Author Archives: dietvorst

New guide on female-friendly toilets by WaterAid, WSUP and Unicef

1 in 3 people across the world don’t have a decent toilet of their own. But it’s not just a question of lacking a household toilet – low availability of public and community toilets is also an issue. Where they do exist, these facilities often don’t meet the needs of women and girls, undermining women’s human rights.

The ‘Female-friendly guide‘, out in October 2018 and written by WaterAid, UNICEF and WSUP, is designed primarily for use by local authorities in towns and cities who are in charge of public and community toilets. It’s also useful for national governments, public and private service providers, NGOs, donors and civil society organisations who play a role in delivering these services.

The guide explains why toilets must be female-friendly, before detailing the essential and desirable features needed to make them so. It also suggests ways to increase gender sensitivity in town planning on sanitation.

Recommendations and practical steps have been drawn from existing literature, expert opinion and analysis of pioneering experiences from around the world.

The guide is available to download now, and will also be presented at the UNC Water and Health Conference on 1 November 2018.

Download “Female-friendly public and community toilets: a guide for planners and decision makers”.

This news item was originally published on WaterAid’s WASH Matters website.

Sanitation and health: what do we want to know?

Experts meet to discuss reaching a consensus on what the evidence tells us.

Radu Ban

Radu Ban

Jan Willem Rosenboom

Jan Willem Rosenbom

This is the first of two blogs written about the “Sanitation and health evidence consensus meeting”, convened by the World Health Organization (WHO) in Seattle on May 24 and 25 of 2018. It was written by Jan Willem Rosenboom and Radu Ban, who are both Sr. Program Officers on the Water, Sanitation and Hygiene (WSH) team at the Bill & Melinda Gates Foundation. This first blog will describe the process used to arrive at the consensus, while the second blog will describe the outcome of the consensus and will come out once the results of the consensus meeting have been published. Also, mark your calendars for a session during the 2018 UNC Water and Health conference dedicated to this consensus!

Cambodia - India Two sides of sanitation rubbish and cleanliness. Credit Bill & Melinda Gates Foundation

Two sides of sanitation: rubbish and cleanliness. Credit Bill & Melinda Gates Foundation, Cambodia/India

Introduction: What is this about?

It is hard to imagine that making improvements in sanitation wouldn’t play a role in improving health. After all, we know that shit spreads disease and the F diagram shows us that sanitation is an important tool in blocking the transmission of pathogens from one person to the next, thus lowering exposure. And sure enough: we have strong evidence about the effectiveness of sanitation interventions and improving health and human capital outcomes from rigorous historical studies, from high- as well as low- and middle-income countries.

At the same time, looking at the specific impact of programmatic sanitation interventions, it can be hard to figure out what the evidence is really telling us. On the one hand, a systematic review of the whole body of evidence on sanitation and health (carried out by Freeman et al. in 2017) suggests that sanitation protects against diarrhoea, active trachoma, some soil-transmitted helminth (STH) infections and schistosomiasis. It also improves height-for-age scores of children (i.e. it decreases stunting, which is an important measure of human capacity). On the other hand, several recent sanitation intervention studies have found limited or no impact on different health outcomes. The table below (copied with permission from a presentation by Tom Clasen), provides a summary of key findings from the most recent sanitation studies:

Sanitation blog - Summary of effects from recent sanitation studies

  1. Fewer observed flies and feces; no change in fecal contamination of water
  2. Fewer observed soiled hands and less fecal contamination of water
  3. Except in the study arm considering just water quality improvements

This seeming lack of agreement is confusing, and partly in response to questions from practitioners, on May 24 and 25 of this year WHO convened a meeting of experts to review the existing evidence and reach a consensus about what it is telling us. The group of experts consisted of researchers across multiple disciplines who had written extensively on the topic of sanitation and health. We thought it was necessary to reach consensus among researchers before engaging, in a unified voice, the practitioner community.

At the same time, to make sure that the concerns of practitioners would be considered in the meeting, we published a “request for input” online (through the SuSanA network as well as the Sanitation Updates blog) and we will summarise the responses here. But first…

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Toilets need water, Indian women suffer under ODF drive

Toilets in households have only increased the drudgery of village women as they have to fetch water from faraway sources for toilet use, writes Amita Bhaduri, Programme Director of the Society for Promotion of Wastelands Development (SPWD), in an article posted on the Indian Water Portal.

