‘I know how stressful it is to lack water!’ Exploring the lived experiences of household water insecurity among pregnant and postpartum women in western Kenya

Collins, Steven M.; Owuor, Patrick Mbullo; Miller, Joshua D.; Boateng, Godfred O.; Wekesa, Pauline; Onono, Maricianah; Young, Sera L.

doi:10.1080/17441692.2018.1521861

Cited by 111 publications

(182 citation statements)

References 45 publications

(44 reference statements)

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“…Our analysis contributes to existing literature by clearly establishing the basic association between water and child's likelihood of achieving MDD, which may shape child nutrition outcomes. Our finding that suboptimal household water access is associated with lower probability of a child achieving MDD advances the emergent body of research that offers insights into a few ways through which the linkage between water access and dietary diversity unfold (e.g., Collins et al, 2019;Gibson, Ferguson, & Lehrfeld, 1998;Schuster, Butler, Wutich, Miller, Young, & HWISE Consortium, n.d). Household water access can affect child's dietary diversity also through gendered and competing demands on caregiver time.…”

Section: Discussionmentioning

confidence: 63%

“…Second, at the household level, water access can affect dietary diversity through budget constraints that may force low-resource households to choose between buying water, food, or fuel. When they purchase water, this leaves insufficient funds for acquiring an adequate and diverse diet (Cumming & Cairncross, 2016;Collins et al, 2019;Mason, 2015). Third, water at the household level may affect child's dietary diversity because water is very important in preparation of household foods Wutich & Brewis, 2014).…”

mentioning

confidence: 99%

“…Complementary foods have high water requirements (Wichmann & Voyi, 2006). Mothers have reported increased demand for water during the first 1,000 days of child life, for preparation of complementary foods and breastfeeding (Collins et al, 2019). An assessment of recipes for complementary foods prepared in low-and middle-income countries identified water as a critical ingredient commonly comprising 70% to as high as 90% of ingredient proportions (Ferguson & Lehrfeld, 1998).…”

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confidence: 99%

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Water insecurity potentially undermines dietary diversity of children aged 6–23 months: Evidence from India

Choudhary

Schuster

Brewis

et al. 2020

Maternal & Child Nutrition

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Dietary diversity is a crucial pathway to child nutrition; lack of diversity may deprive children of critical macro and micronutrients. Though water along with hygiene and sanitation is a known driver of child undernutrition, a more direct role of household water in shaping dietary diversity remains unexplored. Existing literature provides a sound theoretical basis to expect that water could affect dietary diversity among young children. Here, we test the proposition that suboptimal household access to water and low regional water availability associate with lower dietary diversity among young children. Using the nationally representative 2015–2016 India Demographic and Health Survey data, we conducted a probit analysis on the sample of 69,841 children aged 6–23 months to predict the probability that a child achieves minimum standards of dietary diversity (MDD). After controlling for relevant socioeconomic and gender‐related covariates, we found that children in household with suboptimal household water access were two percentage points less likely to achieve MDD, when compared with those from households with optimal water access. Children in high water availability regions had nine percentage points greater probability of achieving MDD compared with children from low water availability regions, accounting for household water access. As dietary diversity is central to nutrition, establishing the role of water access in shaping early childhood dietary diversity broadens the framework on how household material poverty shapes child malnutrition—independent of sanitation and hygiene pathways. This provides additional window for nutrition planning and intervention wherein water‐based strategies can be leveraged in multiple ways.

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Section: Discussionmentioning

confidence: 63%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Water insecurity potentially undermines dietary diversity of children aged 6–23 months: Evidence from India

Choudhary

Schuster

Brewis

et al. 2020

Maternal & Child Nutrition

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“…Psychosocial stress and anxiety have increasingly been appreciated as important individual‐level components of water insecurity that shaped water seeking behavior (Collins et al, 2018; Hadley & Wutich, 2009; Mushavi et al, 2020; Workman & Ureksoy, 2017). Both a lack of water access and the process of negotiating access could lead to psychosocial distress, and women have borne most of this burden given the gender inequities in household water management responsibilities in many societies (Bisung & Elliott, 2017).…”

