Atlas›Domain XV · Nature, philosophy, social & rites of passage›Guide 099
Guide XV-099

Menarche rites and seclusion of girls at puberty

A 34 · L 50 · M 1620 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: menarche rites as their communities publish them in outline (the Navajo Kinaaldá as described in the Navajo Times and in Markstrom and Iborra 2003, a study approved by the Navajo Nation Human Research Review Board; the Mescalero Apache Sunrise Ceremony as Indian Country Today reports it; the Hindu ritu kala samskara as Hinduism Today describes it), and menstrual seclusion (chhaupadi in Nepal) as Nepal's courts, Parliament, National Human Rights Commission, UN agencies in Nepal and major news report it. Clinical tools: the DSM-5 Cultural Formulation Interview (CFI) and its supplementary modules (APA 2013 version; the DSM-5-TR revision [uncertain: not verified]).

This is not a psychotherapy. It covers two very different things that both occur around a girl's first menstruation. The first is the menarche rite: a public, often joyful ceremony by which a family and community mark a girl's change in status. In the Kinaaldá, the rite honours Changing Woman and affirms the girl's place in family and community [source: Navajo Times 2021]; Markstrom and Iborra describe it as shaping identity, endurance and character on the model of Changing Woman [source: Markstrom & Iborra 2003]. The second is menstrual seclusion, in which girls and women are sent out of the home during menstruation (and often after childbirth) because they are regarded as impure. In Nepal this practice, chhaupadi, was banned by the Supreme Court and criminalised by Parliament in 2017, and it has caused documented deaths [source: Al Jazeera 2017; UN Women UNTF 2017]. Because of these documented harms, a harm account follows section 5.

How change happens, as these sources frame it: a rite moves a girl through separation, a liminal "betwixt and between" phase, and reincorporation (van Gennep's scheme as Markstrom and Iborra apply it), and change comes through affirmation by a community of significant others [source: Markstrom & Iborra 2003]. The therapist's role is not to perform any rite. It is to understand what the rite or restriction means to the client and her family; prepare and debrief a young person who takes part; work with conflict, shame or grief when a rite was refused, missed or imposed; screen for menstrual seclusion and act on safeguarding duties; and, where the client wishes, collaborate with the people who hold authority over the rite [synthesis]. The tradition's spiritual claims (for example that a rite shapes a girl's future character, or that a menstruating body angers the gods) are described as their holders state them, neither affirmed nor dismissed.

Out of scope here: genital cutting and virginity testing are covered in Domain XVI and are not described in this guide. Forced and child marriage, which Hinduism Today notes was historically tied to the timing of puberty in some communities, is a safeguarding matter (see sections 4 and 5) [source: Hinduism Today 2004].

2. Framework

There are no sources for session counts or durations for this work. The phases below follow the life of a rite, using van Gennep's separation, transition and reincorporation as Markstrom and Iborra apply them to the Kinaaldá [source: Markstrom & Iborra 2003]. The therapeutic tasks in each phase are [synthesis].

Phase A: Engagement and cultural assessment.

  • Goal: learn the rite or restriction in the family's own words; find out who holds authority over it, which parts are public, and what the client wants.
  • Format: individual sessions, with a parent or caregiver session when the client is a minor (the CFI parent addendum supports this) [source: APA CFI Supplementary Modules].
  • Move on when you can describe the rite as the family describes it, you know the client's own position (wants it, does not want it, is unsure), and you have screened for seclusion, restriction and safeguarding concerns.

Phase B: Preparation (before the rite).

  • Goal: help the young person anticipate the rite's demands and attention, settle conflicts about whether and how it happens, and make sure menstrual-health information and medical care are in place.
  • Move on when the young person has given assent (or a clear refusal has been taken back to the family) and the practical and emotional demands have been anticipated.

Phase C: The rite itself (liminal phase).

  • The therapist is normally absent. If the therapist is invited as a guest or community member, that is a dual-role decision (section 3).

Phase D: Debriefing and reincorporation.

  • Goal: help the young person make sense of the experience and her new status. Markstrom and Iborra describe reincorporation as including blessing others, a new support group of mentors, and reinforcement of identity in the days after the rite [source: Markstrom & Iborra 2003].
  • Move on when the experience has been integrated, or when unresolved distress has become a focus of ordinary therapy.

Pathway S: Safeguarding (at any phase).

  • Triggered by disclosure of seclusion outside the home, denial of food, school or washing during menstruation, threats, coercion into marriage, or any Domain XVI practice. Safeguarding takes priority over the other phases (sections 4.16 to 4.18 and the harm account).

Pathway G: Adults looking back.

  • Adult women who had a rite, missed one, refused one, or were secluded: grief, shame, body image, identity and family relationships, worked with in ordinary therapy using the same tools.

