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Menstruation is a natural process, but can be challenging for millions of women worldwide. My new paper in Global Public Health explores the role of caste/ethnicity in #menstrual knowledge and practices in Nepal. Join me in a thread... bit.ly/2JiuLjt #MenstruationMatters
First, I want to credit my fantastic co-authors: Jessica G. Burke (@jessgrifburke) of @PittPubHealth and Pema Lhaki of @nfccint. 
Nepal is a geographically small yet diverse country of 125 caste/ethnic groups. Given the complexities of caste/ethnic roles and beliefs in the country, understanding how they impact menstrual health is critical.
There are several definitions for ‘caste’ – in our study we define it as a hierarchical social stratification system based on ritual impurity, which has been used to limit certain groups from acquiring land, education and leadership roles.
Certain caste/ethnic groups in Nepal practice chhaupadi, which is the illegal exiling of women from their homes to sleep in small sheds when they are menstruating. Aside from perpetuating a stigma, it can result in death, as @Independent reports: ind.pn/2HDqHIm
What is still missing in research studies is an understanding of the role of caste/ethnicity in #menstrualhealth, particularly in the diverse context of Nepal. We sought to fix that.
Our study spanned across 9 districts of Nepal and included 6 different caste/ethnic groups to answer that very question: What is the role of caste/ethnicity when it comes to #menstrual knowledge, attitudes and practices?
KEY FINDING: Caste/ethnicity was a significant predictor of menstrual knowledge and practices in Nepal. That means that how much a woman knows about menstruation, and her practices during menstruation depend on her caste/ethnicity.
To be more specific: The caste/ethnic groups Tarai/Madhesi/Other, Newar, Janajati, and Muslim all had fewer odds of positive menstrual practices compared to Brahman/Chhetri (high caste groups). Janajati (indigenous ethnic groups) had the poorest outcomes.
These results are concerning! They suggest that certain caste/ethnic groups have fallen behind in terms of #menstrualhealth. Blanket or one-size-fits-all menstrual health programs/interventions may not be sufficient for improving menstrual knowledge and practices for all.
Our findings suggest that menstrual health programming should pay particular attention to the unique challenges faced by Janajatis, as well as other historically marginalized groups such as Tarai/Medhesis, Newars and Dalits.
To create interventions and messages for a variety of groups and belief systems in Nepal, future studies are needed to explore the specific ways in which differences in caste/ethnicity are occurring.
One way to do so is to put women and girls at the center of research, using creative and collaborative methods – which is what my team is doing using collaborative filmmaking! vimeo.com/239271038
The girls at the center of this collaborative filmmaking research have gone on to become advocates in their communities and are challenging the deeply-rooted menstrual stigma they experience in their day-to-day lives. nepalitimes.com/review/bloody-…
Future programming should consider local languages and context-specific content incorporating indigenous beliefs, cultivate partnerships with indigenous health organizations, and develop outcome indicators separated by caste/ethnicity to ensure improved #menstrualhealth for all.
@CherylStrayed I wanted to share this piece with you, given your recent INCREDIBLE work on #menstruation in #nepal!
@jayphuong Thanks for sharing and I hope these results are informative for all the amazing programming you are doing in @Nepal!
