Chhaupadi practice in Nepal – analysis of ethical aspects

Abstract

Chhaupadi practice, which is characterized by banishment of women during menstruation from their usual residence due to supposed impurity, is in existence in the mid-and far-western regions of Nepal. It has been criticized for violation of basic human rights of women and also for its associated physical and mental health impacts. Despite having been outlawed, it continues to exist due to illiteracy, superstitious beliefs, gender disparity and community endorsement of the practice. This article presents an analysis of the Chhaupadi practice from the perspectives of human rights and public health as well as ethical theories of liberalism and communitarianism. It is necessary to increase the ongoing social awareness among affected Nepali communities about the natural character of menstruating and the harmful practice of Chhaupadi in order to eliminate this violence against women while also addressing the community's concerns.

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http://dx.doi.org/10.2147/MB.S83825
Chhaupadi practice in Nepal – analysis
of ethical aspects
Shanti Kadariya
Arja R Aro
Unit for Health Promotion Research,
University of Southern Denmark,
Esbjerg, Denmark
Correspondence: Shanti Kadariya
Unit for Health Promotion Research,
University of Southern Denmark,
Niels Bohrs Vej 9, DK-6700,
Esbjerg, Denmark
Tel +45 7168 9605
Email shantikadariya@gmail.com
Abstract: Chhaupadi practice, which is characterized by banishment of women during
menstruation from their usual residence due to supposed impurity, is in existence in the
mid- and far-western regions of Nepal. It has been criticized for violation of basic human
rights of women and also for its associated physical and mental health impacts. Despite having
been outlawed, it continues to exist due to illiteracy, superstitious beliefs, gender disparity and
community endorsement of the practice. This article presents an analysis of the Chhaupadi
practice from the perspectives of human rights and public health as well as ethical theories
of liberalism and communitarianism. It is necessary to increase the ongoing social awareness
among affected Nepali communities about the natural character of menstruating and the harmful
practice of Chhaupadi in order to eliminate this violence against women while also addressing
the community’s concerns.
Keywords: menstruation, ethics, communitarianism, liberalism, human rights, public health
Introduction
Menstruation is defined as a periodic, normal, healthy shedding of blood and tissues
from the uterus that exit the body through the vagina.1 It marks the beginning of
womanhood, a unique phenomenon among females which starts around the adolescent
age (11–15 years) of their lives, a key sign of reproductive health and a way of preparing
for pregnancy.2 However, there are several taboos in many parts of the world concerning
menstruation, menstrual blood, and menstruating girls/women. Some of those taboos
are based on religious grounds while others have their roots in culture and tradition, and
they are manifested in the form of different practices. For example: in Islam, women
are not expected to pray and fast, and not allowed to have physical relationship dur-
ing menstruation. Likewise, under Jewish tradition, anything and anyone touched by
menstruating women are considered ritually impure.3 One such practice in existence is
separating girls and women from the rest of their family during menstruation considering
them impure. The degree and type of separation, however, differs among communities.
It might take a form of keeping the women in a separate hut at the edge of the village,
a case of extreme separation as seen among Indonesian Huaulu, or keeping them apart
around the house but in a separate hut as seen among the Dogons of central plateau region
of Mali.4 One such practice called Chhaupadi is in existence in certain parts of Nepal
and it involves separating menstruating women from the rest of the family.
Chhaupadi at a glance
Nepal is a geographically small, yet culturally, linguistically, and ethnically diverse
south Asian country situated between the People’s Republic of China and India.
