Stepping Forward in Menstrual Health & Hygiene: Training of Trainers (Part II)

Written by Lisa Bower, Board Member

In Part I, we shared how CCF supported its first Menstrual Health & Hygiene (MHM) Training of Trainers (ToT) in May 2024. This three-day gathering brought together a powerful and diverse group of leaders ready to shift narratives and open up honest conversations around menstruation. In Part II, we follow what happened after the training—how participants turned knowledge into action and sparked lasting change.

MHM ToT participants during the May 2024 training

“Only the Grinding Stone Knows the Pain of the Blade”

The ripple effects of the ToT were felt almost immediately. Lead Trainer Anupa Regmi observed powerful changes in both attitude and behavior among participants that were similarly observed by CCN Director Kesang Yudron and CCN Staff Member Igroom Lama:

• Openness and Comfort: Participants began speaking more freely about menstruation and reproductive health, even approaching Anupa directly to ask personal questions. For some, it was the first time they had ever spoken openly about their experience. Misconceptions about menstrual products, such as fears around menstrual cups, also started to shift.

• Emotional Healing: Survivors of stigma and isolation shared their stories, often tearfully, finding relief in knowing they were not alone, and change was possible.

• Immediate Action: Participants left with clear commitments to bringing MHM training to their communities and workplaces.

On the final day of the training, each participant developed an action plan outlining how they would promote menstrual health over the next year. CCF funded customized training packages, including manuals, visual tools, and role-playing guides to help participants succeed in future trainings. Participants also learned to draft basic proposals to secure support for future training initiatives in their communities.

MHM ToT participants during the May 2024 training

ToT participant Ms. Pema Choeden Tamang stated: “This training personally helps me a lot. I am now able to read my body and can [respond] as it needs during my period. Similarly, I can also help people around me to get rid from unnecessary body pains, cognitive and emotions changes, mood swings and effective uses of sanitary and normal pads. I am now able to conduct Menstrual Hygiene training [for] all the age groups.”

The ToT also had a powerful impact on the men who participated. According to Anupa, many expressed a deeper understanding of the challenges surrounding menstrual health, turning the traditional Nepali saying, “Only the grinding stone knows the pain of the blade,” on its head. “Now, we too understand the pain of menstruation,” one participant shared. Many advocated for greater male involvement in such programs, emphasizing that men also need to be educated about dignified menstruation.

Video: ToT Participants from the Association of Craft Producers share their experience

Impact in Action

Since the ToT, participants returned to their communities and have been busy putting their training into practice through training and the distribution of menstrual hygiene kits. Here are a few examples:

• A training held at the Association for Craft Producers for 40 in-house artisans and staff.

• A participant from Nepalgunj led a community training with a local knitter’s group and is planning a larger session with a nearby school.

• At the Tsoknyi monastery, two teachers who attended the ToT facilitated training sessions and the distribution of menstrual hygiene kits to their students.

• A training was conducted by Nepal Disabled Women Association in Kavre for 27 participants.

• A training on “Inclusive Menstruation Care” was conducted by Mitini Nepal among the LGBTQI + communities.

• In addition, trainer Anupa also conducted 2 follow-on trainings on menstruation in Gorkha among Muslim and non-Muslim communities with 40 participants.

In total, 487 menstrual kits were distributed through these follow-on initiatives—reaching hundreds of women and girls.

Ms. Pema Choeden Tamang, who co-led the training at the Tsoknyi monastery, has already observed a direct shift in her students as a result of the training she provided: “Many of our students are now aware of premenstrual symptoms, [and the] definition and understanding of menstruation and puberty. I believe that they are now being more serious and mindful during their periods [...including the] effective usage and disposal of sanitary pads, menstrual cups and normal pads… I, along with our students, are now aware that we need to manage our period, menstrual supplies like sanitary pads or access to a clean toilet are necessary. They are now understanding that, if not properly managed, menstruation can interrupt daily life and cause health issues.”

Photo Credit: Tsoknyi Monastery. Photo of MHM training held at Tsoknyi Gechak School

The Work Ahead

While the outcomes of this ToT were deeply encouraging, there is still much to be done. Anupa identified several key areas for continued focus, which CCF and CCN will keep front and center as we move forward:

• Menopause Education: Many women shared that they lack information and support around menopause, leading to confusion, isolation, and depression. Expanding the conversation around menstruation to include the full spectrum of reproductive health is essential to supporting women throughout their lives.