3. Guiding principles

  • Describe the tradition in its own terms. Use the family's names and explanations, attributed. In practice: say "in your family the Kinaaldá is…", not "puberty rituals are…" [synthesis].
  • Don't assume harm or shame. Markstrom and Iborra caution against treating menarche as shameful, and contrast the Navajo celebration with the privacy and embarrassment common in European American contexts [source: Markstrom & Iborra 2003]. In practice: ask what the rite means before judging it.
  • Don't assume celebration either. Some girls dread public attention; in one account a second-generation girl was indifferent to the rite and her mother hesitant [source: Hinduism Today 2004]. In practice: ask the young person directly, apart from her parents, how she feels about it.
  • Identity can be relational. Markstrom and Iborra warn against using Western individuation as the only standard; an ascribed, community identity can be a valued outcome [source: Markstrom & Iborra 2003]. In practice: do not treat loyalty to family and tradition as a symptom.
  • The girl is not a passive recipient. Markstrom and Iborra note that the initiate must "permit such ascription to occur" [source: Markstrom & Iborra 2003]. In practice: her assent matters, and her own goals can be woven into the rite.
  • Respect cultural authority and protected knowledge. A girl's ceremonial name is private in the Kinaaldá, and the rite is guided by a mentor and a hataali (ceremonial singer) [source: Markstrom & Iborra 2003]. In practice: do not ask for ceremonial content, songs, prayers or names, and do not record them.
  • Menstrual health is health and human rights, not only hygiene. WHO frames it this way and includes an environment in which menstruation is not "something to be ashamed of" [source: WHO 2022]. In practice: check information, products, facilities, care for pain or disorders, and freedom to take part in school and social life.
  • Seclusion causing harm is a safeguarding matter, not a cultural preference. Nepal's courts, Parliament and Human Rights Commission treat chhaupadi as unlawful and harmful [source: Al Jazeera 2017; Himalayan Times 2019]. In practice: ask about it and act on it, without contempt for the family's beliefs.
  • Women also uphold restrictions. A Nepali women's-rights activist told Al Jazeera that "It's a fallacy that it's men who make the woman do this" [source: Al Jazeera 2017]. In practice: include mothers, grandmothers and mothers-in-law in family work.
  • Cultural humility. In practice: your own culture's menstrual attitudes are also a culture; check them before sessions [synthesis].
  • Consent and assent for minors. In practice: get parental consent and the young person's assent, and tell both the limits of confidentiality before any disclosure [synthesis].
  • Client as author of any therapeutic ritual. In practice: when designing a ritual with a client (section 4.14), she chooses the symbols, people and words; the therapist offers structure only [synthesis, drawing on the resource model in Imber-Black, Roberts & Whiting 1988 as reviewed by Friesen 1994].
  • Boundaries and dual roles. A therapist from the same community may be invited to the rite, or even asked to act as a mentor or sponsor. APA Ethics Code Standard 3.05 on multiple relationships applies [source: APA Ethics Code]. In practice: decide before accepting, discuss it with the client, and document it.
  • Name a spiritual or religious problem if it is the focus. Where the main difficulty is conflict over a rite or loss of faith, the DSM-5-TR "Religious or Spiritual Problem" may apply, coded Z65.8 [source: ICD-10-CM Z65.8 (Unbound Medicine)]; DSM-5-TR wording [uncertain: not verified].

4. Intervention inventory

The sources describe the rites and the harms, not clinical procedures. Apart from the CFI and the cited framing, the procedures below are therapist-side procedures and are [synthesis] unless a source is given.

4.1 Opening the topic with cultural humility

  • Purpose / when: the first time menarche, menstruation or a puberty rite comes up, especially with a young person or a family from a culture other than yours. Many families treat menstruation as private, so how you open matters [synthesis].
  • Steps: (1) Ask permission to talk about the body and periods, and offer a choice of words ("period", the family's own term). (2) Say plainly that families mark this time in very different ways and that you want to learn theirs. (3) Ask who in the family usually talks about it, and whether the young person would prefer to talk with or without a parent present. (4) Use the family's names for the rite and the people involved.
  • Example language (illustrative): "Some families celebrate a girl's first period, some keep it very private, and some have rules about it. I'd like to understand how it is in your family. What word do you use?"
  • Watch for: embarrassment (lower your pace, normalise it), a parent answering for the young person (offer separate time), and your own reactions showing on your face. It is working if the family starts using its own words and explanations.

4.2 Cultural Formulation Interview: core and Spirituality, Religion, and Moral Traditions module

  • Purpose / when: when a rite, a restriction, or a conflict about them is part of what brings the client in. The core CFI asks about the cultural definition of the problem, cultural views of cause, context and support, coping and help-seeking, and current help-seeking [uncertain: not verified]. The supplementary module covers affiliations and community ties, the role of the tradition in daily and family life, practices at home and outside it, how the tradition helps or strains coping, and conflict or discrimination linked to it [source: APA CFI Supplementary Modules].
  • Steps: (1) Use the APA form, which clinicians may reproduce for use with their patients [source: APA CFI Supplementary Modules]; do not improvise new items. (2) Start with the core CFI, then add the spirituality module when the rite or a menstrual rule carries religious meaning. (3) Note where the tradition helps (belonging, pride, a mentor) and where it strains (conflict, fear, restriction). (4) Summarise back what you heard and check it.
  • Example language (illustrative): "You said the ceremony is really important to your grandmother. What does it mean to you? Does it help you in some ways, and make things harder in others?"
  • Watch for: answers given for the benefit of a parent in the room, and conflict between generations. It is working if you can state the rite's meaning in the family's terms and the client agrees with your summary.

