This week, let's employ a gendered lens to explore the ways in which the social determinants of girl’s and women’s physical and psychosocial health, are disproportionately impacted by the ‘everyday sanitation’ experienced in urban slums (MacFarlane et al., 2014).
Shared sanitation facilities (SSFs), often lack the privacy and hygiene necessary for girls and women to manage their daily sanitation needs with dignity. Resulting in a variety of reinforcing health, and socioeconomic impacts, one of the most devastating and monopolising of which is sexual and gender-based violence (SGBV) violence.
SGBV and Sanitation in Urban Slums.
A report published by Water Aid concludes that ‘most sexual violence in slums occurs when someone is using a toilet, bathing and/or maintaining their menstruation’. Let’s turn towards the case studies of Nairobi’s Mathare and Kibera slums, of Nairobi, Kenya, to explore why this is.
Firstly, SSFs are often overburdened. For example, in Mathare, on average, 1 toilet is shared between 85 households. This makes it extremely difficult to maintain the facilities, thus, many stalls having missing locks or doors, which is compounded by the fact that many SSFs don't have separated gender sections. Therefore, SSFs often lack privacy, and are an insecure space, in which girls and women can become targets of SGBV.
Secondly, SSFs are often far from homes. For example, in Mathare, the average distance to a toilet is 52 metres. Amnesty International’s report, provides a shocking collection of women’s experiences of SGBV when walking to SSFs, particularly at night. Moreover, SSFs are often inaccessible due to cost, for example, in Mathare SSFs charge a fee between USD$0.03 - USD$0.10 per-use. This cost disproportionately affects girls and women, who use toilets more frequently than boys and men, and is compounded by the cost of sanitary products. This cost of sanitation can lead to girls and women becoming victims of coercive sex, in exchange for sanitary products, and access to toilets. Lack of accessibility due to cost and distance, also forces many girls and women to manage their sanitary needs in the open, after dark, at high-risk of SGBV.
Furthermore, the unique sanitation needs of girls and women are often neglected in the planning, design and construction of SSFs (O’Reilly, 2015; Schmitt, 2018). Most significantly, SSFs often lack the means for girls and women to discreetly manage menstruation, and dispose of used sanitary products, this risks branding girls as ripe for sexual activity (Elledge et al., 2018) - heightening risk of SGBV.
These issues are compounded by the lack of police presence within urban slums – a symptom of the colonial legacy of underinvestment, discussed previously. Therefore, GBV often goes unpunished, disturbingly contributing to it normalisation. Indeed, rates of rape (36%), and coercive sex (<30%) in the Kibera slum, were found to be much higher than the average rate of 14% across Kenya (Swart, 2012)– of course there is no acceptable rate higher than 0%, but this does highlight a key disparity.
The Impacts (of Fear) of Victimization
(The fear of) SGBV produces a monopoly of psychosocial and health impacts, due to a range a of coping strategies adopted by girls and women:
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| Flying toilets litter the path in the Kibera Slum. Source: Ecumenical Water Network. |
One of the most commonly reported coping strategies is delaying relief by limiting water, or food intake: increasing risk of dehydration, urogenital infections, etc. (Caruso, 2015). Furthermore, many women choose to employ alternative sanitation strategies: a study conducted in the Mathare Valley by Winter et al. (2019), found that 75% of women rely on plastic bags or buckets to relieve themselves. The human waste is then disposed of into open drains or rivers near their homes, posing a threat to public health.
In terms of psychosocial impacts: experience, or threat, of SGBV increases feelings of powerlessness, marginalisation, and shame (Winter et al. (2019). Girls and women become ‘prisoners within their own homes’, due to reductions in mobility, which inherently restricts access to employment and education, and limits participation in political and recreation activities. Therefore, the impacts of (fear of) SGBV iprevent girls and women from expanding their freedoms, capabilities and opportunities, necessary for development as defined by Amartya Sen (1999).
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| Women taking part in a silent march in Korogocho slum, Nairobi, Kenya. Source: Amnesty International |
Clearly, simply building more toilets is not the solution. So, how can we tackle gendered sanitation inequalities, and the associated ‘normalisation’ of SGBV, moving forwards?
1. We must break the silence surrounding SGBV, not only at the community level, by empowering girls and women to share their experiences, and breakdown stigmas, but, also within academia. Whilst, researching for this post, I was shocked at how few academic resources were available, this failure of researchers to provide visibility to this key development issue, inherently affects WASH sector interventions (as discussed previously).
2. Girls and women must be actively involved in decision-making at all stages of sanitation service design, implementation, and management. Studies have actually shown that community WASH projects designed and maintained with female participation are up to 7x more effective, and sustainable - so benefits would be community-wide!
In my next post, I will explore a sanitation solution that can provide the vulnerable with a more dignified sanitation experience in urban slums.
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