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Kadariya and Aro
Although constitutionally a secular country, a vast majority
of the Nepali population follows Hinduism and the reli-
gion plays an important role in Nepali life and society.5,6
Geographically, Nepal is divided into mountains, hills, and
plains and for the administrative purpose it has been divided
into five development regions.7 Out of these five regions,
mid-western and far-western (development) regions lag
behind the rest of the country in terms of overall development
and gender equality. In these regions scarce employment
and livelihood opportunities are common and everyday life
is difficult for most people. In the regions already grappling
with complexities of caste, religion and ethnicity, the his-
torical patriarchal socio-cultural system adds particularly
to the plight of women.8 Although the scale of problem
varies between communities, the status of women in these
two regions is a reflection of the status of Nepali women
in general where they are treated as second-class members
of the society with lesser autonomy, power, and freedom
compared to men.9 Furthermore, a general lack of education
and awareness of their social and legal rights means that they
are also victimized in the name of social rituals, norms, and
traditions.
Chhaupadi is one such traditional practice which has been
in existence in the far- and mid-western regions that banishes
women from their house during their menstrual bleeding.
This practice is derived from a Hindu tradition that relates
to secretions associated with menstruation and childbirth.10
The word Chhaupadi is derived from a local word used in the
Raute dialect of Achham district in the far west where Chhau
means menstruation and padi means a woman.11 Under this
practice, women are considered impure during their periods
and are therefore required to refrain from participating in
normal daily activities. They are forced to isolate themselves
and sleep inside a small shed/hut made up of mud and stones
without windows and locks, usually known as goth. These
huts are especially prepared 20–25 meters away from their
own residential homes and are sized around 1×2 m. Such
sheds lack doors, are very narrow, dark, tight and congested,
and have cold dirty floors, where women sit and sleep.12
Chhau is considered to be of two types, major chhau
and minor chhau. In minor chhau (monthly menstruation)
women have to live in these sheds for up to 5 days and in
major chhau the stay lasts up to 11 days, which is mainly
the period after childbirth and menarche. On the last day the
women take a bath, wash their clothes, bedding and return
home.13 However, even on the last day, they are not allowed
to purge themselves in public water sources. Therefore, the
women practicing Chhaupadi have to bathe and clean their
clothes in “Chhaupadi Dhara”, a separate well or tap near
the village.14
Rationale behind Chhaupadi
Many traditional Nepali Hindu families impose certain
restrictions against women when they are having their
periods. Chhaupadi is a manifestation of such restrictions, but
in a more severe form. It is primarily driven by a superstitious
belief among the people that if women stay at home during
their periods, which is considered a phase of impurity, it
will infuriate the Gods and consequently that wrath will
negatively affect the entire family. There are also beliefs
that if the menstruating women touch cattle it will die, if
they cross a water source it will dry up, if they touch some
fruit it will fall off before it ripens, and so on. As a result,
they are not only banished from their residential homes to
live in cramped huts but are also not allowed to touch their
husbands or even their brothers, cattle, fruit bearing plants
and crops. If they touch someone accidentally, one must be
purified, for example with cow urine, which is considered
holy. They should not walk into the premises of temples
and are prohibited to attend any religious ceremonies, even
weddings, in the belief that they are impure. Women are not
allowed a nutritious diet like milk, meat, fruits, and green
vegetables and they have to survive only on rice, salt, and
some cereals/dry foods. There is always a fear of harm if
they touch something accidentally.14
Health impacts of Chhaupadi
Chhaupadi has several health impacts associated with it.
