Challenging the norm in Nepal: the value of community critical reflection

In Nepal today, while fertility rates are slowly decreasing, the average woman still has more children than she desires. Marginalized women—such as Janajati, Dalit, or Muslims—face higher barriers to health care services and information about fertility and reproductive health than Nepali women from non-marginalized communities.

We know that reproductive health behaviors are shaped by traditions and social norms (the unspoken rules that govern behavior), and that conversations about pregnancy and family planning are deeply taboo in Nepali culture. Unfortunately in the past year, the Chhaupadi practice—where women are confined in cattle huts or sheds during menstruation—has led to the reported death of two young girls in Nepal.

To address this, the government of Nepal recently introduced jail sentences and fines for banishing women to huts during menstruation, making Chhaupadi a criminal offense.

But that’s not enough: why a participatory community approach is key to transformation

Abolishing a traditional practice so entrenched in traditional, gendered roles, community norms, and inequitable rights will require more than jail sentences and fines.

A recent Guardian article, Nepal’s bleeding shame: menstruating women banished to cattle sheds, states that “making Chhaupadi a criminal act on its own may not be enough to prevent women and girls being banished during their menstruation. The tradition is deeply entrenched in the culture of many communities,” writes author Kate Hodal, “…so we need to understand and address the root cause to bring about sustainable change.”

And we agree. Sustainable transformation requires open and thoughtful dialogue within these practicing communities—what we call ‘critical reflection’—to change local norms and customs around menstruation, fertility, and family planning.

Enter: Fertility Awareness for Community Transformation

Under the USAID-funded Fertility Awareness for Community Transformation (FACT) Project and in collaboration with the Ministry of Health and Population (MoHP), the FACT ‘Pragati’ team is working with service providers, community stakeholders, and within existing social networks in Nepal to catalyze community-level conversation across five districts in Nepal about some taboo topics: reproductive health, menstruation, family planning, and fertility awareness.

Fertility awareness is defined as actionable information about fertility throughout the life cycle and the ability to apply this knowledge to one’s own circumstances and needs.

Locally, Pragati means “Fertility Awareness for Quality of Life.” Specifically, Pragati is a package of nine games with instructions and critical reflection questions on side effects and misconceptions about family planning methods, gender and social norms, and more. It was designed to empower women and men to tackle these conversations with their own families and communities, and identifies influential people who can facilitate acceptance and diffusion of more gender-equitable values.

The games create a platform for personal reflection and public discussion to address underlying social and gender norms around reproductive health. This participatory approach allows communities to critically reflect on social barriers, the expectations of others that impact behaviors and practices in their community—such as Chhaupadi—and their personal values.

“[Pragati] Menstrual Cycle Game and Sex Determination (Seed) Game were new [for me]. This certainly has increased fertility awareness among the community people.” – Male participant, Rupandehi

“The Role Play Game provides knowledge on how to talk about family planning with different characters in our society.” – Female participant, Bajura

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[Photo Credit: Sharada Wasti, IRH Nepal]