96 n=106 Stay at school 4(14.8) 3(9.1) 7(21.2) 35(77.8) 6(16.7) 0(.0) 17(17.7) 38(35.8) Go home, change and come back 1(3.7) 2(6.1) 5(15.2) 2(4.4) 7(19.4) 2(7.1) 13(13.5) 6(5.7) Go home, change and stay at home 22(81.5) 28(84.8) 21(63.6) 8(17.8) 20(55.6) 26(92.9) 63(65.6) 62(58.5) Wash inside school's toilet 0(.0) 0(.0) 0(.0) 0(.0) 2(5.6) 0(.0) 2(2.1) 0(.0) Wash and ask for pad 0(.0) 0(.0) 0(.0) 0(.0) 1(2.8) 0(.0) 1(1.0) 0(.0) Have ever washed the menstrual materials at school N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 Yes 1(1.0) 0(.0) 22(22.0) 0(.0) 3(3.0) 0(.0) 26(8.7) 0(.0) No 99(99.0) 98(98.0) 76(76.0) 97(97.0) 90(90.0) 90(90.0) 265(88.3) 285(95.0) Don’t use reusable materials 0(.0) 2(2.0) 2(2.0) 3(3.0) 7(7.0) 10(10.0) 9(3.0) 15(5.0) Reason for not washing sanitary material at school* n=99 n=98 n=76 n=97 n=90 n=90 n=265 n=285 No proper place to wash them 52(52.5) 80(81.6) 62(81.6) 84(86.6) 10(11.1) 82(91.1) 124(46.8) 246(86.3) No water 75(75.8) 69(70.4) 27(35.5) 19(19.6) 26(28.9) 56(62.2) 128(48.3) 144(50.5) Nowhere to dry it 19(19.2) 4(4.1) 16(21.1) 23(23.7) 12(13.3) 75(83.3) 47(17.7) 102(35.8) No soap 8(8.1) 4(4.1) 10(13.2) 7(7.2) 29(32.2) 78(86.7) 47(17.7) 89(31.2) Shyness 4(4.0) 11(11.2) 1(1.3) 0(.0) 20(22.2) 8(8.9) 25(9.4) 19(6.7) Others 1(1.0) 2(2.0) 6(7.9) 2(2.1) 24(26.7) 3(3.3) 31(11.7) 7(2.5) * Percentage may exceed 100 due to multiple responses

67 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 68 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Table 31. Observation of enclosed open pan toilets

Achham Bajura Parsa Total Observation WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS N=12 N=4 N=15 N=4 N=15 N=2 N=42 N=10 Number of enclosed toilets in use 4 2 5 2 4 2 13 6 How many enclosed toilets have: A functioning lock? 2 0 1 0 3 2 6 2 How many enclosed toilets have a bin? 0 0 0 0 0 0 0 0 How many enclosed toilets have A closed bin for sanitary disposal? 0 0 0 0 0 0 0 0 How many enclosed toilets have either types of bin full or overflowing? 0 0 0 0 0 0 0 0 How many enclosed toilets have Water inside the cubicle or building 0 0 2 2 5 1 7 3 How many enclosed toilets have a bucket/jug or other means of putting water 1 0 2 2 2 1 5 3 Number of open pan toilets in use? 8 2 10 2 11 0 29 4 How many of open toilets in use have water and bucket/jug within? 0 0 1 0 1 0 2 0

Table 32. Condition of toilets

Achham Bajura Parsa Total Condition WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS N=12 N=4 N=15 N=4 N=15 N=2 N=42 N=10 How many of all toilets in use have nearby soap and water facilities for hand 0 0 0 0 0 0 0 0 washing? How many of all toilets in use appear clean? 0 0 2 2 3 2 5 4 How many of all toilets in use have a bad smell? 12 3 6 4 4 0 22 7 How many of all toilets in use have faeces in pan or elsewhere? 10 1 5 2 1 1 16 4 How many of all toilets in use have a functioning or enough light? 0 0 1 2 8 0 9 2 How many toilets in use have derogatory graffiti? 0 0 0 0 1 0 1 0 How many toilets are on the inward facing? 0 1 2 0 3 2 5 3 If yes, how many child friendly Water tap are there? 0 0 2 2 1 0 3 2 How many of all toilets in use have disabled access? 0 0 0 0 1 0 1 0

Table 33. Use of toilets during menstruation

Achham Bajura Parsa Total WinS N-WinS WinS N-WinS WinS N-WinS WinS N-WinS Use of toilets N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) During your last period, how often did you change your menstruation materials in a day at school? 1 time 3 (3.0) 3 (3.0) 12 (12.0) 4 (4.0) 7 (7.0) 0 (.0) 22 (7.3) 7 (2.3) 2 time 2 (2.0) 4 (4.0) 25 (25.0) 9 (9.0) 11 (11.0) 1 (1.0) 38 (12.7) 14 (4.7) 3 time 2 (2.0) 0 (.0) 9 (9.0) 4 (4.0) 4 (4.0) 1 (1.0) 15 (5.0) 5 (1.7) 4 time 0 (.0) 0 (.0) 0 (.0) 2 (2.0) 0 (.0) 0 (.0) 0 (.0) 2 (.7) Never 0 (.0) 0 (.0) 2 (2.0) 28 (28.0) 3 (3.0) 16 (16.0) 5 (1.7) 44 (14.7()) Never it’s not necessary 93 (93.0) 93 (93.0) 52 (52.0) 53 (53.0) 75 (75.0) 82 (82.0) 220 (73.3) 228 (76.0) Do you have permission to use the toilet during class? Always 71 (71.0) 55 (55.0) 82 (82.0) 79 (79.0) 91 (91.0) 75 (75.0) 244 (81.3) 209 (69.7) Sometimes 28 (28.0) 39 (39.0) 9 (9.0) 11 (11.0) 8 (8.0) 25 (25.0) 45 (15.0) 75 (25.0) Never 1 (1.0) 6 (6.0) 9 (9.0) 10 (10.0) 1 (1.0) 0 (.0) 11 (3.7) 16 (5.3) Can you use the toilet during break? Always 100 (100.0) 88 (88 96(96.0) 95 (95.0) 100 (100.0) 100 (100.0) 296 (98.7) 283 (94.3) Never 0 (.0) 12 (12.0) 4 (4.0) 5 (5.0) 0 (.0) 0 (.0) 4 (1.3) 17 (5.7)

Table 34 Ability to participate in classroom and school

Achham Bajura Parsa Total WinS Non-WinS WinS Non-WinS WinS Non-WinS WinS Non-WinS Ability to participate N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) When you are menstruating how often do you feel you can -sit in the front of the classroom Always 49 (49.0) 32 (32.0) 60 (60.0) 55 (55.0) 40 (40.0) 32 (32.0) 149 (49.7) 119 (39.7) Sometimes 45 (45.0) 60 (60.0) 27 (27.0) 24 (24.0) 40 (40.0) 52 (52.0) 112 (37.3) 136 (45.3)

69 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 70 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016

Achham Bajura Parsa Total WinS Non-WinS WinS Non-WinS WinS Non-WinS WinS Non-WinS Ability to participate N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Never 6 (6.0) 8 (8.0) 13 (13.0) 21 (21.0) 20 (20.0) 16 (16.0) 39 (13.0) 45 (15.0) focus on what the teacher is saying Always 44 (44.0) 37 (37.0) 65 (65.0) 67 (67.0) 45 (45.0) 40 (40.0) 154 (51.3) 144 (48.0) Sometimes 54 (54.0) 63 (63.0) 35 (35.0) 33 (33.0) 52 (52.0) 55 (55.0) 141 (47.0) 151 (50.3) Never 2 (2.0) 0 (.0) 0 (.0) 0 (.0) 3 (3.0) 5 (5.0) 5 (1.7) 5 (1.7) do classwork Always 48 (48.0) 44 (44.0) 72 (72.0) 75 (75.0) 52 (52.0) 37 (37.0) 172 (57.3) 156 (52.0) Sometimes 50 (50.0) 56 (56.0) 28 (28.0) 24 (24.0) 44 (44.0) 57 (57.0) 122 (40.7) 137 (45.7) Never 2 (2.0) 0 (.0) 0 (.0) 1 (1.0) 4 (4.0) 6 (6.0) 6 (2.0) 7 (2.3) answer questions when called on Always 44 (44.0) 37 (37.0) 64 (64.0) 60 (60.0) 34 (34.0) 34 (34.0) 142 (47.3) 131 (43.7) Sometimes 52 (52.0) 63 (63.0) 30 (30.0) 36 (36.0) 59 (59.0) 57 (57.0) 141 (47.0) 156 (52.0) Never 4 (4.0) 0 (.0) 6 (6.0) 4 (4.0) 7 (7.0) 9 (9.0) 17 (5.7) 13 (4.3) raise hand to answer when the teacher asks a question Always 31 (31.0) 25 (25.0) 46 (46.0) 43 (43.0) 40 (40.0) 35 (35.0) 117 (39.0) 103 (34.3) Sometimes 58 (58.0) 63 (63.0) 35 (35.0) 37 (37.0) 46 (46.0) 34 (34.0) 139 (46.3) 134 (44.7) Never 11 (11.0) 12 (12.0) 19 (19.0) 20 (20.0) 14 (14.0) 31 (31.0) 44 (14.7) 63 (21.0) stand up to answer a question Always 28 (28.0) 22 (22.0) 56 (56.0) 57 (57.0) 37 (37.0) 30 (30.0) 121 (40.3) 109 (36.3) Sometimes 60 (60.0) 58 (58.0) 36 (36.0) 34 (34.0) 49 (49.0) 40 (40.0) 145 (48.3) 132 (44.0) Never 12 (12.0) 20 (20.0) 8 (8.0) 9 (9.0) 14 (14.0) 30 (30.0) 34 (11.3) 59 (19.7) write on the board if you are asked Always 24 (24.0) 12 (12.0) 50 (50.0) 44 (44.0) 27 (27.0) 24 (24.0) 101 (33.7) 80 (26.7) Achham Bajura Parsa Total WinS Non-WinS WinS Non-WinS WinS Non-WinS WinS Non-WinS Ability to participate N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) Sometimes 41 (41.0) 40 (40.0) 28 (28.0) 29 (29.0) 33 (33.0) 23 (23.0) 102 (34.0) 92 (30.7) Never 35 (35.0) 48 (48.0) 22 (22.0) 27 (27.0) 40 (40.0) 53 (53.0) 97 (32.3) 128 (42.7) stay in class the whole time Always 69 (69.0) 65 (65.0) 68 (68.0) 78 (78.0) 35 (35.0) 25 (25.0) 172 (57.3) 168 (56.0) Sometimes 30 (30.0) 35 (35.0) 30 (30.0) 19 (19.0) 60 (60.0) 71 (71.0) 120 (40.0) 125 (41.7) Never 1 (1.0) 0 (.0) 2 (2.0) 3 (3.0) 5 (5.0) 4 (4.0) 8 (2.7) 7 (2.3)

