Empowerment in water, sanitation and hygiene index

Dickin, Sarah; Bisung, Elijah; Nansi, Juste; Charles, Katrina

doi:10.1016/j.worlddev.2020.105158

Cited by 52 publications

(34 citation statements)

References 40 publications

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“…In the same way, a study from rural part of Ethiopia showed that having good information about the benefits of WASH services was associated with having these services at home (49,50). Though it had variation in the types of indicators used to measure empowerment, this finding broadly supports the work of other studies in this area linking sanitation with women's empowerment (48,51). As it can be seen in the supplement file, the control variables that showed association with having improved sanitation service include possession of television, place of residence and household wealth index, which is in line with existing evidence (52).…”

Section: Discussionsupporting

confidence: 58%

“…As a result, these analyses did not consider single, widowed, divorced, and separated women, which could have led to under or over estimation of the results. Another important limitation of the current analyses is that better WASH services may lead to empowerment (e.g., women spending more time on educational and income-generating activities or stay healthy from WASH-related ill-health so that gain time to involve in social and political organizations) (51). Furthermore, there could be other factors confounding or mediating the current associations.…”

Section: Discussionmentioning

confidence: 91%

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Association of Women’s Empowerment With Water, Sanitation, and Hygiene (Wash) Services in Ethiopia: A Cross-sectional Analysis

Bogale

2021

Preprint

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Background: Access to safe drinking water, sanitation, and hygiene (WASH) services is vital for human health and well-being. In Ethiopia, lack of improved WASH services has existed as a health problem for many years. Empowering women is among the most important factors for improving WASH services, but research-based evidence is lacking in this regard. The present study was designed to analyse the association between women’s empowerment and WASH services in Ethiopia.Methods: This analysis is based on the 2016 Ethiopian Demographic and Health Survey (EDHS). The survey-based Women’s emPowERment (SWPER) index approach is used to develop women’s empowerment indices. The three empowerment domains used by the SWPER authors include attitude to violence, social independence, and decision-making. Multilevel logistic regression was used to assess the association between these domains of women’s empowerment and WASH services. Estimates were presented as odds ratio (OR) and expressed per one standard deviation (SD) with significance levels set at the 5% level. Results: Overall, 90.9%, 78.4%, and 50.3% of the households included in this analysis had no basic handwashing facility, improved sanitation facility, and improved water source, respectively. A one SD increase in the social independence domain was associated with 16% higher odds of having basic handwashing facility (AOR: 1.16; 95%CI: 1.02, 1.33). As women’s attitude to violence increased by one SD, the odds of having improved sanitation facility is increased by 22% (AOR: 1.22; 95%CI: 1.05, 1.42). Also, a SD increase in social independence domain was associated with 18% higher odds of having improved sanitation facility (AOR: 1.18; 95% CI: 1.04, 1.34). There was no statistically significant association between domains of women’s empowerment and source of water.Conclusions: This study has shown that most of the households in Ethiopia had no access to improved WASH services. Multiple regression analyses revealed that empowering women had association with having basic handwashing and improved sanitation facility. The findings of this study have suggestive evidence that empowering women could improve WASH cervices.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 91%

Association of Women’s Empowerment With Water, Sanitation, and Hygiene (Wash) Services in Ethiopia: A Cross-sectional Analysis

Bogale

2021

Preprint

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“…In LICs, often at least one dimension of a person’s social identity is deprivileged [ 29 , 36 ]. Scholars have established that in LICs, hygiene behaviors can intersect with inequalities of poverty status [ 37 ], gender [ 38 ], a rural-urban divide [ 5 ], age [ 39 ], education [ 40 ], ethnicity [ 41 ] and social status [ 42 ]. Looking at these dimensions separately obscures their interconnectedness and the overlapping disadvantages experienced by some groups in a given social setting.…”

Section: Introductionmentioning

confidence: 99%

Embracing challenging complexity: exploring handwashing behavior from a combined socioecological and intersectional perspective in Sierra Leone