4.3 CFI School-Age Children and Adolescents module with the parent addendum

  • Purpose / when: with a young person around the age of menarche. The module covers feeling similar to or different from peers at home, at school and among friends; language and naming; age-related stressors and supports; family, school and peer expectations; and the transition to adulthood. The parent addendum covers cultural aspects of development and parenting [source: APA CFI Supplementary Modules].
  • Steps: (1) Interview the young person alone for the core questions, after explaining confidentiality and its limits. (2) Interview the parent separately with the addendum. (3) Compare the two accounts of what this stage of life means and what is expected of her. (4) Share, with the young person's agreement, only what helps the family plan.
  • Example language (illustrative): "At school, do your friends know about the ceremony? Do you feel the same as them or different?"
  • Watch for: a gap between the parent's and the young person's expectations (this is often the real focus), and peer teasing or exclusion. It is working when both sides feel described accurately.

4.4 Mapping the rite in outline and who holds authority

  • Purpose / when: before preparing a client for a rite or collaborating with anyone about it. You need to know what will happen in broad terms, who decides, and what is not for outsiders [synthesis].
  • Steps: (1) Ask the client or parent to describe the rite in outline: who attends, roughly how long, what is public. Published outlines can orient you: the Kinaaldá is a four-day ceremony, usually held in the hogan soon after first menstruation, with running, preparation of a corn cake, a mentor chosen by the family, and an all-night sing led by a hataali [source: Navajo Times 2021; Markstrom & Iborra 2003]; at Mescalero the Sunrise Ceremonies take place at the main campgrounds during the Fourth of July gathering, with families sponsoring their daughters and older women serving as godmothers who mentor them [source: Indian Country Today 2002]; the ritu kala samskara traditionally gives a girl her first sari in a gathering of women who sing and give gifts [source: Hinduism Today 2004]. Other regional names and forms (for example South Indian manjal neerattu vizha) [uncertain: not verified]. (2) Ask who holds authority: parent, grandmother, mentor, priest, ceremonial practitioner. (3) Ask what parts are private, and say you do not need those.
  • Example language (illustrative): "I don't need to know anything that's meant to stay within the family or the ceremony. Can you tell me in general what the days will look like for you, and who will be guiding you?"
  • Watch for: your curiosity drifting into ceremonial detail (stop), and the family feeling scrutinised. It is working if you know the rite's demands and the decision-makers without having asked for protected content.

4.5 Menstrual-health check and psychoeducation

  • Purpose / when: with every young person at or near menarche and with any adult whose difficulties involve menstruation. WHO calls for menstrual health to be treated as a health and human-rights issue, covering information and education, products, water, sanitation and disposal, competent and empathic care, a non-shaming environment, and full participation in work and social life [source: WHO 2022].
  • Steps: (1) Ask what she knows and where she learned it. (2) Check access to products, private facilities at home and school, and a trusted adult. (3) Ask about pain, very heavy bleeding, missed school or activities; refer to her doctor for any medical concern (you do not assess or treat these). (4) Correct myths briefly and factually, without attacking the family's beliefs. (5) Refer to school nurses or reputable menstrual-health education where needed.
  • Example language (illustrative): "Periods are a normal part of health. If they hurt a lot, or stop you going to school, that's worth telling a doctor about. Do you have what you need at school?"
  • Watch for: missed school (a sign of either a medical problem or restriction; see 4.16), and shame. It is working if she can name what she needs and who to ask.

4.6 Assessing body shame and differentiating other problems

  • Purpose / when: when a young person around menarche shows withdrawal, low mood, food restriction, anxiety or avoidance, and the family links it to the rite or to puberty [synthesis].
  • Steps: (1) Ask about feelings about her changing body. (2) Screen routinely for depression, anxiety, self-harm and disordered eating; puberty-related body distress can overlap with an emerging eating disorder. (3) If disordered eating is suspected, refer to an eating-disorder service or registered dietitian; for support, point to the National Alliance for Eating Disorders. Give no diet, weight or food advice. (4) Refer physical symptoms to her doctor. (5) If self-harm or suicidal thoughts appear, follow standard risk assessment (988 in the US; Samaritans 116 123 in the UK and Ireland).
  • Example language (illustrative): "Lots of girls feel strange about their bodies changing. How has it been for you? Has it changed how you eat or how you feel about food?"
  • Watch for: attributing everything to culture or everything to illness. It is working if the presenting problem is clearly separated into a normal reaction, a cultural conflict, or a disorder that needs its own treatment.

