DESCRIPTION

In West Nepal, the lack of safe sanitary options often results in health problems and school absenteeism. Menstruation is a topic touched by embarrassment, insecurity, and degrading traditions for women like chhaupadi.

Chhaupadi is characterised by the banishment of women during menstruation from their usual residence, due to supposed ‘impurity’. It has been criticised for violating the basic human rights of women, and for associated physical and mental health impacts. Despite having been outlawed and criminalised, it continues to exist.

The Rato Baltin Project run by the NGO be artsy is a Menstrual Health Management (MHM) and sexual education program that aims to eradicate this practice. The Project includes girls, boys, women and their communities in its design.Atb eartsy ,webelievethateducationistheonlywaytochangethesedeeplyheldbeliefs.

The project has a four-tiered approach:

1. Workshop which provide sex education to both male and female teenagers in local schools of targeted communities
2. Hygienic education delivered through workshops to all women in targeted communities
3. Menstrual cups and training provided to volunteer girls attending school in targeted communities
4. Participatory photography workshops utilised to showcase how girls and women feel about chhaupadi and their periods, and what they would like to change about the experience

An important component of the Rato Baltin project is the distribution of a healthy and environmentally friendly solution to MHM in rural areas of Nepal: menstrual cups. Ruby Cup, a UK based company, are the manufacturers and donors of this life changing, medical grade silicone menstrual cup of the same name.

Twice a year, we visit remote villages to distribute menstrual cups and conduct hygiene and sexual education training. We also revisit villages to check in on those who have already received training and a cup to see what (if anything) has changed, and evaluate the results of the program.

We have already distributed more than 250 menstrual cups to school girls in remote villages. Each girl received a cup and training in how to use it. They are also given a metal bucket (baltin) to prepare clean water, and have somewhere to boil the cup.

Intended use of the evaluation

The intended use of the Rato Baltin project evaluation is to measure any changes in the lives of individual participants and communities targeted in the program, and assist in reaching new project donors for be artsy to achieve its aims in::

• ●  Educating women, girls, boys and communities on sex, biology and HMH practices
• ●  Reducing school absenteeism of girls in targeted remote communities of West Nepal
• ●  Providing girls and women with tools to facilitate menstrual dignity
• ●  Achieving long term project sustainability of the programFocus of the evaluationThe principal focus of the evaluation is to address the question of:

– What changes have occurred around the practice of chhaupadi in the lives of girls and communities after the implementation our program?

To ensure the program is based on best practice methodology and lessons learnt, the evaluation also aims to address the questions of:

1. How culturally accepted and sustained is the use of menstrual cups in the targeted remote communities of West Nepal?
2. What (if any) aspects of our program can be improved in design and/or implementation?

Data sources and methodology

Throughout the 2017 project implementation period, we have conducted monthly telephone follow-up calls with the volunteer menstrual cup users, as well as participating volunteer local teachers and nurses.

The be artsy Staff Nurse and volunteers have travelled to the targeted communities twice in 2017 to conduct face-to-face follow-up with the girls, in order to measure how implementation of the cup is progressing. During these trips, girls have completed surveys about changes they have experiences around chhaupadi since our first visit, and initial use of the ruby cup. Informal conversations with community members were also used to discern impressions of the use of menstrual cups and the impact of workshop training and education.

Girls that participated in the survey are users of the donated menstrual cups. However, our program has delivered workshop training and education to more than 1000 people since its commencement, in 4 villages: Basti, Kunti Bandali, Rachuli and Chilkhaya.

The results

CHHAUPADI:

Only 9 girls reported no change in their experience of the chhaupadi tradition after our program. The rest of the Ruby Cup users experienced some changes.

Some girls reported changes concerned access to food. Indeed, some girls reported they are now allowed to eat vegetables, some can eat fruits, and some can drink milk. A number of girls reported that after participating in our workshops, their mothers allowed them to have a warm blanket in the chhaugot (Hut), while some reported that they now sleep inside the house but in a separate room or space to other members of their family. A few girls reported that since the workshop trainings they are no longer required to participate in the exclusionary practices of chhaupadi, including being able to cook food.

Girls communicated that because they no longer bleed outside of the body when using the cup, everything is

cleaner, and both their families and themselves feel more self-confident. They attend school during their cycle, reducing their absenteeism, and actively try to help other girls in things related with menstruation.

Girls that did not report changes related to chhaupadi have seen their lives improve in other areas:

“ For me it is a positive experience. In my life this has brought some changes. My blood is not smelly also it is not bleeding out. And going to school is also easy with the cup.” ~ Bhawana Upadhya (Chilkhaya)

MENSTRUAL CUPS:

Of the 111 cups distributed between March and June 2017 to school girls in Achcham and Kalikot, 8 were confirmed as non-users. We were unable to personally contact 14 girls, but on their last follow-up call over the phone they reported they were still using their cups. A minimum of 2 of these girls have been married and now reside in India.

