Over 40 years ago the King of Bhutan first introduced the phrase Gross National Happiness. Research shows that happiness is not only influenced by prosperity, but also by freedom, tolerance and civil rights - on the bright side, and lethal accidents, corruption and gender inequality - on the dark side. Bhutanese national happiness is on the rise. Having said that, one limiting factor needs to be tackled; gender inequality. Especially in rural areas.
Women are often considered less capable than men and this outlook percolates into all areas, including basic needs like safe sanitation and hygiene. “Poor sanitation and hygiene perpetuate gender inequity,” says Thinley Dem, SNV’s WASH advisor in Bhutan. “Girls miss days from school during their monthly period, because they don’t have access to a hygienic toilet or sanitary napkins.”
The influence of menstrual taboos and secrecy across vastly different contexts is increasingly documented all over the world. One study confirms that poor menstrual hygiene, stigmatization, cultural, social or religious practices can limit menstruating women’s and girls’ health, their education, and their capacity to work and engage in society.
In Bhutan, the root of the stigma lies in the local belief of ‘dep’ (impurity), considering women impure during menstruation. Women themselves also tend to perpetuate these mistaken beliefs, rendering them unable to perform simple tasks like drinking tea or coffee for fear of increasing their flow. Buying sanitary pads or reusable sanitary cloths poses a challenge in rural areas because these pads are difficult to get and if available are far too expensive. Only one in ten shops in rural areas sells pads and most women are unaware of their existence.
While the silence around menstruation can be observed through most of Bhutanese society, it is acutely evident amongst nuns who live in the heart of the rural areas. Bhutan has over a thousand nuns living in several nunneries situated on the slopes of its mist clad mountains.
Silence of the nuns
Most nunneries are led by a monk. This makes the nuns reluctant to talk about the lack of water and soap to manage their menstruation safely and privately.
“It is considered disrespectful to even mention menstruation to the male head teacher and secondly, even if we did so, it would be difficult for them to understand issues like physical pain,” said a nun from Pema Thekchog Chholing at an event, organised by SNV and the Ministry of Health, celebrating menstrual hygiene day in May 2017, which aimed at changing the discourse around menstruation. Although nuns sometimes buy disposable sanitary pads, their stipends are not sufficient to cover all the costs of sanitary napkins. To economise, some of them wear these pads for far too long which brings forth a risk of infection.
Breaking the silence
To improve the health and sanitation for women in rural areas, SNV has been working with Bhutan’s Ministry of Health and the Gross National Happiness Commission, with the support of the Australian Government. We promote access to improved sanitation and hygiene practices.
At the event in May 2017, participants talked about menstrual hygiene management, involving both men and women - including the monastic community. It was the third such event in Bhutan. The first, in 2015, focused on Bhutanese school girls. The second, in 2016, focused on nuns. And at the 2017 event, a wider audience participated including teachers and students, mothers and fathers, boys and girls, plus nuns from various monasteries. During those sessions, we spoke candidly about menstruation. We introduced re-usable sanitary pads as an alternative to expensive storebought pads, with the commitment of the Bhutan Nuns Foundation to provide training in how to make these pads.
“The global celebration of Menstrual Hygiene Day was vital, as it helped to build awareness on menstrual hygiene issues, build support amongst male teachers, and encourage both men and women to address this taboo subject. Bhutanese girls and women should be able to manage their menstruation hygienically and with dignity,” said a nun present at the event.
Our approach in Bhutan follows in the footsteps of the successful interventions made by the multi-country programme Girls in Control, launched in 2014 in Africa. After witnessing its positive impact, for example - a 16% decrease in girls missing school in Tanzania, we have scaled up our programmes by integrating Menstrual Hygiene Management into our ongoing rural and urban WASH programmes. Our menstruation activities in Bhutan are part of the broader Sustainable Sanitation and Hygiene for All programme. By changing the negative narrative surrounding menstruation and by improving menstrual hygiene, we aim to contribute towards improving the lives of Bhutanese women. And since they contribute half the country’s Gross Happiness Index, it will be a step forward in the country’s pursuit for happiness.
This article was first published in Connect Magazine 2017. The complete publication is available for download.