CHAPTER 2.2 DOMESTIC WATER AND SANITATION
menstruation, women cannot
fully
participate
in
In many parts of the world gay rights and transgender rights movements also prominently include demands to meet appropriate toilet needs of sexual minorities and to respect transgender choices Photo Credit: © John Arehart/Shutterstock
for boys and girls were provided in schools, the girls’ attendance increased by 11% per year (UN Water 2006).
Sanitation, health and security
The consequences of limited safe access to improved sanitation by women and girls are manifold. The UN Special Rapporteur on the sale of children, child prostitution and child pornography, Maud de Boer- Buquicchio, has observed that “A prevailing climate of discrimination, insecurity and violence, combined with lack of access to adequate sanitation facilities for girls and women in public spaces, enhances considerably the risk of being subject to acts of sexual violence”. Inadequate access to sanitation facilities results in shame, fear, violence, health impairment, economic implications and social injustice.
If women lack safe access to a toilet or have no other option than to urinate and defecate in the open, they are at increased risk of being shamed, sexually harassed, abused and attacked. Women often wait until dark to relieve themselves because they want to avoid using a toilet during the day; this means women without private access to a toilet often avoid drinking fluids, leading to dehydration, long-term damage to the bladder and bowels, urinary tract infections and gastric disorders (Anand 2014; WaterAid 2012; COHRE et al. 2007).
Menstrual hygiene provision and management
Menstrual hygiene management (MHM) is essential to ensure gender equality. Without provisions for
all aspects of society and the economy. Absence of adequate sanitation facilities for menstrual hygiene has direct impacts on women’s right to education, right to work and right to health (George 2013). Yet MHM is largely ignored in policies, research priorities, programmes and resource allocations even within the WASH sector. Although MHM is an integral part of WASH requirements, it remains a marginalized topic in WASH discourse, policy and practice (Winkler and Roaf 2014). Very few countries have national targets for menstrual hygiene promotion programmes, and only about 2% of total WASH expenditure is used for hygiene promotion (WHO and UN-Water 2012).
Until women’s activism brought attention to this issue in the past decade, menstrual shame and the complexities of menstrual management were perceived as private and an inevitable part of the social order, while other priorities for limited existing resources consumed attention (Sommer et al. 2015). Neglect of MHM in the WASH sector and in national policies reflects the persistence of cultural taboos. It also reflects a gender bias: the male expert structure of WASH and its origins as an engineering-oriented field are among the reasons MHM has not received adequate attention (Sommer et al. 2015).
A consequence of this bias (as well as a cause of official inattention to MHM) is the lack of robust gender-disaggregated data on sanitation policies and technologies. Progress in verifying the need for and impacts of gender-responsive sanitation is hampered by an almost complete absence of data (Tilley et al. 2013). Even the evidence base for examining the posited relationship between poor MHM and reproductive tract infections in women, for example, is underdeveloped and only the most limited evidence exists to map the impact of good MHM on health (Sumpter and Torondel 2013; Biran et al. 2012).
In many cultures menstruating women are perceived as “dirty”, “shameful”, “impure” or “contaminated” – characterizations that they have internalized. Women have long been told, implicitly or explicitly, that menstruation should be hidden and managed in secret. In some cultures menstruating women are expected to be invisible and silent (George 2013): their participation in cultural, social and religious activities is restricted and their mobility is limited.
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