Are Nepal’s water, sanitation and hygiene and menstrual hygiene policies and supporting documents inclusive of disability? A policy analysis

Abstract

Purpose This study assesses the inclusion of disability in Nepal’s policy and guidance relevant to water, sanitation and hygiene (WASH), and menstrual hygiene management (MHM) in comparison to gender. We investigated both policy formulation and implementation, using the Kavrepalanchok district as a case study. Materials and methods We used the EquiFrame framework, adapted for disability and gender, and focusing on WASH and MHM. Ten Nepali policies and guidance documents were reviewed and scored for quality against the framework, which included 21 core concepts of human rights. We also interviewed key informants to consider the inclusion of disability in the implementation of MHM interventions. We applied stratified purpose sampling to 12 government officials and service providers working in Kathmandu and the Kavrepalanchock district; conducted in-depth interviews and analysed data thematically using Nvivo 11. Results Disability was inadequately covered within the policy documents, and MHM policy commitments for disability were almost non-existent. Participation of people with disabilities in policy development was limited; within Kavrepalanchok, policy commitments were not implemented as intended and disability service providers were unable to allocate government resources. Inadequate data on disability and MHM resulted in limited professional understanding of the issues, as service providers had no training. A narrow WASH infrastructure approach to improving MHM for people with disabilities was prioritised. MHM interventions were delivered in schools; these failed to reach children with disabilities who are often out of school. Finally, there were indications that some caregivers seek sterilisation for people with disabilities who are unable to manage menstruation independently. Conclusion Though the Constitution of Nepal enshrines gender equality and disability inclusion, there are consistent gaps in attention to disability and MHM in policies and practice. These omit and exclude people with disabilities from MHM interventions. Investment is required to generate evidence on the MHM barriers faced by people with disabilities, which would then be drawn on to develop training on these issues for professionals to improve understanding. Subsequently, policy makers could include more concepts of human rights against disability in relevant policies and service providers could implement policy commitments as intended.

The inclusion of disability and aging in COVID-19 hygiene behavior change interventions across low-and middle-income countries: A review using the COVID-19 Inclusive WASH Checklist

“…A consistent finding across studies which explore inclusive WASH is that caregivers are not recognized for the critical support roles they often play in supporting people with disabilities and older adults with WASH and maintaining personal hygiene (21,26,30,(49)(50)(51). Our study found a greater emphasis on caregivers (Family resource) than in other studies (37,39,48). As noted above, though this indicates an awareness of caregivers' importance, this attention did not translate into clearly articulated actions for this group, meaning they were also unlikely to benefit extensively from these efforts.…”

“…However, the total number of references made to individual core concepts was limited, particularly about aging, which was woefully low. Across this and other similar studies, Individualized services and Access are referenced consistently highly, whilst Participation, Capability based services, and Accountability receive little attention (37,39,48). Some may think this unsurprising because many governments, organizations, and institutions aim to increase access to WASH services, particularly in an emergency setting.…”

Menstrual Health Experiences of People with Intellectual Disabilities and Their Caregivers during Vanuatu’s Humanitarian Responses: A Qualitative Study

“…A growing body of data reveals that people with disabilities face additional challenges in realising their menstrual health in LMICs. This issue is particularly evident for people with intellectual disabilities who often rely on caregivers [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. For instance, a recent study in Vanuatu highlighted that women and girls must independently collect their own water, bathe, and wash their reusable menstrual materials when menstruating.…”

“…Furthermore, women and girls with intellectual disabilities are particularly disadvantaged when menstruating [ 6 ]. Evidence from different settings demonstrates that management strategies applied by caregivers include isolating and physically restraining people with intellectual disabilities during menstruation and, in some cases, sterilisation to cease menstruation [ 5 , 6 , 8 , 9 , 10 ].…”

The practice of menstrual hygiene management and associated factors among secondary school girls in eastern Ethiopia: The need for water, sanitation, and hygiene support

“…33 , 34 Focusing on schools was one of its dimensions, but it remained a barrier 17 in addressing gender equality and inclusive accessibility. 23 , 35 As a result, water, sanitation, and hygiene (WASH) in schools refer to a mix of technical and human development elements that are required to create a healthy school environment and establish proper health and hygiene behaviors. 36 Safe water supply, sanitation facilities, excellent hygiene practice, menstrual hygiene management, and solid and liquid waste management are among the minimal standards for school WASH programs.…”