Tag Archives: editorials

Swimming upstream: why sanitation, hygiene and water are so important to mothers and their daughters

Water, sanitation and hygiene and the most under-recognized interventions when it comes to improving the health and well-being of women, say Clarissa Brocklehurst and Jamie Bartram in an editorial in the Bulletin of the World Health Organization [1].

Let us start with a pregnant woman. She is likely to have to collect and carry water for her baby’s delivery from a hand pump outside her home; globally more than 40% of households do not have a water supply on their premises. If she is very unfortunate she will be among the 13% who do not even have a hand pump and rely on an unimproved water source, made even more risky by the fact that most people in her community lack even a basic toilet. These unhygienic conditions take on new significance when she weans her child. Diarrhoea kills 1.5 million children every year1 and there is a strong link between diarrhoea and malnutrition.

By around the age of six, the child should be going to school. However, if this child is a girl, much of her time will be needed for tasks at home, including water collection. In half of all households worldwide, water is carried to the home and in 72% of households, women and girls are the primary water collectors. Girls are twice as likely as boys to be the carriers. Our girl child is exposed to an increasing range and burden of infections as she encounters the world beyond her home. Intestinal helminths affect 400 million – one in three – schoolchildren. Infestations such as hookworm reduce physical growth and impair intellectual development. Girls weakened by energy loss, intestinal worms and repeated infections are predisposed to anaemia that takes on new significance as they enter menarche, which may also mark the end of their limited schooling. The lack of school toilets with privacy and facilities for menstrual hygiene contribute to sporadic attendance and drop out. If our girl child does not overcome these constraints and she drops out of school, she will likely face early marriage and early childbearing.

But the vicious cycle of inadequate water, sanitation and hygiene that keeps women in poor health, out of education, in poverty and doomed to bearing sickly children can be reversed.

The first hurdle our mother and child encountered was the unsanitary conditions and lack of hygiene at the time of birth. A study in Nepal showed that hand-washing by birth attendants and mothers increased newborn survival rates by up to 44%. Hygiene promotion has been shown to be one of the most cost-effective health interventions, particularly with the use of marketing techniques based on those used by private companies.

In sanitation, though global progress has been poor, some developing countries achieved up to 60% reduction in the proportion of their population lacking improved sanitation. It is likely that political will, modest financing cleverly applied and a focus on changing behaviour and social norms, not just installing infrastructure, contributed to this rapid progress. Building demand for toilets, especially among those people who have practiced open defecation all their lives, helps trigger household investments. Evidence that these approaches are effective suggests that accelerated progress is possible.

Barriers in providing drinking-water can also be overcome. Innovations include low-cost drilling techniques and cheaper hand pumps, the use of locally-managed, small-scale systems, entrepreneurial water kiosks and civil society intermediation between poor communities and service providers. Providing water, sanitation and hygiene in schools is increasingly a priority for ministries of education in developing countries. Emerging designs for toilets that incorporate privacy and facilities for menstrual hygiene provide a multitude of benefits. For instance, women who have been to school are less likely to die during childbirth – each additional year of education prevents two maternal deaths for every 1000 women.

The authors add that “water, sanitation and hygiene also enable women to play roles in their community’s development” including “decision-making and management of water and sanitation systems”.

Clarissa Brocklehurst is Chief of Water, Sanitation and Hygiene at UNICEF headquarters in New York. Jamie Bartram is Professor of Environmental Sciences and Engineering at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.

[1] Read the full editorial, including references:
Brocklehurst, C. and Bartram, J. (2010). Swimming upstream: why sanitation, hygiene and water are so important to mothers and their daughters. Bulletin of the World Health Organization ; vol. 88, no. 7 ; p. 482.
doi: 10.2471/BLT.10.080077

Maggie Black – Creating a stink about the world’s wastewater

Exactly 150 years ago, an exceptionally hot spell of summer weather reduced the Thames flowing through London to a scandalous condition known as The Great Stink. Queen Victoria, travelling down the river to Millwall docks, had to contain her nausea by clamping a bouquet to her nose. The fumes were not only foul but terrifying, since they were thought to be pestilential – the source of cholera.

The Great Stink, with its power of concentrating MPs’ faculties, led to the introduction of legislation for the transformation of sewerage in London. An unprecedented sum for a domestic purpose, £3m, was voted for intercepting sewers to be tunnelled along the riverside by Sir Joseph Bazalgette. The act, rushed through by August 1858 was to lead to revolutions in local government and public health engineering throughout the world.

If only such action was expressed today. Great Stinks are still routinely emanated by rivers swollen with raw sewage and reduced to a trickle in the hot season in parts of Asia, Africa and Central America. But the stench does not instil the same degree of terror.

More – The Guardian

Flushing away old ideas about pipes and potties

DESPITE recent progress, more than one billion people still lack decent water supplies, and more than 2 billion go without sanitation services.

But, while we often assume that the benefits of improving water and sanitation systems always outweigh the costs, this is not always true.

Piped water and sanitation networks are expensive. Consumers in most countries don’t realize this, because the true costs are hidden by subsidies.

New research for Copenhagen Consensus reveals that the full cost of piping water to a household is as high as US$80 per month – more than most households in rich countries pay and far beyond the means of most families in developing countries. Spending a large amount of money to do a little amount of good is not a sound investment.

Read More

Lancet editorial – keeping sanitation in the international spotlight

The shamefully weak presence of the health sector in advocating for improved access to water and sanitation is incomprehensible and completely short-sighted. Children who benefit from the huge international effort and financial and human resources spent on immunisation and bednet distribution still have a strong chance of dying from diarrhoeal illnesses—the second biggest killer of children under 5 years. Yet the global health community is standing aside, absolving itself of responsibility, and firmly passing the buck to the water and sanitation sectors. The health sector could, and should, be a powerful voice in lobbying governments, and demanding that donors give more funding to water and sanitation, just as it has done, with some success, in advocating for access to essential medicines.

The complete Lancet editorial – March 29, 2008