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Helping children survive and thrive: How toilets play a part

Claire Chase's picture



While child mortality rates have plummeted worldwide, nearly one-third of all children under 5 in developing countries are stunted. Children who are stunted (having low height-for-age) suffer from a long-term failure to grow, reflecting the cumulative effects of chronic deficits in food intake, poor care practices, and illness. The early years of life, especially the first 1,000 days, are critical; if a child’s growth is stunted during this period, the effects are irreversible and have lifelong and intergenerational consequences on their future human capital and potential to succeed.  
 
For the water and sanitation community the year 2009 marked a turning point in our understanding of the role that Water, Sanitation and Hygiene (WASH) has on child stunting. A provocative Lancet article (Humphrey 2009) put forth the hypothesis that a key cause of child stunting is asymptomatic gut infection caused by ingestion of fecal bacteria. Small children living in poor sanitary environments are especially at risk, through frequent mouthing of fingers and objects during exploratory play, playing in areas contaminated with human and animal feces and ingesting contaminated food and water (Ngure et al. 2013). Researchers now estimate that up to 43 percent of stunting may be due to these gut infections, known as environmental enteric dysfunction (EED) (Guerrant et al. 2013).
 
Just last week estimates were released suggesting that poor sanitation is the second leading cause of child stunting worldwide (Danaei et al. 2016). In a key departure from previous work, the researchers defined risk as the sanitation level of a community, rather than an individual. This is consistent with mounting evidence showing that a community’s coverage of sanitation is more important than any one household’s (Andres et al. 2013). Across different studies, data sets and outcomes the evidence consistently shows that a threshold of around 60–70 percent household usage within a community is needed before the health and nutrition benefits of sanitation begin to accrue. Studies that have focused on an individual’s toilet use as a predictor, rather than a community’s use, may have vastly underestimated the impacts (Hunter and Prüss-Ustün 2016).  
 
As we advance our understanding of the ways in which a poor sanitary environment impacts growth in small children, we can better design water and sanitation interventions to target these pathways. While there is a role for multi-sectoral interventions, which can simultaneously target the underlying determinants of child undernutrition, such as food security, access to health services, and childcare practices — there are ways that the water sector can adapt its own approaches so that they are more nutrition-sensitive, and more impactful on nutrition. Here are four key actions:

Addressing the urban sanitation crisis: Time for a radical shift

Martin Gambrill's picture

Co-authors:

The Bill & Melinda Gates Foundation – Jan Willem Rosenboom
The University of Leeds – Barbara Evans
Emory University – Christine Moe & Eduardo Perez
The World Bank – Sophie Trémolet, Valérie Sturm, Clémentine Stip
WaterAid – Andrés Hueso
Plan International – Darren Saywell

Children in Maputo, Mozambique 
Photo credit: 
Isabel Blackett/The World Bank

A successful city is economically and culturally vibrant, healthy, safe, clean and attractive to business and tourism, and provides quality of life to its citizens. This vision is appealing but remains hard to realize as developing cities have to cope with changing demographics and climate with limited financial and human resources. The sustainable development goals have given a new impetus for cities to be inclusive, safe, resilient and sustainable (SDG11), ensure citizens’ health and wellbeing (SDG3) and secure access to sustainable water and sanitation services (SDG6).

World Toilet Day on November 19th is the opportunity to remind ourselves of a few facts and propose a set of guiding principles for a renewed and revitalized urban sanitation agenda.

How Countries Can Improve Access to Water for Women

Bhuvan Bhatnagar's picture
Because of water’s multidimensional role in economic development and poverty reduction, addressing the constraints that women and girls face in accessing and managing water is essential for achieving impact. 




Challenges of gender inequality in water include:
  • Women are disproportionately underrepresented in water sector decision making at many levels.
  • Women and girls are often charged with domestic water collection, disadvantaging other spheres of life, such as education.
  • Men benefit disproportionally from economic opportunities generated by the capital-intensive nature of water development and management.
  • Women and girls have specific sanitation needs, both for managing menstruation and for protection against gender-based violence. 

Eau : le point de rupture

Junaid Kamal Ahmad's picture
Also available in: English | Español

La Banque mondiale à la Semaine mondiale de l’eau 2015

Le thème ne pouvait être mieux choisi pour l’édition 2015 de la Semaine mondiale de l’eau de Stockholm : « De l’eau pour le développement ». L’eau est en effet un secteur crucial et qui atteint un point critique dans les affaires internationales. Au cours des 20 prochaines années et au-delà, la course à la sécurité alimentaire et énergétique et à une urbanisation durable exercera des pressions nouvelles et croissantes sur les ressources hydriques. 