Rajasthan is all geared up for the open defecation free (ODF) status well before the national deadline of October 2, 2019. According to the assistant engineer of the nagar parishad, Resha Singh, 4.75 lakh [475 thousand] toilets have been constructed since October 2, 2014 in Alwar district which is about to be declared ODF.

Paari, a 45-year-old woman of Ghevron ki dhaani village in the district got a toilet at her household under this toilet construction drive. She does not have to go far away to find a place for her sanitary needs anymore. She is, however, unhappy and exhausted from the numerous trips to the water source she has to make to get water in the toilet. Her feet are aching from treading the path filled with rocks and thorns without any footwear for protection.

Water access and women's donkey work

Read the full article

SACH Impact Incubator seeks applications from Indian WASH & waste management social ventures

sach-impact-logo

Subhash Chandra Foundation, the philanthropic initiative of Rajya Sabha MP and Essel Group Chairman, Subhash Chandra has launched ‘SACH Impact’ Incubator, in partnership with LetsEndorse, to support early-stage social ventures aspiring to solve the problems of millions of Indians.

Two annual cohorts of resolute social entrepreneurs shall be constituted every year, with each one working on one of the 8 focal areas (Education, Healthcare, Clean Energy, Agriculture, Inclusion, Waste Management, Livelihood, WASH), aligning with the UN Sustainable Development Goals. The programme aims to equip them with market access for pilots, financial support to do so, necessary mentorship, knowledge networks & more, to take their solutions to the next level and prepare them to scale and serve the large Indian population.

Ventures with already developed testable versions of their innovative product/technology/software or those which have just begun conducting pilot tests on-the-ground and have the potential to make transformational impact on the society can apply online through this link: http://bit.ly/SachImpact before 25th June, 2018

Seeking inputs for “consensus” meeting on sanitation interventions

Following the publication of results from a number of recent studies investigating links between improvements in sanitation and health (such as the WaSHBenefits study, studies in Tamil Nadu, Madya Pradesh and Orissa in India and others) some of you have contacted the Gates Foundation WSH team with questions and concerns about the seeming lack of consensus about the relationship between sanitation and health demonstrated in those studies.

Looking at a number of historical studies, it is hard to imagine that improvements in sanitation did not play a significant role in improving population health. And indeed, older as well as more recent historical evidence from US, Europe and developing countries establish causal relationships between sanitation and health. However, when considering more granular evidence considering the effects of individual and categories of interventions, there is less alignment.

Understandably, this has led to concerns about the meaning of this evidence, and questions about how it should be interpreted and used by practitioners, working to design and implement sanitation programs.

Partly in response to those concerns, WHO is convening an expert meeting in May this year, to develop a “consensus statement” around two specific questions:
• Are particular sanitation interventions more likely to have protective effects?
• What pre-conditions are likely to impact the effectiveness of these sanitation interventions?

The meeting will bring together researchers, from both life and social science backgrounds from around the world for two days of deliberations, informed by evidence and identifying points of agreement and contention. The Water, Sanitation and Hygiene team at the foundation strongly supports the organization of this meeting, and to make sure that issues relevant to practitioners are considered (and hopefully answered) during the discussions, we would like to invite you to share with us the most important questions you (and your teams) face when considering the use of evidence in program design.

The consensus meeting is scheduled to take place on May 24 and 25. To allow for review and incorporation into the agenda, the deadline for the submission of questions for consideration is end of day Thursday May 17.

There is no particular format for submission, although when we say we are looking for questions, we mean just that; a short sentence with a question mark at the end (no need to over-think it). If you are concerned that there is the possibility of mis-interpretation, you should feel free to provide some context and explanation.

Following the meeting, the results will be published and broadly disseminated.

We look forward to hearing from you what concerns you. If you have any questions about the process (or the scope) of this effort, please feel free to get in touch.

Jan Willem Rosenboom and Radu Ban

Contact:  janwillem.rosenboom [at] gatesfoundation.org

Menstrual Pads Can’t Fix Prejudice [feminist opinion piece]

In her opinion piece in the New York Times of 31 March 2018, Chris Bobel criticises the type of menstrual activism that has a narrow focus on “better living through more consumption” of sanitary pads. The core problem surrounding menstruation in her opinion is cultural stigma. Many NGOs and social entrepreneurs promote “a simple solution to what is, in reality, a complex problem”. What is needed, she writes, is “access to a clean, secure toilet”, to treat menstruation as something normal rather than a nuisance, and “culturally sensitive community-based education about the menstrual cycle […] not only girls, but also everyone surrounding them — boys, parents, teachers, religious leaders and health professionals”.

