The Physical Burden of Water Carrying and Women’s Psychosocial Well-Being: Evidence from Rural Nepal

Abstract

Many women in low-income countries carry heavy loads of drinking water for their families in difficult terrain. This can adversely affect their health and well-being. The present study is the first to investigate the physical burden of water carrying and women’s psychosocial well-being, and how this relationship is moderated by environmental and health conditions. Trained local interviewers conducted interviews with 1001 women across five rural communities in Nepal. In addition, objective measurement was used to assess the weight carried and distance from the water source. The physical burden of water carrying was calculated from weight, distance, and frequency of trips. Its association with psychosocial well-being was modeled using generalized estimating equations. Two additional models included the terrain and uterine prolapse as moderators. The physical burden of water carrying is directly related to higher emotional distress and reduced daily functioning. This correlation was exacerbated for women carrying in hilly versus flat terrain, and for those who had uterine prolapse. Our results underline the importance of adequate water access for women’s psychosocial well-being, especially for vulnerable populations such as women with impaired health (e.g., uterine prolapse) or those living in hilly terrain. The results further highlight the interconnectedness of the Sustainable Development Goal (SDG) 6: water access, SDG 3: health and well-being, and SDG 5: gender equality.

Drinking water and the implications for gender equity and empowerment: A systematic review of qualitative and quantitative evidence

“…This finding aligns with previous systematic reviews, which have found a lack of WaSH-related water-borne disease studies among adult populations; most focus on children (Pouramin et al, 2020). As drinking water is a heavily gendered issue that disproportionately impacts women and is a known cause of many parasitic, infectious, and diarrheal diseases, we recommend future studies also include adult populations and disaggregate data by gender when evaluating water-related disease incidence (Mourad et al, 2019;Hunter et al, 2001;Beer et al, 2015;Tomberge et al, 2021;Graham et al, 2016). Furthermore, it is important to note the lack of research regarding the impact of water-related parasitic, infectious, and diarrheal diseases on pregnant women and newborns.…”

“…Inadequate access to WaSH services is responsible for 9.1% of the global disease burden and 6.3% of all deaths worldwide (Prüss-Üstün et al, 2008). Additionally, barriers to safe drinking water often lead to various negative health outcomes such as diarrhea, cholera, trachoma, typhoid, shigellosis, and malaria (Beer et al, 2015;Bisung and Elliott, 2017;Hunter et al, 2010;Moura et al, 2019;Mourad et al, 2019;Sengupta, 2013;Tomberge et al, 2021). A global study in 2014 of 145 countries concluded that WaSH-related diarrheal deaths accounted for 1.5% of the total disease burden, 58% of all diarrheal diseases, and 9% of all deaths for children younger than 5 years old (Liu et al, 2012;Prüss-Ustün et al, 2014).…”

“…Women and girls are disproportionately affected by inadequate water access because they are largely responsible for household water management (Graham et al, 2016;Kayser et al, 2019;Pouramin et al, 2020;Tomberge et al, 2021) When water sources are not readily accessible at the home, women and girls are responsible for collecting water in 4 out of 5 households worldwide (United Nations Children's FundWorld Health Organization, 2019). Compared to men, women experience many negative WaSH-related health outcomes, some of which have been disaggregated (Stevenson et al, 2012;Wutich and Ragsdale, 2008).Women and girls account for a higher number of deaths due to diarrheal diseases and higher disability adjusted life years (DALYs) caused by inadequate hygiene (Prüss-Ustün et al, 2019;Pal et al, 2018).…”

Water carrying in hills of Nepal–associations with women’s musculoskeletal disorders, uterine prolapse, and spontaneous abortions

“…Our study was conducted in the difficult terrain of the Nepalese hills where almost half of the women had to carry containers filled with water uphill or downhill. Nevertheless, the topography was not identified as a significant risk factor for water carrying related physical health outcomes among women in the reproductive age, although it was significantly related to higher emotional distress [ 10 ].…”

“…Since the responsibility for ensuring a sufficient supply of water to meet daily household demand lies mostly on women’s shoulders, access to water that is a distance away results in a considerable burden of time and energy for women who carry the water home [ 7 , 8 ]. This work is directly linked to women’s health because it can lead to musculoskeletal pain, fatigue, and emotional stress [ 9 , 10 ]. Geere et al conducted a systematic review of 42 studies on the association between water carrying and health and found moderate quantitative and strong qualitative evidence that water carrying is associated with musculoskeletal pain, fatigue, perinatal health problems, and violence against vulnerable people.…”