Disparities in access to sanitation and hygiene are of increasing concern to the sector. These disparities are driven by a range of interrelated and complex factors, such as socio-economic status, gender and age. Addressing these disparities is critical in ensuring progress towards universal access to sanitation and hygiene.
SHARE is funding research and synthesis to better understand equity and sanitation, such as the Menstrual Hygiene Matters: a free and comprehensive resource for improving menstrual hygiene for women and girls in middle and lower income countries. We are also conducting research into estimating disparities in sanitation-related disease burden, inclusive sanitation and have funded a Sanitation Mapper tool that plots sanitation coverage to reveal disparities in access.
Below is the full list of SHARE equity-related research and outputs, listed under three main thematic areas:
You can find additional material related to these studies, including videos and power point presentations, by going to our Resource Library and searching for the ‘equity’ research theme:
GENDER AND WASH
Menstrual Hygiene Management practitioner’s manual – What works? Synthesising existing knowledge to develop guidelines and an outline forum for practitioners
The SHARE-funded manual aims to address the knowledge gaps related to menstrual hygiene, and help break down the taboos which prevent women and girls from talking openly about the subject. The manual brings together examples of good menstrual hygiene practice from around the world, while providing guidance on building competence and confidence to break the silence surrounding the issue. It also encourages increased engagement in advocacy on menstrual hygiene. The resource is comprised of nine modules and toolkits covering key aspects of menstrual hygiene in different settings, including communities, schools and emergencies.
- Manual: Menstrual hygiene matters: A resource for improving menstrual hygiene around the world.
- Podcast: Menstrual hygiene: breaking the silence
This output was launched at the 'Making Connections: Women, Sanitation and Health' event held on 29th April 2013. Find out more about the event, read the event report, watch the event video, or read the event Storify.
Piloting the MHM manual
This project supports a process of piloting, implementing and evaluating the manual “Menstrual Hygiene matters” in two SHARE countries: Tanzania and Bangladesh. The aim is to develop local capacity, through applying the resource within the country setting, with the active input from national WASH professionals, policy makers, academics, service users and local private sector manufacturers.
Piloting the resource will ensure that the recommendations and toolkits are user-friendly, easy to understand, relevant, useful and practical. It will also test whether additional guidance is required for settings and aspects of MH not currently covered. Following piloting, a training guide will be produced.
Elements of this output formed the basis of a one-day training of trainers workshop at the 2014 Brisbane WASH Conference.
A systematic review of the health and social effects of menstrual hygiene management
This research aimed at identifying the health and social effects of menstrual hygiene management in published peer-reviewed scientific literature. Following the PRISMA guidelines, a structured search strategy was used to identify articles investigating the effects of MHM on health and psycho-social outcomes. 14 articles were identified which looked at health outcomes, primarily reproductive tract infections (RTI). 11 articles were identified investigating associations between MHM, social restrictions and school attendance. MHM was found to be associated with RTI in seven papers. However, methodologies varied greatly and overall quality was low. Meta-analysis of a subset of studies found no association between confirmed bacterial vaginosis and MHM. No other substantial associations with health outcomes were found. Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism.
The management of menstruation presents significant challenges for women in lower income settings. However, the effect of poor MHM remains unclear. It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear. There is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions, in particular for better understanding the nuanced effect that improving MHM may have on girls’ attendance at school.
Violence, gender and WASH practitioners toolkit
The literature on GBV in emergency and development contexts is disparate and requires consolidation as well as synthesis to highlight the key lessons for practitioners and how to implement them. The main objective of this project is to collect, review and synthesise best practices in reducing GBV in sanitation and hygiene programmes in both development and humanitarian contexts in developing countries so that they are made accessible to practitioners for replication in different contexts.
Gender and sanitation - the experiences of the Shack Dwellers Federation of Namibia
The purpose of this research was to provide information about the influence of gender and age upon community decision-making within the Shack Dwellers Federation of Namibia (SDFN) and among other residents in poor urban settlements where SDFN is active. The research aimed to understand if, and how, household development at the settlement level differs by gender or age, and to review previous experiences with toilets. The research aims were met by the analysis of existing household level data, focus group discussions, and semi-structured household interviews.
