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Sub-optimal household water access is associated with greater risk of intimate partner violence against women: evidence from Nepal
Abstract
Household water management is often women's responsibility, as related to the gendered nature of household roles. Ethnographic data suggest that household water insecurity could increase women's exposure to emotional and physical forms of intimate partner violence (IPV), as punishments for failures to complete socially expected household tasks that rely on water (like cooking and cleaning) and the generally elevated emotional state of household members dealing with resource scarcity. Here, we test the associations between sub-optimal household water access and women's exposure to IPV, using the nationally-representative data from Nepal Demographic and Health Survey, 2016. Drawing upon the intra-household bargaining model as the theoretical framework, we run instrumental variable probit regression, to test the association between household water access and prevalence of IPV against women. After controlling for other known covariates of IPV such as women's empowerment and education, the findings substantiate that worse household water access consistently elevates women's exposures to all forms of IPV. This suggests that improvements in household water access may have additional ramifications for reducing women's risk of IPV, beyond currently recognized socioeconomic benefits. While both household water access and IPV have known health consequences, linking them provides another pathway through which water could affect women's health.
... Moreover, WI can affect time use allocation, with increased time needed for water collection, which may interfere with other domestic tasks which gender norms generally dictate are performed by women, including cooking, cleaning, and caring for children or sick or elderly household members. Inability to perform these tasks may trigger punishments or increase justification of IPV from partners (Choudhary et al., 2020). Finally, food insecurity may be a sequelae of WI; for example, insufficient water access may lead to crop failures or related outcomes (Brewis, Workman, Wutich, Jepson, Young, & Household Water Insecurity Experiences -Research Coordination, 2020;Young, 2021), or difficulty preparing food (Young, Frongillo, et al., 2021). ...
... Other studies examine the relationship qualitatively or examine different types of genderbased violence. Our findings align with the two existing quantitative studies which found that sub-optimal water access and drought were linked to increased risk of IPV (Choudhary et al., 2020;Epstein et al., 2020a). In one of those studies, associations between severe drought and emotional IPV were found only among adolescents, who are comparable to the relatively younger age of our study sample, but not adult females (Epstein et al., 2020a). ...
... Rather, this finding may underscore the fact that WI precedes food insecurity, and the latter may lie along the causal pathway between WI and IPV (and thus controlling for food insecurity in these models attenuates the estimated association between WI and IPV). However, our finding of attenuation of the effect of WI is in contrast to that of Choudary and colleagues, who found that the association between water source and IPV in Nepal remained significant when adjusting for food insecurity (Choudhary et al., 2020). Thus, our study findings largely align with those on IPV in the Epstein et al. study. ...
Food insecurity increases intimate partner violence (IPV), but less is known about water insecurity (WI) and IPV. We examined the association between household WI and IPV among adolescents and youth in the Mbeya and Iringa regions of Tanzania. The cross-sectional sample comprised 977 males and females aged 18–23 years living in rural, impoverished households. We conducted multivariate logistic regression analyses to estimate the association between experiences of WI [measured by the Household Water Insecurity Experiences (HWISE-4) Scale] and physical and/or emotional IPV (measured by an adapted Conflict Tactics Scale). Overall, WI (HWISE ≥4) was associated with 74% higher odds of any IPV (marginal effects (ME) of 7.8 percentage points (pp)), compared to those not WI. Among females (but not males), WI was associated with 3-fold higher odds of any IPV (OR = 3.00; 95% CI: [1.52, 5.94]; ME = 14 pp). Compared to non-WI females, WI females had 5- and 2-fold higher odds of IPV (ME = 30.8 and 11.3 pp) among the ever married and never married sub-samples, respectively. The association between WI and IPV among females was attenuated (OR = 1.93; 95% CI: [0.93, 3.97]) when adjusting for household food insecurity. Ameliorating water insecurity is a promising avenue for IPV reduction.
