The Bishesta campaign: menstrual health and hygiene for people with intellectual impairments

WaterAid/ Shruti Shrestha

The Bishesta campaign is an intervention to improve understanding and behaviours around menstrual health and hygiene for people with intellectual impairments and their carers. It was developed and run in Nepal by WaterAid and the London School of Hygiene and Tropical Medicine.

What is the Bishesta campaign?

The campaign centres around two characters named Bishesta and Perana – Nepalese names that mean ‘extraordinary’ and ‘motivation’. In the intervention, Bishesta has an intellectual impairment and is learning to manage her menstruation as independently as possible, with Perana’s support. Using period packs containing necessary materials, and practical tools, visuals such as dolls, and roleplays based on these characters, participants communicate with each other about what menstruation is, and how to manage it hygienically and with dignity.

Who is it for?

The Bishesta campaign is for people with an intellectual impairment who menstruate and anyone who supports them. The resources can be downloaded and used by carers at home, by disability service providers, or people working in water, sanitation and hygiene or in sexual and reproductive health.

Why is this campaign needed?

There are very few menstrual health and hygiene interventions specifically designed for people with intellectual impairments and their carers. Without accessible information, menstruation can be a confusing, frightening and frustrating time, both for the person menstruating and those supporting them.

One of the young people who took part in the pilot campaign, carrying a 'Bishesta' doll, outside Banepa Muncipality office, Banepa, Nepal.
WaterAid/ Shruti Shrestha
One of the young people who took part in the pilot campaign, carrying a 'Bishesta' doll, outside Banepa Muncipality office, Banepa, Nepal.

How is the campaign delivered?

Users can run the whole intervention by delivering the facilitators' training and following the campaign manual, or delivering individual sessions, or using items in the period packs independently. If run in full, the intervention is delivered through three group training sessions and visits to participants’ homes.

What should you do before delivering the campaign?

The Bishesta campaign has been piloted with ten people who have an intellectual impairment and eight of their carers in Nepal’s Kavre District. An evaluation found that the campaign is feasible and acceptable for that group. It has not been tested with a larger group, outside that setting, or adapted for other contexts.

To make sure it is appropriate for your setting, first do formative research to understand whether the target behaviours are relevant for your groups. If you find that they are, next think about who could deliver the campaign, map out existing services that you can refer people to, and identify safeguarding checks and procedures that the team will apply.

If you are not working in Nepal, you may want to revise the campaign visuals to better suit your context. Do the names work for you? If not, change them, but try to keep the meanings: Bishesta means ‘extraordinary’ in Nepali, and Perana means ‘motivation’.

The wider research

The Bishesta campaign is part of wider research called Disabling Menstrual Barriers, by Jane Wilbur in collaboration with WaterAid and the London School of Hygiene and Tropical Medicine, with funding from the Bill & Melinda Gates Foundation. The research aimed to understand and address the barriers that people with disabilities in Nepal face to managing menstrual hygiene. It began with a systematic review of relevant literature, followed by formative research in the Kavre district to understand the barriers faced. That led to the development of the Bishesta campaign, which was delivered, monitored and evaluated in the Kavre district, Nepal.

For more information on the Disabling Menstrual Barriers research, including data collection tools, blogs, posters and presentations, please email [email protected].

Facilitators terms of reference

The lead facilitator and support facilitator terms of reference set out the key responsibilities and skills the campaign delivery team requires. These can be used as they are or adapted.

Facilitators training course

Facilitators can attend a four-day training course on how to deliver the Bishesta campaign and follow the campaign manual. Training materials include an agenda with suggestions on how to run each session, PowerPoint presentations and handouts.

Campaign manual and flash cards

The campaign manual guides facilitators to deliver the campaign. It includes four sections: 1) introduction; 2) three group and household training modules; 3) process monitoring; 4) household monitoring visits.

At the start of each session there are pictures of the materials needed for that session, a ‘to-do’ checklist and a summary box explaining the session’s purpose, materials needed and key messages. The session content then follows. At the end of each group training session there is a checklist of things to complete.

Campaign flash cards are reminders on what to cover in each session for the facilitators to refer to during training. It is still vital to follow the details in the campaign manual.

Artwork for period packs

The period packs, which encourage people with intellectual impairments to adopt the target behaviours, include:

  • A menstrual storage bag which includes a reusable menstrual pad. This should be kept near the young person’s bed and kept well stocked by the carer.
  • A menstrual shoulder bag that contains a small waterproof bag to put a used menstrual pad in when away from the home.
  • A menstrual bin to dispose of used menstrual products in. This should be kept near the young person’s bed.
  • Visual story: 'I change my pad' is about Bishesta menstruating for the first time and how Perana supports her to manage it as independently as possible.
  • Visual story: 'I manage' shows Bishesta learning that she mustn’t take her menstrual pad off and show it to others. Again, Perana helps her with this.

Carers can also use a menstrual calendar to help them track and prepare for the young person’s next menstrual cycle.

Artwork for campaign training materials

The Bishesta campaign is delivered with visual materials. You can download all training materials referenced in the campaign manual here.

This components checklist sets out the number of items and training materials needed to deliver the Bishesta campaign to ten young people and ten carers. The spreadsheet also includes a checklist of materials for facilitators to use when delivering the campaign. This document gives specifications for printing and producing the materials.