This paper describes the components of the Bishesta campaign: a behaviour change intervention for menstrual hygiene management (MHM), targeting young people with intellectual impairments, and their carers in Nepal. The campaign uses two fictitious characters: Bishesta (a young person with an intellectual impairment) and Perana (her carer), and consists of three group training modules. ‘Period packs’, designed to make MHM behaviours attractive and easy to adopt, are given to the young people. Packs include storage bags, a bin, and stories about Bishesta menstruating and learning to manage as independently as possible, with Perana’s support. Carers receive a calendar to track the young person’s menstrual cycle. A Bishesta doll, with removable clothes, underwear, and a miniature ‘period pack’ is used in training to demonstrate MHM. Evaluation findings show the intervention is feasible at small scale, so further research on how to scale up the intervention in an evidence-based way is required.

Aunger, R. and Curtis, V. (2016) ‘Behaviour centred design: towards an applied science of behaviour change’, Health Psychology Review 10(4): 425–46 <https://doi.org/10.1080/17437199.2016.1219673>.

Coe, S. and Wapling, L. (2015) Training Activity 4: Game of Life [online], World Vision <https://assets.worldvision.org.uk/files/8413/8053/8773/Training_Activity_4_game_of_life.pdf> [accessed 15 April 2021].

Dündar, T. and Özsoy, S. (2020) ‘Menstrual hygiene management among visually impaired women’, British Journal of Visual Impairment 38: 347–62 <https://doi.org/10.117/0264619620911441>.

Elrha (2020) ‘MHM for people with intellectual impairments in emergencies’ [online] <https://www.elrha.org/project/mhm-for-people-with-intellectual-impairment-in-emergencies/> [accessed 09 December 2020].

Harvey, K., Mano, P., Lakshminarayana, I. and Gupta, S. (2019) ‘G480(P) Menstruation matters: the impact of menstruation on girls and young women with severe learning difficulties and their families’, Archives of Disease in Childhood 104: A193 <https://doi.org/10.1136/archdischild-2019-rcpch.464>.

Hennegan, J., Torondel, B., Phillips-Howard, P.A., Sommer, M. and Montgomery, P. (2017) ‘Time to talk about menstruation: a response’, Lancet 390: 845–6 <https://doi.org/10.1016/s0140-6736(17)31950-5>.

Hennegan, J., Shannon, A.K., Rubli, J., Schwab, K.J. and Melendez-Torres, G.J. (2019) ‘Women’s and girls’ experiences of menstruation in low- and middle-income countries: a systematic review and qualitative metasynthesis’, PLOS Medicine 16: e1002803 <https://doi.org/10.1371/journal.pmed.1002803>.

Kaskowitz, A.P., Dendrinos, M., Murray, P.J., Quint, E.H. and Ernst, S. (2016) ‘The effect of menstrual issues on young women with Angelman syndrome’, Journal of Pediatric and Adolescent Gynecology 29: 348–52 <https://doi.org/10.1016/j.jpag.2015.12.004>.

Márquez-González, H., Valdez-Martinez, E. and Bedolla, M. (2018) ‘Hysterectomy for the management of menstrual hygiene in women with intellectual disability: a systematic review focusing on standards and ethical considerations for developing countries’, Frontiers in Public Health 6 <https://doi.org/10.3389/fpubh.2018.00338>.

Sebastian, A., Hoffmann, V. and Adelman, S. (2013) ‘Menstrual management in low-income countries: needs and trends’, Waterlines 32: 135–53 <https://doi.org/10.3362/1756-3488.2013.015>.

Sommer, M., Caruso, B.A., Sahin, M., Calderon, T., Cavill, S., Mahon, T. and Phillips-Howard, P.A. (2016) ‘A time for global action: addressing girls’ menstrual hygiene management needs in schools’, PLOS Medicine 13: e1001962 <https://doi.org/10.1371/journal.pmed.1001962>.

Steele, L. and Goldblatt, B. (2020) ‘The human rights of women and girls with disabilities: sterilization and other coercive responses to menstruation’, in Bobel, C., Winkler, I.T., Fahs, B., Hasson, K.A., Kissling, E.A. and Roberts, T.-A. (eds), The Palgrave Handbook of Critical Menstruation Studies, pp. 77–91 [online], Singapore: Springer Singapore <https://doi.org/10.1007/978-981-15-0614-7_8> [accessed 15 April 2021].