... And sexual coercion, such as pressure to engage in transactional sex, has been perpetrated against women and girls vying to advance their chances of securing water (Pommells et al., 2018). Indeed, in the Tallman et al. (2023) review, the risk of physical and sexual violence occurring while women trekked long distances to procure water was the most common dynamic reported (Asaba et al., 2013;Assefa et al., 2021;Barchi & Winter, 2020;Chipeta, 2009;Choudhary et al., 2020;Collins et al., 2019;Epstein et al., 2020;Karim et al., 2012;Logie et al., 2021;Meyiwa et al., 2014;Mukuhlani and Nyamupingidza, 2014;Mushavi et al., 2020;Narang, 2014;Pommells et al., 2018;Shah, 2002;Sultana, 2011;Thompson et al., 2011). ...
... Water inadequacy was also a prevalent driver of physical and psychological violence between women, intimate partners, and other family members in this review (Tallman et al., 2023). In these cases, the primary mechanism connecting water insecurity to GBV appeared to be the opportunity costs of water acquisition that interfered with domestic activities (Assefa et al., 2021;Choudhary et al., 2020;Collins et al., 2019;Karim et al., 2012;Stevenson et al., 2012;Sultana, 2011), and insufficient water within the household for hygiene and consumption producing high levels of household stress Mushavi et al., 2020;Pommells et al., 2018). Fig. 1 showcases the types of GBV that occurred in relation to water insecurity, visualizing the spatial dimensions of this association in the household, to the path back and forth to collect water, and at water access points. ...
... The survey applied in all communities collected general demographic information (age, educational level etc.), characteristics of water access, experiences of household water insecurity (HWISE) and experiences of GBV in the last twelve months. Measures of food insecurity were also included given the association between these factors (Brewis et al., 2020;Bethancourt et al., 2023;Young et al. 2021). ...
... Other indirect factors may include problems for the community to access important infrastructure like a water supply systems, safe and stable housing, and lack of access to medical care and mental health services ( Cardoso et al., 2016 ). A previous study revealed that household water insecurity elevates women's exposure to emotional and physical forms of IPV as punishments for failure to complete socially expected household tasks that rely on water, such as cooking and cleaning ( Choudhary et al., 2020 ). However, Choudhary et al. (2020) used a readily available, safe household water source as a reasonable proxy for access to water sources. ...
... A previous study revealed that household water insecurity elevates women's exposure to emotional and physical forms of IPV as punishments for failure to complete socially expected household tasks that rely on water, such as cooking and cleaning ( Choudhary et al., 2020 ). However, Choudhary et al. (2020) used a readily available, safe household water source as a reasonable proxy for access to water sources. In this paper, we use round-trip time to water sources to assess the water access level in terms of needs met. ...
... data/) . In addition, other studies that utilised data on IPV using DHS have been published elsewhere ( Choudhary et al., 2020 ;Epstein et al., 2020 ;Wado et al., 2021 ). ...
... Consequently, many Liberians are at risk for neglected tropical diseases and their associated chronic morbidities because of poor infrastructure development, including inadequate water and sanitation infrastructure [21]. Elsewhere, studies have revealed that poor WASH accessibility heightens women and girls' vulnerability to domestic abuse and gender-based violence [22][23][24]. Poor access to WASH also increases exposure to toxic contaminants, poor nutrition and food insecurity [25][26][27]. ...
... For demographic factors, we find that male-headed households were less likely to have improved drinking water sources in comparison to their female-headed counterparts (OR = 0.86, p<0.001). In addition, older households (i.e., 40-49 and 50+) were less likely to have improved drinking water sources and sanitation facilities, compared to the youngest cohort (i.e., [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Similarly, married, widowed, and divorced households were all less likely to have improved drinking water sources and sanitation facilities, compared to their single counterparts. ...
... We fully adjusted for socioeconomic, geographical, and demographic factors in Model 3 and found that the patterns observed in Models 1 and 2 remained largely robust in terms of statistical significance. For demographic factors, it is interesting that older households -i.e., 40-49 (OR = 0.87, p<0.05) and 50+ (OR = 0.84, p<0.05)-were less likely to have improved drinking water sources, compared to the youngest cohort (i.e., [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. ...