• Engaging Men: This ToT affirmed how important it is to include men in conversations about menstrual health. When men understand the realities of menstruation, they are better positioned to challenge stigma and support change at home and in the community. Continued outreach to fathers, husbands, and male leaders is vital.

• Access to Products: Some participants, especially from rural areas, reported limited access to safe, affordable menstrual products. This underscores the importance of CCF’s continued work to provide sustainable MHM kits.

Lastly, ongoing mentoring and training, along with stronger communication and facilitation skills, emerged as top priorities for future trainings. Follow-up activities led by Anupa and the CCN team revealed persistent challenges in delivering MHM sessions in communities where cultural and religious taboos remain deeply rooted. Newly trained facilitators often struggled to navigate sensitive conversations with confidence. Although the original ToT included discussion on communication techniques, Anupa emphasized the need for a more in-depth, dedicated session focused on practical skills—such as choosing the right methods for difficult topics, using supportive gestures and expressions, and modeling the qualities of an effective facilitator. Continued mentorship and peer-to-peer support are also vital, providing trainees with space to reflect, ask questions, and grow in their roles. Participants particularly underscored the importance of engaging community and religious leaders to address stigma in a way that honors local traditions while fostering open dialogue—especially in rural areas where change can be slow but deeply impactful.

MHM ToT participants during the May 2024 training

Looking Ahead

The power of ToT lies not just in what was taught, but in who was empowered. When change comes from within the community - led by those who understand its language, customs, and concerns - it is more likely to take root. True behavior change takes time.

Thank you for standing with CCF and CCN on this journey. Your support is helping to break cycles of silence and stigma, and is opening up space for dignity, health, and equity. We’re proud of our inaugural ToT participants and can’t wait to see how they continue transforming conversations across Nepal. Together, we are creating a future where every person can manage their menstrual health with knowledge, confidence, and pride.

Stepping Forward in Menstrual Health & Hygiene: Training of Trainers (Part I)

Written by Lisa Bower, Board Member

Menstrual health education in Nepal has come a long way in recent years, but reaching the most remote and marginalized communities still requires new, creative approaches. Since 2018, the Conscious Connections Foundation (CCF) has supported dozens of menstrual health and hygiene (MHM) programs across Nepal. These safe spaces for learning have enabled women and girls to speak openly about menstruation, sanitation, and cultural taboos that shape their daily lives.

In May 2024, CCF took a transformative next step by supporting its first MHM Training of Trainers (ToT), held from May 4–6 at Dulikhel Village Resort outside Kathmandu. 44 participants came together to build knowledge, confidence, and leadership skills—and to spark change that will ripple across communities.

Participants of the May 2024 Training of Trainers

Why a ToT for Menstrual Health?

The idea for the training was born from the vision of CCN Director Kesang Yudron and lead trainer Anupa Regmi. Both women have witnessed firsthand the power of grassroots education, and they knew that by equipping more local leaders with MHM knowledge, they could expand the reach and deepen the impact of this critical work.

The training had two core goals:

1. Building Community and Connection - Participants came from all walks of life—community health workers, social work students, nurses, persons with disabilities, LGBTQI+ advocates, and staff from NGOs focused on gender-based violence and health. This rich mix of experiences made the ToT a vibrant space for dialogue and collaboration.

2. Empowering Local Leaders to Multiply Impact - The ToT focused on building skills and confidence so participants could lead their own MHM sessions back home. Each participant left not just with new knowledge, but with a sense of responsibility and purpose. The training included men, because menstruation does not only affect those who experience it, but also those who do not.

For a video overview of the training, check out our video on Youtube!

“The demolition of cow shed is not the solution”

Lead trainer Anupa Regmi brought decades of experience as a midwife and educator to the ToT. Her passion for menstrual health runs deep, shaped by years of experience as a midwife in remote Nepali villages in the far west. Through her work, she’s seen how fear, misconceptions, and stigma surrounding menstruation can have serious, long-term impacts on the health and well-being of women and girls.