4.7 Assent, and the young person who does not want the rite

  • Purpose / when: when a young person is reluctant, frightened or opposed. Markstrom and Iborra note that the initiate must allow the ascription of a new identity, so she has a role and is not a passive object [source: Markstrom & Iborra 2003].
  • Steps: (1) Explore her reasons in private: embarrassment, fear of attention, fatigue, religious doubt, gender identity, a peer issue, or concern about something harmful. (2) Separate what she objects to (the whole rite, a public part, the timing) from what she might accept. (3) With her agreement, help her say this to her parents, or hold a family session. (4) Explore with the family whether a part can be private, shorter, delayed or adapted, a decision that sits with the family and the people who hold authority over the rite. (5) If what she fears is seclusion, coercion, marriage or any Domain XVI practice, move to pathway S (4.17).
  • Example language (illustrative): "It sounds like it's not the ceremony itself, it's everyone watching you. Would it help if we worked out together how to tell your mum that?"
  • Watch for: the therapist becoming the young person's advocate against the family (stay balanced), and pressure on her after the session. It is working if she feels heard and the family has a real conversation about it.

4.8 Preparing a young person for a rite

  • Purpose / when: after she has agreed to take part. Markstrom and Iborra observed that initiates were tired and somewhat tense, that girls are told to be cheerful, and that this may hide negative feelings; they also report earlier findings of initiates feeling awkward and tired [source: Markstrom & Iborra 2003].
  • Steps: (1) Help her anticipate the physical and social demands as the family describes them, and normalise fatigue and mixed feelings. (2) Identify a person she can go to during the rite (often the mentor or godmother, where there is one). (3) Plan coping for crowds or attention (breathing, a grounding object she chooses). (4) Check that medical needs (medicines, disability needs, menstrual pain) are known to the family. (5) Agree when you will meet afterwards.
  • Example language (illustrative): "It's okay to feel proud and tired and nervous all at once. Who can you look to if it gets too much?"
  • Watch for: physical risks the family may not have considered (heat, exertion, a health condition): route these to her doctor. It is working if she goes in feeling prepared.

4.9 Debriefing and reincorporation

  • Purpose / when: after the rite. Markstrom and Iborra apply Erikson's markers of identity (feeling at home in oneself, a sense of direction, continuity over time, and affirmation by significant others) and describe reincorporation as including blessing others, gaining mentors and reinforcement of identity [source: Markstrom & Iborra 2003].
  • Steps: (1) Invite her account in her own order. (2) Ask what felt meaningful, what was hard, and what has changed in how others treat her. (3) Help her name any new responsibilities and mentors. (4) Explore any negative feelings she could not show during the rite. (5) Link the experience to her own goals; in one observed ceremony, the community affirmed a girl's chosen career goal [source: Markstrom & Iborra 2003].
  • Example language (illustrative): "Now that it's over, what stays with you? Has anything changed in how your family treats you?"
  • Watch for: distress she did not expect, conflict with peers who do not understand, or new expectations she finds heavy. It is working if she can tell the story with a sense of her own place in it.

4.10 Missed, refused or abbreviated rites: grief and shame

  • Purpose / when: when a client did not have a rite (family decision, migration, poverty, loss of language, conflict, illness) or refused one, and feels grief, guilt or a sense of missing belonging. Hinduism Today reports the practice disappearing in India and barely begun in the US, with mothers hesitant and some girls receiving only a token or abbreviated form [source: Hinduism Today 2004]. Markstrom and Iborra note that loss of language may affect girls' understanding of ceremonial meaning [source: Markstrom & Iborra 2003].
  • Steps: (1) Validate the loss without assuming it is a loss. (2) Explore what the rite would have given her (recognition, a mentor, a link to grandmothers). (3) Separate guilt over her own refusal from grief over what the family could not offer. (4) Explore whether some of what was missed can be found now: a conversation with an elder, learning the meaning, a later family gathering, or a therapeutic ritual (4.14). (5) Where loss of faith or belonging is central, consider Z65.8 (section 3).
  • Example language (illustrative): "When you hear your cousins talk about their ceremonies, what comes up? What do you think it would have given you?"
  • Watch for: idealising the missed rite or blaming a parent harshly. It is working when she can hold both what was lost and what is still possible.

4.11 Interfaith, mixed and diaspora families

  • Purpose / when: when parents disagree about whether to hold a rite, when one side of the family has a tradition and the other does not, or when migration has made the rite hard to hold. Hinduism Today describes second-generation diaspora families as indifferent or hesitant, and argues that better explanation of the rite's meaning would have increased participation [source: Hinduism Today 2004].
  • Steps: (1) Map each parent's and grandparent's position and what the rite means to each. (2) Identify the shared value underneath (honouring the daughter, keeping a link to the homeland, protecting her). (3) Put the young person's own view at the centre. (4) Help the family consider options: the full rite, a simpler home form, a blended celebration, or none. (5) Suggest the family consult their own religious or community leaders on what the tradition allows (4.15).
  • Example language (illustrative): "It sounds like you both want her to feel proud of growing up. You just picture it very differently. What would each of you need to see for it to feel right?"
  • Watch for: the daughter caught between parents, and one side's tradition being treated as less legitimate. It is working when the decision is made with her rather than over her.

