Not just any toilet – women’s solutions to sanitation in informal settlements in Nairobi

Winter, Samantha C.; Barchi, Francis; Dzombo, Millicent Ningoma

doi:10.1080/09614524.2018.1519013

Cited by 5 publications

(13 citation statements)

References 14 publications

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“…A growing number of sanitation interventions have been implemented in Mathare in recent years, such as Sanergy’s Fresh Life toilets, Grand Challenge Canada’s funded Banza toilets, and/or National Youth Service’s (NYS) slum improvement project toilets, to name a few, but little is known about the effect of these interventions on women’s ability to consistently access sanitation throughout a 24-h period, changes in women’s sanitation management strategies or on sanitation-related health outcomes like diarrhea. Findings from a recent article focused on women’s solutions to sanitation challenges in Mathare, suggest that strategies aimed at supporting women’s efforts for collective action around issues of sanitation and co-production efforts between landlords and governments may help women have more and better options to manage household sanitation more safely and, consequently, to reduce household diarrhea [ 23 ]. These collective action and co-production strategies are also in-line with the WHO’s recent Guidelines on Sanitation and Health, which encourage sanitation strategies and interventions that combine government leadership, oversight, monitoring, and potential funding with locally delivered services [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other studies report that women with small children often take their children with them when they leave the home to access sanitation and/or collect water [ 20 – 22 ]—suggesting that the mother’s WASH-related behaviors may be linked to their children’s exposure to different environments and, consequently, their health [ 16 , 18 ]. Additionally, if a woman lacks the ability to pay to use a public toilet for herself, she is also unlikely to be able to pay for her children to use the public facility—suggesting that both she and her children have to find alternative methods of disposal, such as the use of bags/buckets in the home or open defecation (OD), to meet their sanitation needs [ 18 , 23 ]. Lastly, women are typically responsible for two other potential sources of household diarrhea: cooking and handling of food and collecting and managing household water supplies [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Exploring the complex relationship between women’s sanitation practices and household diarrhea in the slums of Nairobi: a cross-sectional study

Winter

Dzombo²,

Barchi³

2019

BMC Infect Dis

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BackgroundDiarrheal disease kills over half a million people each year in sub-Saharan Africa; the majority are children under 5 years. About 58% of diarrhea cases are associated with poor water, sanitation, and hygiene—a critical issue for people living in informal settlements. In Kenya, 60% of Nairobi’s population lives in informal settlements; yet, there is a paucity of research exploring the relationship between water, sanitation and hygiene (WASH) conditions in these settlements and associated health outcomes.MethodsThe study examines characteristics of women’s WASH behaviors and environments as potential factors associated with household diarrhea in Mathare Valley Informal Settlement in Nairobi using cross-sectional survey data collected from 550 women.ResultsApproximately 17% of participants reported that at least one member of the household suffered from diarrhea in the previous 2 weeks—48% of the cases were children under five. Results from a logistic regression exploring factors associated with reports of household diarrhea suggest that women’s sanitation management strategies are associated with recent household diarrhea. Women who use toilets for defecation during the day, but rely on bags, buckets, or open defecation (OD) for urination during the day and for urination and defecation at night have over five time the odds of recent household diarrhea than women who use a toilet for all their sanitation needs. The odds of diarrhea were also higher for participants who walk up to 2 min to reach their toilets/sites for defecation and those who rely on water from taps inside buildings and plots. Odds were 62% lower for participants with clean toilets.ConclusionsFindings suggest that health targets to reduce the prevalence of diarrheal diseases in informal settlements may not be met unless particular attention is paid to the needs of women living in these environments.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exploring the complex relationship between women’s sanitation practices and household diarrhea in the slums of Nairobi: a cross-sectional study

Winter

Dzombo²,

Barchi³

2019

BMC Infect Dis

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“…Women's income-earning has enhanced their ability to make household water and sanitation decisions, particularly pertaining to small purchases or pay-per-use sanitation facilities. 29,45,91,110,133 When large expenditures are involved, such as for latrine construction, women have been excluded from decision-making, 48,55,86,97,105,109,110,117,121,128 potentially resulting in latrines that fail to accomodate needs and thus remain unused. 48,55,110 In Kenya, women reported limited input over home rental decisions, including which WASH services should be available.…”

Section: A Decision-makingmentioning

confidence: 99%

“…Women's collective action has led to funding, demand, construction, repair, and maintenance of water services 42,47,59,64,75,77,111,115,149,151,154,155,179,282 and latrines. 115,125,133,154,156,160,161 Women have organized to form lending groups to support womenled WASH businesses, 52 provide community education about water safety, 42,47,59,64,75,77,111,115,149,151,154,155,179,282 monitor open defecation, 131 and respond to sanitationrelated harassment. 160 Indigenous women in Bolivia and the U.S. have collectively defended water access.…”