Water: At a Tipping Point

Junaid Kamal Ahmad's picture
Also available in: Français | Español

The World Bank at World Water Week 2015

The Stockholm World Water Week’s focus on “Water for Development” comes at an opportune time. Water as a sector in world affairs is reaching a tipping point. Over the next two decades and more, the global push for food and energy security and for sustaining urbanization will place new and increasing demands on the water sector. 

Ours is a world of ‘thirsty agriculture’ and ‘thirsty energy’ competing with the needs of ‘thirsty cities.’ At the same time, climate change may potentially worsen the situation by increasing water stress as well as extreme events, reminding us that the water and climate nexus can no longer be a side event at global climate talks. All of this is happening in a context where the important agenda of access to services – despite the impressive gains over the past several decades – remains an unfinished agenda, requiring an urgent push if we are to fulfill the promise of universal access.

Los recursos hídricos se encuentran en un momento crítico

Junaid Kamal Ahmad's picture
Also available in: English | Français

El Banco Mundial en la Semana Mundial del Agua 2015

La Semana Mundial del Agua en Estocolmo se centra en el tema “Agua para el Desarrollo”, lo cual llega en un momento oportuno. Entre los asuntos mundiales, el sector del agua está llegando a un momento crítico. Durante las próximas dos décadas y posteriormente, los esfuerzos en el mundo encaminados a lograr la seguridad alimentaria y energética y la urbanización sostenible crearán nuevas y mayores demandas en relación con los recursos hídricos. 

Que se passe-t-il lorsqu’un enfant joue et fait ses besoins au même endroit ?

Emily C. Rand's picture
Also available in: English
Imaginons que vous êtes une maman en train de faire la lessive à la borne-fontaine située à proximité de la maison. Votre enfant de deux ans, qui joue par terre, a besoin d’aller aux toilettes. Que faites-vous ? Il y a de fortes chances pour que vous le laissiez faire ses besoins par terre, là où il se trouve.

Selon une analyse récemment menée par le Fonds des Nations Unies pour l'enfance (UNICEF) et le Programme pour l’eau et l’assainissement (WSP) de la Banque mondiale dans un certain nombre de pays clés, plus de 50% des ménages ayant des enfants de moins de trois ans indiquent n’avoir pris aucune précaution d’hygiène la dernière fois que l’un d’eux a fait ses besoins. Ce qui signifie, concrètement, que les enfants défèquent là où ils se trouvent et que leurs excréments sont laissés là, à l’air libre. Par ailleurs, les excréments d’autres enfants du voisinage sont jetés dans une rigole ou un fossé, ou bien enterrés ou jetés avec les déchets solides, et restent donc dans l’environnement direct de la zone d’habitation.

 

What happens when the playground is also the potty?

Emily C. Rand's picture
Also available in: Français

Imagine you are a busy mother scrubbing your laundry next to the public water stand near your yard. You realize your two year old — who is playing in the dirt — has to go to the toilet. What do you do? Chances are good you might just let them go on the ground somewhere nearby.

According to a recent analysis by the United Nations Children Fund (UNICEF) and the World Bank Global Water Practice's Water and Sanitation Program (WSP) in key countries, over 50 percent of households with children under age three reported that the feces of their children were unsafely disposed of the last time they defecated. What this really means is that children are literally pooping where they are and their feces are left there, in the open. Meanwhile, the feces of other children in the neighborhood are put or rinsed in a ditch or drain, or buried or thrown into solid waste streams that keep the feces near the household environment.

 

World Toilet Day: Focus on Equality and Dignity

Water Communications's picture

Today marks the second annual UN World Toilet Day, an important opportunity to promote global efforts to achieve universal access to sanitation by 2030. With a focus on equality and dignity, this year, World Toilet Day aims to highlight sanitation as a global development priority, especially for women and girls who must compromise their dignity and put their safety at risk when lack of access to sanitation forces them to defecate in the open.

World Toilet Day: The link between gender equality and sanitation

Junaid Kamal Ahmad's picture

​​Junaid Ahmad, World Bank Group Senior Director for Water, and Caren Grown, World Bank Group Senior Director for Gender, wrote a blog for Thomson Reuters Foundation ahead of World Toilet Day. Read the blog below, which originally appeared in Thomson Reuters Foundation.

Advancing equality for women in developing countries is not only the right thing to do, it makes good economic sense.

Gender equality enhances productivity, improves well-being, and renders governing bodies more representative. And yet around the world, discriminatory laws, preferences, and social norms ensure that girls and women learn less, earn less, own less, enjoy far fewer opportunities to achieve their potential, and suffer disproportionately in times of scarcity or shock.

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