Achham Bajura Parsa Total WinS Non-WinS WinS Non-WinS WinS Non-WinS WinS Non-WinS Ability to participate N=100 N=100 N=100 N=100 N=100 N=100 N=300 N=300 N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) stay at school the whole day Always 75 (75.0) 68 (68.0) 71 (71.0) 84 (84.0) 46 (46.0) 32 (32.0) 192 (64.0) 184 (61.3) Sometimes 25 (25.0) 32 (32.0) 29 (29.0) 15 (15.0) 52 (52.0) 67 (67.0) 106 (35.3) 114 (38.0) Never 0 (.0) 0 (.0) 0 (.0) 1 (1.0) 2 (2.0) 1 (1.0) 2 (.7) 2 (.7) go to school Always 80 (80.0) 72 (72.0) 80 (80.0) 9f1 (91.0) 61 (61.0) 38 (38.0) 221 (73.7) 201 (67.0) Sometimes 20 (20.0) 28 (28.0) 20 (20.0) 9 (9.0) 37 (37.0) 58 (58.0) 77 (25.7) 95 (31.7) Never 0 (.0) 0 (.0) 0 (.0) 0 (.0) 2 (2.0) 4 (4.0) 2 (.7) 4 (1.3) do homework Always 81 (81.0) 72 (72.0) 92 (92.0) 92 (92.0) 60 (60.0) 40 (40.0) 233 (77.7) 204 (68.0) Sometimes 19 (19.0) 28 (28.0) 8 (8.0) 8 (8.0) 38 (38.0) 57 (57.0) 65 (21.7) 93 (31.0) Never 0 (.0) 0 (.0) 0 (.0) 0 (.0) 2 (2.0) 3 (3.0) 2 (.7) 3 (1.0)

71 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 72 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Brief them about the study and seek informed consent. Give them the information sheet aboutthestudy.Brief themaboutthestudyandseekinformedconsent.Giveinformation Questionnaire 1:SemiStructuredInterviewwithTeacher 20 19 18 17 16 15 14 13 12 11 10 Ask iftheytaughttheclass: 9 8 7 health educationthatisgiveninthisschool. don’t know. Nowwewouldliketoaskyouaboutthemenstrualhygiene, sexualandreproductive You maynotknowtheanswertosomeofthesequestions.Ifyoudon’t know, it’s oktosayyou 6 5 4 3 2 1 Types ofschool District ID School ID Subject taught school Length oftimelivingandworkingin Age (completedage) Gender Health teachername Interviewer Name Interview date Q.N What didyoufinddifficultaboutthisclass? How easywasittoteachthisclass? How didyoufeelwhileteachingthisclass? How didthestudentsreact? this?) How oldarethestudentswhentheytaughtaboutthesetopics?(Howappropriateis used?) -study vs.taughtstudy, howarepictures andothermaterialsused,howisgroupdiscussion How arethesetopicstaught?(Probeforboysandgirlstogether/separate,howmuchself How appropriateisthis? In whatcircumstancesarethesetopicstaught?(probeforinclass,clubs,peereducation) To whatextentdoyouthinkthisisareliable/knowledgeableresource? In thiscommunity, where do youthinkgirlsgetmostoftheirinformationaboutmenstruation? To whatextentarerestrictionandcustomsaroundmenstruationchanging? How dotheserestrictionsandpracticesaffectgirlshere? What aretheculturalpracticesaboutmenstruationthatfollowedinthiscommunity? What arethemenstrualrestrictionsthatfollowedinthiscommunity? How have you been supported by the WASH in schools programme? (for WinS only) How haveyoubeensupported bytheWASH inschoolsprogramme?(forWinS schools activities).Howhas this helped?Howeffectivewasforumforlearning? Where elsedopupilslearnabout menstrualhygiene?(probeforchildclubsandWASH in How hasthistrainingorsupporthelpedyou,affectedyou? menstrual hygiene? Have youorotherteachersatschoolreceivedtraining support toteachtopicsrelated layout/environment, moretime) What wouldhavehelpedyouteachthissubject?(probefor materials,skills,classroom involvement ofhealthworkers,orchildclubsyouthvolunteers) What wouldhavehelpedyoufeelmorecomfortableteaching thisclass?(probeforthe What kindoftrainingorpreparationhadyoutoteach thisclass? WinS Intervention WinS Male DD/MMYYYY

Female

Questions

/ 2016 Non-WinS 46 45 44 43 42 41 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 We wouldliketoaskyouspecificallyaboutthetoiletsandwastedisposalatyourschool. 25 24 23 22 21 Now wewouldliketotalkabouthowgirlshereusuallymanagetheirmenstruationatschool. Q.N To whatextentaregirlsawareofthese facilities?(why?) only) WinS To whatextentwerethesefacilitiesavailable beforetheWASH inschoolsprogramme?(for (Say: wewouldliketoseetheseattheendofinterview) disposal, bins,watersupplyintoiletetc.) changing room;givingsanitarypadtrainingtogirls;toiletrelatedWASH strategy(waste Provision ofsickroom;provisionchangeclothes;pads; (Probe for:providingeducation;medicines(painkillers)and/orhotwaterbags; What facilitiesorservicesareinplacetohelpgirlsmanagetheirmenstruationatschool? If agirls’menstruationstartswhilesheisatschool,unexpectedly, whatwouldshedo? manage theirmenstruationat school?Canyougiveanexample What arethebarriersordifficulties inputtingfacilitiesandservicesplacetohelpgirls age theirmenstrualhygienemorecomfortablyandconfidently? In general(i.e.notjusttoilets)whatcouldbedonetoimprove thefacilitiesforgirlstoman Only) girls comparedwithbeforetheWASH inschoolsprogramme? (Wins In youropinion,towhatextentdothefacilitiesatschoolmeet theneedsofmenstruating toilets? What hasmadethispossible?havebeenthebarriers toimprovingthecleanlinessof How hasthisbeenimprovedoverthepast(x)years? How effectiveisthemanagementofcleaningtoilets? How aresupportstaffsmanaged/supervised? struating girls? To whatextentdoyoufeelthesupportstaffsarehelpfultowardsmeetingneedsofmen How arethetoiletscleaned?(bywhom,howoften?) What wouldmakeiteasiertoimprovethetoiletwastedisposalfacilities? What arethebarrierstoimprovingtoiletwastedisposalfacilities? successful? why/whynot? What effortshavebeenmadetoimprovethewastedisposal?To whatextentwerethese How couldthetoiletwastedisposalbeimproved? How effectivearedisposalsystemsfortoiletwaste? How istoiletwastemanaged(i.e.papersandcloths)? What wouldmakeiteasier(facilitate)theimprovementoftoiletfacilities? What arethebarrierstomakingbettertoiletfacilitiesforgirls? why/why not? What effortshavebeenmadetoimprovethetoilets?To whatextentwerethesesuccessful, How couldthetoiletsbeimprovedtobettermeetneedsmenstruatinggirls? (probe foritemsonobservationchecklist) To whatextentdoyoufeelthatthetoiletsmeetneedsofmenstruatinggirls? school policyaswellteacherpracticeaboutthis–referringtotheirownclassroom) To whatextentarestudentsabletouse thetoiletwhentheyneedto?Why?(whatis these services? How canagirlaccesstheseservices?Canyoutellusaboutthelasttimeaccessed Questions - -

73 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 74 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 65 64 63 62 61 60 59 58 57 56 55 54 53 52 51 50 Now wewouldliketoaskabouthowmenstruationaffectsgirlsatschool. 49 48 47 Q.N tained? To whatextenttoyouthinkimprovements (useexamplestheyhavegivenyou)willbesus sustained? To whatextentdoyouthinkimprovements (useexamplestheyhavegivenyou)been us aboutatimewhenparentsandcommunitymemberswere effectivelyinvolved?) improving theschoolorraisingawarenessaboutWASH relatedissue/subject?(Canyoutell What effectivestrategieshaveyouusedtoinvolveparentsandcommunitymembersin What havebeenthebarrierstoinvolvingparentsinWASH inschoolsprogramme? How effectiveisinvolvementofparentsandcommunitiesinschoolconcernsactivities? menstruation? How haveparentsbeeninvolvedinenablinggirlstofeelmorecomfortablemanagetheir How haveparentsbeeninvolvedinimprovingmenstruationmanagementfacilitiesforgirls? How supportivetotheschoolareparentsinthiscommunity? (Skip ifnoexample,donotanswerhypothetically) her menstruation? Can youtellusaboutatimewhenwereapproachedbygirlwhohadproblemwith How supportivearetheotherteachersandstafftowardsmenstruatinggirls? In youropinion,howsupportiveareclassmatesgenerally? Have younoticedanyteasingthatgirlsexperienceinregardstomenstruation? How doestheschool(you)addressthis? Why dogirlsmissschoolbecauseoftheirmenstruation(notfeelingwellorother)? extent doyouthinkthisistrue? We haveheardthatsometimesgirlsmissschoolbecauseoftheirmenstruation.To what think thisistrue?(Howdoyoutrytomakethemfeelmorecomfortable?) stand atthefrontofclass,upinclasstoanswerquestions.To whatextentdoyou We haveheardthatgirlswhoaremenstruatingoftenfeelunabletoraisetheirhand,sitor extent doyouthinkthisistrue? We haveheardthatgirlswhoaremenstruatingoftenfeellessconfidentinclass. To what done tomakethemfeelmorecomfortable?) How doeshavingtheirmenstruationaffectgirlsatschool?(Whathaveyou(andothers) What arethebarriersordifficultiesinsustainingimprovements? • • • • • What werethedifficultiesthatyoufacedinresponding? How comfortabledidyoufeel? How capabledidyoufeeltorespond? How didyourespond? What didyoudo?(didtalktoanyone,howrespond,etc.) Questions - the study. Brief themaboutthestudyandseekinformedconsent.Giveinformationsheet interviews. information thatisgood,butitnotexpected.Individualexperiencewillbeexploredthroughgroup more forunderstandingnorms,andinvitingdebateaboutthosenorms.Ifagirlwantstosharepersonal groupsareused In afocusgroupdiscussionquestionsarenotaddressedtotheindividualgirl.Focus Topic guideforfocusgroupdiscussionwithadolescentgirls(grade 10) Questionnaire 2:Topic GuideforFocus GroupDiscussionswithgirls 7. 6. 5. 4. 3. 2. 1. First ofallwewouldliketodiscussaboutthiscommunity been taken. This gameisanice-breakerandshouldbeusedtomaketheatmosphereinformalafterconsenthas usually makeseveryonelaughalot. listed. Afewroundsofthiscanbeplayedeliminatingthosewholifttheirfingeratthewrongtime.This that fly, interspersedwiththingsthatdon’tfly. Participantsshouldlifttheirfingeronlyifaflyingobjectis Play ‘flyingfinger’game.Eachparticipantputsafingeronthetabletogether Q.N P4 P3 P2 P1 S.N Types ofSchool Note takername Facilitator name Place ofdiscussion District ID School ID Number ofparticipants Discussion date What differentrestrictionsand taboosarethereforschoolgoinggirlsandolderfemale ethnic groups? To whatextentaretheredifferencesinrestrictionsandtaboosbetweenfamiliesofdifferent What kindsofrestrictionsdohouseholdsherefollowwhen womenaremenstruating? To whatextentdoesthischangewhenthentheyaremenstruating? To whatextentcanwomenmovefreelyoutsidethehouseinthiscommunity? What dowomenhere? What domenhere? family members?Why? Questions • • menstruating? Why? What kindsoftaboosorcustomsdohouseholdsherefollow whenwomenare Why? Whatwouldhappenifthey… (probe fordifferenttypesofhome,timesday) Caste/ethnicity WinS Intervention WinS DD/MMYYYY Age (completed)

