Inadequate sanitation is a direct cause of poor health that costs lives, dignity and productivity. India’s cities are not only increasing in number; they are also expanding and so are the slums within them. Census data suggests that the slum population has tripled in the last three decades, intensifying the strain on already insufficient urban resources. In this entire situation, the female gender is almost always at the short end of the stick. Lack of sanitation and safe water is an acute problem for women and girls living in poor conditions and overcrowded urban slums and rural areas of the developing world.
Sanitation and women
For women, the daily struggle begins well before dawn. Without water supplies and toilets within their homes and being unable to openly defecate during the day due to lack of privacy and fear of harassment, they wait for nightfall to find a secluded spot to defecate - a practice which has serious side effects. Waiting so long to relieve themselves increases chances of contracting urinary tract infections, chronic constipation and psychological stress. That apart, it creates irreparable complications during pregnancy and postnatal recovery. Also, travelling long distances to access public facilities makes them potentially vulnerable to physical and sexual assault.
Sanitation and education
Lack of sanitation is detrimental not only to women’s health and their dignity but also to their education. Girls are reluctant to attend school, and parents are disinclined to send them, if there are no safe, private toilets for them to use.
Urban slums face not only an acute shortage of accessible toilets but also of water - a crucial requirement for hygienic practices. While most localities in Indian cities receive between three to five hours of water per day, certain communities receive as little as 30 minutes of water supply per week. This compels poor urban households to buy water from private vendors and slum mafia at exorbitant prices. Inflated prices force marginalised households to prioritise drinking water needs over sanitation and hygienic practices such as hand washing that help break the link between faeces–fingers–food. In absence of these practices, the urban poor continues to come in contact with human waste in some way, which gravely harms their health.
Developing a gendered approach
Sanitation programmes, as with many other development initiatives, are often built around assumptions of gender-neutrality. The specific needs of men and women are neglected in terms of the design, location and construction of sanitation facilities. This results in gender-specific failures such as toilets with doors facing the street in which women feel insecure, facilities in far-off locations that are difficult to access, school urinals that are too high for boys, absence of disposal for sanitary materials for women and pour-flush toilets that require considerably more work for women in transporting water.
In addition to distinct needs, men and women play different roles in sanitation and hygiene within their families and communities. Women play a crucial role in collecting water for sanitation and ensuring clean toilets as well as raising awareness about sanitation issues and influencing hygiene behaviours of children. On the other hand, men usually pay for sanitation facilities and are responsible for their construction and maintenance.
Given their role in sanitation, women tend to be aware about current facilities and their quality, can identify barriers to accessibility, and provide insights on how to improve hygiene behaviour. Yet, historically there has been a tendency to leave them out of planning, designing and construction in initial stages, and operation and maintenance for income generation later.
There is evidence that water and sanitation services are generally more effective if women take an active role in setting them up, from design and planning, to the operations and maintenance required to make any initiative sustainable. Evidence also shows that their role in educating their families and the community about hygienic practices makes these ventures more likely to succeed. However, in order to bring about gender parity, it is imperative to also involve men, enable them to share their views on gender issues and promote gender sensitivity. As stated before, an inclusive approach to providing sanitation is essential.
Improving hygiene
It is now well accepted that key behaviours such as better menstrual hygiene management and hand washing must accompany infrastructure investments. Menstrual hygiene management is a critical component of sanitation that has been largely neglected and remains absent from much of the policy and practice in the sector. While there is a need for robust scientific research in order to better understand the impact of poor menstrual hygiene on health, respondents in a survey by Water Aid in Bangladesh reported health problems such as vaginal scabies, abnormal discharge, and urinary infections, and associated these with lack of menstrual hygiene. There is a need to incorporate menstrual hygiene within the sector by raising awareness, providing affordable and accessible products and facilities, linking menstrual waste to the waste management system, and the integration of these approaches into mainstream policies and programmes.
Importance of hand washing
Another essential hygiene element that is typically deprioritised in water and sanitation interventions is the importance of hand washing. There is very clear evidence showing the significance of hand-washing with soap at critical times: after defecating and before eating or preparing food. Hand washing with soap breaks the feces–finger–food link, significantly reducing the incidence of diarrhoea. In fact, recent studies suggest that regular hand washing with soap at critical times can reduce the number of diarrhoea bouts by almost 50 per cent.
Realising this, various international donor agencies such as CARE, the Water Supply and Sanitation Collaborative Council (WSSCC), UNICEF and WHO have designed and implemented successful hygiene programmes around the world focusing on explanations of disease transmissions and the effective solution of hand washing. Poor hygiene practices within households are often a major source for contamination of safe drinking water causing life threatening diseases. Communities need to be educated about the benefits of maintaining hygiene and the fact that simple techniques such as hand washing and maintaining menstrual hygiene have lifesaving potential.
In the Indian urban household, it’s the woman who takes care of the house and its sanitation. However, when she is out in public places, there is hardly any respect towards her sanitation needs. Hence, it is the government’s and society’s responsibility to provide for proper sanitation facilities for the Indian public, especially women.
This article has been sourced from a report by Dasra Squatting Rights - Access to toilets in Urban India. Dasra is a philanthropy foundation that works with philanthropists and successful social entrepreneurs to bring together knowledge, funding and people as a catalyst for social change.