Hygiene and the pursuit of happiness

Research shows that happiness is influenced by factors such as prosperity, freedom, tolerance, and civil rights on the positive side, and lethal accidents, corruption, and gender inequality on the negative side. Bhutan's national happiness is increasing; however, gender inequality, especially in rural areas, remains a significant issue that needs to be addressed.

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 are far too expensive if available. 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 in most Bhutanese society, it is acutely evident among nuns living 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.

Most nunneries are led by a monk, who holds a position of authority and influence. This makes the nuns reluctant to talk about the lack of water and soap to manage their menstruation safely and privately, as they fear disrespecting the monk's authority.

'It is considered disrespectful even to 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 insufficient to cover all sanitary napkins costs. To economise, some of them wear these pads for far too long, bringing infection risk.

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 those in 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. 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 reusable sanitary pads as an alternative to expensive 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.

Towards happiness

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, 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 improving menstrual hygiene, we aim to improve the lives of Bhutanese women. And since they contribute half the country’s Gross Happiness Index, it will be a step forward in its pursuit of happiness.

This story is based on an article published in Connect Magazine in 2017. The complete publication is available here.