4.12 LGBTQ+ young people, intersex variations, disability and late or absent menarche

  • Purpose / when: when a rite built around becoming a woman does not fit the young person's gender identity, when a disability affects participation, or when menarche is late or absent [synthesis].
  • Steps: (1) Ask privately how she or they feel about the rite and its gender meanings; do not disclose gender identity or sexual orientation to the family without the young person's consent. (2) Explore whether there is any part of the tradition they want to keep. (3) For disability, identify access needs (mobility, sensory load, stamina, communication) and, with consent, help the family raise them with those who run the rite. (4) For late or absent menarche, or a known intersex variation, refer to the young person's doctor; do not speculate about causes. (5) Address shame about "not being ready" or "not being a proper girl".
  • Example language (illustrative): "The ceremony is about becoming a woman. How does that fit with how you see yourself? There's no right answer here, and what you tell me stays between us unless you're at risk."
  • Watch for: risk of rejection, coercion or harm at home if identity is disclosed (assess safety first), and isolation. It is working if the young person has a plan that protects both safety and dignity.

4.13 Cost, scale and family pressure

  • Purpose / when: when the rite has become a large and expensive event, or when obligations to sponsor or attend strain the family. Families at Mescalero reserve campground places years in advance for their daughters' ceremonies [source: Indian Country Today 2002]. Specific costs are not given in the sources [uncertain].
  • Steps: (1) Ask about financial strain, debt and obligations to kin. (2) Explore what the family believes the rite must include and who says so. (3) Help separate the rite's meaning from its scale. (4) Address the young person's guilt if she feels she is a burden. (5) Refer to financial advice services where debt is a problem.
  • Example language (illustrative): "What would the ceremony need to have for it to mean what it should, even if it couldn't be as big as your cousin's?"
  • Watch for: conflict between parents over money, and pressure on the young person to perform gratitude. It is working when the family can talk about cost without shame.

4.14 Co-designing a therapeutic ritual

  • Purpose / when: when a client wants to mark a transition her culture did not mark, mark a missed or refused rite, or heal shame linked to menarche or seclusion. Imber-Black, Roberts and Whiting describe a resource model in which families are seen first as resourceful; rituals rest on beliefs the family wants to keep or change, use symbols for experiences that need resolution, have a clear beginning, an organised sequence around a theme, and often repetition; types include transition and identity rituals, healing rituals, membership rituals and celebrations [source: Friesen 1994, reviewing Imber-Black, Roberts & Whiting 1988]. Rituals for Our Times by Imber-Black and Roberts offers advice on using words and symbols to create special events adapted to different families and heritages [source: Publishers Weekly].
  • Steps: (1) Clarify what she wants the ritual to mark or change. (2) Invite her to choose the symbols, place, people, words and actions; offer structure (beginning, middle, ending) only. (3) Check that it does not borrow protected content from another tradition, including Indigenous ceremonies she does not belong to. (4) Rehearse the emotional side, not a script. (5) Debrief afterwards.
  • Example language (illustrative): "If you could mark this the way you'd have wanted at twelve, who would be there and what would happen? You decide; I can help you shape it."
  • Watch for: the therapist's preferences shaping the ritual, and a ritual that reopens shame with nothing to contain it. It is working if she owns it and describes a sense of completion.

4.15 Collaborating with religious leaders, mentors and ceremonial practitioners

  • Purpose / when: when the client or family wants help from a priest, elder, mentor, godmother or ceremonial practitioner (for example, the mentor and hataali in the Kinaaldá, or the godmothers at Mescalero [source: Markstrom & Iborra 2003; Indian Country Today 2002]), or when an adaptation needs their approval.
  • Steps: (1) Collaborate only if the client wishes, with written consent that specifies what may be shared. (2) Approach the person with respect for their authority; ask what is possible rather than proposing changes. (3) Share only what is needed (for example an access need or a young person's anxiety), not clinical detail. (4) Never ask for protected ceremonial content. (5) Report back to the client.
  • Example language (illustrative, to a mentor): "She's looking forward to it and she's also anxious about the crowds. Is there a way you'd usually support a girl who feels like that?"
  • Watch for: the leader learning more than the client agreed, and the therapist being drawn into a community dispute. It is working if the young person gets support from within her own tradition.

4.16 Screening for menstrual seclusion and restriction

  • Purpose / when: with clients from communities where menstrual restrictions are practised, and with any girl who misses school during periods. A UN Harmful Practices Working Group study reported that 89% of girls and women in Nepal face some menstrual restriction [source: UN Nepal 2023]. Under chhaupadi, girls and women are sent to a shed outside the home, cut off from family, denied nutritious food, kept from bathing and village water, and effectively kept out of school [source: UN Women UNTF 2017]; they are also barred from touching food, religious icons, cattle and men [source: Al Jazeera 2017].
  • Steps: (1) Ask neutrally where she sleeps, what she eats, whether she can wash, touch family members and go to school during her period. (2) Ask whether anyone has told her she is impure or will cause harm, and how she feels about that. (3) Ask whether the same applies after childbirth for women in the family. (4) Distinguish mild customs she accepts from exclusion that endangers health, education or safety. (5) If she is outside the home, unsafe or denied food or school, go to 4.17.
  • Example language (illustrative): "Some families have rules for when a girl has her period. Are there any in your home, like where you sleep or what you can touch?"
  • Watch for: minimising ("it's only a few days"), fear of getting family into trouble, and diaspora families who keep restrictions inside the home. It is working if she can describe the rules and how she experiences them.

