Although Nepal naturally has abundant sources of water and around 80% of its population has access to drinking water, it is often not adequate for human consumption. According to the International Institute of Water Management in Kathmandu, the country possesses 2.7% of the world’s fresh water and its population is provided with a yearly 9 million liters of water flowing from the Himalaya and from over 6,000 rivers. Conversely, only 18% of Nepal’s population have access to safe drinking water and merely 27% have access to sanitation, while water pollution and scarcity remain one of the many issues faced by the a significant part of the population. Consequently, the country has a high incidence of waterborne diseases, which lead to the death of around 44,000children each year. In the region of Terai, which is home to the Madheshi, groundwater contamination from arsenic has recently become a major concern.

In addition to the lack of proper infrastructures and pollution derived from agricultural pesticides, fertilisers and wastewater, changes in climate are increasingly affecting the monsoon patterns, further affecting the 14thmost vulnerable country to climate change. The 2015 earthquake further exacerbated the situation by destroying many existing water systems and networks, as well as creating around2.8 million internally displaced persons (IDPs) due to lack of water and food.

In spite of these various challenges, the Nepalese Government has remained committed to its sanitation campaign, especially through the National Sanitation and Hygiene Master Plan (NSHMP) 2011-2017, and aimed to become free of open defecation by July 2018. In spite of considerable advances such as the increasing of sanitation coverage from 6% in 1990 to 95.4% at the end of 2017, much is left to be done, in particular with regard to the geographical and social distribution of these improvements. Several districts in the southeast of Terai remain behind the national average, while poverty, difficult geography, caste discrimination, gender disparity and exclusion are factors that further exacerbate inequalities. In addition, due to the fact that the majority of toilets are not connected to sewer systems, but rather being connected to septic tanks that need to be regularly emptied, fecal sludge management poses considerable environmental health risks. The treatment of wastewater and hygiene standards are other great concerns, especially when only 20% of the households have water, soap or other cleaning agents for hand washing.

Moreover, although the NSHMP 2011 referred to the need for children-, women- and disabled-friendly toilet, they are not properly built and operational, which makes it difficult for those people to comfortably use such facilities. This difficulty affects in particular people – mostly women - during menstruation, more specifically those with disabilities. While menstrual hygiene management (MHM) is essential for those who menstruate, it still requires many improvements, especially after the 2015 earthquake and considering how MHM can and is being overlooked in circumstances of crisis, even in humanitarian settings. A study has shown that women rarely, if ever, received menstrual absorbents as relief materials in the first month after the earthquake.

It is worth mentioning that only 69% of the schools in Nepal have separate toilets for girls and that menstruation remains culturally and traditionally associated to the concept of impurity. In fact, discrimination related to menstruation often leads to women being banished from their houses, a tradition known as chhaupadi. During this practice, women are prohibited to eat their regular diets and are forced to live outside of their family houses in huts or mud cowsheds for the duration of their menstrual cycle. Apart from leaving women vulnerable to thieves, rape and even attacks from animals (including snakes), this tradition can lead to several diseases and even to death. Additionally, during chhaupadi women are not allowed to bathe from the tap, in wells or rivers, which further exacerbates poor menstrual hygiene. Moreover, girls often lack proper access to education on sexual and reproductive health, as well as to basic information about the biological process of menstruation.

Combined, unsuitable management of water resources, lack of comfortable toilet facilities, of access to water and cleaning agents for hand washing, of education and basic information, as well as cultural and traditional discriminatory practices, create a sum of obstacles which impede the empowerment of women in Nepal, especially in minority and marginalised groups like the Madheshi. In order for progress and the empowerment of women to be achieved, they must have adequate knowledge, information, tools and confidence to manage their own bodies and sexual and reproductive health, without being afraid or hindered from maintaining their social and working activities during their menstrual cycles.