Socio‐environmental confounders of safe water interventions

Abstract

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.

In pursuit of ‘safe’ water: the burden of personal injury from water fetching in 21 low-income and middle-income countries

“…For example, is it simply the distance to a household’s primary water source that is a barrier, or is it the physical context or terrain, the fear of violence when water fetching, and/or the physical and financial cost of hauling water to the home? 32 Our findings suggest several such opportunities for implementers to help mitigate the effects of water-fetching injuries through existing programming. For example, providing and maintaining numerous shared water points throughout rural and peri-urban communities and supporting affordable local water delivery systems can reduce overall water-fetching trip distance and time spent in queues.…”

Household water insecurity will complicate the ongoing COVID-19 response: Evidence from 29 sites in 23 low- and middle-income countries

“…When households are unable to fetch water, or if fetching presents too large of an opportunity cost in terms of time spent, some may be forced to resort to higher-priced or lower-quality water from tankers, carts, and other forms of water vending, or use nearby surface water ( Smiley and Stoler, 2020 ). For lower income households, higher water costs may present tradeoffs for other household priorities, particularly health care for ill family members or COVID-19 preventive gear such as masks, gloves, disinfectant, soap, detergent and hand sanitizer.…”

“…Physical distancing guidelines would also seemingly discourage water fetching in groups, which eliminates a way of maintaining social capital and an important safety buffer for women and children, who frequently suffer harassment, assault, and accidents while fetching water throughout the world ( Collins et al, 2019 ; Venkataramanan et al, 2020 ). This reality can shape water-related decision making and cause women to take risks, such as using alternative inferior sources or navigating physically dangerous terrain to obtain water elsewhere ( Smiley and Stoler, 2020 ).…”

“…When water insecurity drives relocation, the introduction of COVID-19 into new locations is possible. Further, households often seek out more desirable water sources that can be chained to their commute and may therefore increase the risk of transmission to new neighborhoods if this source is outside their daily activity space ( Smiley and Stoler, 2020 ). Such dynamics may be further complicated if these destinations are ill-equipped to support new arrivals safely.…”

Food Insecurity and Water Insecurity in Rural Zimbabwe: Development of Multidimensional Household Measures

“…It is hypothesized that the impact on stunting reduction could be larger if underlying determinants (e.g., FI and WI) as per the UNICEF’s framework for undernutrition are addressed [ 82 ]. In most instances, efforts to mitigate FI and WI are complicated by interactions with social, environmental, and physical processes [ 83 , 84 ]. Therefore, our deconstructed measures of FI and WI provide an opportunity to explore specific aspects of FI and WI on undernutrition and related interventions for better targets.…”