Section: C Collective Actionmentioning

confidence: 99%

“…General Fears and Perceptions of Safety General safety concerns were widely noted, 86,105,109,125,129,133,157,163,168,172,174,177,187,188,209,[212][213][214][215]219,224,226,227,237,241,243 including feeling unsafe collecting water, 86,105,163 or using sanitation facilities at night, 154,157,176,215,[241][242][243] and when toilets lack doors, locks, lighting, or are far. 157,176,200,209,[225][226][227]238,241 Safety issues were described as particularly intense for adolescent girls, young women, and minorities.…”

Section: Ai Safety and Securitymentioning

confidence: 99%

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Water, Sanitation, and Women’s Empowerment: A systematic review and qualitative metasynthesis

Caruso

Conrad

Patrick

et al. 2021

Preprint

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BackgroundWater and sanitation programs historically have focused on women’s instrumental value in improving effectiveness and impact of programs, though focus is shifting to consider how programming and conditions may contribute to women’s empowerment an gender equality. To date no systematic review has comprehensively assessed and synthesized evidence on water and sanitation and women and girls’ empowerment. The primary aims of this review were to: a) identify empirical water and sanitation research that engaged empowerment and/or empowerment-related domains from a pre-specified conceptual model; b) tabulate and report how empowerment-related terminology was used, where and when research was conducted, what methods were leveraged, and if water and/or sanitation was the primary focus; c) synthesize findings by empowerment domain and water and/or sanitation focus.Methods and FindingsThe conceptual model of women’s and girls’ empowerment developed by van Eerdewijk et.al (2017) informed our search strategy and analysis. The model presents three interrelated domains (agency, resources, institutional structures) and 13 sub-domains of empowerment. We searched MEDLINE, EMBASE, CABI Global Health, PsycINFO, CINAHL and AGRICOLA for any peer-reviewed sources presenting research related to water and/or sanitation and either empowerment and/or related terms from the conceptual model (4 May 2020). Systematic and ancestry and decendency searching identified 12,616 publications, of which 257 were included following screening, representing 1,600,348 participants. We assessed all studies using the Mixed-Method Appraisal Tool (MMAT). We followed the ‘best-fit framework synthesis’ approach for analysis, using the domains and sub-domains of the conceptual model as codes to assess all included sources. During coding, we inductively identified two additional sub-domains relevant to water and sanitation: privacy and freedom of movement. Thematic analysis guided synthesis of coded text by domain and sub-domain. The majority of research took place in Asia (46%; 117) or Africa (40%; 102), engaged adults (69%; 177), and were published since 2010; (82%; 211). A greater proportion of studies focused on water (45%; 115) than sanitation (22%; 57) or both (33%; 85). Over half of articles use the term empowerment yet only 7% (17) provided a clear definition or conceptualization. Agency was the least commonly engaged domain (47%; 122) while the Resources domain was dominant (94%; 241). Measures for assessing empowerment and related domains is limited. This review was limited by only including sources in English and only includes menstruation-focused research in the context of water and sanitation.ConclusionsWater and sanitation research specifically engaging women’s and girls’ empowerment in a well-defined or conceptualized manner is limited. A substantial body of research examining domains and sub-domains of empowerment exists, as does research that illuminates myriad negative impacts of water and sanitation conditions and circumstances women’s and girl’s well-being. Available research should be used to develop and evaluate programs focused on improving the life outcomes of women and girls, which has only been minimally conducted to date. A more comprehensive ‘transformative WASH’ that includes gender-transformative approaches to challenge and reduce systemic constraints on women’s and girls’ resources and agency is not only warranted but long overdue.

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Indicators for evaluating shared sanitation quality: a systematic review and recommendations for sanitation monitoring

Lebu,

Sprouse,

Akudago

et al. 2024

npj Clean Water

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Not just any toilet – women’s solutions to sanitation in informal settlements in Nairobi

Cited by 5 publications

References 14 publications

Exploring the complex relationship between women’s sanitation practices and household diarrhea in the slums of Nairobi: a cross-sectional study

Exploring the complex relationship between women’s sanitation practices and household diarrhea in the slums of Nairobi: a cross-sectional study

Water, Sanitation, and Women’s Empowerment: A systematic review and qualitative metasynthesis

Indicators for evaluating shared sanitation quality: a systematic review and recommendations for sanitation monitoring

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