4.17 Safeguarding response and legal duties

  • Purpose / when: when seclusion, denial of food, school or care, threats, coercion into early marriage, or any Domain XVI practice (genital cutting, virginity testing) is disclosed or suspected.
  • Steps: (1) Ensure immediate safety. (2) Follow your jurisdiction's child-protection and mandatory-reporting procedures and your service's safeguarding policy; consult your safeguarding lead. (3) In Nepal, forcing a woman into chhaupadi is a criminal offence with a penalty of up to three months' jail, a 3,000-rupee fine, or both [source: Al Jazeera 2017; Himalayan Times 2019]. (4) Tell the young person what you must do and why, and what happens next. (5) For forced or child marriage and for Domain XVI practices, follow those procedures; do not investigate the details yourself. (6) Continue support after referral.
  • Example language (illustrative): "What you've told me means you're not safe at the moment, and I have to share it with people whose job is to protect you. I'll tell you exactly what I'm going to say."
  • Watch for: retaliation against the young person, and families moving her out of reach. It is working if she remains safe and stays connected to support.

4.18 Family work with those who uphold restrictions

  • Purpose / when: when the family wants to keep its tradition but the restrictions harm a girl. A Nepali activist has said women themselves often maintain the practice, and an NHRC member described the psychological pressure it creates [source: Al Jazeera 2017]. A UN Trust Fund programme in Nepal worked through peer educators, community leaders and traditional healers, and reported that one healer persuaded his wife to stay at home, bathe and eat well during menstruation [source: UN Women UNTF 2017].
  • Steps: (1) Start from the family's fears (what they believe will happen if the rule is broken). (2) Acknowledge love and protection behind the rule. (3) Offer health information (4.5) without ridicule. (4) Explore which parts of the tradition can be kept without exclusion that harms. (5) Suggest community or religious figures the family respects who have spoken against harmful restriction, if the family is open to it. (6) Safety overrides family work if the girl remains at risk.
  • Example language (illustrative): "I can see you want to protect her and the family. Can we look together at which rules keep her safe, and which might put her at risk?"
  • Watch for: apparent agreement in session with no change at home, and a mother-in-law or grandmother who has not been included. It is working when the girl reports actual change.

4.19 Working with adults who experienced seclusion

  • Purpose / when: adult women, including migrants, who were secluded as girls or after childbirth, and who carry fear, shame, trauma or anger [synthesis].
  • Steps: (1) Ask about specific experiences at her own pace (cold, fear of animals or of men, hunger, missing school), since the UN and news reports list cold, sexual violence and animal attacks as risks [source: UN Women UNTF 2017; Al Jazeera 2019]. (2) Screen for PTSD, depression and anxiety and treat with evidence-based trauma therapy where indicated. (3) Work with internalised beliefs about impurity, without forcing her to abandon her faith. (4) Explore grief for lost schooling or for anyone who died. (5) Explore her choices for her own daughters.
  • Example language (illustrative): "You were told your body was dangerous. What do you believe about that now, and what would you want your daughter to believe?"
  • Watch for: loyalty conflicts with family, and shame about speaking out. It is working if she can describe her experience without self-blame.

4.20 Therapist self-reflection and protective documentation

  • Purpose / when: throughout. The therapist's own attitudes to menstruation and ritual shape every session, and clinical records can expose protected knowledge [synthesis].
  • Steps: (1) Before working with a family, reflect on your own learned attitudes to periods and to ritual. (2) Seek consultation from a colleague with knowledge of the culture where possible. (3) Record clinical facts and safeguarding actions, not ceremonial content, private names (such as a girl's ceremonial name in the Kinaaldá [source: Markstrom & Iborra 2003]) or details the family asked you not to write down. (4) Review dual-role invitations (section 3).
  • Example language (illustrative, to the client): "I'll write down that the ceremony is coming up and how you feel about it. I won't write down anything about the ceremony itself."
  • Watch for: fascination or disapproval leaking into your questions. It is working if the family trusts you with what matters and you hold what is protected.

5. Handling problems

The sources do not address clinical problems directly. All guidance below is [synthesis] except where a source is cited.