The menstruating women are forced to endure freezing
temperatures in winter and sweltering temperatures in
summer inside the goth. This can cause life-threatening health
problems like pneumonia, diarrhea, chest infection, suffo-
cation, and respiratory tract infection.11 During those days
although women are forbidden from going inside the house
they are still expected to do more laborious work outside
like carrying heavy loads, digging, collecting firewood and
grass despite the lack of a nutritious diet and comfort. As
a consequence, the rate of prolapsed uterus is high among
this group.15 Even the mothers who have recently given birth
are confined within goth. Postpartum mothers are weak and
feeble and to make it worse, they have to look after their
newborn child by themselves. Because of poor nutrition and
vulnerable living conditions, neonatal and maternal mortality
is high in those regions where Chhaupadi is common.16
Chhaupadi also has an impact on psychosocial well-being
of the women and girls. Isolation from family and social

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Chhaupadi and ethical analysis
exclusion results in depression, low self-esteem, and
disempowerment among girls. Furthermore, there is also a
fear of sexual abuse and assault at night alongside the attack
of wild animals and snake bites. Most of the deaths due to
wild animals are not revealed and neither are the cases of
rape, fearing for the future of the unmarried daughter.12
Chhaupadi in the context of
international agreements on human
rights and reproductive rights
Universal declaration of human rights, article 25 states
“Everyone has a right to live standard life with adequate
health care, security, food, clothing, housing and necessary
social services”.17 World Conference on Women’s Rights,
the Beijing declaration and platform for action has agreed
that “Women and girls’ human rights are an inalienable,
integral and indivisible part of all human rights and fun-
damental freedom”.18 Vienna declaration and the program
of action (paragraph 38) calls for “the eradication of any
conflict which may arise between the rights of women and
the harmful effects of certain traditional or customary
practices, cultural prejudices and religious extremism”.19
Since Chhaupadi as a traditional practice violates the
rights of women as human beings and as members of a
reproductive age group it is not hard to see that the practice
is a case of direct violation of all these international laws
and declarations.
Chhaupadi in the context
of national laws addressing
human rights
Nepal’s interim constitution of 2007 ensures right to
equality in its article 12 and right to reproductive health in
article 20. In particular, article 29(2) mentions “No one shall
be exploited in the name of any custom, tradition and usage
or in any other manner whatsoever”.20 More specifically, in
May 2005 the supreme court of Nepal issued a directive to
the Nepal government for the formulation of laws to eliminate
Chhaupadi. In 2008, the ministry of women, child and social
welfare promulgated guidelines to eliminate Chhaupadi.14
Although made illegal by the Nepali law and as a violation
of international laws and agreements, Chhaupadi as a tradition
is still alive in parts of Nepal mainly because it has been pro-
moted and preserved by the society for generations. As such,
Chhaupadi gives rise to several legal and ethical concerns.
Those ethical concerns will now be discussed in the context
of liberalism and communitarianism.
Liberalism and Chhaupadi:
a matter of personal freedom
Liberalism is a branch of philosophy which proposes
that individuals need to be treated with respect, as ends
in themselves, not as means to other individuals’ ends.21
Liberalists are of the idea that since human beings are capable
of developing and implementing their decisions about how
to live, they have the right to do so.22 In general it can be
said that liberalism has its focus on individual well-being
and individual rights. In broad political sense it refers to
minimal government control over individual pursuits, which
are believed to be undertaken by individuals guided by
their inherent rationality for overcoming obstacles to good
life.23 The same idea is discussed here in terms of societal
control over women’s liberty in relation to Chhaupadi. Here
the women of mid- and far-western Nepal who are forced
to be banished under Chhaupadi are thought of as rational
individuals who should be able to realize full freedom over
how to pursue their interests and go about their daily lives.
From the liberalistic stand, one can argue that it is a
matter of individual choice and freedom of the women in
every household living in the mid- and far-western regions of
Nepal on how to go about running their daily lives, whether
they are menstruating or not. Deciding to enter the kitchen
in their own house like on any other day, spending the night
in their own cozy bed like on every other night and showing
their veneration to their deity of choice by visiting the temple
of their choice like on any other occasion should be a matter
of personal choice. The same applies to having nutritious food
and going to school. None of these daily pursuits should be
influenced by some pre-defined societal norm which attempts
to prescriptively govern the ways women pursue their daily
lives in such a way that the women are treated as the means
to the ends of superstitious community beliefs.
