Research On Water, Sanitation And Hygiene Programs In African Schools

The United Nations General Assembly set 17 Sustainable Development Goals (SDGs), as part of the 2030 Agenda for Sustainable Development. The SDGs are global targets that aim to eliminate poverty and inequality by 2030. SDG 6 aims to ensure access to water and sanitation for all. Of the eight targets listed within goal 6, only one is specifically gendered, target 6. 2: “By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations. ” The United Nations General Assembly stated that: “The human right to sanitation entitles everyone, without discrimination, to have physical and affordable access to sanitation, in all spheres of life, that is safe, hygienic, secure, socially and culturally acceptable and that provides privacy and ensures dignity. ”

To achieve SDG 6 the needs of 5. 6 billion people’s safe sanitation needs must be met. The target looks at food hygiene, handwashing with soap and menstrual hygiene management (MHM). SDG is an increase on the outputs from the Millennium Development Goals (MDGs) which only sought to improve sanitation, while the SDG seeks to provide safely managed sanitation for all. Under the MDGs, many more people would be considered to have improved sanitation, however under the SDGs, these sanitation facilities would not be considered safe, hygienic and sustainable. In addition, even when sanitation facilities are available, they are not necessarily accessible to all.

People suffer discrimination in accessing safe and hygienic sanitation facilities, often because of the intersection of various discriminatory factors such as poverty, gender, race or disability. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), through the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP), are responsible for monitoring SDG target 6. 2. According to JMP, few countries had data on the proportion of schools providing MHM education, sanitary towels and facilities for the disposal of used materials. While access to basic water, sanitation and hygiene (WASH) services is essential for the health and wellbeing of girls and boys of all ages, poor quality services affect girls more as they often struggle to manage their periods while at school. Girls at school need private toilets where they can wash and change, and access to water and soap so they can confidently manage their periods and continue attending school. UNICEF estimates that in 2016, 335 million girls went to school without water and soap available for handwashing when changing sanitary pads, an essential part of MHM. A UNICEF report on monitoring WASH in schools showed that globally only 66% of schools have access to adequate sanitation, and only 17% of countries monitor hygiene access in schools. Monitoring and data need to be improved in order to effectively achieve target 6. 2.

A gendered approach to WASH programs is complex with issues including equality, vulnerability, risks, access, rights and entitlements. When there is limited availability and access to water and sanitation in schools, it presents a major health concern and barrier to education. According to a 2018 report by Agol & Harvey, in sub-Saharan Africa, poor WASH is common in schools, creating challenges for schoolgirls trying to manage menstrual hygiene with inadequate or no water and sanitation facilities. According to Fukuda-Parr, the agenda of the SDGs is much broader than that of the MDGs with respect to gender, with a specific goal for gender concerns. It “…reflects gender equality and women’s empowerment as a multi-dimensional process, going beyond straightforward outcomes, and incorporates targets related to gender-based violence, harmful practices, unpaid care work, voice, sexual and reproductive health and rights, economic resources, technology, and legislative change. ” In addition to the gender-specific goal, some other goals have gendered targets.

I will look at target 6. 2, highlighted by three case studies in Africa (Uganda, Kenya and Zimbabwe), which look at the gendered effects of lack of access to toilets, clean water and hygiene. I will focus on WASH and how sanitation affects girls more than boys, particularly during menstruation. The case studies show how a gendered approach is necessary to achieve target 6. 2 as women and girls have different sanitation needs. According to WHO, hygiene includes “conditions and practices that help maintain health and prevent spread of disease” including handwashing, MHM and food hygiene. MHM relates to good hygiene practices during menstruation. This is challenging for many women and girls due to poverty and other factors. The 2014 case study by Kwiringira et al looks at the use and cleaning of latrines in Kampala slums in Uganda and how they’re regulated by gender. The study looked at six slums and found many issues affecting females rather than males. The latrines in the slums were unsanitary: poor drainage, foul smells, uncollected garbage, open defecation, plus there were latrine access issues and abandoned latrines. Nicer toilets were pay-per-use which most women couldn’t afford. Many women resorted to using a bucket inside their home. If there were long queues for public latrines, women had to leave chores and children unattended. If women had to defecate in the open, they were at risk of sexual assault. This risk was higher at night or during rainstorms, as “even if you shouted when under attack, no one will hear you”. Unlike men, women didn’t want to relieve themselves in public due to their anatomy, values, upbringing and susceptibility to attack. Unhygienic latrines left women at risk of infections, and women were at greater risk of disease from poor sanitation as they were usually responsible for disposing child waste.

These issues were heightened during menstruation. Accessibility was a major concern for women including filthy and narrow paths, and steep inclines that made access a challenge especially to females. Many women mentioned access to latrines being difficult at night because latrines are far and locked; in comparison, men were generally not affected by this. Men often left the slums during the day for work and so had access to better toilet facilities. Women would often need someone to accompany them to avoid sexual assault. Design of latrines was also an issue. Some were doorless and women said they required privacy. “The current conceptualization and design of latrines in slums is androcentric; androcentrism is the practice of consciously or otherwise making the male Worldview subsume female identity, culture and history. ” According to Kwiringira et al, these gendered issues with latrine access and use, which are more acute in slums than elsewhere, are denying women equitable access, as latrines are shared, unclean, small and not private enough for specific gender needs. Design, access and cleaning of latrines needs to consider gendered issues such as embarrassment, self-respect and safety for the poor. Kwiringira et al argue that despite the SDGs and global agencies insisting on improved access to sanitation, few governments consider the effects of poor sanitation on women living in poverty. A separate report by Sommer et al in three Kampala slums identified similar concerns: flawed sanitation facilities, fear of assault when using latrines at night, and feelings of shame and helplessness when trying to practise sanitation without clean, private and safe facilities. “Women’s added need for privacy during menstruation adds to the complexity of their burden. ” McMahon et al examine MHM and WASH interventions among Kenyan schoolgirls at six rural schools in the Nyanza Province of Western Kenya. The WASH program aims to improve female attendance at school. This study shows that when girls are menstruating, their attendance drops, due to inadequate facilities to clean themselves, and the unaffordability of sanitary pads.