  • The young person will not talk about periods at all. Respond: do not push. Offer written questions, a same-gender colleague if available and wanted, or a trusted adult she chooses. Return to the subject later with a general opening (4.1).
  • A parent insists on being present and answers for her. Respond: explain that it is standard to see young people alone for part of each session, with the limits of confidentiality stated to both. Use the CFI parent addendum to give the parent a full voice of their own (4.3).
  • The family hears your questions as criticism of their tradition. Respond: name the misunderstanding and repair it: "I asked because I don't know your ceremony, not because I think something is wrong with it." Return to their meaning first (4.2, 4.4). Markstrom and Iborra warn against assuming such rites are harmful [source: Markstrom & Iborra 2003].
  • The opposite rupture: the young person feels you are siding with the family. Respond: acknowledge it, restate that her view matters, and offer a session just for her (4.7).
  • She says she is fine with the rite, but shows distress. Respond: Markstrom and Iborra note that girls are told to be cheerful, which may contain negative feelings [source: Markstrom & Iborra 2003]. Make it safe to have mixed feelings without rejecting the rite.
  • She refuses, and the family will not budge. Respond: if the rite is not harmful, your role is to help her cope and keep communication open, not to overrule the family. If it involves seclusion, coercion, marriage or any Domain XVI practice, go to pathway S (4.17).
  • Overwhelm during preparation or debriefing. Respond: slow down, ground her, and contain; move trauma-focused work to later if a frightening experience emerges. Screen for PTSD.
  • Non-adherence to plans agreed in family sessions (for example, restrictions continue). Respond: ask what got in the way and who else in the household was not part of the agreement. Apparent agreement without change is common where women of an older generation uphold the rule [source: Al Jazeera 2017]. Re-check the girl's safety each time.
  • Disclosure of seclusion, food denial or exclusion from school. Respond: act on safeguarding (4.17). Note that legal bans alone have not ended the practice in Nepal: no complaints had been registered with district police in two districts, and arrested family members were released for lack of evidence [source: Himalayan Times 2019]. Do not rely on the law alone to keep a child safe; ensure services follow up.
  • The therapist is invited to the rite or asked to be a mentor. Respond: treat it as a multiple-relationship decision under APA Standard 3.05 [source: APA Ethics Code]: consider whether it could impair objectivity or harm the client, discuss it with her, consult, document, and say no if in doubt.
  • The family or client shares protected ceremonial content. Respond: thank them, do not record it, and do not repeat it to others (4.20).
  • An LGBTQ+ young person fears the rite will expose them. Respond: safety and confidentiality first; help them plan what, if anything, to say, and when (4.12).
  • A client wants a ritual that borrows from a tradition not her own. Respond: explore what she is looking for and help her find symbols from her own life and heritage; do not help reproduce another community's ceremony (4.14).
  • The rite raises questions about menstrual disorders, delayed menarche or intersex variation. Respond: refer to her doctor; never interpret physical findings yourself (4.5, 4.12).
  • Disordered eating appears around menarche. Respond: refer to an eating-disorder service or registered dietitian; for support use the National Alliance for Eating Disorders. Give no food or weight advice (4.6).
  • Self-harm or suicidal thoughts. Respond: follow standard risk assessment and safety planning; crisis lines 988 (US) and Samaritans 116 123 (UK and Ireland).
  • Forced or child marriage is linked to puberty in the family's expectations. Respond: this is a safeguarding and legal matter; follow child-protection procedures and refer to specialist services. Do not mediate it as a cultural disagreement.
  • Rite-related conflict has become a crisis of faith or belonging. Respond: work with it as a religious or spiritual problem (Z65.8, section 3), with the spirituality module of the CFI (4.2), and consider referral to a chaplain or religious leader if the client wishes (4.15).

Harm account

This account concerns menstrual seclusion (chhaupadi) in Nepal, the case documented by courts, Parliament, the National Human Rights Commission (NHRC), UN agencies and major news. It does not concern the celebratory menarche rites described above. No victims are named.

What was actually done

  • Where: most common in the far- and mid-western regions of Nepal [source: UN Women UNTF 2017]; the NHRC's hearings centred on Achham and Dailekh, and the practice is reported to persist in Bajura, Doti, Bajhang, Mugu, Kalikot, Baitadi and other districts [source: Himalayan Times 2019].
  • Rationale given: menstruating women and new mothers are regarded as impure; the Himalayan Times reports a belief that "unclean bodies" would anger the gods [source: Himalayan Times 2019; Al Jazeera 2017].
  • What a girl or woman experienced: at menstruation (in the UN Women account, from a girl's first period) she was sent to a small shed outside the home or village, the chhau goth or chhaushed, until bleeding stopped. There she had no contact with family, was denied nutritious food, was kept from bathing and from village water sources, and was effectively kept out of school [source: UN Women UNTF 2017]. She was barred from touching food, religious icons, cattle and men [source: Al Jazeera 2017]. The NHRC-based report states that unmarried women stayed in the shed for seven days and married women for five [source: Himalayan Times 2019].
  • After childbirth: in some areas women gave birth in the hut and stayed there for up to two weeks under the same restrictions [source: UN Women UNTF 2017].
  • Inside the home: restriction does not always mean a shed. A UN Harmful Practices Working Group study found 89% of girls and women in Nepal face menstrual restrictions, and in Achham 60% of women cannot sleep in the same house as their family while menstruating [source: UN Nepal 2023].
  • Legal history: the Supreme Court of Nepal ruled against chhaupadi in a verdict of 2 May 2005, issuing guidelines and directing that a law be passed if they failed [source: Al Jazeera 2017; UN Women UNTF 2017; UN Nepal 2023; verdict date: Himalayan Times 2007]. After the verdict the government drafted Chhaupadi Elimination Directives (year 2064 in the Nepali calendar, reported in May 2007) [source: Himalayan Times 2007]; a later Himalayan Times report dates the Court's direction to eliminate the practice to 2008 [source: Himalayan Times 2019], which may refer to these directives [uncertain]. The 2010 National Plan of Action against Gender-Based Violence recognised it as a harmful practice and a form of violence against women [source: UN Women UNTF 2017]. In August 2017 Parliament unanimously passed a law that a woman during menstruation or after childbirth should not be kept in chhaupadi, with up to three months' jail, a 3,000-rupee fine, or both, taking effect one year after passage [source: Al Jazeera 2017]. The offence is in section 168(3) of the new National Penal (Criminal) Code, with penalties in sub-sections 4 and 5 [source: Setopati 2018].