“I am happy that i got the opportunity to use the ruby cup.” ~ Binda B.K. (Rachuli)

REASONS FOR USING THE CUP:

• –  No fear of staining clothes
• –  No feeling that they are menstruating
• –  They do not have to worry about drying rags
• –  They do not feel self-conscious of having a bad smell
• –  It is easier to attend school as they do not need to carry any pads or replacement materials, nor hide anyrubbish
• –  Nobody knows they are menstruating, so they can engage in regular activities such as touching tapwater
• –  They feel cleaner than when using traditional methodsREASONS FOR NOT USING THE CUP:

• –  They are pregnant, but after the baby’s birth they want to begin using it again
• –  Some reported slight pain/feelings of discomfort
• –  Having lost it
• –  Superstitions at home:

▪ The house of one of the girls collapsed; a chaman told the family it was due to a bad spirit, and the family was not allowed to reenter. They were forced to leave the house, and in turn left the village. The cup user could not go inside to take their cup. When her family left she had already been married to someone in the village and now resides there. She asked us to provide her with another cup, which we did. She will continue going to school until she finishes grade 10.

EMERGENT MYTHS:

• –  A mother from Kunti Bandali communicated that she believes the cup will prevent girls from being raped during their menstruation, both when they are in the chhaugot and when they have to go into the jungle alone
• –  In Basti, some people were telling users not to use the cup because it might cause cancer when it is inside themWhat the girls think about our program:All girls feel more comfortable with their bodies after our workshop. They understand the biological processes and reasoning for what is happening, and many feel that they are now able to help other girls understand.

  Most of the girls considered their participation in the program to have been a positive experience, and that their lives have changed for the better in using the cup.

  In response to the question of “What would you change about Rato Baltin?”, most girls communicated that they would not change anything. Girls also rated the workshops on a scale of 0 – 10, with 0 being bad and 10 being excellent. Respondents rated the workshops with an average score of 9.

  BUDGET EVALUATION

The 2017 budget exceeded the initial proposed expenditure by 2,586 Euros. This was the case for several reasons:1.b eartsy receivedanunexpectednewdonationof160menstrualcupsfromRubyCups

2. This donation led to the doubling of the expected amount of work and needed complementary resources, particularly in terms of the menstrual kits

3. Difficulty in finding volunteers to travel to West Nepal without financial compensation

4.TheneedtoprovideKathmandu-basedvolunteerswithfundsfortravelandfoodrelatedto beartsya ctivities

5. Difficulty in contracting a staff nurse for only three to four months of the year requiring higher than expected remuneration

Great care was taken to adjust the budget and account for the increase in work and resources required by the unexpected donation, but a substantial increase was unavoidable to deliver the new cups.

Discussion and plan for the future

The results of the evaluation lead us to the conclusion that project is working well. Findings from the survey reveal our initial idea that the cups can break the taboos surrounding menstruation and chhaupadi was correct. However, our evaluation of the program also illustrates a need to implement some changes in the future.

We have seen the need to design a workshop component aimed at the men in targeted communities, in order to holistically disseminate MHM knowledge and education. We will pursue the design of a men’s group workshop to be delivered in 2018.

To see the full scope of the impact of the project among non-Ruby Cup users in communities, we will design a survey for all girls in participating schools, as well as the participants of the women’s group. This will be implemented in 2018.

be artsy is also aware of a large gap in the delivery of the program. The menstrual cups donated by Ruby Cup are to be disseminated among girls that attend school, as a way of addressing absenteeism and MHM. However, not every girl in targeted communities are able to attend school. For instance, some girls are married, must stay at home to assist their families with housework, or tend to family owned fields. be artsy will work to make the program and provision of menstrual cups more inclusive of all girls and their contexts. be artsy is considering implementing a chhaupadi and menstrual cup education program on college and university campuses to raise awareness of this issue, and fundraise for this component of the 2018 project. This will require the hiring of one or two persons for the entirety of 2018 to successful and sustainably implement.

We experienced problems working with our Nepali partner organisation, the Starts Foundation, throughout every stage of the 2017 Pilot Project. These difficulties in communication and delivery of agreed human and material resources rendered the implementation and evaluation phases difficult. Although the 2017 Pilot Project was successful thanks to the hard work of be artsy volunteers and President Clara Garcia Ortes, present in Nepal for 11 months of the year, it is necessary to consider other options to ensure effectiveness and accountability.

We have been working to establish a strong volunteer team assembled under the banner of a new Nepali NGO. This new Nepali NGO will be named: be artsy Kalaa Shakti Nepal (be artsy, the power of art).

In conclusion, in August of 2017, the Government of Nepal passed a law that punishes those forcing women to adhere to chhaupadi-mandated exile while menstruating with a fine of 3,000 Nepalese rupees or three months jail-time. Yet we believe that these advances will not have a significant impact on its prevalence. The practice of chhaupadi is strongly embedded in social norms and cultural practices. However, it is a significant step forward in the right direction on the political level, and represents a developing social change in opinion. Combined with programs such as Rato Baltin that address education on the local grassroots level in remote areas where the practice is still prevalent, we believe that there is significant potential for change into the future.