Section: Resultsmentioning

confidence: 99%

Socio‐environmental confounders of safe water interventions

Smiley

Stoler

2020

WIREs Water

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The international development community spends billions of dollars annually on safe drinking water projects globally in low-and middle-income settings. These projects are driven by the World Health Organization's Joint Monitoring Programme metrics that rely on indirect measurements of water insecurity via water source and fetching time, with tacit acknowledgment of price inelasticity. But the success of water interventions, as framed by these metrics, is often tempered by the reality that people do not always use the safest, nearest, or least expensive water source. Drinking water interventions are confounded by diverse social and environmental factors that shape household water seeking behaviors in unexpected or underappreciated ways. These caveats to human water-related behaviors are littered throughout the drinking water literatureoften as an anecdote to a given study's primary findings-and present significant barriers to providing universal safe water as outlined by Sustainable Development Goal 6. We review and categorize these socio-environmental confounders into six themes at multiple scales: social relations, water properties, intermittency, affordability, fetching practices, and physical and mental health. We illustrate how efforts to mitigate drinking water insecurity are complicated by the interaction of these social and physical processes. We highlight emerging metrics that enable a richer assessment of household water insecurity, and emphasize the importance of transdisciplinary approaches to improve the effectiveness of clean water interventions.

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“…Data collection for this study was structured in four phases (Table 1). The first phase, formative data collection, explored the experiences of water insecurity through “go-along interviews” (Activity A) [46,47], Photovoice photo elicitation interviews (Activity B) [48,49], and the Delphi method (Activity C) [50], which was conducted concurrently with focus group discussions (FGDs; Activity D)) [35]. The second phase involved the assembly (Activity E) and revision of HHWI scale questions using cognitive interviews (Activity F) [51–53].…”

Section: Methodsmentioning

confidence: 99%

A Novel Household Water Insecurity Scale: Procedures and Psychometric Analysis among Postpartum Women in Western Kenya

Boateng

Collins

Mbullo

et al. 2018

Preprint

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Our ability to measure household-level food insecurity has revealed its critical role in a range of physical, psychosocial, and health outcomes. Currently, there is no analogous, standardized instrument for quantifying household-level water insecurity, which prevents us from understanding both its prevalence and consequences. Therefore, our objectives were to develop and validate a household water insecurity scale appropriate for use in our cohort in western Kenya. We used a range of qualitative techniques to develop a preliminary set of 29 household water insecurity questions, and administered those questions at 15 and 18 months postpartum, concurrent with a suite of other survey modules. These data were complemented by data on quantity of water used and stored, and microbiological quality. Inter-item and item-total correlations were performed to reduce scale items to 20. Exploratory factor and parallel analyses were used to determine the latent factor structure; a unidimensional scale was hypothesized and tested using confirmatory factor and bifactor analyses, along with multiple statistical fit indices. Reliability was assessed using Cronbach’s alpha and the coefficient of stability, which produced a coefficient alpha of 0.97 at 15 and 18 months postpartum and a coefficient of stability of 0.62. Predictive, convergent and discriminant validity of the final household water insecurity scale were supported, based on relationships with food insecurity, perceived stress, per capita household water use, and time and money spent acquiring water. The resultant scale is a valid and reliable instrument. It can be used in this setting to test a range of hypotheses about the role of household water insecurity in numerous physical and psychosocial health outcomes, to identify the households most vulnerable to water insecurity, and to evaluate the effects of water-related interventions. To extend its applicability, we encourage efforts to develop a cross-culturally valid scale using robust qualitative and quantitative techniques.

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‘I know how stressful it is to lack water!’ Exploring the lived experiences of household water insecurity among pregnant and postpartum women in western Kenya

Cited by 111 publications

References 45 publications

Water insecurity potentially undermines dietary diversity of children aged 6–23 months: Evidence from India

Water insecurity potentially undermines dietary diversity of children aged 6–23 months: Evidence from India

Socio‐environmental confounders of safe water interventions

A Novel Household Water Insecurity Scale: Procedures and Psychometric Analysis among Postpartum Women in Western Kenya

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