Open Defecation Increases Violence, Other Gender-Based Health Inequalities in Women and Young Girls
Lack of sanitation facilities remains a major challenge for girls around the world—often forcing women to remain uneducated. Women are at risk during childbirth and home care, young girls and teenagers are forced to stay at home or leave school at puberty, due to inadequate sanitation facilities. Globally one in three girls and women lack access to decent toilets. Similarly, one in three women also suffer physical, sexual or emotional abuse in their lifetimes. This creates an overlap between poor sanitation and violence on women.
Health disparities (related to women) are often seen as a higher burden of disease or death rates attributed majorly to lack of access and use of care. But access is not enough, if care received is not of good quality and underlying factors cannot be sustained or improved outside of the hospital space. Healthy humans and environments largely depend on social determinants like wealth, power and prestige. These are critical when providing and maintaining accessible, available and affordable care for vulnerable populations like women, young girls and children. Most importantly, women, who when situations become worse, in most cultures, are often on the most receiving end of social problems related to poverty and health.
The absence of functional or improved WASH facilities in our hospitals and care centers, creates a rise in hospital-related infections. With low and lack of access to quality and functional WASH facilities, caring for people in maternal and newborn or paediatric units becomes a critical challenge. A 2019 report by the Maternal and Child Survival Program revealed that 16% of neonatal deaths are due to infection, 50% of Nigerian health care facilities (HCFs) lack a basic water service, while 88% lack basic sanitation services. Midwives, mothers and children become vulnerable. Yearly, Nigeria loses at least 100,000 children under the age of 5 years, to diarrhoeal diseases attributable to unsafe water and sanitation.
In poorly-built homes with dysfunctional or total absence of hygiene and sanitation facilities, women and young girls are often faced with the challenge of looking for where to defecate. This has to be a private place where they feel safe. Most times, the only option is a nearby bush or a river. Homes without toilets are not safe. Bushes and rivers are the most unsafe options. Women and young girls have encountered the worst in these conditions, from diseases, to sexual harrasment, rape, death or drowning. Those who survive may often not have the enablement to share their stories. Open defecation amplifies the risk of insecurity and violence against women, young girls and children. Additionally, the experience of women who engage in this practice is accompanied by fear, shame, lack of privacy, dignity and conflict. These affect their overall quality of life: marital affairs, sexual relationships, menstrual health, amongst others.
In relating violence to poor WASH conditions, a 2013 joint report shows that incidents of violence against women occur more often where open defecation is common. These are grouped into:
Sexual violence: rape, assault, molestation, inappropriate touching
Psychological violence: harassment, bullying, or causing fear, stress or shame
Physical violence: beating or fighting leading to injury or death
Socio-cultural violence: social ostracism, discrimination, political marginalisation, social norms with negative impacts
These harassments can occur when walking long distances to collect/fetch water, using public or communal toilets, waiting till dark hours to go and defecate, and fights from long water queues during water scarcity. They are also often teased, shamed or verbally abused when seen by others defecating in the open. More so, the men who are household leaders in these communities do not often have the means or see the need to provide clean and safe toilets. These speak to why 67% of adult females in Nigeria, in a 2012 survey, felt not very safe or totally unsafe about using public/community toilets.
With Nigeria’s 47 million citizens who still practice open defecation, a consequent 1.3% reduction in the annual GDP due to ill health and low productivity from poor sanitation, the work has only just begun. Since good WASH facilities are non-negotiable for the day-to-day activities in homes, hospitals, work places, public spaces or communities, there is a strong need for the government to strengthen her efforts towards achieving her 2025 goal of being open-defecation free. Non governmental organizations, donors, and civil society groups can also work together to achieve an increase in investment and an improvement in WASH services to everyone by 2030. Sponsoring functional WASH facilities in hospitals, schools and communities are crucial for women to feel safe in public and private spaces. Provision of equitable access to WASH services, strengthening and sustaining tailored community approaches to total sanitation in rural, peri-urban and riverine settings are other important means for addressing these gaps and keeping women, young girls and children healthy and safe in their communities
Chidindu Mmadu-Okoli is a health writer and licensed medical laboratory scientist, who is passionate about telling purposeful and persuasive health stories that promote patient-provider interactions, patient-centered care and inspires healthy living.
She is a 2019 #PreventEpidemicsNaija Fellow with the Nigeria Health Watch where she lends her voice towards advocating for the need for sustainable funding for disease prevention. She is a 2019 Science Communications Fellow of the Africa Science Literary Network, a TEDx Speaker whose talk advocates for patient-centred storytelling as the future of healthcare and a member of the Society for Health Communications, USA.
Chidindu currently hosts The Vital Signs Podcast show for humanizing healthcare, and has contributed through her various communications roles to write, create and design health awareness, education and promotion materials for vulnerable patient populations, the public and policymakers.