Communitarianism and Chhaupadi:
the community’s perspective
Communitarianism is a branch of philosophy which
focuses on the notion of community and emphasizes
the idea of prioritizing community goals over those of
individuals. As such its principles are in direct disagree-
ment with the ideas of liberalism and libertarianism,
both of which have their emphasis on individual rights
and personal choice over community obligations and
expectations.21 This line of thinking is further divided into
two types universalistic communitarianism and relativistic
communitarianism. Universalistic communitarianism is based
on the idea that there is a single true form of good society and

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Kadariya and Aro
its associated virtues. Therefore its proponents believe that
all societies should adopt and follow one pre-defined way
of thinking and living which has been endorsed by them as
virtuous. On the other hand, relativistic communitarianism
sees morality and virtue of a society as inherently contextual
for pursuing the common good.21
In communities where Chhaupadi is a well-accepted
practice among community elders, husbands, mothers-in-law,
traditional healers, and priests (who have profound influence
in the community) and also the practicing women in many
cases, the continuity of this practice to them is one way of
preserving a tradition which has been in existence for a long
time with a focus on purity, aimed at pleasing the venerable
deities believed to take care of the community. Those who
support this practice as a justifiable one, regardless of whether
or not it is a good practice from an objective outsider’s
perspective, do so on the grounds that it is done for the purpose
of overall common good of the women, families, and the
community as a whole. They believe that letting women live
inside the family house instead of the secluded goth, allowing
them to enter the kitchen and welcoming them into temples
will infuriate the Gods and that wrath can inflict serious con-
sequences on the family and the entire community.
This could easily be interpreted as a case of a women-
suppressing baseless argument from the standpoint of, for
example liberalism, or a matter of enforced social tradition
from the standpoint of universalistic communitarianism.
But on the contrary, from the perspective of the community
members, it could also be understood as the people’s belief in
the existing tradition, and their belief in the idea of contextual
morality and virtue within a society. They could on the same
grounds instead argue and ask, “What harm could one be doing
by attempting to protect the entire community (the common
good) from the consequences emanating from non-allegiance
to restrictions to be observed during menstruation?”
The assessment by an outsider based on the principles
of universalistic communitarianism might find Chhaupadi
a superstitious and baseless practice being perpetuated as a
result of illiteracy, ignorance, and overall backwardness which
uses powerless women as scapegoats, the insiders on the other
hand might earnestly believe that non- compliance to this
“tradition” would mean suffering and harm to the community,
which is against their relativistic idea of common good.
Chhaupadi as a public health issue:
beyond philosophical debate
This philosophical debate leads us to a point where one
might want to align themselves with one side of the
argument based on their belief of whose goals and priorities
should come first - those of the community which has
one set of beliefs regarding this issue or of the women
who are affected by this practice for whom it is an issue
of oppression and their alienation of personal freedom.
But when Chhaupadi is viewed as a public health issue,
an issue which directly involves the health (and is also a
matter of life and death in many instances) of thousands
of helpless women in some of the poorest and most remote
Chhaupadi parts of the world, it extends beyond a merely
philosophical argument of the centrality of community
goals versus individual freedom.
The health effects on women resulting from this
practice are manifold. The isolated women are at a high
risk of suffering from hypothermia during winter and
dehydration leading to heat stroke during summer. Lack
of running water in those huts leads to poor hygiene and
subsequent infection. Isolation of menstruating women
for a prolonged period of time with no one to talk to or
share their feelings with can be a reason behind fear and
depression in the long run. A prolonged period of isolation
after childbirth is serious in the regions where maternal
mortality ratio and neonatal mortality rates are relatively
very high. It is also important to note that infection and
hypothermia are major factors responsible for the death
of neonates in Nepal.24,25 In addition to poor nourishment,
the risk of animal attack, snake bites, and rape attempts
make it very hard for women to go through the ordeals of
seclusion inflicted by Chhaupadi.
