Gender disparities in water, sanitation, and global health

Caruso, Bethany A.; Sevilimedu, Varadan; Fung, Isaac Chun-Hai; Patkar, Archana; Baker, Kelly K.

doi:10.1016/s0140-6736(15)61497-0

Cited by 56 publications

(45 citation statements)

References 4 publications

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“…But, some significant stress effects of water insecurity on women's BP are independent of those associated with food insecurity. There are growing literatures attesting to how gendered responsibilities for managing low household water place women at elevated risk of infectious disease, mental illness, and physical attack or trauma (Caruso, Sevilimedu, Fung, Patkar, & Baker, ; Ray, ). To our knowledge, this is the first demonstration that the stress of managing low water access could also elevate a risk factor for chronic disease.…”

Section: Discussionmentioning

confidence: 99%

Low water access as a gendered physiological stressor: Blood pressure evidence from Nepal

Brewis

Choudhary

Wutich

2019

American J Hum Biol

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Objectives The study aims to test novel proposed biocultural pathways linking the stressful lived experience of water insecurity to elevated blood pressure, a risk factor for chronic disease. Using the case of Nepal, where women have primary responsibility for managing household water, allows testing for potentially gendered mechanisms that exacerbate negative physiological consequences of water insecurity for women relative to men. Methods Data are from the nationally representative 2016 Nepal Demographic and Health Survey (DHS), N = 8633 women and 6209 men. Multiple regression models tested effects of low household water access on systolic and diastolic blood pressure, as stress biomarkers, comparing women to men. Key covariates included HFIAS food insecurity scores, household wealth class (high, medium, low), and body mass index. Results In this cross‐sectional study, low water access was consistently associated with higher women's systolic and diastolic blood pressure across all wealth levels. The strongest results were for the lowest wealth households, where low water access is concentrated. Higher food insecurity was also associated with higher systolic blood pressure values in women in these households. Men showed no such effects. Conclusions This is the first study, to our knowledge, to demonstrate a consistent and direct association between living with water insecurity and elevated blood pressure measures. Findings support the proposition that the stress of living with water insecurity could manifest as chronic disease risk. In the Nepali case, the proposed mechanism appears highly gendered, reflecting the culturally prescribed responsibilities women particularly face for managing household water. Living with food insecurity compounds further the apparent effects.

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Section: Discussionmentioning

confidence: 99%

Low water access as a gendered physiological stressor: Blood pressure evidence from Nepal

Brewis

Choudhary

Wutich

2019

American J Hum Biol

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“…We examine this association by joining two distinct literatures on sexual violence and water, sanitation and hygiene. It has been pointed out that discussions about making progress toward Millennium Development Goal (MDG) 7c – to “halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation” – have overlooked the importance of this goal for women’s safety [13]. There is a critical need to understand the implications of sanitation facilities beyond the realm of illness.…”

Section: Introductionmentioning

confidence: 99%

Household sanitation facilities and women’s risk of non-partner sexual violence in India

2016

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BackgroundGlobally, one in ten individuals practice open defecation. Despite media speculation that it increases women’s risk of sexual violence, little empirical evidence supports the claims. We investigate the relationship between household sanitation facilities and women’s risk of non-partner sexual violence (NPSV) in India, where nearly half of the population lives without a pit or toilet.MethodsWe use the most recent NPSV data, from the National Family Health Survey-III, to estimate logistic regression models of the effects of household sanitation facilities (toilet, pit, or none) on NPSV in the last year among women who have resided in their current home for one year or more. These effects are estimated net of other socioeconomic factors, compared to effects of household sanitation facilities on child diarrhea, and, as a falsification test, compared to effects of household sanitation facilities on intimate partner sexual violence (IPSV) in the last year.ResultsNet of their socioeconomic status, women who use open defecation are twice as likely to face NPSV as women with a household toilet. This is twice the association between open defecation and child diarrhea. The results of our falsification test indicate that open defecation is not correlated with IPSV, thus disconfirming a simultaneous selection of women into open defecation and sexual violence.ConclusionsOur findings provide empirical evidence that lacking household sanitation is associated with higher risk of NPSV.

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“…Where water insecurity co‐occurs with poverty and psychosocial disorders, we need a better understanding of the right entry and integration points for improved intervention efficacy. Moreover, because the impacts of water insecurity are socio‐economically differentiated and gendered (Adams, ; Caruso, Sevilimedu, Fung, Patkar, & Baker, ), we must improve the design of interventions for more targeted outcomes.…”

Section: Conclusion and Future Research Frontiersmentioning

confidence: 99%

Water insecurity and urban poverty in the Global South: Implications for health and human biology

Adams

Stoler

Adams

2019

American J Hum Biol

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Objectives: Over half of the world's population (4 billion people) experience severe water scarcity at least one month per year, while half a billion people experience severe water scarcity throughout the year. Despite progress from national and global interventions, a staggering proportion of the Global South remains water insecure. Rapid urban growth and associated demographic changes, climate change, and governance failure have also fostered the growth and expansion of urban informal settlements and slums where widespread poverty and environmental hazards exacerbate the impact of water insecurity on health. This article reflects on the interactions between water insecurity and urban poverty in the Global South across four categories of health outcomes: gastrointestinal diseases, mosquito-borne diseases, injuries, and mental illness. These examples highlight the mechanisms through which urban poverty exacerbates the adverse health effects of water insecurity.Methods: The four selected health outcomes were chosen a priori to represent two communicable conditions with well-developed literatures, and two noncommunicable conditions with newer literatures that have emerged over the last decade. We conducted a narrative literature review of scholarly and gray literature appearing between January 2000 and April 2019 using several online scholarly databases. Results: Gastrointestinal diseases, mosquito-borne diseases, injuries, and mental illness all exemplified the relationship between water insecurity and urban poverty through human biological pathways. For each of the four health categories, we identified frontiers for human biology research contributions to the water-poverty-health nexus. Conclusions: We discuss our findings in the context of three crosscutting themes that merit innovative research approaches: stressor interactions and trade-offs, exposure thresholds, and intervention efficacy. We reiterate that the global burden of disease associated with water insecurity cannot be addressed in isolation from efforts to alleviate extreme poverty.

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Gender disparities in water, sanitation, and global health

Cited by 56 publications

References 4 publications

Low water access as a gendered physiological stressor: Blood pressure evidence from Nepal

Low water access as a gendered physiological stressor: Blood pressure evidence from Nepal

Household sanitation facilities and women’s risk of non-partner sexual violence in India

Water insecurity and urban poverty in the Global South: Implications for health and human biology

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