An Analysis of Water Collection Labor among Women and Children in 24 Sub-Saharan African Countries
It is estimated that more than two-thirds of the population in sub-Saharan Africa (SSA) must leave their home to collect water, putting them at risk for a variety of negative health out- comes. There is little research, however, quantifying who is most affected by long water col- lection times.
In the 24 SSA countries studied, an estimated 3.36 million children and 13.54 million adult females were responsible for water collection in households with collection times greater than 30 minutes. We suggest that accessibility to water, water collection by children, and gender ratios for water collection, especially when collection times are great, should be considered as key indicators for measuring progress in the water, sanitation and hygiene sector.
Source: Graham JP, Hirai M, Kim S-S (2016) An Analysis of Water Collection Labor among Women and Children in 24 Sub-Saharan African Countries. PLoS ONE 11(6): e0155981. doi: 10.1371/journal. pone.0155981
A Systematic Review of Water and Gender Interlinkages
Significant developmental challenges in low-resource settings limit access to sustainable water, sanitation, and hygiene (WASH). However, in addition to reducing human agency and dignity, gendered WASH inequities can also increase disease burden among women and girls. In this systematic review, a range of challenges experienced by women relating to inadequate WASH resources are described and their intersection with health are explored. We further assess the effectiveness of interventions in alleviating inequalities related to the Sustainable Development Goals (SDGs) three (health), five (gender), and six (water).
Key themes from our search included that women and girls face barriers toward accessing basic sanitation and hygiene resources, including a lack of secure and private sanitation and of Menstrual Hygiene Management (MHM) resources. In total, 71% of identified studies reported a health outcome, suggesting an intersection of water and gender with health. Half of the research studies that included a health component reflected on the relationship between WASH, gender, and infantile diseases, including under-5 mortality, waterborne parasites, and stunting. In addition, we found that women and girls, as a result of their role as water purveyors, were at risk of exposure to contaminated water and of sustaining musculoskeletal trauma. A limited number of studies directly compared gender differences in accessing WASH resources, and an even smaller fraction (N = 5, 8.5%) reported sex-disaggregated outcomes. Educational, infrastructural, and programmatic interventions showed promise in reducing WASH and health outcomes. Indeed, infrastructural WASH interventions can be successful if long-term maintenance is ensured.
Source: Pouramin P, Nagabhatla N and Miletto M (2020) A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health. Front. Water 2:6. doi: 10.3389/frwa.2020.00006
Water, sanitation and hygiene in health care facilities
The term “WASH in health care facilities” refers to the provision of water, sanitation, health care waste management, hygiene and environmental cleaning infrastructure, and services across all parts of a facility. “Health care facilities” encompass all formally- recognized facilities that provide health care, including primary (health posts and clinics), secondary, and tertiary (district or national hospitals), public and private (including faith-run), and temporary structures designed for emergency contexts (e.g., cholera treatment centers). They may be located in urban or rural areas.
Why WASH services are a priority in health care facilities
The availability of WASH services, especially in maternity and primary-care settings where they are often absent (3, 4), supports core universal health care aspects of quality, equity, and dignity for all people. Basic WASH services in health care facilities are fundamental to providing quality care and for ensuring that primary health commitments, as detailed in the Astana Declaration, are achieved (5,6). It can also improve health outcomes at the community level.
Make childbirth and primary care safer
More than one million deaths each year are associated with unclean births, while infections account for 26% of neonatal deaths and 11% of maternal mortality (7,2). Most of these deaths are concentrated in low- and middle-income countries where the rates of health care associated infections (HCAI) are twice that of high-income countries (8). An estimated 15% of patients in low- and middle-income countries develop one or more infections during a hospital stay (8). Many of these patients are women who come to health facilities to deliver. If a woman lives in a country with a high rate of neonatal mortality, her infant faces a risk of sepsis- related neonatal mortality 34 times greater than in countries with a low rate of neonatal mortality (9).
Although not all HCAI can be traced to inadequate WASH services, evidence shows that lack of access to WASH in health care facilities may significantly compromise safe childbirth and access to primary health care (4). A recent review of nationally-representative health care facility data from four East African Countries found that fewer than 30% of delivery rooms had access to water (10). Previous estimates from United Republic of Tanzania (3), India, and Bangladesh (4) noted similar gaps. In short, far too many pregnant mothers are required to bring their own water to wash themselves and their baby following birth.
