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Gender

An institutional view on Menstrual Hygiene Management

Christian Borja-Vega's picture
Recent research points out that adequate water, sanitation and hygiene (WASH) in schools improves school attendance, health and cognitive development of students, nurtures better WASH habits, while addressing gendered dimensions of exclusion. Despite this evidence, operationalizing and streamlining important Menstrual Hygiene Management (MHM) elements into interventions that upgrade overall school infrastructure is often challenging.

The problem is partially rooted in institutions, who having imperceptibly supplanted traditional & cultural rites of passage often fail to recognize the extent of the need for robust, wholistic and sustained alternatives. Girls experiencing menarche not only require WASH infrastructure, but meaning; they not only need materials, space and privacy to change and dispose of menstrual products, but an environment free from aspersions, taboo and social restriction.
 
Download the full infographic to learn about WASH-based MHM interventions in schools. 

Connecting with the people beyond the computers: my experience in flood risk management in Buenos Aires

Catalina Ramirez's picture
Also available in Español 

After spending several years in front of a computer every day, I began to feel removed from those people who were the real reason for my work, which aims to build a safer, healthier and more prosperous environment. But when people I knew were directly affected by the issues I was working on, my work took on more meaning and urgency.

Women and jobs in water

Gaia Hatzfeldt's picture

On a busy street corner in Nairobi, Kenya, Abuya uses water to prepare and cook the food she sells to passersby. At the market in Hyderabad, India, Dimah splashes water on her fruit and vegetables to keep them fresh. In the make-shift hair-cutting salon in her basement in Medellin, Colombia, Isabela uses water to wash her customer’s hair.

The tyranny of toilets

Maitreyi Bordia Das's picture
Students heads to a female only toilets in Maskoke Primely and Secondly School
in Gode Town in Ethiopia. Credit: UNICEF Ethiopia

In the lead-in to World Toilet Day, we hear a great deal about the role of toilets in sanitation and in better health and human development outcomes.  Toilets are good development. Period.
 
We hear less about the fact that toilets are often sites and instruments of social exclusion.
 
Let me explain.
 
Segregated toilets for males and females were intended to give women privacy and to respect the “intrinsic” physical differences between the sexes.  In fact, in most developing countries, segregated toilets are a sine qua non for female participation in public spaces, in education and in employment. 
 
But the story is more complex.

Gender and sex inequalities in water, sanitation, and hygiene

Libbet Loughnan's picture

This blogpost is part of a series of thematic blogs for the World Bank's Water Supply, Sanitation, and Hygiene (WASH) Poverty Diagnostic.

Woman carries water containers near polluted stream and water pipe in Maputo, Mozambique

Addressing gender and sex inequalities in WASH is not only recognized in Sustainable Development Goals (SDGs) 4 and 6, it is central to the entire ambition of the SDGs themselves. Some water, sanitation, and hygiene issues are faced only by women because of their biological sex, whereas others are more influenced by gendered societal norms. To truly leave no one behind, we need to be mindful of and work against gender and sex inequalities in all development work. 
 
New World Bank research is a valuable contribution to doing just that.  ‘Reducing Inequalities in Water Supply, Sanitation, and Hygiene in the Era of the Sustainable Development Goals’ reveals that a drastic change is required in the way countries manage resources and provide key services, starting with better targeting to ensure they reach those most in need.  In many cases, this means women and girls. 

Water flows through development – big ideas from World Water Week

Guangzhe CHEN's picture
Guangzhe Chen, Senior Director, the World Bank’s Water Global Practice, 
speaks at the opening plenary of World Water Week 2017. Credit: Tim Wainwright

It was inspiring to see so many committed water practitioners at World Water Week in Stockholm the last week of August, coming together to share experiences and advance global action to achieve the Sustainable Development Goal of safe and accessible water and sanitation for all (SDG6) by 2030.  As we know, access to water and sanitation is key to thriving communities. It determines whether poor girls are educated, whether cities are healthy places to live, whether industries grow, and whether framers can withstand the impacts of floods and droughts.

Without it, we are limiting our full potential. In fact, today we face a “silent emergency”, with stunted grown affecting more than a third of all children under five in countries such as Bangladesh, Indonesia, Niger and Guatemala. This was presented in the new World Bank report WASH Poverty Diagnostics, provides new data on water, sanitation and hygiene (WASH) for 18 countries and finds that we get the biggest bang for the buck when we attack childhood stunting and mortality from many angles simultaneously, in a coordinated way. While improving water and sanitation alone does improve a child’s well-being, the impacts on child height are multiplied when water, sanitation, health, and nutrition interventions are combined. The report also pinpoints the geographical areas in a country where access to services are low or missing completely, and suggests that to move the needle on improving poverty indicators, policies need to be implemented and resources have to be better targeted to reach the most vulnerable.

Self-Help Women’s Groups in India help change behavior around diets and toilet use to improve health

Vinay Kumar Vutukuru's picture



Sushila Devi, a mother of four in the rural Rohtas district of Bihar, India, has no significant assets and depends primarily on casual labor for income. She recently was able to take out a bank loan of INR 12,000 (US$180), which she used to construct a toilet in her family home

It was the Self-Help Group (SHG) in her village that persuaded Sushila of the importance of sanitation for her children’s health and nutrition, and helped her get the loan she needed. SHGs generally consist of 12 to 15 rural women, grouped into larger federations. They engage with formal financial institutions to help unbanked households access financial services, acting as platforms for standardized large-scale sensitization of community members on a variety of subjects.

Sushila’s actions are part of a larger change driven across Bihar by the recently launched Bihar Transformative Development Project (BTDP), commonly known as JEEViKA-II. This joint initiative of the Government of Bihar and the World Bank covers 300 (56 percent) of the blocks of rural Bihar. The project is working through SHGs to deliver awareness, training, finance, and monitoring on sanitation and nutrition in an integrated manner.

Lack of access to a toilet and handwashing materials hits women and girls hardest, especially when menstruating

Libbet Loughnan's picture

Women and girls are particularly affected by the lack of safe and accessible water, sanitation and hygiene (WASH). They suffer during menstruation and childbirth, and also carry the burden of hours spent collecting water when is it not easily accessible, causing them to miss school and risk rape and harassment. To address this, women and girls are emphasized in Sustainable Development Goal (SDG) #6: “By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.”
 
While anecdotal evidence is important — and well known — it is critical to also collect data and indicators to quantify the problems, to sensitize and inform stakeholders, and ultimately, to find solutions. However, we are struggling with a global lack of monitoring to collect such data.

The “5Ds”: Changing attitudes to open defecation in India

Vandana Mehra's picture
In the village of Bharsauta in Uttar Pradesh, India, construction worker Vishwanath lives with his wife, four children and their elderly parents. Three years ago, the government paid to build a toilet in their house. But the job was not done well: the pit was too shallow, it overflows frequently, and the smell makes it suffocating to use.

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:

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