SRHR: What’s water, sanitation, and hygiene got to do with it?
SRHR: What’s water, sanitation, and hygiene got to do with it?

SRHR: What’s water, sanitation, and hygiene got to do with it?

Roughly half of the world’s population, 4.3 billion people, is of reproductive age. Meeting the sexual and reproductive health and rights (SRHR) needs of this population is vital to their wellbeing, as well as critical to achieving the Sustainable Development Goals. But multiple, entrenched barriers mean that today, SRHR remains out of reach for millions … Continued

Roughly half of the world’s population, 4.3 billion people, is of reproductive age.

Meeting the sexual and reproductive health and rights (SRHR) needs of this population is vital to their wellbeing, as well as critical to achieving the Sustainable Development Goals. But multiple, entrenched barriers mean that today, SRHR remains out of reach for millions of people.

Some barriers are easy to spot (though not necessarily easy to change): politically motivated restrictions on safe abortion, harmful cultural practices around menstruation, and stigma around youth seeking sexual health services.

A less obvious barrier is the lack of access to clean water, decent toilets, and good hygiene. Approximately 785 million people around the world do not have clean water close to home, and 2 billion people do not have a decent toilet of their own.

But what does water, sanitation, and hygiene (WASH) have to do with SRHR?

Actually, a lot.

WaterAid – together with partners International Planned Parenthood Federation, International Women’s Health Coalition, Marie Stopes International and Simavi – explored this topic in a new paper, launched at the Women Deliver 2019 Conference, detailing eight key areas where WASH and SRHR outcomes are interdependent. The paper showed that from the moment a young person gets their first period, though their reproductive years, and all the way through menopause, clean water, decent toilets, and good hygiene play a role in whether they can maintain their sexual and reproductive health and realize their sexual and reproductive rights.

Not convinced? Take a closer look at some of the connections from the eight areas below:

  • Menstrual health: Menstruation is inextricably linked to sexual and reproductive health. Adequate WASH services – including safe, private and accessible toilets equipped with soap and water, where individuals can change and clean or dispose of menstrual hygiene products – are important for women and girls to manage their periods safely, hygienically, and with dignity. In addition, menstrual health can be used as a key entry point and pathway for discussions of sexuality, reproduction, family planning and early pregnancy.
  • Contraception: Ensuring that women and girls have access to a range of contraceptive methods is a key element of quality SRH services, and WASH can affect method mix. For example, long-acting reversible contraceptives (LARCs),such as intrauterine devices and implants, require clean hands and clean instruments for insertion and removal to prevent infection. Insertable barrier methods (such as a diaphragms, cervical caps and sponges) and insertable hormonal methods (such as the vaginal contraceptive ring) also require clean hands in order to prevent vaginal infections.
    Christine Sogoba, Nurse Obstetrician, washing her hands at a washbasin installed in the maternity room in Bougoura Communal Health Centre, Bougoura Village, Commune of Yangasso, Circle of Bla, Region of Segou, Mali. [Photo Credit: WaterAid/Basile Ouedraogo]
  • Pregnancy, childbirth and abortion: WASH is a key ingredient of quality, respectful maternity care. Women have the right to a safe and dignified birth experience, which is not possible without clean water, accessible toilets, and proper hygiene. WASH is also critical for infection prevention during pregnancy, childbirth, and abortion. Sepsis and other infections are among the leading causes of preventable maternal and newborn deaths. Legal restrictions on abortion increase the risk of women using underground providers and being exposed to unsafe and unhygienic conditions.
    Nurse-midwife Jackeline Gideon Mwiguta wipes the newborn baby of Eva Paulo, 23 in the delivery room at Nyarugusu Dispensary, Nyarugusu, Geita District, Tanzania. September 2017. [Photo Credit: WaterAid/ Carolynne Wheeler]
  • Fistula and other reproductive tract injuries: Having access to an adequate supply of clean water is important in fistula treatment and throughout recovery to prevent infections. Women with fistula experience leaking of urine and/or feces from their bodies. Inadequate access to WASH makes it harder for women to bathe, clean themselves and cope with the condition, exacerbating the social stigma and exclusion that often comes with fistula.
  • HIV/AIDS: Unsafe drinking water and poor sanitation contribute to people living with HIV becoming more susceptible to opportunistic infections causing diarrhea. Diarrheal diseases affects close to 100% of people living with HIV in developing countries. Chronic diarrhea leaves people living with HIV with an increased viral load and increased risk of AIDS-related illnesses. It also contributes to enteropathy (inflammation of the gut), which reduces absorption of antiretroviral therapies.
  • STIs and other infections: People with sexually transmitted infections such as gonorrhea, chlamydia and trichomoniasis need access to clean water for washing to manage symptoms, and to take oral medications. Genital ulcers and sores caused by some infections (herpes, syphilis, chancroid) are exacerbated by poor hygiene. Hygiene – including clean, dry underwear and the ability to wash and wipe properly – is also important in preventing bacterial vaginosis, yeast infections and urinary tract infections.
  • Discrimination in accessing WASH services: Because of myths or cultural practices, menstruating women can have their movements restricted, or be prohibited from accessing water, cooking facilities or toilets. People living with HIV still face stigma and discrimination, including exclusion from access to basic services such as safe water and sanitation. When using public, community or institutional toilets around the world – which are often sex-segregated – transgender, intersex or gender non-conforming people can face not only exclusion but also verbal harassment, physical abuse and even arrest.
  • Sexual and gender-based violence: In 8 out of 10 homes without running water, it’s women and girls who are tasked with collecting it. They often leave home before dawn and travel long distances in the dark to get to the water point early. Traveling alone or in remote areas leaves women and girls vulnerable to sexual assault. Lack of safe sanitation facilities for women and girls also increases their vulnerability to violence.
Female health volunteer conducting hygiene session at District Hospital Khalanga, Jajarkot, Nepal, May 2017. [Photo Credit: WaterAid/ Mani Karmacharya]