While it may sound shocking, women in Karnali still face a high risk of malnutrition—even during sensitive times such as menstruation—because they are denied access to nutritious food. Although menstruation is a normal and natural process, the lack of adequate nutrition during this period puts women at heightened risk of malnutrition.
According to the Nepal Demographic and Health Survey, 2022 and the World Health Organization (WHO), nutritional deficiency is a serious problem for both women and children in the region. The WHO estimates that more than 60 percent of women in Nepal are malnourished. It is estimated that by 2030, the prevalence of anemia among women in Karnali will decline by only 11 percent.
This problem is rooted in social and religious discrimination against women. Poverty and remoteness of Karnali further compound the situation. About five percent of the region’s population suffers from severe food insecurity. For women in rural areas, the main health challenges are anemia and being underweight, as they often lack even the minimum nutrition their bodies require. According to the Demographic Health Survey, 18.5 percent of malnourished women in Karnali are underweight.
Among non-pregnant women aged 15–49, 31.9 percent suffer from anemia, while over 20 percent of pregnant women face the same condition. This poor nutritional status also directly affects children. According to the Demographic Health Survey, although stunting (low height-for-age) among children under five dropped from 57 percent in 2016 to 36 percent in 2022, the rate remains far above the national average. Children born to women deprived of food and care during menstruation due to traditional practices face particularly high health risks.
Mainkala Shahi (32) from Hima Rural Municipality of Jumla recalled spending her adolescence in a chhaupadi shed (mensuration hut), fearing that defying the practice would anger the gods. She was even forced to stay in the same shed after childbirth. She remembers crawling through a small opening into a dark hut, sleeping on a straw mat meant for cattle and enduring both menstrual and postpartum isolation.
Although new mothers require proper nutrition and care for up to six weeks after giving birth, in most remote districts of Karnali, women are still confined to sheds — nine days if they give birth to a son and 12 if to a daughter. male child and twelve days for a female child.
On the other hand, Jira Aidi (63) from Pachchhal Jharana, Kalikot, downplays these hardships. She recalls spending a week each month in a dark cave during her periods. “Until I was 20, I stayed at least seven days a month in a cave,” she says. “Many nights, I couldn’t sleep because of the howls of jackals and other wild animals.”
“What could we do? We worked all day, then slept in caves at night, with no filling food or milk products. It’s a wonder I survived,” Jira added. She considers moving from caves to sheds near the house a major improvement. According to her, the custom persists because of the belief that if menstruating women consume milk, curd or ghee, deities will be angered and dairy cattle will stop giving milk.
Samjhana Shahi Hamal, a dietician at the Karnali Provincial Hospital in Surkhet, said women should eat fresh, nutritious food during menstruation, as poor nutrition at this sensitive time can cause both short-term and long-term health problems. “During menstruation, a woman's body needs 15 to 18 grams of iron per day,” Hamal said. “At least 50 to 60 ml of blood is lost during each cycle, and with it, iron. This loss leaves the body weak.”
According to Hamal, blood loss during menstruation raises the body's need for iron and other nutrients. Without iron, women may suffer from fatigue, weakness, dizziness, lack of concentration and reduced physical performance.
“Even if you only eat two meals a day during your period, make sure they include vegetables, fruits, fish, meat and dairy products,” Hamal advised. “Iron is also abundant in locally available foods such as carrots, asparagus, cabbage and nettle.”
Hamal expressed concern that adolescent girls who lack proper nutrition are at risk of giving birth later to underweight, malnourished babies with developmental problems, which also increase the chances of infant mortality. She advised women to treat menstruation as a normal physiological process, requiring not isolation or stigma but special dietary care.
Doctors warn that inadequate nutrition can result in amenorrhea (absence of menstruation), ovulation problems, infertility and lower success rates in assisted reproductive treatments.
Menstrual discrimination also violates several fundamental rights guaranteed by the constitution, including the right to live with dignity, the right to freedom, right to equality, rights related to untouchability and discrimination, right to clean environment, right to health, food and housing, and right of women. Instead of effectively implementing these constitutional provisions and eliminating menstrual discrimination, most local governments in Karnali are focused on populist programs such as distributing eggs, chicken or maternity allowances to new mothers in the name of nutrition.