Read the full opinion piece in the New York Times. See also Is Bollywood’s Pad Man movie too good to be true?

Chris Bobel is an associate professor of women’s, gender and sexuality studies at the University of Massachusetts, Boston and past president of the Society for Menstrual Cycle Research. She is the author of the forthcoming The Managed Body: Developing Girls and Menstrual Health in the Global South.

 

Is Bollywood’s Pad Man movie too good to be true?

Checking the facts and assumptions about menstrual hygiene in developing countries.

Mensrual hygiene painting-crop

Painting by students of the Dr. M.M. den Hertogschool, The Hague, on the importance of menstrual hygiene management and school WASH. Photo: IRC

March 8th was International Women’s Day. Which approach to menstrual hygiene management fits best with this year’s theme urging everyone to #PressforProgress on gender parity? Is it pressing for access to affordable menstrual products or is there more to it?

A few weeks ago, I joined a group of my female colleagues and family to watch “Pad Man”, the Bollywood film inspired by the life of Arunachalam Muruganantham.  He is an acclaimed Indian social activist and entrepreneur who invented a low-cost sanitary pad-making machine. Muruganantham famously tested sanitary pads on himself, using a bladder with animal blood, while riding his bicycle. “Pad Man” is a feel good, uplifting movie. We left the cinema dancing to the tune of the Pad Man Song.

Too good to be true?

But then, a few days later an IRC colleague from India referred us to a blog that claimed to tell the “real story” about the man, who “shot to fame by selling shame”. The author, Sinu Joseph, is Managing Trustee of the Myrthi Speaks Trust, a Bengaluru-based social activist group working on issues including menstrual health and sanitation. Sinu had initially been involved in distributing Mr. Muruganantham’s sanitary pads until angry mothers complained that she was “trying to get rid of some cheap stuff by dumping it” on their daughters.

Fact check

Sinu counters several of the “facts” mentioned in “Pad Man”, which are also regularly quoted in the media. The first is that Indian women use ash, sand and husks as menstrual absorbents and consequently suffer “from Reproductive Tract Infections for want of a Pad”.  Sinu has found no evidence of this, both from her own experience and the literature. In fact, she says there is no evidence linking the use of menstrual products such as cloth to any menstrual disorder.

Second is the widely quoted statistic that only 12% of Indian women use sanitary napkins. Wrong again, says Sinu: the National Family Health Study of 2015-16 found that the real number is 57.6% , 48.5% in rural, 77.5% in urban areas. Finally, there is no evidence that girls in India drop out of school owing to menstruation and the lack of sanitary napkins. Similar findings emerged from a 2010 study in Nepal, which at the time was not welcomed by the pro-sanitary napkin development lobby.

A developing country problem?

The evidence Sinu refers to, comes from a review of 90 papers, which Myrthi Speaks conducted in 2016. The review not only dispels the “facts” mentioned above but also challenges the assumption that developing countries have a greater prevalence of menstrual disorders than in the West. In fact, the review found that the opposite is true. In developed nations, a higher percentage of adult women and adolescents suffer from heavy bleeding and painful or irregular periods than in developing countries.

Shame

So why has the real-life Pad Man attracted so much uncritical support? Is it because this unlikely hero, an uneducated man, took it upon himself to elevate Indian women from their shameful state? Indeed, most of the women in the Pad Man movie are portrayed as ignorant, led by superstition. In Sinu’s words, “shame has been sold to us in a nice package with celebrity endorsements”.

Glorifying traditional practices?

Sinu has been criticised for promoting the traditional practice of seclusion, which she says provides women who are part of joint families “privacy and comfort during menstruation”. A 2015 blog by Eco Femme, an Indian social enterprise producing washable sanitary pads, said that Sinu neglects those women who experience being excluded as degrading. Harrowing stories about the illegal Nepali practice of Chhaupadi, where girls are forced to spend their periods in cattle sheds, come to mind. The Pad Man film similarly condemns the segregation of women during menstruation.

Interestingly, Arunachalam Muruganantham, Sinu Joseph, Eco Femme, along with many development agencies all claim that they understand women’s needs. Whose view do you support? Or have they all got it wrong?

This blog was originally posted on the IRC website.

Update, 21 March 2018

On 16 March 2018 a TEDxKLETech talk by Sinu Joseph on the “Super science behind Menstrual practices” carried the following warning by TEDx “This talk contains several assertions about Ayurveda that are not supported by studies in gynecological medicine. While some viewers might find advice provided in this talk to be helpful as a complementary approach, please do not look to this talk for medical advice”.