Today, over 200 million hours will be spent by girls and women walking for water. And without decent toilets, the hygiene and safety of people who menstruate is at risk.
Girls and women are particularly affected when communities lack clean water, decent toilets and good hygiene.
Why are girls and women worst affected by a lack of clean water?
Typically responsible for unpaid domestic work, girls and women are often expected to collect water from unsafe sources like rivers, streams and holes in the ground.
Carrying full water containers, as heavy as 20kg, on their heads or backs leaves its mark on them physically, contorting their spines and leading to problems in childbirth and later in life.
Collecting water – often for hours every day – can make them late for school or unable to work, putting them at a disadvantage to men and boys.
And drinking, cooking and washing with this dirty water exposes them to deadly diarrhoeal diseases every day.
Why are decent toilets and good hygiene particularly important for those who menstruate?
Not having a decent toilet at home or in public places can be especially difficult for people who have periods.
It can put them at increased risk of harassment and physical and sexual violence while going to the toilet in the open.
It makes managing their periods much more challenging, causing children to miss school or people to miss out on earning opportunities.
Without clean water, soap or a toilet, keeping themselves and their family healthy is incredibly difficult.
Overview of resources on gender-sensitive data related to water
In many countries, women are the main providers and managers of water at the household level. Women’s productive and reproductive roles are often highly dependent on water and differently dependent than men’s. Many small-scale location-specific studies suggest that women and men express different priorities for water use and conservation and “household”-level analyses have limited value in revealing these kinds of gendered patterns. Access, use, management and authority over water resources are all highly gendered. For these reasons, women constitute distinctive key stakeholders in water policy and programmes – and are treated as such, at least in declarations of interest and in most major policy platforms in development broadly, and in water and sanitation sectors specifically.
Over the past two decades, the connected issues of gender and water have received considerable international policy attention. Principle 3 of the 1992 Dublin Statement on Water and Sustainable Development (ICWE, 1992) recognized women’s central role in provisioning, managing and safeguarding water. Agenda 21, the action plan that resulted from the 1992 United Nations Conference on Environment and Development, strongly supported women’s involvement in water management, governance and education (UNCED, 1992, see for example sections 18.12n; 18.19; 18.33; 18.34d; 18.45). The Johannesburg Plan of Implementation from the 2002 World Summit on Sustainable Development includes an agreement to: “support capacity-building for water and sanitation infrastructure and services development, ensuring that such infrastructure and services meet the needs of the poor and are gender- sensitive” (WSSD, 2002, paragraph 25a). Similarly, in 2002, the United Nations Committee on Economic, Social and Cultural Rights confirmed, in its General Comment on the Right to Water, women’s important roles in water collection (CESCR, 2003).
Over the past 25 years, the JMP has been instrumental in developing global norms to benchmark progress and facilitating critical reflection among WASH sector stakeholders. The JMP was responsible for tracking progress towards the 2015 Millennium Development Goal (MDG) target 7c and will be responsible for monitoring the new 2030 Sustainable Development Goal (SDG) targets 6.1 and 6.2.
The SDG targets aim for universal access to drinking water, sanitation and hygiene and call for enhanced monitoring to ensure that no one is left behind. This report considers the implications of target 6.1, “by 2030, achieve universal and equitable access to safe and affordable drinking water for all,” and outlines JMP plans for enhanced global monitoring of drinking water during the SDG era.1
The first section examines the SDG vision for universal access and the specific language used in the formulation of global targets. It acknowledges the limitations of indicators based on source type and introduces a more ambitious indicator for SDG monitoring that takes account of accessibility, availability and quality of drinking water. ‘Safely managed drinking water services’ represents a higher level of service and a new rung at the top of the drinking water ‘ladder’ used by the JMP for global monitoring.
‘Universal access’ means everyone. The report draws attention to those populations who remain unserved and outlines JMP plans for tracking inequalities between and within countries. ‘Universal’ also implies expanding monitoring efforts beyond the household, to include institutions and other settings. The report identifies global indicators that the JMP will use to monitor access to water in schools and health care settings as a first priority.
The second section of the report examines the availability of data on the different elements of safely managed drinking water services and discusses data-related challenges. It illustrates how the JMP will combine data from different sources in order to track the progressive elimination of inequalities in access and service levels, and global progress towards the SDG target over the next 15 years.
The report concludes that monitoring progress towards safely managed drinking water will be more challenging in some countries than others, but estimates are expected to improve over time as more and better data become available.