/ 2016 Non-WinS Class . Thefacilitatorliststhings

Remarks

75 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 76 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 We wouldliketoaskyou aboutreusablesanitarypads Pass aroundproductsandmaterials (thishelpsgirlsfocusontheissue) 19. Now wewouldliketoaskyouabouthowgirlshereusually managetheirmenstruation. 18 17. 16. 15. 14. 13. 12. 11. cards (onebyone). floor whereeveryonecanseethem. AskthegirlswhyKabitawouldbefeelinglikewordson describe howKabitawasfeeling.Gatherallthecardsatonce,andthenplacethemontable/ Give eachgroupmemberseveralmetacards,andaskthemtowriteonetwowordsthatwould 10. not dotopuja. some clothtoputinherunderwear, told hertowashsurwaal,andnotenterthekitchen, she noticedthathersurwaalwerestainedwithblood.Shespoketosister-in-law, whogaveher day afterschoolshehadpaininherlowerabdomen,andwenttorelieveherself(urinate), school, despitethefactthatherfamilywereunsurehowusefulitwasshewenttoschool.One defecate andurinateinthebushesalittlefarfromherhouse.Shewas13yearsoldenjoyed Kabita livedinaruralvillage(ADDdistrict)herfamilydidn’thavetoiletandsheusedto Now wewouldliketodiscussthesituationofagirlcalledKabita.(Readvignette) 9. 8. To whatextentdoyouthinktheserestrictions andtaboosarechanging?Why? What kindsoffamiliesaremorestrictaboutfollowingrestrictionsandtaboos? disposal What dotheyuseduringtheirmenstruation? organs? with theirmenstruation,menstrualhealthorrelatedtoyoursexualandreproductive Where dogirlsheregetinformationoradviceiftheyareconcernedaboutsomethingto What wouldagirllikeKabitadoiftherewerenofemalerelatives? had seenhowolderfemalefamilymembersmanagetheirmenstruation? To whatextentwouldagirllikeKabitaknowhowtomanagehermenstruationbecauseshe feel abouttheinformation?(useful,easytounderstand) How istheinformationthatgirlsusuallyreceivebeforetheystartmenstruating?doyou menstruating? How muchdoyouthinkagirllikeKabitawouldknowaboutmenstruationbeforeshestarted unsupportive parents,notoilet,gothelpfromhersisterinlaw) How isKabitadifferentfromgirlsinthecommunityhere?(emphasisepartsofstory– How doyouthinkshefelt? Why? (Nuclear, migrated,lotsofwomen,socioeconomic status) Probe for:comfort,cost,availability, absorbency, easytokeepinplace,washing, • • • • (Disposable, reusablecloths,old/newreusable/disposable sanitarypadsother) • • • • • 2. 1. What arethedisadvantagesofusingthismaterial? What aretheadvantagesofusingthismaterial? How didtheystartusingthatmaterial? Why dotheyusethatmaterialinsteadofothers? How dotheymanagetheirmenstruation? How satisfactoryiftheinformationoradvicethatisreceived? Why dotheyprefertogothisresourcethanothers? Where wouldshegetadvice? Where dogirlsgetinformationaboutmenstruationfromusually? ents) getinformationaboutmenstruation? Where wouldagirllikeKabita(firstmenstruation,withouttoilet,unsupportivepar fore theystartmenstruating? In youropinionandexperience,howmuchdogirlsknowaboutmenstruationbe (Probe forrestrictionsandcauses) - - 28. 27. 26. 25. 24. Now wewouldliketoaskyouaboutmenstruationandyourschool After brainstorming,gofromheadtofootdescribethefeelingsagirlhaswhilemenstruating. If isitnotobviouswheretomarkonthebody-becreative.Probeforphysicalandmentalfeelings. In particular, probeforwhengirlsareatschoolorthinkingaboutgoingtoschool,howdotheyfeel? Girls shouldmarkonthepictureplaceinbodyexperiencingsymptomorfeeling. Ask: Howtogirlsfeelswhentheyaremenstruating? Ask avolunteertodrawpictureofgirlonnewsprint. Tell heritdoesn’thavetobeperfect. Body Mapping: 23. 22. 21. We wouldliketoaskyouaboutdisposablesanitarypads 20. think thisistrue? at thefrontofclass,standupinclasstoanswerquestions etc.To whatextentdoyou We haveheardthatgirlswhoaremenstruating oftenfeelunabletoraisetheirhand,stand extent doyouthinkthisistrue? We haveheardthatgirlswhoaremenstruating oftenfeellessconfidentinclass. To what a placetochange,nothavinggoodtoiletfacilities, sanitaryclothsetc.) Why dogirlsmissschoolbecauseoftheirmenstruation? (probe: notfeelingwell,having extent doyouthinkthisistrue? We haveheardthatsometimesgirlsmissschool becauseoftheirmenstruation.To what school, andhowgirlsfeelaboutparticipatinginclass) How doesmenstruationaffectgirlseducation?(probeforhowfeelaboutgoingto What wouldgirlshereprefertousemanagetheirmenstruation? Probe for:comfort,cost,availability, absorbency, easytokeepinplace,washing,disposal What haveyouheardaboutdisposablesanitarypads?To whatextentdogirlsusethem? Probe for:comfort,cost,availability, absorbency, easytokeepinplace,washing,disposal before) What haveyouheardaboutreusablesanitarypads?(onlyaskiftheynottalked 1. • • (where, when,how) • Why? • • • • • • • • • • • • • • • • When girlsneedtodisposeofmenstrualhygienematerials,howdotheythis? What restrictionsarethereregardingwheregirlscanwashanddryclothes? How dogirlsusuallydrythem? If reusableclothsorpadsareused,howdogirlsusuallywashthem? Would youliketousethem–why, whynot? What arethedisadvantageswithusingdisposablesanitarypads? What aretheadvantagesinusingdisposablesanitarypads? How dotheyfeelincomparisonwithothermethods? (What isyourexperiencewithdisposablesanitarypads?) What dotheythinkaboutthem? Would youliketousethem–why, whynot? What arethedisadvantageswithusingreusablesanitarypads? What aretheadvantagesinusingreusablesanitarypads? How dotheyfeelincomparisonwithothermethods? pads?) What dotheythinkaboutthem?(Whatisyourexperiencewithreusablesanitary To whatextentdogirlsusereusablesanitary pads? once? ProberegardingtheWASH inschoolsprogramme) making them?Wherearetheyavailabletobuy?Havebeenmademorethan What isyourexperiencewithreusablesanitarypads?(Haveyouparticipatedin What arethedisadvantagesofdoingthis? What aretheadvantagesofdoingthis? Why dotheythisinsteadofburning/buryingetc.?

77 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 78 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 41. 40. to theirnormalworkandKabitawasleftfeelingconfused andembarrassed. When theteacheraskediftherewereanyquestions,everyone wassilent. Then theclass went on girls wereembarrassed. class hadboysandgirlstheteacherfeltabitembarrassed. The boyswerelaughingandthe Kabita hadreceivedaclassaboutsexualandreproductivehealthmenstruationatschool. The 39. 38. 37. 36. 35. 34. 33. changed overthepast(x)years. Now wewouldliketoaskyouabouttheschoolfacilitiesformenstruatinggirls,andhowthesehave 32. 31. 30. 29. sustainability) improved toilets,sanitarypads/clothesavailableatschool(ALWAYS available,checkfor (probe forWASH inschoolsprogrammefactors–supportivestaff, achangingroom, How easydogirlsherefindittomanagetheirmenstruationwhenatschool? What doyouthinkwouldhavemadetheclassbetter/improve theclass? What doyouthinkaboutthewaythatthisclasswastaught? If menstruationstartswhilegirlsareatschool,unexpectedly, whatdotheydo? ing girls? What otherimprovementshavebeenmadeinyourschooltomakeiteasierformenstruat To whatextentarethecleaningstaffsupportive/helpful? How dogirlsdisposeoftheirclothsorsanitarypadswhentheyareatschool? How havethetoiletsbeenimproved? during breaks)? To whatextentcangirlsusethetoiletwhentheyneedto(duringclass,beforeclassand How dothe In yourschoolhowmuchteasingofgirlsaboutmenstruationisthere? staff) Where dogirlsgethelpinmanagingtheirmenstruationhere?(probe,friends,teachers, Where dogirlsherechangetheirsanitarymaterials? • • • • • • • • • • • • • • What arethethingsthatmakeiteasiertomanagemenstruationatschool? What arethethingsthatmakeitdifficulttomanagemenstruationatschool? How isthisdifferentfrombefore(theWASH inschoolsprogramme) others above–toiletsetc.) How weregirlsconsultedorinvolvedinanyimprovement(otherimprovements How hascleaningofthetoiletsimproved? • • • • for castediscrimination) To whatextentcanallgirlsusethewatersourceinschoolcompound?(Probe comfortable managingyourmenstruation? How couldthetoiletbeimprovedtohelpyoumaintainhygienebetterandmore menstruation? What arethetoiletrelatedfactorsthatmakeiteasyordifficulttomanageyour Discuss theitemsonobservationchecklist. How wasthisdealtwith?(Didtheytalktoanyone,howdidrespond,etc.) Can yougiveanexampleofthis? How usefulisthishelp? How dogirlsmanagedirtyclothesatschool? What arethedifficultiesinchanging? toilets How havethedisposalfacilitiesbeenimproved? What dogirlsherethinkaboutthedisposalfacilities? What happenswhenthetoiletsarenotavailable? How oftenarethetoiletslockedorinaccessible? meettheneedsofmenstruatinggirls? - Thank youforyourtime. 43. 42. friends, familymembers,neighboursetc.) tion throughanyothersources(probeformentors/youngchampions,childclubs,media, Have youreceivedanyinformationaboutsexualandreproductivehealthmenstrua Have youreceivedanyclassesaboutsexualandreproductivehealthmenstruation? • • • • • • Was theteachermaleorafemale? Were boysandgirlstaughtseparately? What didyounotlikeaboutit?Why?(Whatmadeitthat?) What didyoulikeaboutit?Why?(Whatmadeitthat?) etc.) whether theteacherdiscussedtopicornot,textbookwasused) probe forwhotooktheclass,whethertheywereabletoaskquestionsornot, How wastheclass?Tell meaboutit Is thereanythingelseyouwouldliketotellus? Do youhaveanyquestions? -

79 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 80 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Brief them about the study and seek informed consent. Give them the information sheet aboutthestudy.Brief themaboutthestudyandseekinformedconsent.Giveinformation Questionnaire 3-Topic guideforgroupinterviewswithmenstruatingadolescentgirls Types ofSchool Interviewer name VDC ID District ID Place ofinterview School ID Grade participants) Age (completedageof participants Caste/ethnicity ofgirls Participants Name Number ofparticipants Interview date We wouldliketoaskyouabouthowwomeninyourfamilymanagetheirmenstruation. 9 8 7 6 We wouldliketoaskyouthinkback first startedmenstruating. 5 4 3 2 1 Q.N To whatextentcanwomenmovefreelyoutsidethehouseinyourhouseholdnormally? In yourexperience,towhatextentdoyouthinkrestrictionsandtaboosarechanging?Why? What happensiftheserestrictionsortaboosarenotfollowed? is menstruating? What kindsofrestrictionsortaboosdoyoufollowinyourhousewhenafemalefamilymember To whatextentareyouawarethatyourfemalefamilymembersorfriendsmenstruating? Have youreceivedanyclasses aboutsexualandreproductivehealthmenstruation? What didyouknowaboutmenstruation beforeyoustartedmenstruating? How didyoufeelwhenstartedmenstruating? Please tellusaboutyourexperience. • • • (Probe forfeelingconfused,upset,embarrassed,happy, proud) • • • Why? To whatextentdoesthischangewhenthentheyaremenstruating? How doyouknowthattheyaremenstruating? Where didyougetthisknowledge andinformationfrom?(Whatdidthey/ittellyou?) How didothersreact? What didyoudo? What happened? DD/MMYYYY WinS Intervention WinS Participant 1 Others………………….98 Brahmin/Chettri………..7 Muslim………………….6 Madhesi………………...5 Terai Janajati…………4 Hill Janajati……………..3 Terai Dalit………………2 Hill Dalit………………..1 Participant 1

/ 2016 Questions Non-WinS

Participant 2 Others……………………..98 Brahmin/Chettri…………..7 Muslim…………………....6 Madhesi…………………..5 Terai Janajati……….….4 Hill Janajati………………3 Terai Dalit……………….2 Hill Dalit…………………1 Participant 2