McMahon et al explore how menstruation is managed by girls at school and the schoolgirls’ perceptions and practices related to menstruation. The teachers were also interviewed. They noted that a girl’s behaviour changes when she is menstruating, “A girl will be among the most lively in class, she will participate and make good marks. Then she turns a corner and she will not partake and she is gone. ” The study showed that girls were scared of getting their periods at school as they might have blood stains on their uniforms and be teased by other students. Some girls talked about the societal expectation that periods should be secret and how visible blood stains would therefore make them the target of bullying.

The issue with menstruating at school was exacerbated by the lack of adequate sanitary facilities. Girls interviewed said that they were unable to properly manage their periods at school due to the lack of water. They said they could not bathe, washrooms were not private or the water was cold. Bathing was only available in a few schools, via WASH programs, but was rare. Some girls said bathing in school was difficult as there is no soap or basin, and nowhere dry to put sanitary napkins. Adequate water and soap for washing or private latrines for girls to wash and change their supplies were important factors for girls in this study. In Kenya, Amnesty International identified that the inadequate availability of latrines in Nairobi slums results in violence against women when they use latrines. Ndlovu et al report on how WASH in schools has not prioritised MHM through a study of a girl’s experience in Zimbabwe. In Masvingo Province there are inadequate water sources, which contribute to poor sanitation and hygiene, which is a key element in effective MHM. The case study says that national WASH programs have been “negatively affected by limited evidence. As a result, there has been an inclination to treat girls and boys as homogenous in WASH programming for schools and communities. ” The study explored knowledge, attitudes, community practices, and religious and cultural beliefs regarding menstruation and how it affects girls and MHM. Similar to the McMahon et al study, this study discusses how inadequate sanitation causes girls to be absent from school, therefore affecting their future career prospects. The authors believe that adequate MHM can be achieved with good WASH programs if an understanding of cultural practices is determined.

In the schools reviewed, the availability of WASH facilities, their functionality, use, state and maintenance were below adequate standards, exposing schools to health hazards. “Most rural schools do not have water sources within 500 m of the school grounds. ” The lack of access to water means girls cannot wash blood from their hands, pads, underwear and uniforms. In addition, most of the rural schools don’t have doors on the toilets, so girls have no privacy, and there is no running water. “Programmes must strengthen the connections between the rights to water and sanitation and other rights, including health, education, food, work, land, freedom from violence, and the right to information (rights-based programming). ” The three case studies draw together the issues faced by women when there is inadequate sanitation and hygiene, and how the lack of access to clean latrines and running water adversely affects them more so than men. It not only places them at risk of violence and disease, but also affects their education and employment prospects. Some WASH programs do not adequately consider gender and culture. For example, a toilet must have doors to give women privacy when menstruating so they can change sanitary napkins and wash without disturbance. Men are less likely to be concerned with a doorless latrine. Women must use the toilet more frequently than men as they are less likely to leave the home, the school or the village, plus due to their anatomy, their values and cultural upbringing they are less able to urinate or defecate in public.

In a separate African study, Sommer et al investigated the intersections of sanitation, sexual coercion and girls’ safety at school. Girls reported that toilets were unsafe during class because boys hid in them. Attention was needed to reduce opportunities for harassment. A UN Women study of rural schools in Cameroon echoed the sentiments of the earlier case studies. More than 60% of the time there was no soap available for girls to wash their hands, some latrines didn’t have doors and only 39% of the latrines were considered clean enough to use. The most common problems faced by women relating to MHM in public places are non-functional toilets, no water, toilet paper or soap, stains, absence of public toilets and nowhere to change. In order for target 6. 2 to address the needs of females, women and girls need to be able to manage sanitation and hygiene needs with dignity. It also needs to address the risks associated with accessing latrines or open defecation sites at night, as women and girls are subject to violence and harassment. Women and girls must be targeted for WASH in a way that is relevant to their cultural context. For example, Oxfam reported that including women in the design of their hygiene campaigns for their Ebola response would have improved outcomes, particularly by using their input to construct and disseminate culturally appropriate hygiene messages. “Gender mainstreaming into Ebola response needed to involve considering appropriate ways to deliver health messaging to women and girls, and to traditionally marginalised groups. ”

The Ebola response also taught Oxfam that a generic response isn’t appropriate as cultural requirements change across nations and from cities to rural areas, and across different communities, religions and social practices. The minimum standards on gender in WASH practice, according to Oxfam, covers the basics on equal access for women and girls. However, more needs to be done. In order to be effective, school toilet facilities need to incorporate female-friendly design by determining local and cultural preferences or girls in relation to privacy and MHM. They also need to include handwashing facilities, soap and somewhere to dispose menstrual waste. In terms of target 6. 2, this definition proposed by the JMP (WHO and UNICEF) highlights the ideal result: “Women and adolescent girls are using a clean menstrual management material to absorb or collect blood, that can be changed in privacy as often as necessary for the duration of the menstruation period, using soap and water for washing the body as required, and having access to facilities to dispose of used menstrual management materials. ” Achieving good MHM ensures that women and girls can better participate in school and society without shame or risk of violence or disease.