Public health and wellbeing in Liberia have been compromised by a lack of access to safe drinking water, sanitation, and hygiene (WASH), compounded by 14 years of civil unrest. After almost two decades of relative peace and stability, disparities in WASH access persist and diseases linked to WASH such as Ebola, cholera, and COVID-19 have posed major public health challenges. Yet, there is nascent research in the context of post-war Liberia examining the determinants of access to WASH. To contribute to WASH policy in Liberia, this study examined the predictors of improved water and sanitation using the 2019–20 Liberia Demographic and Health Survey. Using the complementary log-log link function, we found that some socioeconomic and geographical factors were associated with access to improved water and sanitation. For example, poorer and rural households were less likely to have access to improved water and sanitation compared to their wealthier and urban counterparts, respectively. Based on these findings, we discussed policy implications and potential directions for future research.
... Water access, conceptualized here as how an individual or household acquires water, was the most frequently mentioned driver of gender-based violence (94% of studies). The risk of sexual violence, including harassment, assault, and rape while accessing water sources, was one of the most common concerns expressed across studies (Asaba et al., 2013;Assefa et al., 2021;Barchi & Winter, 2020;Chipeta, 2009;Choudhary et al., 2020;Collins et al., 2019;Epstein et al., 2020;Karim et al., 2012;Logie et al., 2021;Meyiwa et al., 2014;Mukuhlani & Nyamupingidza, 2014;Mushavi et al., 2020;Narang, 2014;Pommells et al., 2018;Shah, 2002;Sultana, 2011;Thompson et al., 2011). For example, Narang (2014) found that young girls were verbally harassed when walking to water sources in India, creating a constant atmosphere of fear. ...
... (Shah, 2002) After implementation of an irrigation management project Women suffered unspecified "abuse" while collecting water from irrigation canals (access). (Choudhary et al., 2020). ...
... Water inadequacy, which we conceptualize as an insufficient quantity or sub-optimal quality of water to meet daily household needs, was a major driver of violence between women, intimate partners, and other family members (44% of studies). The primary mechanism connecting these phenomena appears to be the opportunity costs of water acquisition that interfere with domestic activities (Assefa et al., 2021;Choudhary et al., 2020;Collins et al., 2019;Karim et al., 2012;Stevenson et al., 2012;Sultana, 2011), and insufficient water within the household for hygiene and consumption Mushavi et al., 2020;Pommells et al., 2018). Regarding opportunity costs, Stevenson et al. (2012) found that Ethiopian women expressed concerns over the time it took to obtain water as it prevented them from doing their household chores such as cooking. ...
We reviewed the existing literature documenting the association between water insecurity and gender‐based violence to (1) describe the characteristics and contexts of available studies, and (2) identify and classify documented gender‐based violence across domains of water insecurity (access, affordability, adequacy, reliability, and safety). 18 peer‐reviewed articles mentioned associations between water insecurity and gender‐based violence. All studies were conducted in sub‐Saharan Africa and South Asia and were published in English. The most common manifestation of the relationship between water insecurity and gender‐based violence was an increased risk of sexual and physical violence for women who walked long distances to access water. This was followed by intimate partner violence sparked by the inability to meet domestic obligations due to household water inadequacy. Despite these trends, the domains of water insecurity, and the types of violence experienced by women, were often intertwined. We conclude that there is a dearth of information assessing gender‐based violence and water insecurity, especially in Latin America, North America, and Southeast Asia, and involving locally‐based scholars. We suggest that the spectrum of what is considered “violence” in relation to water insecurity be expanded and that scholars and practitioners adopt the term “gender‐based water violence” to describe water‐related stressors that are so extreme as to threaten human health and well‐being, particularly that of women and girls. Finally, we encourage the development of cross‐culturally validated measures of gender‐based violence, which can be deployed in conjunction with standardized measures of water insecurity, to evaluate interventions that target these linked threats to global health.
This article is categorized under: Engineering Water > Water, Health, and Sanitation
Human Water > Rights to Water
... According to previous research, feelings of fear, anxiety or sadness often appear in someone who is diagnosed with depression. 16 So this is in line with the results of the study. In older adults with depression, there were symptoms of anxiety and sadness. ...
... However, for someone who does engage in silent treatment, there is still a lack of data to show whether this is beneficial or detrimental from a psychological perspective. 16 Some older adults in the Pucang Gading Semarang home care feel that there has been no significant change since living in the nursing home. However, some feel a change, even though they feel uncomfortable living in the nursing home. ...