UNICEF (2019) Guidance on Menstrual Health and Hygiene [online] <https://www.unicef.org/documents/guidance-menstrual-health-and-hygiene> [accessed 15 April 2021].

WaterAid (2020) ‘The Bishesta campaign: menstrual health and hygiene for people with intellectual impairments’ [online], WASH Matters <https://washmatters.wateraid.org/publications/bishesta-campaign-menstrual-health-hygiene> [accessed 15 April 2021].

Wilbur, J., Bright, T., Mahon, T., Hameed, S., Torondel, B., Mulwafu, W., Kuper, H. and Polack, S. (2018) ‘Developing behaviour change interventions for improving access to health and hygiene for people with disabilities: two case studies from Nepal and Malawi’, International Journal of Environmental Research and Public Health 15: 2746 <https://doi.org/10.3390/ijerph15122746>.

Wilbur, J., Mahon, T., Torondel, B., Hameed, S. and Kuper, H. (2019a) ‘Feasibility study of a menstrual hygiene management intervention for people with intellectual impairments and their carers in Nepal’, International Journal of Environmental Research and Public Health 16: 3750 <https://doi.org/10.3390/ijerph16193750>.

Wilbur, J., Torondel, B., Hameed, S., Mahon, T. and Kuper, H. (2019b) ‘Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people’, PLoS ONE 14: e0210974 <https://doi.org/10.1371/journal.pone.0210974>.

Wilbur, J., Kayastha, S., Mahon, T., Torondel, B., Hameed, S., Sigdel, A., Gyawali, A. and Kuper, H. (2021) ‘Qualitative study exploring the barriers to menstrual hygiene management faced by adolescents and young people with a disability, and their carers in the Kavrepalanchok district, Nepal’, BMC Public Health 21: 476 <https://doi.org/10.1186/s12889-021-10439-y>.

Wilson, E., Haver, J., Torondel, B., Rubli, J. and Caruso, B.A. (2018) ‘Dismantling menstrual taboos to overcome gender inequality’, The Lancet Child & Adolescent Health 2: e17 <https://doi.org/10.1016/S2352-4642(18)30209-8>.

Wingfield, M., Healy, D.L. and Nicholson, A. (1994) ‘Gynaecological care for women with intellectual disability’, Medical Journal of Australia 160: 536–8 [online] <https://europepmc.org/article/med/8164550> [accessed 15 April 2021].

Aunger, R. and Curtis, V. (2016) ‘Behaviour centred design: towards an applied science of behaviour change’, Health Psychology Review 10(4): 425–46 <https://doi.org/10.1080/17437199.2016.1219673>.

Coe, S. and Wapling, L. (2015) Training Activity 4: Game of Life [online], World Vision <https://assets.worldvision.org.uk/files/8413/8053/8773/Training_Activity_4_game_of_life.pdf> [accessed 15 April 2021].

Dündar, T. and Özsoy, S. (2020) ‘Menstrual hygiene management among visually impaired women’, British Journal of Visual Impairment 38: 347–62 <https://doi.org/10.117/0264619620911441>.

Elrha (2020) ‘MHM for people with intellectual impairments in emergencies’ [online] <https://www.elrha.org/project/mhm-for-people-with-intellectual-impairment-in-emergencies/> [accessed 09 December 2020].

Harvey, K., Mano, P., Lakshminarayana, I. and Gupta, S. (2019) ‘G480(P) Menstruation matters: the impact of menstruation on girls and young women with severe learning difficulties and their families’, Archives of Disease in Childhood 104: A193 <https://doi.org/10.1136/archdischild-2019-rcpch.464>.

Hennegan, J., Torondel, B., Phillips-Howard, P.A., Sommer, M. and Montgomery, P. (2017) ‘Time to talk about menstruation: a response’, Lancet 390: 845–6 <https://doi.org/10.1016/s0140-6736(17)31950-5>.

Hennegan, J., Shannon, A.K., Rubli, J., Schwab, K.J. and Melendez-Torres, G.J. (2019) ‘Women’s and girls’ experiences of menstruation in low- and middle-income countries: a systematic review and qualitative metasynthesis’, PLOS Medicine 16: e1002803 <https://doi.org/10.1371/journal.pmed.1002803>.