Progress on household drinking water, sanitation and hygiene
The 2030 Agenda for Sustainable Development called for ‘ensuring availability and sustainable management of water and sanitation for all’ under SDG6, and established ambitious new indicators for WASH services under targets 6.1 and 6.2. While the number of countries with estimates available for the new SDG global indicators has increased with each JMP progress update, many still only have a small number of data points making it difficult to assess trends. However there are now enough data to begin to assess the prospects for achieving the SDG targets. This 2021 report extrapolates estimates based on existing trends to illustrate current trajectories and the acceleration required to achieve universal coverage by 2030.
Five years into the SDGs, the world is not on track to achieve SDG targets 6.1 and 6.2. Achieving universal coverage by 2030 will require a quadrupling of current rates of progress in safely managed drinking water, safely managed sanitation, and basic hygiene services. Least Developed Countries have the furthest to go and it will be especially challenging to accelerate progress in fragile contexts. Many more countries are facing challenges in extending services to rural areas and to poor and vulnerable populations who are most at risk of being left behind.
Progress on Drinking Water, Sanitation and Hygiene
No child should die or get sick as a result of drinking contaminated drinking water, being exposed to other people’s excreta, or having no place to wash their hands. No child should have to stay away from school for lack of a clean toilet and privacy. No mother or newborn should contract an infection from an unsanitary delivery room when they are most vulnerable. And no one should suffer the indignity of having to defecate in the open.
But unfortunately, far too many children, women and men around the world experience some or all of these risks to their health and wellbeing - and, thus to their futures.
That is why the 2030 Agenda for Sustainable Development recognize safe drinking water, effective sanitation, and good hygiene (WASH) both as an end in itself and as a driver of progress on many of the SDGS, including health, nutrition, education and gender equality. To meet these targets, we need a better understanding of the progress we have made and a strategic approach to meet the challenges that lie ahead in our shared effort to reach every community, every family, and every child.
WHO and UNICEF established the Joint Monitoring Programme for Water Supply, Sanitation and Hygiene in 1990, and published regular global updates throughout the Millennium Development Goal period. This report is the first update of the SDG period. It is by far the most compre- hensive global assessment of drinking water, sanitation and hygiene to date and includes a wealth of new information on the types of facilities people use and the level of service they receive.
SDG 6 is critical to sustainable development. Safe drinking water and sanitation are human rights. Access to these services, including water and soap for handwashing, is fundamental to human health and well-being. They are essential to improving nutrition, preventing disease and enabling health care, as well as to ensuring the functioning of schools, workplaces and political institutions and the full participation in society of women, girls and marginalized groups.
SDG 6, however, goes far beyond water and sanitation services to cover the entire water cycle. Aside from domestic purposes, water is needed across all sectors of society, to produce food, energy, goods and services. These uses also generate wastewater which, if not properly managed, can spread diseases, and introduce excess nutrients and hazardous substances into rivers, lakes and oceans. Ultimately, as ecosystems provide water to society, a significant share of the water needs to stay within the ecosystems for them to remain healthy. Healthy ecosystems in turn safeguard the quantity and quality of freshwater, as well as overall resilience to human- and environmentally-induced changes.
The effects of climate change are often seen in changes in water availability, such as increasing water scarcity in some regions and flooding in others. Consequently, water is a key factor in managing risks related to famine, disease epidemics, migration, inequalities within and between countries, political instability and natural disasters. With limited water resources, it is important to fairly balance the water requirements of society, the economy and the environment. Also, most of the world’s water resources are shared between two or more countries. As such, the development and management of water resources has an impact across transboundary basins, making cooperation essential.
Most of the world’s 1.2 billion poor people, two thirds of whom are women, live in water- scarce countries and do not have access to safe and reliable supplies of water for productive and domestic uses (IFAD 2001a). The bulk of these rural poor people are dependant on agriculture for their livelihoods and live in sub-Saharan Africa and South Asia, the regions which are also home to most of the world’s water poor (Molden 2007).
One third of the world’s population is currently experiencing some kind of physical or economic water scarcity. A growing competition for water from different sectors, including industry, agriculture, power generation, domestic use, and the environment, is making it difficult for poor people to access this scarce resource for productive, consumptive and social uses. In water-scarce regions and countries, inequity in access to water resources is increasing because of competition for limited resources, and this particularly affects poor rural people, especially women.