Private Connection Water Supply Systems Promoting Dignified Menstruation Management

Authors

Manju Bhatta

Behaviour Change Communication Officer

RVWRMP III

Contact: manju.bhatta@rvwrmp.org.np

Love Raj Pant

Water Resources Adviser, TSU Darchula/Baitadi

RVWRMP III

Contact: loveraj.pant@rvwrmp.org.np

Pamela White

Senior Manager, FCG

Home-office Coordinator & Rural Monitoring and Reporting Specialist

RVWRMP III

Contact: pamela.white@fcg.fi

Summary

In Sudurpaschim province, Nepal, most women consider that menstruation is dirty, making them impure, and they are unhappy while menstruating. This is the result of long traditions of taboos and discrimination. Most women want to be a mother one day, but they don't like having to go through menstruation. If women teach family members to think positively about menstruation, it is possible to change attitudes and understand that menstruation is a natural process. If the mother or mother-in-law allows her daughter in-law and daughter to use the tap and toilet during menstruation, as well as allowing them to touch others, and drink milk and curd, it helps to develop positive thoughts in the community.

Apihimal RM is located in a cold and mountainous area. There are geographical challenges to easily respond to human basic needs, yet local people are now practicing good behaviour regarding total sanitation and menstrual hygiene. Every woman now has access to an enabling environment during menstruation. There has been a change in the practices their mothers or mothers-in-law followed from a young age. The new generation is not observing the old menstrual taboos. All women are using the tap and sleeping in safe places, and they are allowed to drink milk and curd during menstruation.

Ten years’ ago, women used cattle sheds to sleep, and streams instead of water taps for personal hygiene during menstruation. The new generation has been successful in changing that behaviour nowadays, and the private tap connection system makes it easy to maintain personal hygiene. The parents-in-law accept the behaviour change, and are not sending their daughter or daughter-in-law to the cattle shed during menstruation. They now understand that menstruation is a natural process and not a curse. Mothers are now convinced to change the risky behaviours, and men have changed and are supporting their wives, daughters and sisters, rather than querying what they touch or do.

We can observe the changes in behaviour of both the older and younger generations in the area where RVWRMP has supported development of the water supply scheme. Additional supports for changing the traditional behaviours have come from behaviour change awareness activities on sanitation, hygiene and menstruation management conducted by RVWRMP, different support projects, other organisations, and the rural municipality (RM) itself.

Interactions took place during a field visit in the area covered by the drinking water supply areas (DWS) (Jhaskuchaud DWS, Khhattoli DWS and Kurmul DWS of Api Himal RM). Households were randomly selected for monitoring, and individual and group interactions were held with Use Committees, users and mothers’ groups. The same responses regarding menstruation behaviour were found in the different DWS.

After receiving support from the Project and RM, the residents have fully changed their lives. Menstruation behaviours have changed because of project support to connect the private tap connection system in their yard. Every household has sanitation structures constructed and in use, and they know how to make them sustainable for long term use. Mothers’ groups have a weekly plan to clean the footpath, from one household to the next. One member from each household (generally the mothers’ group member) is involved in the weekly sanitation plan.

Background

The Rural Village Water Resources Management Project (RVWRMP) operates with the Rural Municipalities of Sudurpaschim and Karnali Provinces (with funding from the Governments of Finland and Nepal, the European Union, local government and users). It has been promoting water supply, sanitation and hygiene activities for many years, among other activities. This includes menstrual hygiene management (MHM) activities at school and community level, and support for Dignified Menstruation Management under the auspices of the local governments.

Apihimal Rural municipality was included as a project core RM since 2017. Since then, RVWRMP has been working in the main themes of water supply, sanitation, hygiene and livelihoods; and in other cross-cutting themes such as Gender Equality and Social Inclusion (GESI), capacity building and awareness-raising activities for the RM. When Apihimal was selected as a core RM there had been very few activities conducted and no water supply scheme had been constructed by other projects. They used the temporary water supply or traditional water sources. The Project selected the most critical water supply schemes via the Water Use Master Plan (WUMP) process and started to construct the schemes in 2017. Initially they constructed a public tap connection system, but then once the community realised the importance of the private tap connection, they raised demands for private tap connection systems in other wards. The result is that now other projects are following the RVWRMP guideline for constructing the water supply scheme. The RM has made it compulsory for other projects to construct the scheme using the RV model.

After the first private tap connection scheme was piloted in the RM, it proved to be the most effective scheme of the RM. After that scheme was completed, other schemes have raised demands to install a private tap system in each community in the RM. So now the RM is developing a system to ensure that each household will have a tap, toilet and metal stove. Other external donors are also following this system in the RM. Accordingly, all the new schemes have private tap connections throughout the RM.

