Disabling Menstrual Barriers: Investigating and addressing the barriers to menstrual hygiene management that young people with disabilities face in the Kavre district, Nepal

BACKGROUND: People with disabilities face inequalities in many areas of life, so are likely to experience poor menstrual hygiene management (MHM). Evidence or interventions to support MHM for this population is lacking. STUDY AIM: To develop an MHM behaviour change intervention for young people with disabilities in Nepal and assess its feasibility. METHODS: The Behaviour Centred Design’s five steps were used to develop the MHM intervention. Assess: systematic review of MHM requirements of people with disabilities and coping strategies. Build: analysis of Nepal’s MHM and water, sanitation and hygiene policies, and a qualitative study exploring MHM behaviours of young people with disabilities in the Kavre district. Create: The “Bishesta” campaign - an MHM behaviour change package for young people with intellectual impairments (hereto referred to as ‘young people’) and their carers. Deliver: Implementation of the Bishesta campaign to 10 young people and carers in Kavre. Evaluate: a feasibility study of the campaign. KEY FINDINGS: The systematic review highlighted limited evidence about the barriers to MHM that people with disabilities and their carers face. People with intellectual impairments experienced the most negative outcomes, but only one MHM intervention was identified for this population. Within Nepal, disability was insufficiently addressed across policy, guidance and implementation. The qualitative study supported the findings of the systematic review, so people with intellectual impairments and their carers were targeted in the Bishesta campaign. The campaign was delivered through three group training modules and household visits; ‘period packs’ containing storage bags, a bin and MHM visual stories were distributed. The campaign was delivered with fidelity, and all target behaviours improved. CONCLUSION: People with disabilities in Nepal, particularly those with intellectual impairments, have large unmet MHM needs. The Bishesta campaign could support MHM for this group but requires efficacy testing before scaling up.