Accepted Manuscript Version – Women’s Reproductive Health – First Published February 2021 - For fully formatted PDF please contact corresponding author or visit: https://doi.org/10.1080/23293691.2020.1861413 Beyond the Menstrual Shed: Exploring Caste/Ethnic and Religious Complexities of Menstrual Practices in Far-West Nepal Sara E. Baumann, Pema Lhaki, Martha A. Terry, Marni Sommer, Trevor Cutlip, Monica Merante & Jessica G. Burke CONTACT Sara E. Baumann, Ph.D. Sab269@pitt.edu University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, 130 De Soto St, Pittsburgh, PA 15216, USA. ABSTRACT Throughout Nepal, women and girls follow a range of menstrual practices, many of which leave them vulnerable to negative health outcomes. We applied a participatory visual research method called Collaborative Filmmaking to acquire a nuanced and sensory understanding of menstrual practices and motivations in Kanchanpur, Nepal. The study also provides insight regarding menstrual practice complexities across different castes/ethnicities and religions. Results show an array of menstrual practices related to cleansing, cooking, touching, worshipping, and sleeping. Participants’ menstrual practices varied by caste/ethnic and religious background and were motivated by religious and spiritual beliefs, family tradition, negative consequences, and social pressure. KEYWORDS Nepal; menstruation; chhaupadi; caste/ethnicity; visual methods; collaborative methods; participatory research Menstrual health, a growing global public health issue, refers to social, political, structural, educational, and environmental factors that affect experiences of menstruation and impact health. Though menstruation is a natural physiological process and its occurrence is generally a sign of good health, it can be a difficult experience for millions around the world (Geertz, Iyer, Kasen, Mazzola, & Peterson, 2016). Challenges associated with menstruation include the lack of access to affordable absorbent materials (Kuhlmann, Henry, & Wall, 2017), shortage of improved sanitation facilities to manage menstruation hygienically with privacy (Kuhlmann et al., 2017; Sommer & Sahin, 2013; Sommer, Schmitt, & Clatworthy, 2017), and missed educational opportunities during menstruation, though evidence regarding the extent to which this occurs and consequences of missing school is mixed (House, Mahon, & Cavill, 2012; Mason et al., 2013). Menstrual health challenges can also be social, cultural, or psychological in nature. Societies around the world attribute different meanings to menstruation, which are manifested in a variety of cultural practices. In many cultures menstruation is shrouded in silence, myths, taboos, and stigma that can lead to unsafe practices (Ali & Rizvi, 2010; Garg, Sharma, & Sahay, 2001; Hennegan & Montgomery, 2016; Human Rights Watch, 2017; Kuhlmann et al., 2017; Mason et al., 2013; Sommer, Ackatia-Armah, Connolly, & Smiles, 2015). As a result, menstruation is often associated with fear (Crawford, Menger, & Kaufman, 2014), loneliness (Lama & Kamaraj, 2015), stress (Crawford et al., 2014; Karki et al., 2017), inferiority (Action Works Nepal, 2012), disgust, shame (Dasgupta & Sarkar, 2008), and embarrassment (WaterAid, Water Supply and Sanitation Collaborative Council, & Unilever, 2013).