Long-running advocacy in Nepal to realize menstrual health and hygiene for all

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Interview with the national convener of the MHH alliance

By Renu Kshetry

KATHMANDU, Nepal – Mr Gunaraj Shrestha is the National Convener of Menstrual Health and Hygiene Management Partners’ Alliance (MHMPA) since 2017. The MHMPA is an informal network with 80 members of various organizations working in the field of sanitation and hygiene. Shrestha was WSSCC’s National Coordinator in Nepal between 2013 and 2018.

WSSCC: Can you provide a brief background of MHMPA?

Mr Gunaraj Shrestha, National Convener of Menstrual Health and Hygiene Management Partners’ Alliance: In 2017, WSSCC began to focus on menstrual health and hygiene and identified two areas of required work: developing human resources for Menstrual Hygiene Management (MHM) and policy formulation.

In response to this need, WSSCC provided a seven-day residential training of trainers in Nagarkot, Nepal, where international trainers and a team of experts from Geneva gathered to train 50 participants from Nepal and 20 from Pakistan in MHM. Out of the 50 participants from Nepal, 25 participants were from the Government Ministries, Departments and the Federal Government and 25 were representatives of the UN, international NGOs (INGOs) and media. Representatives from the Ministry of Women, Children and Senior Citizen (MoWCSC), Ministry of Education (MoE), Ministry of Water Supply (MoWS) and Ministry of Health (MoH) also attended.

The team of experts – from Ministries, UN agencies, INGOs and media – that were engaged in this training felt the need to continue discussions beyond the initial training programme, resulting in the formation of the MHMPA as an informal network, which meets every two months.

As MHM was not seen as a government priority in Nepal, we had to lobby hard with the government and partners to outline the importance of MHM. The main objective of the alliance is to create a knowledge-sharing platform of the initiatives of various organizations working in this field. The MHMPA is focused on policy advocacy, human resource development, preparing consolidated plans and programmes and providing support to the government on plans and programmes.

WSSCC: What was the most important thing that was needed to support MHM in Nepal?

Mr Shrestha: During the training, we realized that there was no proper policy on MHM in Nepal. At that time, the Department of Water Supply and Sewerage Management under MoWS was a leading agency on hygiene and sanitation. After our consistent lobbying, in 2017, the Ministry agreed to draft a policy on MHM and formed a policy-drafting committee with representatives from four line ministries - MoH, MoWCSC, MoE and MoWS - and various experts from development partners, NGOs and other sectors. I represented the team from WSSCC and was appointed the Coordinator of this drafting committee. WSSCC also provided funding to hold meetings. Later, we realized that it is not only the issue of hygiene that is important, but it is also about the dignity of a woman. So, we changed the name of the policy to National Policy on Dignified Menstruation. We submitted the draft in six months.

WSSCC: Why the delay in endorsing that draft bill?

Mr Shrestha: When the policy was drafted, it was led by the Ministry of Water Supply, along with support from three other line ministries, as it covered four policy areas - education, health, women and WASH. But later, after discussions with the experts, government officials and the MHMPA members, we agreed to approach it as a human rights issue. Thus, it came under the purview of the Ministry of Women, Children and Senior Citizens. This transition caused some delay. We are now hopeful that the MoWCSC will table the bill in the Parliament and endorse it soon.

WSSCC: What role do you think the MHMPA has played in creating awareness about MHM at the policy level?

Mr Shrestha: Before, all the activities in this area were scattered. But, with the formation of MHMPA, we now know who is doing what and how best we can contribute to making it more effective, through concerted intervention by various partners. Today, we have become a stronger voice of expertise in MHM.

WSSCC: Why do you think there is a need for increased investment in MHM sector?

Mr Shrestha: Menstrual health and hygiene has a multi-dimensional impact on women and girls, and it needs comprehensive efforts to establish it as a human rights issue related to the dignity of women. It is also directly linked with education, health, water supply and hygiene. It costs a lot in order to intervene in these areas. For example, in education, we have to invest in curriculum development, textbook and reference materials. It takes research and evidence to develop these educational materials, which will have a long-term impact on the students as well as teachers. In the case of informal education, which caters to out of school girls and women, we need to organize training, an awareness campaign, develop and distribute IEC (information, education and communication) materials. All these works need huge investment.

In health, we need to mainstream menstrual health and hygiene into all health-related plans and programmes, as it is still not a priority in the WASH sector. We also need investment in building menstruation-friendly toilets in all the schools and public offices. In Nepal, only 15% of women have access to sanitary pads, and 85% of women rely on used clothes. This unhygienic use of clothes without access to clean water can have a long-term impact on the health of women and girls. So, the government should invest in producing biodegradable and reusable sanitary pads.

WSSCC: How do you think the government and development partners can help to eliminate taboo and stigma associated with menstruation?

Mr Shrestha: As the taboo and stigma are directly linked with culture and religion, we need a long-term strategy. Inclusion of MHM in school level curriculum will have a long-lasting impact on the psyche of the students. Besides, the government’s endorsement of ‘National policy on dignified menstruation’ has also created a favourable environment towards recognizing menstruation as dignity. As for eliminating taboos, the local governments in the west have dismantled around 60% of chhaupadi. We now have Nepal Criminal Code 2018 that criminalizes a practice that forces women to stay in a cowshed during menstruation. Under the law, anyone who forces a woman to stay in a cowshed during their period will face three months jail sentence and Rs. 3,000 (US$ 24) fine.

WSSCC: How do you think we can translate our policies into action?

Mr Shrestha: The most important thing is that sanitary pads should be easily assessable and affordable to all the women aged 9-50. It should be listed under essential items, just like condoms. If condoms can be distributed free of cost, then why can sanitary pads not be distributed free of cost? If the government can’t distribute them free of cost, then it should at least make sanitary pads tax free and promote local companies’ production of affordable and reusable sanitary pads, including reducing the 35 % tax on raw materials for the pads.

After two years of regular lobbying with the government, the governmental plans and policies now mention providing free distribution of sanitary pad in schools. The Government of Nepal has also endorsed Sanitary Pad Distribution and Management Guidelines in 2019, which now has to be channelled through the local governments. Now, our focus is to campaign for affordable and assessable sanitary pads for 85 % of women who do not have access to menstrual health and hygiene.