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


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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 paper “What can existing data on water and sanitation tell us about menstrual hygiene management?” is short-listed in the recent Waterlines’ Jeroen Ensink Memorial Prize, commemorating the efforts of Dr. Ensink to improve the lives of those who today still live without access to safe drinking water and sanitation. 
Data where sex or gender differences might be inferred

In order to find ways to quantify gender and sex inequities in an internationally comparable manner, for the first time this paper helps establish the use of the handwashing and open defecation estimates long collected by the UNICEF Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS), and calculated and disseminated by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP).
Through such data, we understand that menstruating women are likely to have a less private and a more stressed experience when confronted by water scarcity and poor sanitation than their male counterparts. The article presents global and national estimates for 10 countries picked from the World Bank’s WASH Poverty Diagnostic, currently underway.
We found some striking data:

  • Half a billion women globally, or 13% of all women, lack a place to defecate, and likely lack privacy for menstrual hygiene management (MHM).
    • 197: Number of countries for which such estimates were available in 2015.
  • Data on handwashing suggests, by proxy, that lack of cleansing materials is a particular challenge for MHM. In six out of ten countries with available data, over 3/4 of women lack access to soap and water.
    • 54: Number of countries for which such estimates were available in 2015. 
World Bank research is also exploring other data, for example information on the location, privacy, and type of latrines available to a household. The table below notes a range (28) of distinctions that might help unpack gender and sex-related aspects of WASH.
Is it useful to estimate what percentage of girls or women live in a household who generally travel some distance to use a pit latrine that any stranger can walk into? We can calculate that. The categories “w” and “x” below represent it. The further distinction between “w” and “x” is whether or not they also lack a fully equipped handwashing station, an additional obstacle to menstrual hygiene management. Data on that, and each of the 28 measurements, is available for many countries, by background characteristics including subnational region, urban vs rural, ethnicity, religion, and wealth status.

*”XXX” is used to signify that as the surveys record how many households share the toilet/latrine, and there is not yet widespread consensus on the best number to use, this can be replaced in analysis with a specific number.
Data on a woman’s unique WASH experience
More data and direct measurements are also needed to better target solutions to women and girls. Since first deploying these measurements in Belize, the MICS are now rolling out new measurements for women and girls who menstruate, asking them:
  • When did your last menstrual period start?
  • Was the last menstrual period within last year?
  • Due to your last menstruation, were there any social activities, school, or work days that you did not attend?
  • During your last menstrual period were you able to wash and change in privacy while at home?
  • Did you use any materials such as sanitary pads, tampons, or cloth?
  • Were the materials reusable? 
In coming years, the answers to these questions will be available for multiple countries.

What happens beyond the household — in schools and health centers?
Under the SDGs, the WHO/UNICEF JMP — the responsible agency for the monitoring of SDG 6.1 and 6.2 — plans to shine a light on WASH challenges in locations that should be better prepared — such as schools and health care centers – as these facilities are a large part of an individual’s personal life and critical experiences.
The effects on women and girls
Looking to the bigger picture, it is worth noting that while some of the estimates mentioned here might help build an international picture of where and how inequities exist within the WASH experience, only the MICS question “Due to your last menstruation, were there any social activities, school, or work days that you did not attend?” directly quantifies the potential effect on women and girls’ participation in society, education, and work. These large-scale surveys also collect information on well-being, life satisfaction, education, desire to have children, violence and harassment, feelings of safety walking alone at night, etc. Any patterns we might find here will hold clues to how a woman’s WASH situation can impact her broader life.   
We will be sharing evidence we find on how gender or sex inequities in WASH correlate with broader life experiences and outcomes with you as our data grows.
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    Libbet Loughnan

    Water, Sanitation, Hygiene Statistics and Communications Specialist

    Mohammed Adamu
    April 14, 2017

    i work with action against hunger as a data enumerator I do collect data on WASH KAAP Survey I aksi have experience in GBV Case Management. I will like to volunteer either as GBV case worker or wash data assistant community mobilization assistant please thank you

    Nand Kishore Kumar
    April 14, 2017

    Good study.But is toilet facilities available in forest areas? Our children have to adjust with environment.Also moral standards safeguard girls in tribal areas.However school has improved sanitary facilities.Thanks World Bank.

    April 16, 2017

    I like this project, the problem is real particularly in African countries. Girls children in schools (i.e primary, secondary and colleges) are in great danger due to lack of sanitary environment suits them. The impacts from poor and uncoordinated way of helping them include spread of diseases, less concentration on studies or activities and even absenteeism from studies or wok. I highly recommend for further efforts towards addressing appropriate measures to ending this problem and making a better world for girl-children.

    Birahmani Ghulam Haider
    April 17, 2017

    Dear Madam/Sir,
    I hope you would be fine and busy in your routine activities.
    It would be very kind of you if send me all the material related to mentioned topics, as well as.
    Looking forward to your kind response.

    Haroon Rashid
    April 30, 2017

    Endorse Birhamani Ghulam Haider on gender based hygiene particularly female on menstrual hygiene, sanitation, and of course use of ETS (Electronic toilet System) which is a combination toilet commode, and bidet. Earlier Toto of Japan pioneered which was too expensive. But last year Chinese Tourism Dept., encouraged and made thousands of public toilets based on electronic cleaning, washing, particularly for females sanitation hygiene. The cost was very high earlier. Chinese pioneered with electronic digital microprocessor based toilet at amazingly low price. This could be a model to produce more as the price will come down. This would change the privacy of women/girls, women with problems of menstrual cycle, and hygiene. I suggest if this forum could write more and encourage the Chinese toilet price to come down to the price of US$10-00 and be subsidised by the World Bank or DFI's.

    April 18, 2017

    This is a great initiative
    I would like to support this studies in Africa/Kenya
    Thank you

    Emmanuel Quarshie
    April 18, 2017

    Thank you very much, World Bank for this study. It brings a lot of issues downplayed by leaders to the limelight. I would like to recommend that your future studies on water should also capture availability of safe and clean water during child birth, immediately after child birth and the nursing period of the child. These are very critical since they can have significant health impact on both the child and the expectant mother. How does the SDGs mimic the various policies which are country specific to achieve water security? Do they tend to have similar frameworks?

    September 14, 2017

    Despite the fact that menstruation is an integral part of a woman's life and managing it is a struggle in many developing countries, the matter did not get as much attention as it deserves in the development community, even in the WASH sector. That is why, we still do not have a comprhensive data on the impact of poor MHM. For example, there is lack of evidence on impact of poor MHM specially in school settings. Some studies show that poor MHM results in school absenteeism and while other studies claim that there is no definitive link between the two. I hope your study will give us the much needed data on the impact of menstrual hygiene management in livelihood, health, education, economic empowerment, participation etc