Voices have been raised publicly for some years regarding dignified menstruation, and RVWRMP has campaigned from the start. Now there is a Government campaign to ensure a ‘dignified menstruation-friendly environment’ everywhere. Every local level has to plan to raise awareness on menstruation taboos. The Project aims to have 80% of women having access to toilet use during their menstrual period. To achieve the target, the project has conducted many capacity building activities and provided support to construct water supply schemes, ensuring the participation of 50% women in the scheme area.

After construction of the water supply scheme, conducting many behaviour change and awareness activities, and capacity building activities, we can find many healthy behaviours are followed by community people. The drinking water user committees are committed to change the community. They are working to change unhealthy behaviours such as open defecation, encouraging hand washing, maintaining personal hygiene and promoting dignified menstruation.

In Apihimal RM Ward no.3 the private tap connection scheme User Committee (UC) leads the whole community on how to maintain the cleanliness of the scheme area. They determined some rules in the monthly UC meeting and all community members are following them.

The agreed rules are:

• Conduct a monthly meeting and deposit the water tariff in the UC

• Community sanitation campaign in each Saturday (the public foot track is cleaned by individuals from each household near the track)

• No open defecation. Use the toilet at all times

• Private tap constructed by all households

• All households will install a metal stove (improved cooking stove) in each house (external support will be provided)

These rules apply for everybody and they are following them strictly.

The additional capacity building activities from the RM and project side are:

• Total sanitation campaign, menstrual hygiene training, reusable sanitary pad making training, workshop on sanitation and hygiene at the RM level, and RM support to monitoring the activities. The RM has provided support to construct the foot track with machinery in the village, and this process was led by women. So now the women feel ownership to maintain it in a clean condition.

• Monthly meetings are held regularly in the mothers’ groups and they have collected some funds for sanitation materials, such as gloves, sweepers, dustbins, etc. Some areas need a public waste disposal pit. At present, they are using a temporary pit, and they want a permanent masonry pit in a public place. All the awareness activities are led by women in the community.

In this report, the observed schemes were Jhaskuchaud DWS, Khattoli DWS and Kurmul DWS. In these three scheme areas, the same rules and behaviour were found during the trip. Jhaskuchaud DWS has 24 households and 27 private taps, with one Village Maintenance Worker (VMW). Khattoli DWS has 26 households and 27 private taps, with one VMW. Kurmul DWS has 141 households and 162 private taps in the system with two VMWs. In total, 194 households have permanent utensil drying racks and 216 tap stands are present in households and public places. All tap stands are functioning well.

Findings

Discussions were held with individuals and groups, and household observations took place in the scheme area. Discussions related to what they are doing for sustainability of the scheme and what is their plan to make the village achieve total sanitation status.

A) Individual meeting: Sabita Manyal (Treasurer of the Jhaskuchaud DWS UC)

Sabita Manyal is a UC Treasurer. She has good knowledge about total sanitation and healthy behavioural practices for her family and the scheme, and she also shares this with other community people. She follows model behaviours for total sanitation in the scheme. She has installed a metal stove, uses the toilet and tap during menstruation, and maintains household level sanitation very well.

Sabita has five members in her household (two female, three male). Two household members are of menstruating age and her grandfather is a traditional healer. Before connecting the private tap, they were using a separate water source for to wash and using a temporary toilet during menstruation. After connecting the private tap in the yard, it has made daily life much easier, and

everyone can maintain individual and household

level sanitation very well. Nowadays, both mother and daughter can freely use the tap and toilet during menstruation. As a traditional healer, the grandfather earlier maintained taboos regarding menstruation. However, now he also uses the toilet when the menstruating women use it, and he doesn’t feel any hesitation.

Throughout the scheme area, menstruation behaviour has become healthy. According to Sabita, all women are using tap and toilet during menstruation, and they are discussing this topic in their monthly meeting in the scheme. Every woman is following the rules of the UCs. The men are not a barrier to behaviour change in this scheme because they also want to support the declaration of total sanitation in the scheme.

The household sanitation status is maintained with very good hygiene in each household (see the rubbish collection to the left, and the clean and tidy tap stand). They try to maintain the distance between kitchen and cowshed, with good management of manure in the shed and compost heap.

When visiting many households in the scheme area, all respondents gave the same answers and demonstrated good knowledge about the sanitation plan. Nobody in the scheme area shared any menstruation problems. Women themselves choose not to enter the kitchen during the first two days of their menstrual period, but they are allowed to eat every type of foodstuff as normal. They face no discrimination in food consumption and use a safe place for sleeping. Some households use the same bed as normal, while some use a separate bed until they wash after the fourth day of their menstruation.