Therefore, from the public health standpoint, there are
several arguments one can make on why this is a harm-
ful practice that undermines the health and well-being of
girls and women (and in many cases of the newborns) and
present a case for the abolition of the practice, which is
already banned by law but continues to exist due to strong
community beliefs and deep-rooted traditions and the fear
of boycott from the community in case any family tries to
ignore the practice.26,27
Conclusion
This article focused on general discussions about Chhaupadi
practice existing in mid- and far-western regions of Nepal,
which involves isolation of women during menstruation, the
ethical debates surrounding this practice (communitarianism
versus liberalism), and its public health significance. The
philosophical debates on issues like this which involve strong
societal sentiments and beliefs are bound to divide people
based on what they think is of prime concern, the attempt to

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Chhaupadi and ethical analysis
belong to the community norm in the belief that individual
freedom is less important an issue as compared to what the
community deems necessary for the common good, or an
attempt to raise voices of personal freedom and be able to
reject the community beliefs that do not necessarily address
issues of individual interest. But it is not hard to see from a
public health point of view that the practice has negatively
affected health and well-being of many young girls and
women. Despite that and despite it being declared illegal
by the legal justice system, the practice continues to exist
because of illiteracy, ignorance, traditional belief system,
gender disparity, and power difference. The only way to
abolish this practice is through mass awareness and education
at the community level. That calls for a prolonged multi-
sectorial involvement of the government as well as national
and international non-governmental organizations (which is
existent even at present) in areas of education, health, women
empowerment and livelihood to increase the ongoing social
awareness among affected Nepali communities about the
natural character of menstruating and the harmful practice
of Chhaupadi. This also requires a lot of patience with the
recognition that age-old practices do not die easy.
Disclosure
The authors report no conflicts of interest in this work.
References
1. Unicef. Sharing Simple Facts: Useful Information about Menstrual
Health and Hygiene. Unicef India; 2008. Available from: http://www.
indiasanitationportal.org/sites/default/files/MHM_Book.pdf. Accessed
May 27, 2015.
2. Dasgupta A, Sarkar M. Menstrual Hygiene: How Hygienic is the
Adolescent Girl? Indian J Community Med. 2008;33(2):77–80.
3. UKessays [homepage on the Internet]. Adolescent girls reflecting
on their bodies. Available from: http://www.ukessays.com/essays/
sociology/adolescent-girls-reflecting-on-their-bodies-sociology-essay.
php. Accessed December 15, 2014.
4. Guterman M, Mehta P, Gibbs M. Menstrual Taboos Among Major
Religions. The Internet Journal of World Health and Societal Politics.
2007;5(2).
5. US Library of Congress [homepage on the Internet]. RELIGION.
Available from: http://countrystudies.us/nepal/33.htm. Accessed
January 2, 2015.
6. Central Intelligence Agency [homepage on the Internet]. THE
WORLD FACTBOOK. Available from: https://www.cia.gov/library/
publications/the-world-factbook/. Accessed May 27, 2015.
7. World Health Organization [homepage on the Internet]. STEPwise
approach to surveillance (STEPS). Available from: http://www.who.
int/chp/steps/en/. Accessed May 27, 2015.
8. United Nations [homepage on the Internet]. Nepal Information Platform.
Women from the mid and far west. Available from: http://un.org.np/
oneun/undaf/women_mid_far. Accessed May 27, 2015.
9. Bhadra C, Thapa SM. NEPAL: Country Gender Profile. 2007.
10. examiner.com [homepage on the Internet]. Deslierres J. Chaupadi is still
being practiced in western Nepal; 2013. Available from: http://www.
examiner.com/article/chaupadi-is-still-being-practiced-western-nepal.
Accessed May 27, 2015.
11. womennewsnetwork.net [homepage on the Internet]. Nilima R, Tandon S.
Centuries old Nepal banishment ritual endangers girls and women;
2011. Available from: http://womennewsnetwork.net/2011/03/20/nepal-
banishment-ritual-girls/. Accessed May 27, 2015.
12. Amgain B. Social Dimension of Chhaupadi System: A Study from
Achham District, Far West Nepal. Nepal: Social Inclusion Research
Fund (SIRF) SNV Nepal; 2012.