22 21 20 19 Now wewouldliketoaskyouabouthowmanageyourmenstruationathome. 18 17 16 15 14 13 12 11 10 (Probe formentors/youngchampions,childclubs,media,friends,familymembers,neighbours through anyothersources Have youreceivedanyinformationaboutsexualandreproductivehealthmenstruation Was theteachermaleorafemale? Were boysandgirlstaughtseparately? What didyounotlikeaboutit?Why?(Whatmadeitthat?) What didyoulikeaboutit?Why?(Whatmadeitthat?) What doyouthinkwouldhavemadetheclassbetter/improveclass? How wastheclass?Whatdoyouthinkaboutwaythatthisclasstaught? What isyourexperiencewithdisposablesanitarypads? (Probe for:comfort,cost,availability, absorbency, easytokeepinplace,washing,disposal) What haveyouheardaboutreusablesanitarypads?(onlyaskiftheynottalkedbefore) Why doyouusethatmaterial/productinsteadofothers?Howdidstartusingmaterial? (reusable cloths,disposablesanitarypads,reusablepadsetc.) What materialsdoyouusetoabsorbthebloodfromyourmenstruation? health orrelatedtoyoursexualandreproductiveorgans. Think backtoatimewhenyouwereconcernedaboutsomethingdowithyourmenstrual clubs? What isyourexperienceofthemenstrualhygienerelatedactivitiesconductedbychild etc.) • • • • • • • • • • • • • • • • • • • • • • • • Whether thetextbookwasusedetc.) whether theteacherdiscussedtopicornot whether theywereabletoaskquestionsornot Tell meaboutwhotooktheclass What aretheadvantagesinusingreusablesanitarypads? How dotheyfeelincomparisonwithothermethods? Where aretheyavailabletobuy?(ProberegardingtheWASH inschoolsprogramme) Have youparticipatedinmakingthem?theybeenmademorethanonce? Have youusedthem? What isyourexperiencewithreusablesanitarypads?doyouthinkaboutthem? ty, costetc. Probe forabsorbency, leakage,stayinginplace,disposal,washing,drying,availabili What arethedisadvantagesofusingthismaterial? What aretheadvantagesofusingthismaterial? Why doyouprefertogothisresourcethanothers? To whatextentareyousatisfiedwiththeresponsereceived? How helpfulwerethey? Why didyougotothem? Who didyoutalkto? What didyounotlikeaboutit? What didyoulikeaboutit? How wereyouinvolved? What weretheactivities? • • • • • Would youliketousethem–why, whynot? What arethedisadvantageswithusingreusablesanitary pads? What doyouthinkarethedisadvantageswithusingdisposable sanitarypads?) What doyouthinkaretheadvantagesinusingdisposable sanitarypads? Would youliketousethem–why, whynot? How dotheyfeelincomparisonwithothermethods? How didyougetthem/buythem? -

81 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 82 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 43 42 41 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 Now wewouldliketoaskyouaboutthemenstruationandschool 24 23 If yourmenstruationstartswhileyouareatschool,unexpectedly, whatwouldyoudo? To whatextenthasthischangedoverthepast(x)years? teachers? Why? How supportivearetheteachersandotherstaff?would youfeelaskingforhelpfrom How supportiveareyourfriends? it…) (Think backtoatimewhenyouhadproblemwithyourmenstruationatschool.Tell usabout Who doyougotoforsupportifhaveaproblemwithyourmenstruationatschool? How wereyouinvolvedindiscussionsaboutimprovingfacilities? (Probe: aroomfortakingrest,otherfacilitiestochangeorbatheetc.) about thesefacilities? What otherfacilitiesareavailableforgirlswhentheymenstruating,whatisyouropinion To whatextentdoyoufeelthecleaningstaffsaresupportive/helpful? during breaks)? To whatextentareyouabletousethetoiletwhenneed(duringclass,beforeclassand How havethetoiletsbeenimprovedoverpast(x)years? What arethethingsabouttoiletthatmakeiteasyordifficulttomanageyourmenstruation? How dothetoiletsmeetneedsofmenstruatinggirls? (Probe forwashinganddryingthem,takingthemhomeetc.) How doyoumanagethereusablecloths? How havedisposalfacilitiesbeenimprovedoverthepast(x)years? What difficultiesdoyouhaveinchangingyoursanitarymaterialswhileareatschool? What makesitdifficulttomanageyourmenstruationatschool? toilets, sanitarypads/clothesavailableatschool(ALWAYS available,checkforsustainability) (probe forWASH inschoolsprogrammefactors–supportivestaff, achangingroom,improved What arethethingsthatmakeiteasiertomanagemenstruationatschool? What makesiteasiertomanageyourmenstruationatschool? How easyisittomanageyourmenstruationatschool? What wouldyouprefertousemanageyourmenstruation?Why? What haveyouheardaboutreusablesanitarypads? • • • • • • • • • • • Where wouldyougointheschooltochange?) Would yougetcleanunderwearorclothes? Who wouldyouaskforhelp? How wouldyoufeelaskingforhelpfromfriends?Why? How hasthecleaningoffacilitiesbeenimprovedoverpast(x)years? available? How oftenarethetoiletslockedorinaccessible?Why?Whatdoyouwhenit’snot To whatextentdothetoiletsmeetthesecriteria? Show anddiscusstheobservationchecklist. • • What doyouthinkarethedisadvantagesofreusablesanitarypads? What doyouthinkaretheadvantagesofreusablesanitarypads? Have youheardanythingaboutwomenorgirlsmakingreusablesanitarypads? What doyouthinkaboutthedisposalfacilities? How doyoudisposeoftheusedclothsatschool? Thank youforyourtime. 49 48 47 46 45 Now wewouldliketoaskyouabouthowmenstruationaffectsatschool. 44 Have youevermissedschoolbecauseofyourmenstruation(halfdayorfullboth)?For do youthinkthisistrue? We haveheardthatsometimesgirlsmissschoolbecauseoftheirmenstruation.To whatextent We haveheardthatgirlswhoaremenstruatingoftenfeellessconfidentinclass. How doesmenstruationaffectthewayyoufeelinschool? only) How isthisdifferentfromwhatyouwoulddobeforetheWASH inschoolsprogramme?(WinS menstruation? Can youtellusaboutanyteasingthatoryourfriendshaveexperiencedinregardsto (Probe: Canyoutellusaboutthelasttimemissedschoolwhenweremenstruating?) what reasondoyoumissschoolwhenaremenstruating? • • • • • • • • • • • Why? How havetheattitudesofboysandstaffchangedoverpast(x)years? teasing, andalsostrategiestodealwithteasing) How hasthischangedorimprovedoverthepast(x)years?(frequencyandincidenceof How didyoudealwiththis?(didtalktoanyone,howrespond,etc.) When youaremenstruating? What didyourparentsthinkaboutthis? How didyoufeelaboutmissingschool? To whatextenttoyouthinkthisistrue? or standatthefrontofclassupintoanswerquestionsetc. We haveheardthatgirlswhoaremenstruatingoftenfeelunabletoraisetheirhandsit To whatextentdoyouthinkthisistrue foryouoryourfriends? What areyourmainconcerns? How doyoufeelaboutgoingtoschool? Is thereanythingelseyouwouldliketotellus? Do youhaveanyquestions?

83 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 84 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Brief themaboutthestudyandseekinformedconsent.Giveinformationsheetstudy. Questionnaire 4:Semi-structuredinterviewwithmothers 9 8 7 6 5 4 Now wewouldliketotalkyouabouthowmanageyourmenstruation. 3 2 1 School Types VDC ID District ID School ID Age (completedage) Caste/ethnicity ofparticipant Mother Name Interviewer name Interview date Q.N making reusablesanitarypads? What haveyouheardaboutreusablesanitarypads?Haveanythingwomen Why doyouusethatmaterialinsteadofothers? (disposable, reusablecloths,sanitarypadsother) How doyoumanageyourmenstruation? How doyoufeelwhenarerestrictedmenstruating? (What restrictionsarefollowedinthishousehold?) What arethemenstrualtaboosorcustomsrestrictionsthatfollowedinthishousehold? To whatextentcanwomenmovefreelyoutsidethehouseinyourhouseholdnormally? If youusereusableclothsor pads, howdoyoumanagethewashingofthem? What wouldyouprefertousemanageyourmenstruation? Why? What isyourexperiencewithdisposablesanitarypads? Why? (where, when,how) • • • • • • • • • • • • What wouldbetheadvantagesofusingthem? What arethedisadvantagesofusingthismaterial? What aretheadvantagesofusingthismaterial? How didyoustartusingthatmaterial? How dotherestrictionsandcustomsmakeyoufeel? To whatextentdoesthischangewhenthentheyaremenstruating? How doyoumanagethedrying ofthem?Why? Would youliketousethem–why, whynot? (probe forcost,availability, comfort,etc.) What arethedisadvantageswithusingdisposablesanitary pads? What aretheadvantagesinusingdisposablesanitarypads? How dotheyfeelincomparisonwithothermethods? What wouldbedisadvantagesofusingthem? WinS Intervention WinS Others………………….98 Brahmin/Chettri………..7 Muslim………………….6 Madhesi………………...5 Terai Janajati…………4 Hill Janajati……………..3 Terai Dalit………………2 Hill Dalit………………..1 DD/MMYYYY

Questions

/ 2016 Non-WinS

28 27 26 Now wewouldliketoaskyouabouttheschoolfacilitiesfor menstruatinggirls 25 24 23 22 21 20 19 18 17 We wouldliketotalkyouaboutmenstruationandyourdaughters’school. 16 15 14 13 12 11 Now wewouldliketotalkyouaboutyourdaughterandmenstruation. 10 30 29 struating andgoingtoschool? What haveyouheardyourdaughtersay, orobservedherfeelingsaboutwhensheismen How doeshavingtheirmenstruationmakegirlsfeelatschool? Can youtellusaboutthelasttimeyourdaughtermissedschoolwhen she wasmenstruating? Has yourdaughterevermissedschoolbecauseofhermenstruation? Why dogirlsmissschoolbecauseoftheirmenstruation(notfeelingwellorother)? tion. To whatextentdoyouthinkthisistrue? We haveheardthatsometimesgirlsmissschool(halforfullday)becauseoftheirmenstrua children? Why? In thiscommunity, howappropriateisittotalkaboutmenstruationgenerallyandwithyour If youhaveason,spokentohimaboutmenstruation? you do?Why?Howdofeelaboutthat? To whatextentdoesyourdaughterfollow thesamemenstrualtaboosandrestrictionsthat available? How doyouthinkthatbetteradviceandinformationaboutmenstruationcouldbeprovided/ Where doesyourdaughtergetinformationandadviceaboutmenstruation? Have youeverspokentoyourdaughteraboutmenstruation? When youneedtodisposeofmenstrualhygienematerials,howdothis?Why? How doesyourdaughterdispose ofclothsorsanitarypadswhensheisatschool? To whatextent dothetoiletsmeetneedsofmenstruatinggirls? What haveyouheardyourdaughtersayaboutthetoilets at school? To whatextentdothefacilitiesatschoolmeetneedsofmenstruatinggirls? they aremenstruating? What doyouknowaboutthefacilitiesformenstruatinggirls atyourdaughter’sschoolwhen regards tomenstruation? Has yourdaughtertoldyouaboutanyteasingthatheror her friendshaveexperiencedin How easydoesyourdaughterfindittomanagehermenstruationwhensheisatschool? extent doyouthinkthisistrue? We haveheardthatgirlswhoaremenstruatingoftenfeellessconfidentinclass. To what • • • • • • • • • • • • • How hasthischangedoverthepast(x)years? How supportivearetheteachersandotherstaff? How supportiveareyourdaughtersfriends? What arethethingsthatmakeiteasiertomanagemenstruationatschool? What arethethingsthatmakeitdifficulttomanagemenstruationatschool? Has yourdaughtertoldyouanythingaboutthis? How didyouadviseherwhenthishappened? How easywasitforyoutotalkhimaboutmenstruation? What didyousay? To whatextentdoyouthinkthisappropriate/optimal? • • • • What arethedisadvantagesofdoingthis? What aretheadvantagesofdoingthis? Why doyouthisinsteadofburning/buryingetc.? How didshereact? How easywasitforyoutotalkyourdaughteraboutmenstruation? What didyousay?(probeforknowledgeaboutwhywomenmenstruate) In whatcontext? • • How satisfiedwereyouwiththisresponse? How wasthisdealtwith? - -

