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Kamala B.K. in front of a menstrual hut. Image courtesy of Cecile Shrestha/WaterAid.

On November 18, 2016, a 21-year-old Nepali woman, Dambara Upadhyay, died in a menstrual hut away from her home in the small village of Timalsena. While this outlawed practice of chhaupadi is indeed suspect, Upadhyay’s death was ruled natural. As if there is anything natural about banishing menstruating women to the outdoors because it will anger the gods or contaminate the home.

And before you get all misty-eyed thinking menstrual seclusion is some kind of Red Tent-esque women’s empowerment practice, these menstrual huts are far from romantic. Most often, they are makeshift shacks or flimsy mud huts with a corrugated steel or even a thatched roof that barely protects the women from the elements, let alone wild animals like snakes and jackals, as well as opportunistic men who will risk the wrath of the gods to rape a vulnerable woman.

Sometimes these huts don’t even have walls, and women are only allowed to eat salted bread or rice for the duration.

In some communities, women are relegated to actual cow sheds — not just for five days during menstruation, but also for weeks after giving birth. The mortality rate in those cases is staggering, and the irony is heartbreaking: for a patriarchal culture that prides itself on women as breeders, you would think they’d do the utmost to protect the newborn and mother. Instead, the woman is stigmatized even further to include the baby, having been defiled by toxic uterine blood and tissue. First-time menstruators are secluded for at least 14 days, according to a 2011 field bulletin published by the Office of the United Nations High Commissioner for Human Rights.

Nepali menstrual hut. Image courtesy of Cecile Shrestha/WaterAid.

Nepali menstrual hut. Image courtesy of Cecile Shrestha/WaterAid.

This centuries-old practice related to Hindu beliefs promotes the idea that if a woman doesn’t follow these dictates, she will bring death and destruction to her entire family. The word chhaupadi even translates to “untouchable being,” and is still required in many South Asian countries such as Bangladesh, India and Pakistan. In August, all women who have reached menarche are required to participate in the Rishi Panchami festival, which involves purifying their female bodies and atoning for all sins they have committed while bleeding that might bring disaster on their families.

Related: Chinese Swimmer Fu Yuanhui Breaks Barriers With Comment About Period In Rio

In 2012, Action Works Nepal put together a comprehensive research paper, “Miteri Gau — Let’s Live Together Campaign to Initiate Chhaupadi Free Community.” They describe in detail the psychological and emotional fallout of menstrual seclusion and the demonization of menstruation in general:

“A highest number of respondents (77%) mentioned that they feel humiliation in front of others during the menstrual period. … They consider themselves impure and inferior in comparison to boys when the menstrual cycle starts. About two thirds of the girls reported that they feel loneliness and scared during each menstrual period as they have to live and sleep alone inside the cowshed or a dark room inside the house. Respondents also said that they feel scared because of chances of snake bite, chances of violence and rape…”

The 2011 field bulletin published by the Office of the United Nations High Commissioner for Human Rights further notes that rapes taking place in the menstrual hut or cowshed are rarely reported, due to further stigma around that event, and also that these five required days in seclusion detract from girls’ and young women’s educations, as they are not permitted to go to school.

Cecile Shrestha, associate director of WaterAid America and one of the major proponents of the “Menstrual Hygine Matters” Campaign tells Bustle:

“As girls encounter adolescence and begin their periods they often opt out of school because schools are not supportive environments where they can manage their periods hygienically and with dignity. This can be as simple as not having a private bathroom where they can manage their periods privately, or access to water to use for washing.”

I had the opportunity to talk further with Shrestha about her work with WaterAid and the practice of chhaupadi. Regarding the biggest obstacles to eliminating menstrual huts, Shrestha tells me:

“Changing the mindset, often of the women themselves who perpetuate the practice. These practices are entrenched in people’s experience of tradition and culture. Deconstructing the physical infrastructure of a hut is not the main challenge. In the villages I have visited, many menstrual huts had been knocked down, but the chhaupadi practice was still prevalent. Looking at the source of the taboos around menstruation and rationale for building the menstrual huts is the main issue.”

I also asked what have been the most useful methods of educating people about why not to practice menstrual seclusion and Shrestha says:

“The first, and often most difficult, step is getting people to talk about menstruation. Menstruation is a difficult and uncomfortable topic in open-minded places like New York, let alone in a marginalized community in rural Nepal. It is incredibly taboo. Getting women and girls to talk about menstruation and the challenges they uniquely face openly and without fear of retribution, shame and judgment, is key. For younger girls, this support can come from female health workers and community mobilizers in their communities, who make them feel safe and protected. For mothers, this support comes from other women they trust — fellow female family members or friends who no longer practice or enforce the tradition. As we know, children are often great agents of change, and schools can be a perfect starting point for young girls and boys to learn about menstrual health and its implications. Young people often take their knowledge home to their families, which can have a powerful ripple effect in their communities.”

Related: Women Threaten to Send Menstrual Blood to VP-Elect Mike Pence

As to where the main resistance to ending this practice comes from Shrestha explains:

“Superstition around menstruation is pervasive. Many women and girls in marginalized communities have been raised with the belief that menstruation is a curse, and if they do not uphold certain customs, they will anger the gods. Women and girls fear that their families will be punished — their families will be cursed, animals will die, and there is a risk of becoming crippled. The resistance is linked to fear of the consequences if certain practices are not upheld. It is more common that the women themselves are perpetuating the tradition and imposing it on their daughters and daughters-in-law.”

In terms of best practices in ending chhaupadi, Shrestha and WaterAid dig deep:

“WaterAid’s approach is two-fold, and our interventions are designed to tackle the hardware and software elements of the issue. The actual physical destruction of sheds needs to be strongly coupled with awareness, education and advocacy initiatives. Also, allowing true behavior change around mindsets and traditions requires time. Changes do not occur overnight, so understanding this is critical in designing programming, as well as a deep understanding of the cultural and religious context.”

Shrestha further notes:

“Breaking menstrual taboos requires courage. On a personal and professional level, this is an issue that I am passionate about and feel personally invested in. And even in the last year or two, I have seen it gain incredible traction in the media and other channels. It’s amazing to see this issue gain momentum, because what humbles and continues to drive me are the young girls who I met in Surkhet, in far West Nepal. In particular, Kamala, the 14-year old girl who was featured in front of her hut in the NPR piece. She has become somewhat a hero for this cause, and she has no clue how many people across the world she has touched with her powerful images and her story.”

A step in the right direction is being taken by the Nepali Ministry of Women, Children and Social Welfare, which is considering a law that would penalize those who continue to encourage and permit this malpractice, as reported by The Himalayan Times. Narayan Prasad Kafle, the spokesperson for the Ministry of Women, Children and Social Welfare, further noted that while menstrual seclusion is becoming more and more rare, he told The Himalayan Times, “ … We have not been able to achieve 100 percent result in the far-western districts,” and they are still performing a great deal of outreach in those communities to halt this antiquated and unsafe tradition.

The most recent case in Nepal has sparked a resurgent interest in ending this practice, and that’s just about the only positive thing about these menstrual huts at all — that people are beginning to value women’s lives over the misperceived destruction menstruation culturally signifies. Dambara’s sister, Nirmala Upadhyay, tells NPR:

“I don’t know if God will punish us. I don’t know what other people do, but from now on we will stay home. We’re not going outside.”

If you’re interested in helping stamp out these menstruation taboos that impact women’s physical, emotional, and psychological wellness as well as their education and personal and professional development, check out WaterAid, Menstrual Hygiene Day, and Wash United for the different ways you can contribute towards de-stigmatizing  menstruation around the world.

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