One example is Chhaupadi, a traditional practice in Nepal that isolates menstruating women and girls, labeling them "impure." Forced to stay in poorly built huts with no heat or ventilation, many face exposure to extreme weather, illness, animal attacks, and even sexual violence. In winter, attempts to stay warm with indoor fires can lead to death. While most visible in rural areas of the west, the practice persists across towns and cities as well, where women are often confined to corners of their homes—causing both physical harm and psychological strain.

Anupa emphasized that legal reforms alone aren’t enough to change these practices. Since the government began demolishing Chhaupadi huts in 2017, families have often resorted to makeshift shelters like tents—sometimes even more dangerous to women and girls than the original huts were. Anupa stated "the demolition of the cow shed is not the solution," she said. "You have to change the mindset—of discrimination, taboos, and stigma." She stressed that the problem lies not in the huts themselves, but in the belief around menstruation: “Instead of just demolishing visible Chhaupadi huts, it is crucial to challenge the deeply rooted belief that menstruation requires isolation... However, in Nepal, this remains a challenge due to religious, cultural, and traditional influences.”

Lead Trainer Anupa Regmi during the ToT

Her message is clear: lasting change takes more than laws and information – it demands empathy, open-mindedness, and the courage to challenge deeply rooted cultural beliefs. With this in mind, the TOT curriculum and approach was designed to foster not just knowledge, but mindset shifts, among participants.

“The knowledge I gained was beyond my expectations”

The participants were highly engaged throughout the training, despite diverse backgrounds and different experiences with menstruation. During the group sessions, according to CCN Director Kesang, they were remarkably open and collaborative, discussing menstruation and other health topics with honesty and mutual respect.

One participant, Ms. Pema Choeden Tamang shared:

“The knowledge I gained within three days of training was beyond my expectations… I [had] taken Reproductive Health and Menstrual Hygiene training before. But the [level] of knowledge I gained was drastically different... I expected that the training might be long, boring and repetitive. But it was full of knowledge and entertainment. The training reminds me of a lot of small things that I tend to forget. Like, about puberty, sexual, gender, equality...”

These moments of connection were key. According to Kesang, while discussing a traditionally taboo topic was initially challenging —particularly in normalizing conversations about body parts—patience and sensitivity by Anupa helped navigate deeply ingrained cultural and personal stigmas around menstruation. Anupa agreed, stating that one area of commonality among participants was that everyone in the group was following “some form of menstrual restriction - whether it was restrictions on mobility, restrictions on food, and restrictions on touch. Along with that, there was also the belief that menstrual blood is dirty or impure.”

Embracing Diversity, Deepening Understanding

The ToT’s success was rooted in large part in its inclusivity. Participants came from both urban centers and remote villages of the far west, and included men and women. Participants included rural healthcare workers and members of the disabled and LGBTQI+ communities. This diversity brought new insights, and also required extra care. According to Anupa, this approach required a major focus on trust building and relationship management early in the training, to ensure participants all had a base level of understanding about menstruation and to carefully build a comfortable environment where all participants felt comfortable sharing their experiences and questions.

ToT participants engaged in group activity

Sessions featured interactive discussions, creative activities, and guest speakers—including a gynecologist who provided in-depth medical information and answered sensitive questions.

ToT participant Pema reflected:

“The most interesting part was by getting to interact and knowing various thoughts, experiences and beliefs from diverse participants. I got to know closely regarding the actual issues, problems that faced in the rural areas during menstruation and pregnancy. The mis-conception, superstitious beliefs, and myths our society carries about Menstruation, Menopause and pregnancy was [heartbreaking].”

Even male participants expressed surprise at what they learned. "Some of them later shared that they had never thought about menstruation from a health or dignity perspective before," said Anupa, noting that she had observed male participants to be more engaged and curious than she originally expected. According to Anupa, they told her, "Now we can openly talk about menstruation in our families and communities," recognizing that there is a big difference between caring for someone without understanding menstruation and providing informed care. This awareness can help women experience dignified menstruation, and reduces discrimination at home, in schools, and in workplaces.

What's Next?

This blog is the first in a two-part series exploring the impact of our MHM Training of Trainers. In Part II, we’ll share the impact of the ToT and how participants put their training into action—leading sessions, shifting mindsets, and sparking change in their communities.

We’re also working on a blog post that dives deeper into the diverse experiences of people with disabilities and members of the LGBTQI+ community around menstruation. These voices are vital to building a more inclusive conversation about MHM.

Stay with us—there’s more to come!