85 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 86 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 37 36 35 34 33 32 31 girls? (why/whynot?) How haveyoubeeninvolvedintheschoolactivitiestoimprovefacilitiesformenstruating ing girls? What roledoyouthinkthatparentsshouldhaveinimprovingschoolfacilitiesformenstruat How sustainedhavethesefacilitiesoractivitiesbeen?(Why?Whynot?) How successfulhavetheseactivitiesbeen?(Why?Whynot?) How hasyourdaughterbeeninvolvedintheseactivities?(Why?whynot?) chhaupadi andothertaboos) sion ofpadsorotherfacilitiesformenstruatinggirls,advocaciesthathasbeendonetoend improved wastedisposal,waterandsanitationfacilities(includingtoilet),orprovi (probe forestablishment/reactivationofWASH committee,reusablesanitarypadtraining, years? What activitiesrelatedtomenstrualhygienehastheschoolconductedoverpast(x) do? If yourdaughter’smenstruationstartswhilesheisatschool,unexpectedly, whatwouldshe Do youhaveanyquestions? Thank youforyourtime. - - Questionnaire 5:Semi-structuredInterviewwithHeadTeachers you havehadwithWater andSanitationissuesmenstrualhygienemanagement. We wouldliketoaskyousomequestionsaboutschoolstaffing,management,andanysupport Number ofStudents No. ofteachersinschool Types ofSchool Temple onschoolcompound Ward VDC/municipality code District code School Gender Head teachername reason behindrefusing) (Instruction; pleasemention Interview result Interviewer's Name Interview Date 4 3 2 1 No. ofhealthteachersinschool Q.N Grades meetings? ly parents-teachersAssociation Does theschoolhaveregular month ers association? Does theschoolhaveparents-teach health personinyourSchool? Do youhaveSchoolNurseortrained Teacher inyourSchool? Do youhaveWASH focalPerson/ 10 9 8 7 6 Questions N Girls Male Other (specify)...... 5. Refused forInterview...... 4 Interview Incomplete………………………...... 3 Not metconcernedpersonforinterview……….2 Interview completed…………………………...... 1 Male Intervention WinS Yes DD/MMYYYY Male

No

Female

- - Female Female No Yes No Yes No Yes No Yes

/ 2016 Response Non-WinS N Boys

DD/MMYYYY

Code 0 1 0 1 0 1 0 1

q.n. 5 If no,skipto Total / 2016 Instruction

87 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 88 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 15 14 13 12 11 10 9 8 7 6 5 17 16 Q.N (WinS orothertraining),howmany (WinS If theschoolhasreceivedsupport If yes,whattypesofsupport education atschool? port toteachmenstruationrelated Has yourschoolreceivedanysup pound andtoilet? manage thecleanlinessofcom Does yourschoolhaveafundto provement plan? WASH featuresintheschoolim Does yourschoolhaveanannual How activearethey? water andsanitation? work onissuesofmenstrualhygiene, If yes,areanyclubsthatdiscussor clubs? Does theschoolhaveanyChild related matters?(Openquestion). and sanitationormenstrualhygiene agement Committeehaveinwater What roledoestheSchoolman If yeshowactiveisit? agement Committee? Does theschoolhaveaSchoolMan teachers havereceivedthetraining? the training? Was menstrualhygieneincludedin What wasthesourceofsupport? Questions - - - - - Very active No Yes No Yes Please write………….. Formed butnotactive Less active Moderately active Very active No Yes No Yes Others (Specify)……… Restless Development Red Cross Office District Education No. ofmaleteachers No. offemaleteachers Others (specify) training WinS No 0 Yes No Yes No Yes Formed butnotactive Less active Moderately Active Response

Code 1 0 1 0 1 4 3 2 1 0 1 3 2 1 1 0 1 0 1 4 3 2 q.n. 11 If no,skipto q.n. 7 If noskipto 19 If noskipto Instruction 25 24 23 22 21 20 19 18 Q.N struation atschool? comfortable tomanagetheirmen implemented tomakegirlsfeelmore What strategieshastheschool teased aboutmenstruation? or teasing,forexampleifgirlsare What istheschoolpolicyforbullying situation? school inanemergency/accident materials) availableforgirlsatthe Are sanitarynapkins(orequivalent on aregularbasis? materials) availableforgirlsatschool Are sanitarynapkins(orequivalent information? grade dogirlsstartsgettingthis taught atschool,whatageand If menstruationrelatededucationis curriculum atschool? Who teachesmenstruationrelated (multiple response) related educationatschool? How dogirlsreceivemenstruation question). ers andgenerallytheschool(open has affectedthestudents,teach Please tellusabouthowthetraining If yourschoolhasreceivedtraining. Questions - - menstruation related They don’treceive information Only whentheyaskfor training As partofaspecific ulum As partofthecurric School: Teachers: Students: ………………………… Please write: No Yes No Yes Grade Age Others (specify)…… pions Mentors/Young Cham Health workers School Nurse Teachers Others (Specify)… education atschool Response

- - Code 96 96 4 3 2 1 0 1 0 1 4 3 2 1 Instruction

89 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 90 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Signature ofHeadTeacher: Signature ofResearcher: 28 27 26 Q.N only for WinS schools) only forWinS (openquestion of promotingWinS? Please tellusaboutthedifficulties schools) question onlyforWinS (open helped youtopromoteWinS. Please tellusaboutthefactorsthat school? able tomanagetheirmenstruationat ed tomakegirlsfeelmorecomfort What facilitieshastheschoolprovid • • • • • • • • • • • • • water supplyinschool separate toiletsforteachers, agement committee, priority fromschoolman tion ofWASH facilities, Political influencesinalloca with soapstation) promotion (Handwashing personal hygiene,Hygiene regular monitoringof training/orientation, education andpadmaking capacity building:MHM ers, students, common toiletsforteach CGD friendly, to maintain/cleantoilet, CGD friendly, regularroutine disposal, watersupply- Toilet improvement,waste CGD friendlytoilets) tion andmaintenance, Fund orsystemforopera dents, Hygiene behaviorofstu WASH facilities, monitoring mechanismof toilets, Questions ------96 Others (Specify)……… bins intoilets Attached incinerator/ Water supplyintoilets Waste disposalfacility training togirls Giving sanitarypad room Provision ofchanging Provision ofsickroom water bags (painkillers) and/orhot Providing medicines Providing education Response Code 8 7 6 5 4 3 2 1 Instruction (to beusedbyresearcherobservingtoiletsandalsoindiscussionwithteachersgirls) Questionnaire 6:Schooltoiletsobservationchecklist 9 8 7 6 5 4 Intervention Types Ward VDC code District code School Code Observer Name Observation date 10 3 2 1 Q.N How manyofalltoiletsinuse have a badsmell? How manyofalltoiletsinusehave faeces) visible fliesandsmellofurineor are visiblycleanandthereno the floor, pan andwallofthetoilets (Instruction: "Clean"meansthat appear clean? How manyofalltoiletsinuse hand washing? nearby soapandwaterfacilitiesfor How manyofalltoiletsinusehave have waterandbucket/jugwithin? How manyofopentoiletsinuse How manyenclosedtoiletshave: a functioningorenoughlight? How manyofalltoiletsinuse have faeces inpanorelsewhere? How manytoiletsarethereinuse? toilet? only girls’ separate there a Is Is thereatoiletintheschool Question DD/MMYYYY WinS Intervention WinS

in toilet? A bucket/jugorothermeansofputtingwater Water insidethecubicleorbuilding Either typesofbinfulloroverflowing? A closedbinforsanitarydisposal? A bin? A functioninglock? Open Pan Enclosed toilet No Yes No Yes

sponse

Re

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Non-WinS Code

0 1 0 1

toilet then observethecommon no separatetoiletforgirls the girltoiletandIfthereis If it’sagirlstoiletobserve

Instruction

91 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 92 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Any additionalcomments: 13 12 11 15 14 16 Q.N disabled access?(addcriteria) How manyofalltoiletsinusehave on thetoilet.] seating arrangementsandsupport cubicles, appropriatetypesof the toilet railing inthepassageand,within a wheelchairinthepassage,hand sufficient spacefor should includearampuptotoilet, [Differently-abled friendlytoilet: Is theredisabledfriendlytoilet? tap ] require lessforcetooperatethe height forthemtooperateeasily, handrails ,havingtapatlower should beany)andwithproper less steepstaircase(ifthere easy toaccessbychildren,having should bebuiltinaplacewhichis friendly tap.Havingsaidthis-this children ofallagesiscalledachild [A tapwhichisaccessibleby Is therechildfriendlyWater tap? facing? How manytoiletsareontheinward derogatory graffiti? How manytoiletsinusehave secondary classes Is thereaseparatetoiletforgirlsin Question No Yes No Yes

No Yes sponse Re

- Code 0 1 0 1 0 1 If “No’”skiptoQN16 Instruction Now wearegoingtoaskyousomeinformationaboutandyourhome. Questionnaire 7:Semi-structuredInterviewwithBoys 7 6 5 4 3 2 1 Type ofschool VDC Code District Code School Code Class Student ID Interviewer ID Interview date Q.N Religion Caste/Ethnicity ed age? What isyourcomplet have? tion doesyourfather What levelofeduca have? tion doesyourmother What levelofeduca yourself asdisabled? Would youdescribe Primary language Questions - - - Section 1Sociodemographicinformation Don’t know University Class 10andabove Below class10 None Don’t know University Class 10andabove Below class10 None No Yes Others (Specify) Doteli Gurung Tamang Bhojpuri Nepali Maithali Other(specify) Christian Buddhist Muslim (Islam) Hindu Others(specify) Brahmin/Chettri Muslim Madhesi Terai Janajati Hill Janajati Terai Dalit Hill Dalit WinS Intervention WinS DD/MMYYYY

Response

/ 2016 Non-WinS Code 98 98 96 98 3 2 1 4 3 2 1 4 3 2 1 0 1 6 5 4 3 2 1 4 3 2 1 7 6 5 4