Lanfer

Reifegerste

2021

BMC Public Health

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Background Handwashing with soap is a cost-effective, efficient health behavior to prevent various diseases. Despite its immense health benefits, the lowest prevalence of handwashing is found in low-income countries. Here, its practice is not only determined by individual behavior, but also heavily shaped by deprivations in the social and structural ecology. Moreover, handwashing barriers are not equally experienced as overlapping social identities (e.g., age and gender) intersect and create inequities between members of different social groups. To embrace the complexities of handwashing beyond individual-level behavior and singular social identities, a combined socioecological and intersectional perspective is employed. This multi-level approach with regards to intersecting privileges and disadvantages serves as a basis to promote this highly important health behavior. Methods This study used a qualitative, theory-based approach and combined data from two samples: experts in health promotion (n = 22) and local citizens stratified by gender and rural/urban location (n = 56). Data was collected in face-to-face interviews in Sierra Leone between November 2018 and January 2019 and analyzed using thematic analysis and typology of the qualitative data. Results The conceptualization of multi-level determinants of handwashing within a socioecological model showed the high relevance of inhibiting social and structural factors for handwashing practice. By establishing seven distinguishing social identity dimensions, data demonstrates that individuals within the same social setting yet with distinct social identities experience strikingly differing degrees of power and privileges to enact handwashing. While a local leader is influential and may also change structural-level determinants, a young, rural wife experiences multiple social and structural constraints to perform handwashing with soap, even if she has high handwashing intentions. Conclusion This study provides a holistic analytical framework for the identification of determinants on multiple levels and accumulating intersections of socially produced inequalities for handwashing and is applicable to other health topics. As the exploration of handwashing was approached from a solution-focused instead of a problem-focused perspective, the analysis can guide multi-level intervention approaches (e.g., using low-cost, participatory activities at the community level to make use of the available social capital).

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“…Data for this study were collected as part of household data collection for developing the EWI (Dickin et al 2021). The EWI is a survey-based tool developed to measure, monitor, and carry out diagnostics of empowerment in WASH-related interventions.…”

Section: Data Collectionmentioning

confidence: 99%

“…However, there is growing recognition of the role household dynamics play in WASH uptake (Augsburg & Rodríguez-Lesmes 2020;Danert & Hutton 2020), and few recent studies have sought to address the role of decision-making. The recently developed Empowerment in WASH index (EWI) includes indicators on intra-household decision-making related to sanitation expenditure, community planning, and water collection as indicators of empowerment (Bisung & Dickin 2019;Dickin et al 2021). Similarly, proxy measures of women's decision-making power for major household purchases were found to be strongly linked to better sanitation outcomes in Kenya (Hirai et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Who does what and why? Examining intra-household water and sanitation decision-making and autonomy in Asutifi North, Ghana

Bisung

Dickin

2021

Journal of Water, Sanitation and Hygiene for Development

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While under-researched in the water, sanitation and hygiene (WASH) sector, it is increasingly clear that women's agency is fundamental to addressing inequalities in many contexts. However, focusing on agency alone can overlook the underlying reasons for decision-making behaviour. This article examines two important aspects of decision-making: motivations behind a person's actions, and the extent to which decisions are perceived to be sole or joint decisions. We draw on a household survey of 600 respondents to examine decision-making related to three domains: water collection, WASH expenditures, and WASH community planning among dual adult household members in Asutifi North district, Ghana. On average, women were more likely to report no input into decision-making related to sanitation expenditure and community participation. However, women had high decision-making autonomy related to water collection and community participation compared to men. Disagreement on decision-making among partners was substantial and systematic across the three domains. These findings imply that decision-making in WASH are gendered, and better contextual understanding of the underlying gender dynamics is very important for promoting women's empowerment in WASH. These dynamics are particularly important to consider in interventions that rely on household self-supply of water or sanitation facilities.

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Empowerment in water, sanitation and hygiene index

Cited by 52 publications

References 40 publications

Association of Women’s Empowerment With Water, Sanitation, and Hygiene (Wash) Services in Ethiopia: A Cross-sectional Analysis

Association of Women’s Empowerment With Water, Sanitation, and Hygiene (Wash) Services in Ethiopia: A Cross-sectional Analysis

Embracing challenging complexity: exploring handwashing behavior from a combined socioecological and intersectional perspective in Sierra Leone

Who does what and why? Examining intra-household water and sanitation decision-making and autonomy in Asutifi North, Ghana

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