The Impact of Norms on Adolescent Girls' Menstrual Health in Nepal

这项研究将探索规范如何影响尼泊尔青春期女孩的月经健康，并确定如何处理这些规范。这项研究将在英国皇家国际研究院资助的“中低收入国家月经正义”(MeJARa)项目中进行。它将包括与尼泊尔环境、健康和人口活动研究中心(CREHPA)合作进行的主要数据收集和分析，以及对通过MeJra产生的数据的二级分析。月经禁忌是负面的社会规范，对青少年的健康和福祉构成了主要障碍。在某些情况下，月经禁忌和耻辱已经转化为限制性做法，这些做法在几代人的社区内已经常态化。尼泊尔的特点是高度的性别歧视和严格的长期月经规范。一个特别令人担忧的问题是Chhaupadi的传统做法，即月经妇女和女孩被要求远离她们的家睡在Chhau小屋、动物棚或外面。这种做法在2018年被定为刑事犯罪，但这项法律很少得到执行。像Chhaupadi这样的限制与关于月经血不纯的宗教和文化信仰有关，如果不遵守，就会带来对报复的恐惧。青春期女孩背负着沉重的负担，追随乔帕迪，同时如果她们不遵守社区的月经规范，就会冒着耻辱和家庭声誉的风险，从而危及人身安全。这些压力意味着许多人患有焦虑和抑郁。提高我们对规范如何影响月经健康的理解是解决月经不公正的关键一步。然而，缺乏对月经的研究，尽管月经对性健康和生殖健康、权利、教育、两性平等和环境具有重要意义，但在国家和国际政策中，月经在很大程度上被忽视了。单独解决像Chhaupadi这样的个人月经习惯并不能消除围绕月经的耻辱和禁忌。当务之急是了解影响这些做法的规范，以及能够维持或破坏这些做法的权力结构和交叉因素。研究将采用探索性的混合方法，以下问题将指导研究：1.是什么影响了尼泊尔关于月经的规范和信念？2.月经规范和信念如何影响青春期女孩的月经经历？3.尼泊尔政府如何支持月经健康？研究将包括通过深入采访和焦点小组讨论的形式与宗教和社区领袖进行定性工作，以扩大我们对信仰为什么存在、它们对月经健康的影响以及对他人的规范期望的理解。MeJARa还将包括对初潮后青春期女孩、她们的家人和更广泛社区成员的定性研究，主题包括纯洁和羞耻、包容和排斥以及青春期女孩的生活经历。这将包括PhotoVoice，这是一种基于社区的参与式方法，让个人参与研究，通过摄影直观地记录他们的生活经历。这项研究将探讨尼泊尔境内的规范、信仰和做法有何不同，办法是与环境和环境保护局合作，从乔帕迪和非乔帕迪受影响地区以及城市和农村地区收集数据。还将通过MeJARa收集关于女孩月经经历和对月经的态度以及生活质量的纵向定量调查数据。这项研究将有助于改善全球月经健康，其成果将增加关于有害健康规范的日益增长的文献。尼泊尔的一个技术咨询委员会将在整个研究过程中就材料提供建议，并渴望将结果用于政策和规划。因此，它具有巨大的影响潜力。

This research will explore how norms impact adolescent girls' menstrual health in Nepal & identify how these norms can be addressed. The research will sit within the broader UKRI-funded 'Menstrual Justice in Low- and Middle-Income Countries' (MeJARa) project. It will include primary data collection & analysis conducted in collaboration with the Center for Research on Environment, Health & Population Activities (CREHPA) in Nepal & secondary analysis of data produced through MeJARa.Menstrual taboos are negative social norms that present a major barrier to adolescent health & wellbeing. In some contexts, menstrual taboos and stigma have translated into restrictive practices that have been normalised within communities over generations. Nepal is characterised by highly gendered discrimination and severe longstanding menstrual norms. A particular concern is the traditional practice of chhaupadi where menstruating women and girls are required to sleep away from their home in a chhau hut, animal shed, or outside. The practice was criminalised in 2018, however the law is rarely enforced. Restrictions such as chhaupadi are tied to religious and cultural beliefs about the impurity of menstrual blood and carry with them fear of retribution if they are not adhered to. Adolescent girls are significantly burdened and risk personal safety by following chhaupadi while simultaneously risking stigmatisation and family reputation if they do not comply to the menstrual norms of their community. These pressures mean many suffer from anxiety and depression. Advancing our understanding of how norms impact menstrual health is a crucial step towards addressing menstrual injustice. However, there is a dearth of research on menstruation and it has been largely neglected in both national and international policy despite its significance for sexual and reproductive health and rights, education, gender equality and the environment. Addressing individual menstrual practices like chhaupadi on their own will not remove the stigma and taboos surrounding menstruation. It is imperative that the norms that influence these practices are understood, as well as the power structures and intersecting factors that can sustain or disrupt them. An exploratory mixed-methods approach will be adopted and the following questions will guide the research: 1. What influences norms and beliefs regarding menstruation in Nepal?2. How do menstrual norms and beliefs affect adolescent girls' menstrual experiences? 3. How can the Nepali government support menstrual health?The research will include qualitative work with religious and community leaders in the form of in-depth interviews and focus group discussions to broaden our understanding of why beliefs exist, their influence on menstrual health and normative expectations of others. MeJARa will also include qualitative research with post-menarcheal adolescent girls, their families and members of the wider community on topics including purity and shame; inclusion and exclusion; and the lived experience of adolescent girls. This will include Photovoice, a community-based participatory method that involves individuals in research to visually document their lived experiences through photography. The research will explore how norms, beliefs and practices differ within Nepal by working with CREHPA to collect data from both chhaupadi and non-chhaupadi affected areas as well as urban and rural areas. Quantitative, longitudinal survey data on girls' experiences of and attitudes towards menstruation, and quality of life outcomes, will also be collected through MeJARa. This research will contribute to improving menstrual health globally and the outputs will add to the growing literature on norms that are harmful to health. A technical advisory committee in Nepal will advise on materials throughout the study and is eager to utilise the results in policy and programming. It therefore has significant potential for impact.