Instruction

93 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 94 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Now wewouldliketoaskyou somequestionsaboutmenstruation. 14g 14f 14e 14d 14c 14b 14b 14a 14 13 12 11 10 9 8 Q.N Radio Sloar Electricity have Does yourhousehold water atyourhome? What isthesourceof where doyougo? If youdon’thavetoilet you have? What kindoftoiletdo your house? Do youhavetoiletin your housemadeof? What isthewallof made of? What isyourroof Bank account Livestock Computer Mobile phone Television Questions Tin/Metals Tiles/stones Planks/wood Bamboo Thatch/palm leaf/reed/grass Well/Inar/Kuwa tap Public River /springsource Tube well/boreholewater Pipe waterincompound Others (Specify) Neighbours toilet Forest area Field Open place Others (Specify) Pit latrinewithoutslab/openpit Pit latrinewithslab Flush tosomewhereelse Flush toseptictank No Yes Others (Specify) Cement block Stone andcement Brick andcement Plywood/Wooden plank Stone andclay Bamboo andclay Unburnt brickandclay Burnt brickandclay Cane/Palm/trunks/Bamboos Others (specify) Cement Dhalan Calamine/cement fibre Yes 1 1 1 1 1 1 1 1 Response No 0 0 0 0 0 0 0 0 Don’t know Code 96 96 98 96 96 3 2 1 0 1 9 8 7 6 5 4 3 2 1 7 6 5 4 3 2 1 5 4 3 2 1 4 3 2 1 4 No. 12 If NoSkiptoQ Instruction Now wewouldliketoaskyouaboutyourhouseholdandmenstruation 25 24 23 22 21 In yourhousehold: 20 19 18 17 16 15 Q.N Have youeverhelped about menstruation? other familymembers Have youevertalkedto they aremenstruating? If yes,howdoyouknow who areaged12to60? family membersathome Do youhaveanyfemale struation? Do youknowaboutmen needed them? friend orfamilymember buy sanitarypadsifa Would youfeelableto their menstruation? female friendtomanage a familymemberor If no,whynot?(Tick one) ing, cantheyattendtemples? When womenaremenstruat puja? ing, cantheydohousehold When womenaremenstruat (Tick one) If no,whynot bratabandha) wedding,blessings, (Puja, occasions? ing cantheyattendreligious When womenaremenstruat Questions - No Yes No Yes No Yes No Yes No Yes Others (Specify) WhentheyhaveLeakage kind ofpain When theyhavestomach/any When theydryusedcloths Restriction athome - - - No Yes Others (specify) to do They feelitistherightthing They don’twantto Their familydon’tallowthem They feardivineretribution They don’tfeelwell No Yes Others (Specify) to do They feelitistherightthing They don’twantto Their familydon’tallowthem They feardivineretribution They don’tfeelwell No Yes Response Code 96 96 96 0 1 5 4 3 2 1 0 1 5 4 3 2 1 0 1 0 1 0 1 0 1 4 3 2 1 0 1 0 1 to 27 If "Yes" skip to 25 If "Yes" skip to 23 If "Yes" skip to 18 If "No"skip Instruction

95 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 96 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 33 32 31 30 29 28 27 26 Q.N tions) (i.e. eatwithoutanyrestric drinks? ing cantheyeatanyfoodsor When womenaremenstruat (tick one) If nowhynot? much asnormal? ing, cantheygooutsideas When womenaremenstruat (tick one) If nowhynot? kitchen? ing cantheycook/enterthe When womenaremenstruat (tick one) If no,whynot? family members? ating, cantheytouchmale When womenaremenstru (tick one) If no,whynot? Questions - - - - - Their familydon’tallowthem They feardivineretribution They don’tfeelwell No Yes Others (Specify) to do They feelitistherightthing They don’twantto Their familydon’tallowthem They feardivineretribution They don’tfeelwell No Yes Others (specify) to do They feelitistherightthing They don’twantto allow them Their familymembersdon’t They feardivineretribution They don’tfeelwell No Yes Others (specify) to do They feelitistherightthing They don’twantto Their familydon’tallowyou They feardivineretribution They don’tfeelwell No Yes Others (Specify) to do They feelitistherightthing They don’twantto Response Code 96 96 96 96 2 1 0 1 4 3 2 1 0 1 5 4 3 2 1 0 1 5 4 3 2 1 0 1 5 4 3 to 31 If "Yes" skip to 29 If "Yes" skip to 35 If "Yes" skip to 33 If "Yes" skip Instruction 42 41 40 39 38 37 36 35 34 Q.N (tick one) If nowhynot? same bedasothers? ating cantheysleepinthe When womenaremenstru (tick one) If nowhynot? your family? same buildingastherestof ating cantheysleepinthe When womenaremenstru If no,whynot?(tickone) household)? community (outsideyour about menstruationinthe myths ormisconceptions Have youeverchallenged strual taboosorrestrictions? challenging communitymen Have youeverparticipatedin household? about menstruationinyour myths ormisconceptions Have youeverchallenged taboos? hold menstrualrestrictionsor or helpedchallenge,house Have youeverchallenged, Questions - - - - No Yes No Yes No Yes No Yes Others (specify) to do They feelitistherightthing They don’twantto Their familydon’tallowthem They feardivineretribution They don’tfeelwell No Yes Others (specify) to do They feelitistherightthing They don’twantto Their familydon’tallowthem They feardivineretribution They don’tfeelwell No Yes Others (Specify) bleeding She willhaveheavymenstrual to do They feelitistherightthing They don’twantto allow her Her familymembersdon’t She feardivineretribution in herbody ance (betweenheatandcold) She wantstomaintainbal They makeherfeelunwell Response - Code 96 96 96 5 4 3 2 1 0 1 7 6 5 4 3 2 1 0 1 0 1 0 1 0 1 5 4 3 2 1 0 1 to 37 If "Yes" skip to 39 If "Yes" skip Instruction

97 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 98 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 school andtheirmenstruation Now wewouldliketoaskyouaboutgirlsat 53 52 51 50 49 48 47 46 45 44 43 Q.N community? or misconceptionsinyour restrictions, taboos,myths, Do youfeelabletochallenge home? or misconceptionsinyour restrictions, taboos,myths Do youfeelabletochallenge health andmenstruation? class onsexualreproductive Have youeverreceiveda tion? How usefulwasthisinforma mation aboutmenstruation? From wheredoyougetinfor menstruation? What arethesymptomsof ation? What isthecauseofmenstru ing (tickallthatapply) do) whentheyaremenstruat girls cannotdo(shouldnot What aretheactivitiesthat menstruating? around girlsafterstart Do boysbehavedifferently menstruating? around boysaftertheystart Do girlsbehavedifferently struating? female classmatesaremen Are youawarewhenyour Questions - - - - - Sports They candoanything Don’t know No Yes Don’t know No Yes No Yes No Yes No useatall Not veryuseful Useful Others (specify) Champions Child clubs/Mentors/Young Internet Friends Health workers Female familymembers Male familymembers Teacher Others (Specify) Dizziness Tiredness Pain (alltypes) Others (specify) Supernatural reason Bad bloodbeingshed Curse Internal bleeding Normal healthyprocess Others (Specify) a question Going totheboardanswer swer aquestion Standing upinclasstoan Don’t know No Yes Don’t know No Yes Response - Code 98 98 96 96 96 96 98 98 1 0 1 0 1 0 1 0 1 3 2 1 7 6 5 4 3 2 1 3 2 1 5 4 3 2 1 3 2 0 1 0 1 to 48 If "No"skip Q.N.57 If "no"skipto Instruction 63 62 61 60 59 58 57 56 55 54 their menstruation? teasing ofgirlsbecause Have youeverchallenged their menstruation? teasing ofgirlsbecause months haveyouwitnessed How ofteninthepastthree their menstruation? teasing ofgirlsbecause Have youeverwitnessed If yes,whichactivities? activities? menstrual hygienerelated Has thechildclubdoneany the childclub? in anyactivitiesorganisedby Have youeverbeeninvolved school? Is thereachildclubatyour taught thisclass? How wouldyouprefertobe How didyoufindthisclass? tions? Were youabletoaskques - Not useful Dull Interesting Embarrassing No Yes No Yes in past3months Not experiencedorobserved Once in3months Once in2months Once amonth Once aweek No Yes Others (specific) eventsoradvocacy Public Training onpadmaking Awareness raising No Yes No Yes Don’t know No Yes gender Class notdisaggregatedby gender Class disaggregatedby Others (specify) 98 96 2 1 0 1 0 1 2 1 4 3 2 1 0 1 0 1 5 4 3 2 1 0 1 3 61 skip toQ.N. don’t know, If noand interview If noStopthe

99 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 100 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Questionnaire 8:Semi-structureinterviewwithgirls 7 6 5 4 3 2 1 Class Student name Type ofschool School Code VDC code District Code ID Interviewer Name Interview date What levelofeducation as disabled? Would youdescribeyourself Primary language Religion Caste/Ethnicity What isyourcompleteage? your fatherhave? What levelofeducationdoes have? (Class) doesyourmother Questions WinS Intervention WinS DD/MMYYYY

Section 1Sociodemographicinformation

Terai Janajati Hill Janajati Terai Dalit Hill Dalit Don’t know University Class 10andabove Below class10 None Don’t know University Class 10andabove Below class10 None No Yes Others (Specify) Doteli Gurung Tamang Bhojpuri Nepali Maithali Others(Specify) Christian Buddhist Muslim Hindu Others(Specify) Brahmin/Chettri Muslim Madhesi

/ 2016 Non-WinS Response

Code 98 98 96 96 96 4 3 2 1 4 3 2 1 4 3 2 1 0 1 6 5 4 3 2 1 4 3 2 1 7 6 5 Instruction 15h 15g 15f 15d 15c 15b 15a 15 14 13 12 11 10 9 8 15e made of? What iswallofyourhouse made of? What istheroofofyourhouse Bank account Livestock Computer Mobile phone Television Radio Solar Electricity Does yourhouseholdhave your home? What isthesourceofwaterat do yougo? If youdon’thavetoilet,where toilet? Who elseregularlyusesyour have? What kindoftoiletdoyou house? Do youhavetoiletinyour Khapeta Tin/Metals Tiles/stones Planks/wood Bamboo Thatch/palm leaf/reed/grass Others (Specify)… Community tap River /springsourcepond Tube well/boreholewater Pipe waterincompound fy)…………………………. Other (speci Neighbours toilet Forest area Field Open place Shared withotherfamilies family Just themembersofyour Others (Specify) pit Pit latrinewithoutslab/open Pit latrinewithslab Flush tosomewhereelse Flush toseptictank No Yes Others (Specify) Cement block Stone andcement Brick andcement Plywood Stone andclay Bamboo andclay Unburnt brickandclay Burnt brickandclay Cane/Palm/trunks/Bamboos (Other Specify) Cement Dhalan Calamine/cement fibre Yes 1 1 1 1 1 1 1 1

- No 0 0 0 0 0 0 0 0 Don’t know 96 96 98 96 96 96 4 3 2 1 2 1 9 8 7 6 5 4 3 2 1 8 7 6 5 4 3 2 1 4 3 2 1 4 3 2 1 2 1 Q.N.13 If "No"skipto

101 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 102 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 16 22 21 20 19 18 17 affected yourhome? How hastheearthquake helped themost) (Singleoption-focusonwho to use) was, advisedyouaboutwhat advised youaboutwhatit (advisedyouwhattodo, menstruation atfirst? Who helpedyoumanageyour tion? How usefulwasthisinforma answer) information from?(multiple Where didyougetthat ed menstruating? menstruation beforeyoustart Did youknowanythingabout started menstruating? What agewereyouwhen menstruation? believe wasthecauseofyour menstruating, whatdidyou When youfirststarted Questions Menstruation –knowledgeandsourcesofinformation - - Others (Specify)………….. home duetoearthquake temporary structureorothers Major damageandlivingin Major damagetohome Minor crackstohome No effectofearthquake Book/magazine/health Teacher Friend Male relative female relative Female cousinorother Older Sisterinlaw Older Sister Mother No Yes Don’t remember Age: Others (Specify) Don’t know Supernatural reason Bad bloodbeingshed Curse Internal bleeding Any typeofillness Normal healthyprocess Others (Specify) FCHV Health Worker Teacher Friend Male relative female relative Female cousinorother Older Sisterinlaw Older Sister Mother Not veryuseful Useful Other(Specify) Mentor/Young Champion Internet TV Radio FCHV Health Worker magazine Response Code 98 96 98 96 10 96 14 13 12 11 10 96 9 8 7 6 5 4 3 2 1 0 1 6 5 4 3 2 1 9 8 7 6 5 4 3 2 1 2 1 4 3 2 1 to 21 If "No"skip Skip 30 29 28 27 26 25 24 23 (multiple option) tional informationfrom? Where didyougetthataddi any moreinformation? menstruation, haveyouheard Since youfirstlearnedabout tion? the causeofyourmenstrua Now, whatdoyoubelieveis community? about menstruationinthe myths ormisconceptions Have youeverchallenged community? about menstruationinthe myths ormisconceptions Do youfeelabletochallenge about menstruationathome? myths ormisconceptions Have youeverchallenged about menstruationathome? myths ofmisconceptions Do youfeelabletochallenge ation? talking toaboutyourmenstru Who doyoufeelcomfortable - - - Supernatural reason Bad bloodbeingshed Curse Internal bleeding Any typeofillness Normal healthyprocesses No Yes Other(Specify) Male familymembers FCHV Health Worker Teacher Mentors/Young Champions Friend female relative Older Sisterinlaw Older Sister Mother Other on/Mentors Child club Internet TV Radio FCHV Health Worker magazine Book/magazine/health Teacher Friend Male relative female relative Female cousinorother Older Sisterinlaw Older Sister Mother No Yes Others (Specify) Don’t know No Yes No Yes No Yes ( Specify) / Young Champi - 13 12 11 10 96 98 96 10 96 15 14 9 8 7 6 5 4 3 2 1 0 1 6 5 4 3 2 1 0 1 0 1 0 1 0 1 9 8 7 6 5 4 3 2 1 to 26 If "No"skip

