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. CONTENTS About this report .......................................................................................................................................v Acknowledgements ................................................................................................................................ vii Acronyms ...............................................................................................................................................viii Executive Summary ..................................................................................................................................1 Introduction ..............................................................................................................................................4 Methods ...................................................................................................................................................6 Setting ...........................................................................................................................................6 Sampling and Data Collection ......................................................................................................7 Quantitative Methods and Sampling ............................................................................................7 Structured Interviews with girls .....................................................................................................7 Structured Interviews with boys ....................................................................................................8 Structured observations of the schools ........................................................................................8 Qualitative Methods and Sampling...............................................................................................8 Group interviews with girls ............................................................................................................8 Focus group discussions with girls ..............................................................................................8 Interviews with teachers and mothers ..........................................................................................8 Data Collection ..............................................................................................................................8 Ethical concerns ...........................................................................................................................8 Data management and analysis ...................................................................................................8 Results ....................................................................................................................................................11 The WinS Programme .................................................................................................................11 Socio-demographic and socio-economic characteristics of girls and their families .................12 Menarche - practices, knowledge and information ....................................................................13 Cultural Practices and Restrictions .............................................................................................14 Menstrual seclusion ....................................................................................................................15 Restrictions on physical contact .................................................................................................16 Restrictions in entering the kitchen, cooking and eating ............................................................16 2016 Religious restrictions ...................................................................................................................17 Restrictions on movement ..........................................................................................................17 Girls' current knowledge of menstruation ...................................................................................18 Boys current knowledge of menstruation ...................................................................................18 Materials for managing menstruation .........................................................................................20 Menstrual management during the school day ..........................................................................22 Absence from school ..................................................................................................................24 Teasing ........................................................................................................................................26 Toilet facilities in schools .............................................................................................................27 Participation in school .................................................................................................................29 ANALYSIS OF MENSTRUAL HYGIENE PRACTICES IN NEPAL: HYGIENE PRACTICES IN NEPAL: OF MENSTRUAL ANALYSIS IN SCHOOLS PROGRAMME FOR GIRLS EDUCATION THE ROLE OF WASH i Limitations ..............................................................................................................................................31 Discussion and recommendations ........................................................................................................32 Conclusion .............................................................................................................................................35 Annexes ..................................................................................................................................................36 References ...........................................................................................................................................115 Websites ...............................................................................................................................................116 Tables Table A WASH supportive structures in schools .........................................................................11 Table B. Menstrual restrictions by district ...................................................................................16 Table B.1 Material usually used to manage menstruation ..........................................................20 Table C: Reasons for not using Disposable Sanitary Pads ........................................................21 Table D: Menstrual Management at school ................................................................................23 Table D.1 Whole days missed at school in past 3 months due to menstruation .......................24 Table E: School absenteeism during a one month period .........................................................25 Table F: Teasing Practices...........................................................................................................27 Table G: Observation of school facilities.....................................................................................28 Table H: Comfort level in school during menstruation ................................................................29 Table I: Boys opinion about activities that can't be done by girls during menstruation* ............30 Annex Tables Table 1 List of Schools ................................................................................................................36 Table 2 Characteristics of participants in the qualitative study ...................................................36 Table 3 Data collected.................................................................................................................37 Table 4 Support for WASH in schools .........................................................................................38 Table 5 Menstrual education and Facilities provided by schools to manage menstruation at school ..................................................................................................39 Table 6 Socio-demographic characteristics of girls....................................................................40 Table 7 Socio-demographic characteristics of boys ..................................................................42 Table 8 Knowledge of Menstruation ...........................................................................................44 Table 9 Social taboos and their reasons by WinS schools and non-WinS schools ...................46 Table 10 Social taboos and their reasons by Wins and non-WinS .............................................47 2016 Table 11 Social taboos and their reasons by Wins and non-WinS .............................................48 Table 12 Social taboos and their reasons by Wins and non-WinS .............................................49 Table 13 Social taboos and their reasons by Wins and non-WinS .............................................50 Table