How it caused harm

  • Deaths: an NHRC report found that 15 girls and women died in chhau sheds over 13 years in Achham and Dailekh alone [source: Himalayan Times 2019]. Major news reported further deaths of girls and women in sheds in 2016, 2017, 2018 and January 2019, the last including a woman and her two young sons in Bajura; the causes reported were smoke inhalation or suffocation, a snake bite, and in one case a cause not established [source: Al Jazeera 2017; Al Jazeera 2019]. Rights activists say many deaths likely go unreported [source: Al Jazeera 2017].
  • Mechanisms: cold exposure, and fires lit for warmth in unventilated huts (smoke inhalation and suffocation); snake bites and wild-animal attacks; sexual violence, including rape, against women alone outside the home [source: UN Women UNTF 2017; Al Jazeera 2019]; poor nutrition and lack of washing; risk to mothers and newborns when birth and the postnatal period take place in the hut [source: UN Women UNTF 2017].
  • Education and psychological harm: girls effectively barred from school during menstruation [source: UN Women UNTF 2017]; an NHRC member said the custom isolates women and creates psychological pressure [source: Al Jazeera 2017]. The sources cited give no systematic psychological outcome data [uncertain].
  • Who was most at risk: girls and women in remote far- and mid-western districts; adolescent girls newly menstruating; new mothers and their infants; young children who share the hut with their mother (as in the 2019 deaths) [source: UN Women UNTF 2017; Al Jazeera 2019].
  • Why harm continued after the ban: no complaints had been registered with police in Dailekh or Achham, and family members arrested during an NHRC inquiry were released by a court for lack of evidence [source: Himalayan Times 2019]; activists call the belief system deeply entrenched [source: Al Jazeera 2017].

Recognising it today

  • Persistence: the practice continues despite the ban [source: UN Nepal 2023], and restrictions short of a shed (sleeping apart, not touching food or family) are widespread [source: UN Nepal 2023; Al Jazeera 2017].
  • Features to listen for in a client's account [synthesis]: sleeping in a shed, cowshed, outbuilding or separate room during periods or after childbirth; being kept from the kitchen, water, family members or religious objects; missing school every month; being told she is impure or that the gods, cattle or crops will be harmed.
  • Rationales by which it is defended [synthesis, drawing on the sources above]: "it is our tradition"; "it protects the family"; "the women insist on it, not the men" (activists note women often uphold it [source: Al Jazeera 2017]); "it is only a few days".
  • Red flags in a colleague's or service's practice [synthesis]: treating seclusion as a cultural preference that requires no safeguarding response; not asking about menstrual restrictions with girls from affected communities; relying on the existence of the law as proof a child is safe.
  • How legitimate practices differ [synthesis]: a celebratory menarche rite (section 1) marks a girl's status among her family and community; customs a woman freely chooses that cost her no food, shelter, schooling, care or safety are a different matter from enforced exclusion. When unsure, assess the effect on health, education and safety, and the girl's own wishes.

What to do instead and how to help those harmed

  • Safer alternatives: menstrual health as WHO defines it: information and education, products, water and sanitation, empathic care, a non-shaming environment and full participation in school and work [source: WHO 2022]. In Nepal, measures include free sanitary pads in schools, locally produced reusable pads, community awareness work and a 2019 campaign to demolish sheds in Achham and Bajura [source: UN Nepal 2023]. A UN Trust Fund programme using peer educators, community leaders and traditional healers reported a fall in girls and women sleeping in huts from almost 20% to 5% in its areas [source: UN Women UNTF 2017]. The NHRC recommended strict enforcement, free pads, lessons in the school curriculum and awareness programmes [source: Himalayan Times 2019].
  • Assessing and treating affected clients: screen as in 4.16; assess safety now (including for daughters); screen for trauma, depression and anxiety; treat with evidence-based trauma therapy where indicated; work with shame and beliefs about impurity respectfully (4.19); address grief for lost schooling or bereavement [synthesis].
  • Ethical, reporting and legal duties: follow child-protection and mandatory-reporting procedures in your jurisdiction (4.17); in Nepal the practice is a criminal offence [source: Al Jazeera 2017]. Coordinate with safeguarding services rather than relying on family agreement alone. Genital cutting and virginity testing, if disclosed, are handled under Domain XVI; forced or child marriage under safeguarding procedures [synthesis].

Sources

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