103 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 104 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Managing MenstruationatHome 35a 35 34a 34 33a 33 32.a 32 31a 31 When youaremenstruating, Can youattendtemple? If nowhynot? en? Can youcook/enterthekitch If no,whynot? members? Can youtouchmalefamily If no,whynot?(mainreason) Can youdohouseholdpuja? If no,whynot?(mainreason) puja, bratabanda)? occasions (wedding,blessing, Can youattendreligious If no,whynot?(mainreason) Questions - Other (Specify) You feelitistherightthingtodo You don’twantto Your familydon’tallowyou You feardivineretribution You don’tfeelwell No Yes Other (Specify) You feelitistherightthingtodo You don’twantto Your familydon’tallowyou You feardivineretribution You don’tfeelwell No Yes Others (Specify) You willruinthefood You feelitistherightthingto do You don’twantto Your familydon’tallowyou You feardivineretribution You don’tfeelwell No Yes Other (Specify) You feelitistherightthingtodo You don’twantto Your familydon’tallowyou You feardivineretribution touch unwell You willmakethepeopleyou No Yes Others (Specify) You feelitistherightthingtodo You don’twantto you Your familymembersdon’tallow You feardivineretribution You don’tfeelwell No Yes Response Code 96 96 96 96 5 4 3 2 1 0 1 5 4 3 2 1 0 1 6 5 4 3 2 1 0 1 5 4 3 2 1 0 1 5 4 3 2 1 0 1 to 33 If "Yes" Skip to 32 If "Yes" Skip to 36 If"Yes" Skip to35 If "Yes" Skip to 34 If "Yes" Skip Skip 39a 39 38a 38 37a 37 36a 36 39_1 Can youlifttheheavyloads? If nowhynot? bed asothers? Can yousleepinthesame If nowhynot? family? house astherestofyour Can yousleepinthesame If no,whynot? restrictions) drinks? (i.e.eatwithoutany Can youeatanyfoodsor If nowhynot? as normal? Can yougooutsideasmuch Questions You don’tfeelwell No Yes Yes Others (Specify) You feelitistherightthingtodo You don’twantto Your familydon’tallowyou You feardivineretribution You don’tfeelwell No Yes Others (Specify) You willhaveheavybleeding You feelitistherightthingtodo You don’twantto you Your familymembersdon’tallow You feardivineretribution body (between heatandcold)inyour You wanttomaintainbalance They makeyoufeelunwell No Yes Others (Specify) You feelitistherightthingtodo You don’twantto Your familydon’tallowyou You feardivineretribution No Yes Others (Specify) You feelitistherightthingtodo You don’twantto Your familydon’tallowyou You feardivineretribution You don’tfeelwell No Response Code 96 96 3 2 1 0 1 5 4 3 2 1 0 1 0 1 5 4 3 2 1 0 1 5 4 3 2 1 0 1 7 6 5 4 to 38 If "Yes" Skip to 37 If "Yes" Skip to 40 If “Yes” Skip to 39_1 If "Yes" Skip to 39 If "Yes" Skip Skip

105 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 106 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 50 49 48 47 46 45 44 43 42 41 40 39_1.i If nowhy? If yes,howdidyougetthem? sanitary pads? If yes,howoftendoyouuse pads? Have youeverusedsanitary Where doyoudryusedcloth? them? somewhere privatetowash If youusecloths,dohave clothes? How oftendoyouusedry clothes? How oftendoyouuseclean new? If youuseclothisitoldor tion? (tickoneonly) use tomanageyourmenstrua Which materialdoyouusually menstruation? restrictions andtaboosabout Do youfeelabletochallenge menstruation athome? restrictions andtaboosabout Have youeverchallenged Questions - Always Never Sometimes Always New Old Other Sanitary pads(reusable) Sanitary pads(disposable) Cloth (reusable) Don’t know No Yes No Yes Others (Specify) You feelitistherightthingtodo You don’twantto Your familydon’tallowyou You feelhard You don’tfeelwell Made them Relative bought Self-bought Rarely Sometimes Usually Always No Yes Others (Specify) Dry usinghotiron By thefire clothes Inside homecoveredbyother Inside homeinahiddenplace Inside homeinanormalplace clothes Outside homecoveredbyother place awayfromview Outside homeinthesunlighta dried Normal placewhereclothesare Outside homeinsunlightthe No Yes Never Sometimes Response Code 96 98 96 96 1 3 2 1 2 1 3 2 1 0 1 0 1 5 4 3 2 1 3 2 1 4 3 2 1 0 1 8 7 6 5 4 3 2 1 0 1 3 2 Skip to48 to 52 If "No"Skip Skip 61 60 59 58 57 56 55 54 53 52 51 to washthem? you havesomewhereprivate If youusereusablepadsdo sanitary pad? Have youeverusedreusable reusable sanitarypads? If yes,Wheredidyougetthe able sanitarypads? Have youeverboughtreus sanitary pads? Have youevermadereusable make reusablesanitarypads? Have youeverlearnedhowto reusable sanitarypads? Have youeverheardabout (tick onlyoneoption) manage yourmenstruation? what wouldyoulikebestto If youcouldchooseonething, (Multiple choice) use them? are thereasonsyoudonot ly usedsanitarypads,what If youhaveneverusedorrare sanitary pads? your homewhereyoucanbuy minutes walkingdistanceof Is thereashopwithin20 If yes,whereweretheyfrom Questions - - Others (specify) Women’s group Medical shop Bazaar (town)shop Retail shop School Friends Women’s group Town market Medical shop Retail shop No Yes No Yes No Yes No Yes Other (Specify) Sanitary pads(reusable) Sanitary pads(disposable) Cloth (reusable) Not applicable Other (Specify) Never heardofthem Unsure ofhowtousethem them Embarrassed togoandbuy Difficult todisposeof Not easilyavailable Expensive Don’t know No Yes No Yes No 2 Yes 1 Others (Specify) Health facility Response Code 96 98 96 96 96 3 2 1 9 6 5 4 3 2 1 0 1 4 3 2 1 0 1 7 6 5 4 3 2 1 0 1 0 1 0 1 0 1 Q.N. 63 If no,Skipto to 60 If no,skip to 62 If no,skip Skip

107 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 108 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 65 64 63 62 pad? Where doyoudryreusable strikes)? school (excludingholidaysand you missedawholedayat What wereallthereasonsthat (excluding holidays,strikes) while youweremenstruating? ing thewholedayatschool many daysdoyourecallmiss In thepast3months,how pose ofthem? where andhowdoyoudis cloths, reusablesanitarypad If youusedisposablepads, Questions Questions Menstrual hygienemanagementinSchool - - Throw theminthegutter Throw awayinponds themintoilet Put home Bury themonlandawayfrom Bury theminrubbishpit Throw awayfarfromhome Burn them Others (Specify) Dry usinghotiron By thefire clothes Inside homecoveredbyother Inside homeinahiddenplace Inside homeinanormalplace clothes Outside homecoveredbyother place awayfromview Outside homeinthesunlighta dried Normal placewhereclothesare Outside homeinsunlightthe Others(specify) Don’t usedisposables Throw theminastream Others(specify) materials Had togoandgetsanitary cloths/napkins Nowhere todisposeofpads/ soap, toodark,nolocketc.) management (i.e.nowater, no Toilet facilitiesinadequatefor Fear ofteasing leakage Heavy bleedingleadingtofearof school Family preventfromgoingto Family advisenottogoschool Tiredness Pain (anykind) (if 0) Days (1to15) Response Response Code Code 96 96 96 7 6 5 4 3 2 1 8 7 6 5 4 3 2 1 9 8

9 8 7 6 5 4 3 2 1 to 67 If"0"skip Skip Skip 69 68 67 66 (Single option) you usuallymanage? and youareatschool,howdo When youstartmenstruating menstruation? day atschoolbecauseofyour that youmissedapartofthe What wasthemainreason menstruation? more hours)becauseofyour of theday(one or for part class how manydaysdidyouleave During thelastthreemonths, strikes) school (excludingholidayand you missedawholedayat What wasthemainreasonthat Questions Others (Specify) home Go homechangeandstayat back Go homechangeandcome buy materials Go toanearbyschoolshopand Ask teacherformaterials Ask friendsformaterials with you Use materialsthatyoubrought You donothing Other (Specify) materials Had togoandgetsanitary cloths/napkins Nowhere todisposeofpads/ soap, toodark,nolocketc.) management (i.e.nowater, no Toilet facilitiesinadequatefor Fear ofteasing Fear ofleakage school Family preventfromgoingto Family advisenottogoschool Tiredness Pain If 0 Number ofdays(1to15) Others (Specify) materials Had togoandgetsanitary cloths/napkins Nowhere todisposeofpads/ soap, toodark,nolocketc.) management (i.e.nowater, no Toilet facilitiesinadequatefor Fear ofteasing Fear ofleakage school Family preventfromgoingto Family advisenottogoschool Tiredness of pain) Pain (cramps/headache/anykind Response Code 96 96 8 7 6 5 4 3 2 1 7 6 5 4 3 2 1 8 7 6 5 4 3 2 1 to 69 If "0"Skip Skip

