The landscape of Nepal is a geographical staircase, descending from snow-capped Himalayan mountains, through steep middle hills, to the lush flat plains of the south.

In the middle step, in the remote far west of the country, life has changed little over the decades.

For 18-year-old Ishwari Joshi, this means doing as her mother and grandmother did before her and leaving her home when she has her period.

The practice is called “chhaupadi” - a name for menstruation which also conveys the meaning that a woman is unclean when she is bleeding.

“The first time I had my period I was 15. I had to stay out for nine days,” she says.