WEALTH AND WASH
Analysis of disparities in sanitation coverage
The objectives of this study are to model the following for 10 low-income countries in sub-Saharan Africa and South Asia:
1. The distribution of sanitation-related health burden by wealth quintile;
2. The distribution of health benefits for targeting different wealth quintile groups;
3. The spatial distribution of sanitation-related health burden and benefits.
This work used existing household survey data from the Demographic and Health Surveys for the 10 countries to estimate disparities in sanitation-related services, exposures, susceptibility, burden and impact of infrastructure improvements.
- Podcast: Equity matters: Policy-makers need to improve sanitation for the poorest in developing countries
- Research report: Estimating inequities in sanitation-related disease burden and estimating the potential impacts of pro-poor targeting
- Policy brief: Exploring the inequities in sanitation-related disease burden and estimating the potential impacts of pro-poor targeting
- Rheingans R, J Anderson, R Luyendijk, O Cumming (2013) Measuring disparities in sanitation access: Does the measure matter? Tropical Medicine & International Health (in press, 2013).
A cross-sectional study to investigate disparities in water, sanitation and hygiene-related exposure and outcomes in an urban community of Kisumu, Kenya
Access to sanitation in developing countries is generally highly inequitable, with the lowest levels of access often found among the poorest and most vulnerable groups. The primary purpose of this research is to test the assumptions and conclusions of a model developed earlier, through direct data collection. The research team will collect household and community level data to assess the association between measures of environmental exposure and susceptibility, and the distribution of disease burden in three settings. A cost-effectiveness analysis (CEA) will be undertaken to estimate the cost-effectiveness for reaching the poorest and most at risk populations. After completion of the research, findings will be jointly interpreted with SHARE partners (WaterAid and IIED) to identify policy and practice reforms that will lead to more effective interventions for the poorest households.
This work is ongoing. There are no outputs as yet.
Sanitation Mapper: an investigation into district-level sanitation monitoring interventions as tools for empowerment, advocacy and evidence-based decision-making
Inspired by the previous successful development of the WaterPoint mapper by WaterAid, this project aimed at developing a low cost and participatory sanitation monitoring tool (including a spreadsheet and map‐based outputs), called the Sanitation Mapper. It enables collecting data and mapping the level of sanitation coverage in chosen areas, in order to better inform sanitation-related interventions. It was piloted in Bangladesh.
- Roma, E, J Pearce; C Brown; I Sirajul (2012) Sanitation Mapper: A tool for mapping and monitoring sanitation in low-income countries. Waterlines, 31:4, October 2012, pp. 309-313(5).
- Sanitation mapper tool
- WaterPoint Mapper website
- Sanitation mapper user guide
- Sanitation conditions and practices in Dar es Salaam
This research focuses on the urban poor in Dar es Salaam with unsafe, unhygienic and inadequate sanitation facilities and practices. It explores and documents many activities and processes, including existing household sanitation facility upgrading behaviour; the motivations, facilitators and barriers to upgrading among the urban poor; variations in preference for upgrading improvements in terms of sanitation facility design, operation, cleaning, and usage; and the determinants of demand. The study was conducted through an equity lens, exploring the relationship between indicators of household situation and wealth (e.g. household income, expenditures, housing type, gender of household-head, tenancy, neighbourhood access conditions), levels of investment made in current sanitation facilities, and sanitation upgrading preferences, motivations and constraints.
Jenkins MCW, O Cumming, B Scott & S Caincross (2013) Sanitation Preferences of Urban Population in Dar Es Salaam, Tanzania. Journal of WASH & Development (in press).
DISABILITY AND WASH
Undoing inequity: inclusive sanitation and hygiene programmes that deliver for all
The aim of the study is to develop and test an approach that aims to improve access to WASH for all, and thereby provide equal access to people who are marginalised and vulnerable. In Uganda and Zambia, WaterAid and its project partners will implement its inclusive WASH approach in order to improve access for all. The proposed research will report the lessons learnt from the intervention, and will measure the change in access to WASH following the intervention.
- Research summary
- Briefing note: Disability workshop in March 2011
- Video on Investigating the Cost of Inclusive Water, Sanitation and Hygiene Service Delivery
- Report on mainstreaming disability and ageing in water, sanitation and hygiene programmes
- Baseline findings poster
- Report to WEDC International Conference in Kenya, 2013, on the baseline findings and how they have been used so far
- WaterAid submission to the International Development Select Committee's new inquiry on Disability and Development
- Research poster summarising the project (including mid-term review results)
- Report: Undoing Inequity Mid Term Review - Uganda (April 2015)
- Report: Undoing Inequity Mid Term Review - Zambia (April 2015)