109 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 110 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 81 80 79 78 77 76 75 74 73 72 71 70 struation whodoyouask? compound duringyourmen If youhavetoleavetheschool room? sit inthefrontofclass how oftendoyoufeelcan When youaremenstruating playing sports? how comfortabledoyoufeel When youaremenstruating ation materials? Where doyoudrythemenstru all thatareapplicable) itary materialsatschool?(tick Why don’tyouwashyoursan materials atschool? Do youeverwashyoursanitary break? Can youusethetoiletduring the toiletduringclass? Do youhavepermissiontouse sanitary materialsatschooletc.) not feelcomfortabletochange water, toilet,sanitarymaterials, (Reason likeunavailabilityof cloths) inadayatschool? menstruation materials(pad/ often didyouchangeyour During yourlastperiod,how manage yourmenstruation? asking forsanitarymaterialsto Who doyoufeelcomfortable to useatschoolifyouneedto? (pads/cloths) availableforyou Are theresanitarymaterials pound? you hadtoleaveschoolcom Would youtellthemthereason Questions - - - - - (open) Number oftimestheychange Never becauseofanotherreason Never it’snotnecessary Other Not comfortable/no-one Friends Female teacher Male teacher Don’t know No Yes No Yes Others (Specify) Male/Female Classrepresentative teacher) Other teacher(includinghead Male /Female Classteacher No-one Never Sometimes Always sports No sportsatschool/don’tplay Not comfortable Comfortable Not applicable Other (specify)……….. At home grounds In privateplaceonschool At schooltoilet Other(specify) No soap Nowhere todrythem Use disposablecloths/pads No water No properplacetowashthem Don’t usereusablematerials No Yes Never Sometimes Always Never Sometimes Always Response Code 77 88 96 98 96 96 96 4 3 2 1 0 1 0 1 4 3 2 1 3 2 1 3 2 1 9 3 2 1 5 4 3 2 1 2 0 1 3 2 1 3 2 1 72 If "1"skipto 80 78 79 Skip 95 94 93 92 91 90 89 88 87 86 85 84 83 82 96 ation? teasing becauseofmenstru Do youfeelabletochallenge ation? teasing becauseofmenstru Have youeverchallenged choice) ried willteaseyou?(multiple teased, whoareyouwor If youworryaboutbeing being teased? in schooldoyouworryabout When youhaveyourperiod boys? able beingintheclasswith school, doyoufeelcomfort When youhaveyourperiodin do yourhomework? how oftendoyoufeelcan When youaremenstruating go toschool? how oftendoyoufeelcan When youaremenstruating stay atschoolthewholeday? how oftendoyoufeelcan When youaremenstruating stay inclassthewholetime? how oftendoyoufeelcan When youaremenstruating asked? write ontheboardifyouare how oftendoyoufeelcan When youaremenstruating tion? stand uptoansweraques how oftendoyoufeelcan When youaremenstruating question? swer whentheteacherasksa can raiseyourhandtoan how oftendoyoufeel When youaremenstruating on? answer questionswhencalled how oftendoyoufeelcan When youaremenstruating do yourclasswork? how oftendoyoufeelcan When youaremenstruating saying? focus onwhattheteacheris how oftendoyoufeelcan When youaremenstruating Questions ------Don’t know No Yes No Yes Others(Specify) Male Teachers Female Teachers Boys Girls No Yes No Yes Never Sometimes Always Never Sometimes Always Never Sometimes Always Never Sometimes Always Never Sometimes Always Never Sometimes Always Never Sometimes Always Never Sometimes Always Never Sometimes Always Never Sometimes Always Response Code 98 96 3 2 1 3 2 1 3 2 1 3 2 1 3 2 1 3 2 1 0 1 0 1 4 3 2 1 2 1 2 1 3 2 1 3 2 1 3 2 1 3 2 1 to 95 If "No"skip Skip

111 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 112 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Thank You! 110 109 108 107 106 105 104 103 102 101 100 99 98 97 If youhaveleakagewhen leaks? school, howoftendoyouhave When youhaveyourperiodin If yes,whichactivities? activities? menstrual hygienerelated Has thechildclubdoneany child club? any activitiesorganisedbythe Have youeverbeeninvolvedin school? Is thereachildclubatyour taught thisclass? How wouldyouprefertobe How didyoufindthisclass? tions? Were youabletoaskques Who taughtthisclass? and menstruation? on sexualreproductivehealth Have youeverreceivedaclass (Multiple options) who hasdonetheteasing? If youhaveeverseenteasing, ation inthepast3months? teasing ofgirlsaboutmenstru enced teasing,orobserved How oftenhaveyouexperi girls aboutmenstruation? teasing orobservedof Have youeverexperienced are atschool,whatdoyoudo? Questions - - - Others(Specify) Male Teachers Female Teachers Boys Girls past 3months Not experiencedorobservedin Once in3months Once in2months Once amonth Once aweek No Yes Others (specify) home Go home,changeandstayat back Go home,changeandcome Stay atschool Never Sometimes Always Others (specific) events oradvocacy Public Training onpamaking Awareness raising No Yes No Yes Don’t know No Yes gender Class notdisaggregatedby Class disaggregatedbygender Other Not useful Dull Interesting Embarrassing No Yes Others (specify) Health worker Other teacher Health teacher No Yes Response Code 96 96 96 98 96 96 4 3 2 1 5 4 3 2 1 0 1 3 2 1 3 2 1 3 2 1 0 1 0 1 0 1 2 1 4 3 2 1 0 1 3 2 1 0 1 skip t0102 If option5, 102. to If "No"skip 99 to If "No"skip interview End the 107 If "No" Skip Thank You! 110 109 108 107 106 105 104 103 102 101 100 99 98 97 If yes,whichactivities? activities? menstrual hygienerelated Has thechildclubdoneany child club? any activitiesorganisedbythe Have youeverbeeninvolvedin school? Is thereachildclubatyour taught thisclass? How wouldyouprefertobe How didyoufindthisclass? tions? Were youabletoaskques Who taughtthisclass? and menstruation? on sexualreproductivehealth Have youeverreceivedaclass (Multiple options) who hasdonetheteasing? If youhaveeverseenteasing, ation inthepast3months? teasing ofgirlsaboutmenstru enced teasing,orobserved How oftenhaveyouexperi girls aboutmenstruation? teasing orobservedof Have youeverexperienced are atschool,whatdoyoudo? If youhaveleakagewhen leaks? school, howoftendoyouhave When youhaveyourperiodin Questions - - - Others (specific) events oradvocacy Public Training onpamaking Awareness raising No Yes No Yes Don’t know No Yes gender Class notdisaggregatedby Class disaggregatedbygender Other Not useful Dull Interesting Embarrassing No Yes Others (specify) Health worker Other teacher Health teacher No Yes Others(Specify) Male Teachers Female Teachers Boys Girls past 3months Not experiencedorobservedin Once in3months Once in2months Once amonth Once aweek No Yes Others (specify) home Go home,changeandstayat back Go home,changeandcome Stay atschool Never Sometimes Always Response Code 96 96 96 96 96 98 0 1 2 1 4 3 2 1 0 1 3 2 1 0 1 4 3 2 1 5 4 3 2 1 0 1 3 2 1 3 2 1 3 2 1 0 1 0 1 interview End the 107 If "No" skip t0102 If option5, 102. to If "No"skip 99 to If "No"skip Skip Questionnaire 9:IndividualDiary–Girls Other nonmenstruationrelated Other menstruationrelated way toschool There istempleinschooloronthe Lack ofsanitarypad/cloth Lack ofsanitarydisposalfacilities Fear orpresenceofteasing Fear ofleakage school No adequatetoiletfacilityat Tiredness Tiredness Pain School holiday Reasons for beingabsent (markxfor thereason you were absent) school) imate numberofhoursmissed Time offschoolinhours(approx (H)) one hour at least for Absent or (mark Pifpresent,orAforabsent, Were youpresentatschool? if youmenstruated) Menstruation days(pleasemarkx Date andday (prefilled) Months: Field Diary - 1

2

3 1 st Week 4

5

6

7

1 2 3 2 nd week 4 5 6 7

113 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 114 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 Other nonmenstruationrelated Other menstruationrelated way toschool There istempleinschooloronthe Lack ofsanitarypad/cloth Lack ofsanitarydisposalfacilities Fear orpresenceofteasing Fear ofleakage school No adequatetoiletfacilityat Tiredness Pain School holiday the reason you were absent) Reasons for beingabsent (markxfor school) imate numberofhoursmissed Time offschoolinhours(approx (H)) one hour at least for Absent or (mark Pifpresent,orAforabsent, Were youpresentatschool? if youmenstruated) Menstruation days(pleasemarkx Date andday (prefilled) - 1

2

3

3rd Week 4

5

6

7

1 2 3 4th week 4 5 6 7 Development 18(1),2010.pp. 99-115. sanitation andhygiene)programmes in SouthAsia:aneglectedissueforWASH (water, Mahon, T. andM.Fernandes, health sciencesandresearch4(4),2014. do duringmenstruation and Socio-culturalpractices:whatschoolgirls Hamal, M.andS.K.C., Education (MoE),October2016,p.x. Development Plan2016-2013, Government ofNepal, 397-398. and AfricanStudies (54.02),London,1991,pp. pp.353. andinBulletinoftheSchoolOriental and Oxford:ColumbiaUniversityPress.1989, roles ofhigh-castewomeninNepal, wives andsacredsisters:socialsymbolic Gellner, DavidNandLynn Bennett, body mapping the storiesofundocumentedworkersthrough research: Methodologicalconsiderationsfortelling Gastaldo, Denise,etal., 426-39. stigma inNepal, This isanaturalprocess':managingmenstrual MengerandM.R.Kaufman, Crawford, M.,L.M. 2014. Commission, GovernmentofNepal,Kathmandu, Monograph ofNepal2014, Central BureauofStatistics, Government ofNepal,Kathmandu,2012. Commission, CentralBureauofStatistics, and HousingCensus2011 Central BureauofStatistics, London, 2011. Research Unit,InstituteofEducationUniversity systematic reviewoftheevidence enrolment, attendanceandcompletion?A have ontheirprimaryandsecondaryschool provision ofseparatetoiletsforgirlsatschools Birdthistle, Isolde,etal., REFERENCES experiences ofmenstrualcups andpads etal., Mason, L, , Toronto: Creative Commons, CultHealthSex16(4),2014,p. Adolescent schoolgirls' School Sector ? Internationaljournalof Hygiene, HealthProblems What impactdoesthe Body-map storytellingas , NationalPlanning NationalPlanning Population Population National Population Menstrual hygiene Ministry of , SocialScience Dangerous NewYork , Genderand 2012. attendance: Evidencefromarandomized Menstruation, sanitaryproductsandschool Oster, Emily, andRebeccaThornton, Nepal, and UnitedNationsDevelopmentProgramme, Planning Commission,GovernmentofNepal Geography, UnlockingHumanPotential Nepal HumanDevelopmentReport: Central BureauofStatistics,Kathmandu,Nepal National Population andHousingCensus2011, Sindhuli districtsofNepal menstrual hygienemanagementinUdaypurand Morrison, J, etal., Waterlines 34.1, 2015,p.15-30. in ruralwesternKenya:aqualitativestudy Pakistan and SriLanka Pakistan Bangladesh, Bhutan,India,Maldives, Nepal, Provisional Draft,StateofArt in Afghanistan, UNICEF, ROSA, UNICEF, 2009. UNICEF, Study, (ADAP)Baseline Development andParticipation UNICEF andPopulation Council, Health(14),2014,p.1118. BMC Public female adolescentstudentsinNortheastEthiopia, management andschoolabsenteeismamong Tegegne, T.K. andM.M.Sisay, e1001962. Needs inSchools Addressing Girls’MenstrualHygieneManagement Sommer, M.,etal., Compare 45(4),2015,pp.589-609. in Tanzania, Ghana,CambodiaandEthiopia, menstruation andeducationexperiencesofgirls Sommer, M.etal., Health27(7),2015,pp.785-95. J Public Reproductive HealthofWomeninNepal Ranabhat, C.,etal., Economics 3.1, 2011,pp.91-100. evaluation Nepal,November2014. 2014. Child FriendlySchoolsManual , AmericanEconomicJournal:Applied WASH forSchoolChildren. , PLoSMed 913.20,2016: Formative researchon Formative A comparisonofthe A Time forGlobalAction: Chhaupadi Cultureand . , July2016. Menstrual hygiene Adolescent Beyond , NewYork: , National , AsiaPac ,

115 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 116 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: THE ROLE OF WASH IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION 2016 https://www.statnews.com/2017/02/17/nepal-tradition-chaupadi-menstruation/ surrounding-periods-in-nepal-video https://www.theguardian.com/global-development/video/2017/may/27/girls-challenge-the-stigma- women-banished-cattle-sheds https://www.theguardian.com/global-development/2016/apr/01/nepal-bleeding-shame-menstruating- http://sticerd.lse.ac.uk/seminarpapers/dg10052010_1.pdf https;//www.census.gov/population/international/data/idb/worldpop.php http://www.bbc.co.uk/programmes/b08pnszp WEBSITES ;