Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.
BMC Womens Health. 2021 Feb 28;21(1):84. doi: 10.1186/s12905-021-01231-6.
During their menstrual period, women are generally considered impure in Nepal; in the rural areas of the western part of the country, they are even banished to stay in sheds (called chhaupadi) during this time, which increases their vulnerability to a variety of health consequences. There is lack of clarity regarding the effectiveness of interventions that have been implemented to address menstrual taboo and improve menstrual hygiene and practices in Nepal (e.g., public awareness, community sensitization and legislation). In this paper, we discuss why menstruation management interventions, particularly those implemented to change the menstrual taboo might not work, and the opinions and experiences regarding the implementation of such interventions.
Anecdotal reports from the field and empirical studies suggest that interventions to address menstrual taboos have only been effective for short durations of time due to several reasons. First, local community stakeholders have been reluctant to take actions to abandon retrogressive menstrual practices in rural areas. Second, women who have stopped practising chhaupadi have faced stigma (e.g., fear of exclusion) and discrimination (e.g., blaming, physical and verbal abuse). Third, contextual factors, such as poverty and illiteracy, limit the effectiveness of such interventions. Fourth, community sensitization activities against chhaupadi have faced resistance from community leaders and traditional healers. Fifth, the law prohibiting chhaupadi has also faced implementation problems, including poor filing of complaints.
Multilevel, multisectoral interventions could be more effective than single-component interventions in breaking the prevailing menstrual taboo and in improving menstrual health and hygiene practices among young girls and women in the rural areas of Nepal. Moreover, interventions that have an active community mobilization component could be effective within local contexts and cultural groups.
在尼泊尔，女性在月经期间通常被认为是不洁的；在该国西部的农村地区，她们甚至被禁止在这段时间内留在棚屋里（称为 chhaupadi），这增加了她们遭受各种健康后果的脆弱性。目前尚不清楚为解决月经禁忌和改善尼泊尔月经卫生和习惯而实施的干预措施的有效性（例如，公众意识、社区宣传和立法）。在本文中，我们讨论了为什么月经管理干预措施，特别是那些旨在改变月经禁忌的干预措施可能不起作用，以及对实施此类干预措施的意见和经验。
实地的传闻报告和实证研究表明，由于以下几个原因，解决月经禁忌的干预措施仅在短时间内有效。首先，当地社区利益相关者不愿意采取行动放弃农村地区落后的月经习俗。其次，停止实践 chhaupadi 的妇女面临污名化（例如，害怕被排斥）和歧视（例如，指责、身体和言语虐待）。第三，贫困和文盲等背景因素限制了此类干预措施的有效性。第四，反对 chhaupadi 的社区宣传活动遭到社区领导人和传统治疗师的抵制。第五，禁止 chhaupadi 的法律也面临执行问题，包括投诉提出不力。
多层次、多部门的干预措施可能比单一组成部分的干预措施更有效，可以打破普遍存在的月经禁忌，并改善尼泊尔农村地区年轻女孩和妇女的月经健康和卫生习惯。此外，具有积极社区动员组成部分的干预措施可能在当地背景和文化群体中有效。