B) Group interaction:

Group interactions were held with UCs and common answers were given by all to the questions.

In the group meeting, women expressed interest to do all necessary activities for maintaining total sanitation in the scheme. They are all participating in the weekly sanitation campaign, which was decided in the meeting. The UC members are maintaining personal hygiene and are well aware of household level hygiene. Before connecting the private tap in each household, they were facing many problems to maintain the hygiene on the individual and household level, but now there is easy access to the sanitation structures.

Each household has permanent utensil drying racks, tap stand and metal stove, and a water seal toilet. After connecting the private taps, the village looks very clean and residents have formed good habits regarding proper use of all sanitation structures.

Some questions asked in the mothers’ group meeting:

1. What changes did you find after connecting the private tap in your house?

(Mixed answers)

• It is easier to clean the house and improve hygienic behaviour.

• All the family use the toilet always, nobody defecates outside.

• It is easy to maintain personal hygiene during menstruation and every woman has access to use the toilet and tap.

• We are saving time and we can do other work, which supports us to earn money.

• Children themselves are able to maintain their personal hygiene.

• It supports us to maintain a clean household.

• Our grandparents give us a permission to use the shared toilet and bathroom during menstruation.

• The mothers’ group has fixed a weekly village sanitation plan in order to declare the scheme to have achieved total sanitation.

2. Are all women and girls using the toilet during menstruation? Are they allowed to touch the tap and toilet?

Before the private connection we used a separate pot for toilet use and a separate water source for washing during menstruation. After connecting the tap in our yard, we are allowed to use it normally, we can wash in the yard or bathroom, and are allowed to use the toilet. When there is sufficient water available in the bathroom and toilet, there are no barriers to using the toilet during menstruation. All households of the scheme area are using taps and toilets during menstruation.

3. How many women in your community always use the toilet when menstruating?

In our scheme area nobody goes for open defecation anymore. All the women have access to use the tap and toilet. The elderly people (like father-in-law or mother-in-law) are not raising any barriers to use the toilet. They feel comfortable to use the toilet even if menstruating women are also using it.

4. Imagine if a female in your community used the toilet and tap during menstruation, how much would people approve or disapprove?

All households are giving permission to menstruating women to use toilet. Nobody disapproves. Some beliefs remain but they don’t interfere with women’s rights. If there is a menstruating woman washing clothes at the tap, nobody will go there with her to wash or fetch water. She can wash at the tap stand, and afterwards the other people use the same tap.

5. Where do you sleep when you are menstruating?

(Mixed answers)

• I sleep in the same bed as normal and wash the bed sheet on the fourth day of my period.

• I sleep in the same room and use a separate bed, and I wash the used cloths on the fourth day of my period.

• I sleep in the same room. I have no problem for sleeping during menstruation.

• We use the same bed and room during our period. There is no untouchability system in our scheme area.

6. What materials do you use for hygiene maintenance during menstruation?

(Mixed answers)

Sometimes we use the non-reusable (commercial) pads, but they are not available all the time in the village, so we normally use cotton cloth. One female tailor makes reusable cloth pads in the scheme area, and some women are using reusable cloth pads too. Women are feeling a little uncomfortable to dry the reusable pad under the sun openly, so they sometimes prefer to use old cloths, which dry easily under the sun with other clothes.

Heru Bohara, a female tailor, shares a story regarding the reusable pad. One time she made a reusable pad, sewing by machine. She used the pad during her menstrual period. One day she washed that pad and dried it in the sunlight in front of her yard. Her husband came home and saw something new - the new design of the cloth. He didn't know what it was and asked his wife what is was. But Heru couldn’t reply anything because the grandparents were also there. “Tell me Heru, I didn't see this type of design before. What is this?” asked her husband, but she felt very embarrassed. After that she told everything about the reusable pad to her husband, and nowadays her husband also supports her, and encourages other brothers or male people in the community. Now other men also know about this reusable pad, which is available in the local market also.

7. Do you feel any health improvement during menstruation after connecting the private tap and toilet?

Yes, before connecting the private system, we were using a separate source of water which is far from here, and as it's a very cold place, we couldn't wash regularly during our periods. There was a shortage of water, and we used dirty water to clean the toilet and wash, so we suffered from health problems. These included itching, different kinds of skin allergies and urinary tract infections. But nowadays we are not seeing that type of problem in the scheme area.