13. volunteercharitywork.org [homepage on the Internet]. Chaupadi
research volunteer. Chhaupadi research and eradication program info.
Available from: http://www.volunteercharitywork.org/chaupadi-
research-volunteer. Accessed May 27, 2015.
14. UNHR Office of the High Commissioner for Human Rights. Field
Bulletin: Chaupadi in the Far-West. United Nations Resident and
Humanitarian Coordinator’s Office; 2011. Available from: http://
www.ohchr.org/Documents/Issues/Water/ContributionsStigma/others/
field_bulletin_-_issue1_april_2011_-_chaupadi_in_far-west.pdf.
Accessed May 27, 2015.
15. feminismnwomenrights.blogspot.co.nz [homepage on the Internet].
Gautam J. Untouchability during menstruation and Chaupadi
Custom; 2011. Feminism and Women Rights. Available from: http://
feminismnwomenrights.blogspot.co.nz/2011/04/untouchability-during-
menstruation-and.html. Accessed May 27, 2015.
16. PHASE Worldwide [homepage on the Internet]. Chhaupadi: Giving
Birth in the Cow Shed; 2013. Available from: https://phaseworldwide.
wordpress.com/2013/10/05/chhaupadi-giving-birth-in-the-cow-shed/.
Accessed May 27, 2015.
17. United Nations [homepage on the Internet]. The Universal Declaration
of Human Rights. Available from: http://www.un.org/en/documents/
udhr/. Accessed May 27, 2015.
18. Office of the High Commissioner for Human Rights. Beijing +20: human
rights of women. United Nations Human Rights Office of the High
Commissioner. Available from: http://www.ohchr.org/Documents/
Issues/Women/WRGS/Beijing20Review.pdf. Accessed May 27,
2015.
19. Office of the High Commissioner for Human Rights. Women ’s
Rights are Human Rights. United Nations Human Rights Office of
the High Commissioner; 2014. Available from: http://www.ohchr.
org/Documents/Events/WHRD/WomenRightsAreHR.pdf. May 27,
2015.
20. asianpressinstitute.org [homepage on the Internet]. Bakhadyo L.
Chaupadi: Another form of Untouchability in Nepal; 2014. Available
from: http://www.asianpressinstitute.org/?p=925. Accessed January 12,
2015.
21. Roberts MJ, Reich MR. Ethical analysis in public health. Lancet. 2002;
359(9311):1055–1059.
22. O’Neill O. Constructions of Reason. New York: Cambridge University
Press; 1989.
23. History Learning Site [homepage on the Internet]. Liberal Democracy;
2014. Available from: http://www.historylearningsite.co.uk/liberal_
democracy.htm. Accessed January 7, 2015.
24. Khanal V, Gavidia T, Adhikari M, Mishra SR, Karkee R. Poor
thermal care practices among home births in Nepal: further analysis
of Nepal Demographic and Health Survey 2011. PloS One. 2014;
9(2):e89950.
25. Rhee V, Mullany LC, Khatry SK, et al. Maternal and birth attendant
hand washing and neonatal mortality in Southern Nepal. Arch Pediatr
Adolesc Med. 2008;162(7):603–608.
26. infochangeindia.org [homepage on the Internet]. Infochange Women.
Nepal Supreme Court verdict on chhaupadi paves the way for women’s
rights; 2005. Available from: http://infochangeindia.org/women/
news/nepal-supreme-court-verdict-on-chhaupadi-paves-the-way-for-
womens-rights.html. Accessed January 10, 2015.
27. trn.gorkhapatraonline.com [homepage on the Internet]. The Rising
Nepal. Abolish Inhumane Chhaupadi System; 2012. Available from:
http://www.trn.gorkhapatraonline.com/index.php/editorial/8774-
abolish-inhumane-chhaupadi-system.html. Accessed May 27,
2015.

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