Gender and social outcomes of WASH interventions: synthesis of research evidence

Abstract

Safely managed water, sanitation, and hygiene (WASH) are fundamental for human health and wellbeing and are thought to contribute to a range of positive outcomes related to education, livelihoods, dignity, safety, and gender equality. However, gender and other social categories (e.g. age, ethnicity, caste, disability, marital status) can mediate who benefits from WASH services and in which ways. As progress in gaining access to safe WASH services has not occurred equally, there has been a focus on mainstreaming gender equality and social inclusion (GESI) in interventions. Despite awareness in the sector of the importance of promoting gender and socially inclusive WASH services, evaluations of interventions focus largely on technical or health outcomes, while social outcomes are not included. This systematic evidence synthesis aimed to collate evidence on the impact of WASH interventions on GESI outcomes in low- and middle-income countries (LMICs). It also aimed to synthesise evidence on violence-related outcomes, and to advance understanding of barriers to, and facilitators of, change in violence-related outcomes in the context of WASH interventions.

Impact on childhood mortality of interventions to improve drinking water, sanitation, and hygiene (WASH) to households: Systematic review and meta-analysis

“…Even though the review was restricted to endemic disease circumstances, the findings may also be relevant for epidemic disease control including Coronavirus 2019 [ 95 ]. It is well known that water supplies and sanitation are pro-poor and gender-inclusive interventions due to the time-savings and safety they may enable [ 96 – 98 ]. Our results suggest significant contributions could be made to reducing the global disease burden in childhood from improvements in water supplies and community-wide sanitation where access is particularly inadequate, especially in sub-Saharan Africa and parts of South Asia.…”

Evidence claims for informing decisions relating to socio-economic development

“…For two studies, the theory of change at the centre of the analysis was developed with input from stakeholders. The scope of a review about WASH, with an emphasis on gender and social equity, was co-designed with stakeholders, ensuring the relevance of the findings for WASH policy and practice (Macura et al, 2022). A logic model for involving men and boys in family planning, based on both stakeholder consultation and prior research, provided a framework for synthesising qualitative research (Aventin et al, 2023).…”

“…Presentation 1. A framework synthesis on violence outcomes of water, sanitation and hygiene (WASH) interventions led to evidence claims about the risk of violence being linked to sanitation infrastructure, social acceptance of violence and lack of consequent punishment, and the wider built environment, and about social cohesion and group protection facilitating feelings of safety (Macura et al, 2022). As this broad range of issues was identified from studies that applied various methods, confidence in the claims came from applying a mixed-methods critical appraisal tool (MMAT) to identify and synthesise only those studies that were of high or medium quality.…”

“…Another study (Macura et al, 2022) emphasised the relevance of findings in a blog post, statement: 'The review scope is co-designed with stakeholders ensuring relevance of findings for WASH policy and practice.' 6 This statement is justified by the fact that feedback on the protocol was made publicly available.…”

“…'there are substantial time savings from water supply interventions, which largely accrue to women, as well as substantial time savings from sanitation accruing to both women and men.' (Macura et al, 2022) However, studies available for synthesis rarely provided the data required for extended analyses of equity to encompass a specific caste or class, the elderly, ethnicity, religion, or people with disabilities; and never provided data on gender and sexual minorities (Macura et al, 2022).…”