C) Interactions with the older generation:

We had interactions with older women, individually and in a group. They have very positive thoughts on menstruation management. Their daughters, daughters-in-law and granddaughters have started to use the toilet, and the grandparents have no objection. They don't feel any hesitation to use the toilet after use by menstruating women, as it is now cleaned well.

Many of the mothers-in-law have experienced menopause, but they allow others who are menstruating to use the toilet and tap. The mothers-in-law had faced challenges to manage their menstruation in their youth. At that time, they faced taboos and didn't know about alternative menstrual management materials, and only used old cloths to absorb the blood and clean themselves after the fourth day of menstruation (bathing and washing the used cloths). They used to sleep in cattle sheds and use separate water sources far from the house, and they couldn’t use the toilets at that time. But nowadays there is sufficient water and there are better sanitation materials. They have educated children and they want to make the household environment easy to work in.

Some questions for the mothers-in-law:

1. Would you use a toilet that has just been used by a menstruating woman?

Before connecting the private tap, we didn’t have sufficient water to clean the toilet. I have reached menopause myself, and I have a daughter and daughter in-law at menstruation age. I felt uncomfortable earlier to use the toilet when others were menstruating. After connecting the private tap system, I feel comfortable to use the toilet at all times. Nowadays I don't think it is a problem. My daughter-in-law can go to the toilet any time, and I don't feel hesitant because we have sufficient water to clean. And my daughter and granddaughter can go to school during their periods.

2. What makes defecating outside during menstruation dangerous?

The biggest problem is that it makes the environment dirty. We have a plan to declare our scheme area as a total sanitation scheme, and if anybody defecates outside, we cannot declare it. The other problem is that we will go back to suffering many kinds of diseases, like diarrhoea and Typhoid.

3. Does anyone in this scheme area disapprove of women using toilet during menstruation?

Nobody disapproves of menstruating women using the toilet. This is because we have all decided to make this a total sanitation-declared scheme, so we have made this a rule for all people. If anybody is caught defecating outside, they will have to pay a fine to the User Committee or mothers’ group. Each household has a toilet and uses it properly. Mothers dispose of their baby’s faeces in the toilet.

After this interaction, it is clear that everyone has a good knowledge of the principles of total sanitation and thinks positively about menstruation. No barriers have been found to using the tap or toilet during menstruation. Female students can attend school, they can drink milk and curd, and every woman uses a safe place for sleeping and maintaining personal hygiene during menstruation.

D) Interaction with tailors:

The Project has conducted training in menstrual hygiene management for tailors and other community members. Almost all the training participants are now using reusable cloth pads themselves, and the tailors started selling commercial pads, and also sewing cloth pads for sale.

Rajmati Thekare (photo to the right) is one of the tailors of Api Himal RM. She operates from a shop in the RM headquarters selling cosmetic goods and commercial pads, as well as reusable pads made in her tailoring centre. Before the training, she had a tailoring shop only, and sewed ladies’ clothes items. After attending the MHM training and developing pad-making skills, she started sewing cloth reusable sanitary pads in her shop and selling them in the local market. She also decided to stock commercial pads for sale, because the higher secondary school is located near the shop. The school has installed a sanitary pad vending machine, and the demand for commercial pads has been increasing. Rajmati reports that female students mainly want to purchase non-reusable (commercial) pads, but other community women want to buy the cloth reusable pads. She sells the reusable pads for NPR 80-85 each.

These days menstrual hygiene materials are easily available in the local market. One tailor is selling in the local market so far, while other tailors have produced pads for their own use or for limited sales. The tailor makes different styles of reusable pads and sells them to girls and women. School girls and some other organisations have demanded that reusable pads are marketed to other communities as well, as there is an increasing demand for MHM materials in the local area.

In the scheme area women want to use the cloth pads because they have problems with safe disposal of the commercial pads. Burying the commercial pads in the typical disposal pit is not a good solution as they don’t decompose easily. Some women collect the used pads and at the end of their menstrual period they burn them in a fire in a safe place, though some are putting them in the pit. On the other hand, women report that reusable pads are easy to wash and dry under the sun, and they are environmentally friendly.

Conclusion

In the drinking water supply schemes of Jhaskuchaud DWS, Khhattoli DWS and Kurmul DWS of Api Himal RM, the installation of private taps in each household has totally changed behaviours. This is been a more significant trigger of change that many years of awareness raising and capacity building. In particular, menstrual taboos are being forgotten and the scheme areas have rapidly changed their sanitation status. They can soon be declared to have achieved ‘total sanitation’. It is also clear that the role of women is very important in order to teach their family members that menstruation is a natural process, and to develop healthy habits and hygienic behaviour in the community.