IntroductionThe work of carrying water falls mainly on women and children, particularly in sub-Saharan Africa and rural areas. While concerns have been raised, how water carriage is associated with health of the water carrier is not clear. The aim of this review is to summarise evidence on whether, and how, water carriage is associated with the water carrier’s health.MethodsA systematic review of literature was conducted, searching Embase; Medline; Web of Science Social Sciences Citation Index; Web of Science Arts and Humanities Citation Index; International Initiative for Impact Evaluation website; WHO Virtual Health Sciences Library and WHO African index medicus, from inception to 8 November 2017.ResultsForty-two studies were included. Their ability to demonstrate cause and effect relationships was limited by study design and fair or poor methodological quality. Overall, the studies suggest that water carriage is associated with negative aspects of the water carriers’ health. There is moderate quantitative and strong qualitative evidence that water carriage is associated with pain, fatigue, perinatal health problems and violence against vulnerable people, and inconclusive evidence of an association with stress or self-reported mental health and general health status.ConclusionIn many circumstances, water carriage is a potential barrier to Sustainable Development Goal (SDG) 6 target ‘universal and equitable access to safe and affordable drinking water for all’ and SDG 3 ‘ensure healthy lives and promote well-being for all at all ages’. Efforts should focus on providing water on premises, and where this is not possible, providing water close to home and reducing risk of gender-based violence.

The levels of sanitation and water services coverage as well as health attainment are low among indigenous peoples. This exclusion from basic service has not been sufficiently studied. The present review has analyzed 185 articles dealing with indigenous peoples and the water, sanitation and hygiene complex. The literature is dramatically skewed towards water resources, and overwhelmingly focused on conflicts, at the expense of basic sanitation and hygiene. More initiatives towards the acknowledgement of indigenous peoples' world-views and institutions in all aspects of the water management cycle are needed. To this end, the development of effective intercultural dialogue mechanisms is crucial.

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