Kathmandu, Nepal - In Nepal's far western Achham, a remote arid region where farming villages dot the foothills of the Himalayas, government and aid workers have walked from door to door for nearly a decade to advocate against chauupadi, an ancient Hindu ritual where women are banished from their homes during menstruation.
Their ultimate goal is to end segregation, yet the dangers these women are exposed to have added urgency to their campaign.
In Achham alone, at least 12 women have died while following chauupadi since 2007. And just last week, the practice claimed another life.
Gauri Kumari Budha, a 22-year-old student, was found dead on January 8 after she spent the night in a chauu goth, a low, windowless mud hut where she confines herself during her period.
Officials said she died of smoke inhalation after she lit a fire to stave off the cold. Others have previously died due to snake bites and infections.
Hers is the first death reported since the Nepali parliament voted to criminalise chauupadi last year.
The new law, due to come into effect in August, sets a three-month jail term and a 3,000 rupee ($30) fine for those who force women to follow the custom.
Birendra Budha, Gauri's husband of 18 months, said he was aware chauupadi was illegal and had advised his wife against sleeping in the chauu goth.
"I used to tell her time and again not to sleep in that hut since it was unsafe and unhygienic," he told Al Jazeera by phone. "But people here are dogmatic in their beliefs, and many women practise chauupadi even if they are told not to."
The policeman who works in the capital, Kathmandu, said he was devastated by her death.
"It was so sudden. We are all still in shock," he said.
'They will hide and do it'
Pema Lhaki, a women's health advocate, told Al Jazeera she was saddened and angered by Gauri's death.
"When the spouse of a Nepali policeman dies because of chauupadi, that gives you an indication of the kind of challenges we face in ending the practice," she said.
In 2005, the Nepali Supreme Court banned the practice. However, women still followed chauupadi, prompting the government to introduce the law criminalising it.
But campaigners like Lhaki said a lot more effort was needed to end chauupadi. Raising awareness about the science behind menstruation, as well as the buy-in of religious and political leaders, was key to that process, they said.
They were of the view that God would be angry if women stayed inside their homes during their periods. So I told them, I will take care of God but don't send women to the chhau goth."
Megh Nath Yogi, village shaman
In the far west of Nepal, where the chauupadi tradition is prevalent, many believe that menstruating women are impure and can bring bad luck to a household. In addition to being forced from their homes, women on their periods are banned from social gatherings, denied access to some foods and can also be barred from toilets in their homes.
Describing the superstitions some Nepalis hold about menstruation, two local activists, in a recent article for the Republica website, wrote: "They believe if a menstruating woman fetches water, the well will dry up. If she touches a tree, it will never again bear fruit or will die; if she consumes milk, the cow will stop giving milk; if she reads a book, Saraswati, the goddess of education, will become angry; if she touches a man, he will be ill."
The practice is enforced by religious leaders in most villages, but women "do it themselves, too, because they believe they are protecting their families," said Lhaki, who works for the Nepal Fertility Care Centre.
"If I am told that my actions could cause harm to my daughter, husband or family, of course I will do it."
Lhaki hailed the new law as a positive step but said women and girls would continue to die or suffer from health problems associated with chauupadi as long as people linked menstruation to impurity.
Without a change in such beliefs, "the women themselves will hide and do it, and they will not report it being done either" even when the law comes into effect, argued Lhaki.
Radha Paudel, founder of the charity Action Works Nepal, said the solution was to create a national dialogue about menstrual stigma. "It's very simple. Menstruation is natural ... and we need to deliver the scientific message," she told Al Jazeera.
In Jumla district in midwestern Nepal, that change was under way, Paudel said.
A key step towards that was educating the village shamans about menstruation, she said.
Megh Nath Yogi, a 38-year-old shaman from the village of Tila-3 in Jumla, said he stopped advocating for chauupadi when he understood that "menstruation is a natural process".
"Some people were sending women to chauu goths until recently," he told Al Jazeera. "They were of the view that God would be angry if women stayed inside their homes during their periods.
"So I told them, I will take care of God but don't send women to the chhau goth."
For Paudel, the campaign does not end with the destruction of the chauu goths.
"To me, the underlying principle of chauupadi is segregation," she said. "Menstrual restrictions are a human rights issue. It ends when gender discrimination ends."
Back in Achham, residents of Gauri's village are still in mourning.
"She was well-loved here," her husband, Budha, said.
"Chhaupadi is blind faith. My wife would not have died if she had stayed inside our home that day. People should be told that menstruation has nothing to do with religion."
Roshan Sedhai reported from Kathmandu. Zaheena Rasheed reported and wrote from Doha.