Kaskowitz, A.P., Dendrinos, M., Murray, P.J., Quint, E.H. and Ernst, S. (2016) ‘The effect of menstrual issues on young women with Angelman syndrome’, Journal of Pediatric and Adolescent Gynecology 29: 348–52 <https://doi.org/10.1016/j.jpag.2015.12.004>.

Márquez-González, H., Valdez-Martinez, E. and Bedolla, M. (2018) ‘Hysterectomy for the management of menstrual hygiene in women with intellectual disability: a systematic review focusing on standards and ethical considerations for developing countries’, Frontiers in Public Health 6 <https://doi.org/10.3389/fpubh.2018.00338>.

Sebastian, A., Hoffmann, V. and Adelman, S. (2013) ‘Menstrual management in low-income countries: needs and trends’, Waterlines 32: 135–53 <https://doi.org/10.3362/1756-3488.2013.015>.

Sommer, M., Caruso, B.A., Sahin, M., Calderon, T., Cavill, S., Mahon, T. and Phillips-Howard, P.A. (2016) ‘A time for global action: addressing girls’ menstrual hygiene management needs in schools’, PLOS Medicine 13: e1001962 <https://doi.org/10.1371/journal.pmed.1001962>.

Steele, L. and Goldblatt, B. (2020) ‘The human rights of women and girls with disabilities: sterilization and other coercive responses to menstruation’, in Bobel, C., Winkler, I.T., Fahs, B., Hasson, K.A., Kissling, E.A. and Roberts, T.-A. (eds), The Palgrave Handbook of Critical Menstruation Studies, pp. 77–91 [online], Singapore: Springer Singapore <https://doi.org/10.1007/978-981-15-0614-7_8> [accessed 15 April 2021].

UNICEF (2019) Guidance on Menstrual Health and Hygiene [online] <https://www.unicef.org/documents/guidance-menstrual-health-and-hygiene> [accessed 15 April 2021].

WaterAid (2020) ‘The Bishesta campaign: menstrual health and hygiene for people with intellectual impairments’ [online], WASH Matters <https://washmatters.wateraid.org/publications/bishesta-campaign-menstrual-health-hygiene> [accessed 15 April 2021].

Wilbur, J., Bright, T., Mahon, T., Hameed, S., Torondel, B., Mulwafu, W., Kuper, H. and Polack, S. (2018) ‘Developing behaviour change interventions for improving access to health and hygiene for people with disabilities: two case studies from Nepal and Malawi’, International Journal of Environmental Research and Public Health 15: 2746 <https://doi.org/10.3390/ijerph15122746>.

Wilbur, J., Mahon, T., Torondel, B., Hameed, S. and Kuper, H. (2019a) ‘Feasibility study of a menstrual hygiene management intervention for people with intellectual impairments and their carers in Nepal’, International Journal of Environmental Research and Public Health 16: 3750 <https://doi.org/10.3390/ijerph16193750>.

Wilbur, J., Torondel, B., Hameed, S., Mahon, T. and Kuper, H. (2019b) ‘Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people’, PLoS ONE 14: e0210974 <https://doi.org/10.1371/journal.pone.0210974>.

Wilbur, J., Kayastha, S., Mahon, T., Torondel, B., Hameed, S., Sigdel, A., Gyawali, A. and Kuper, H. (2021) ‘Qualitative study exploring the barriers to menstrual hygiene management faced by adolescents and young people with a disability, and their carers in the Kavrepalanchok district, Nepal’, BMC Public Health 21: 476 <https://doi.org/10.1186/s12889-021-10439-y>.

Wilson, E., Haver, J., Torondel, B., Rubli, J. and Caruso, B.A. (2018) ‘Dismantling menstrual taboos to overcome gender inequality’, The Lancet Child & Adolescent Health 2: e17 <https://doi.org/10.1016/S2352-4642(18)30209-8>.

Wingfield, M., Healy, D.L. and Nicholson, A. (1994) ‘Gynaecological care for women with intellectual disability’, Medical Journal of Australia 160: 536–8 [online] <https://europepmc.org/article/med/8164550> [accessed 15 April 2021].