Older people suffering from depression often exhibit low self-efficacy, which causes them to quickly give up on challenges caused by various problems related to ageing, such as physical, social and mental aspects, including depression, which ultimately impact their quality of life and productivity. Depression in the elderly is caused by physical, psychological, and social interactions with other people, especially caregivers in nursing homes. This study employed a phenomenological approach to analyse self-efficacy among older adults suffering from depression through qualitative inquiries. The participants who met the inclusion criteria lived in nursing homes for more than one year and experienced depression. In-depth interviews were conducted using a structured guide with a general self-efficacy scale (GSES), Indonesian version. The study was conducted in an older adult nursing home in 2022 with 14 older adults. The results were divided into four themes – accompanying performance, vicarious learning, verbal encouragement and emotional states – and indicated that older adults with depression experienced poor self-efficacy and described how to cope with poor self-efficacy.
... Women can also be harassed, assaulted, raped, or injured while collecting water (Geere & Cortobius, 2017;Pommells et al., 2018). In addition, water scarcity can lengthen waterfetching time, which may expose women to violence within the home due to delays or failures to complete socially expected and gender-specific "household duties" (Choudhary et al., 2020;WHO, 2005). For example, a study from India noted that women were at higher risk for marital violence during times of irrigation systems failures (Karim et al., 2012). ...
... This failure increased the travel time to fetch water, which prevented women from completing household obligations. In Nepal, lack of water access has been linked to physical and emotional forms of IPV as a response to failure to perform socially expected duties in the household (Choudhary et al., 2020). ...
Numerous studies have examined the effects of climate change on many aspects of both human health and violence. Fewer studies have investigated the links between climate change and intimate partner violence (IPV). We expand on this literature by examining the association between climate variability and IPV, including physical, sexual, and psychological forms of violence. We examine both direct associations and potential mediation via water insecurity, in a sample of women from 15 sub-Saharan African countries. Our results suggest there is a direct effect of climate variability on IPV but also that this effect is mediated through water insecurity. These results contribute to the literature by highlighting pathways through which climate change may affect IPV, including water insecurity, and changes in soil moisture and precipitation. Our findings are important for policy makers and international development organizations as they indicate specific areas where improvements to water insecurity can help reduce the incidence of IPV globally.
... Across 25 sub-Saharan countries, women collectively spend 16 million hours per day collecting water (Global Environmental Outlook, 2019). Water fetching exposes women to musculoskeletal and other physical injuries Venkataramanan et al., 2020), intimate partner violence (Choudhary et al., 2020), and poor mental and psychosocial health (Wutich et al., 2020). ...
... Across 25 sub-Saharan countries, women collectively spend 16 million hours per day collecting water (Global Environmental Outlook, 2019). Water fetching exposes women to musculoskeletal and other physical injuries Venkataramanan et al., 2020), intimate partner violence (Choudhary et al., 2020), and poor mental and psychosocial health (Wutich et al., 2020). ...
In sub-Saharan Africa, water insecurity is intertwined with gender and sociocultural norms. While extensive scholarship exists on gender-water relations in the region, it predominantly focuses on women’s roles and responsibilities, seldom considering the role of masculinities. This paper examines masculinities, gender relations, and women’s embodied experiences of water insecurity. It situates women’s embodied experiences of water insecurity within household and community masculinities. The study was conducted in Lilongwe, Malawi, and data were drawn from interviews, focus groups, observations, and household surveys. The findings advance the gender-water literature in at least three significant ways. First, they demonstrate how gendered labour underpins women’s embodied experiences of water insecurity. Second, they show that women’s decisions and strategies for coping with water insecurity are themselves an embodied consequence of water insecurity. Finally, they illuminate how men’s perceptions and constructions of masculinity, expressed through marital expectations of femininity, shape women’s embodied experiences of water insecurity. Together, the findings reveal intricate intersections between masculinities, gender relations, and women’s everyday embodied experiences of water insecurity, validating the body as a significant site of geographic inquiry.
... Although accessible and affordable, Tiruppur's municipal borewells impose considerable invisible costs-the lost time, physical stress, and emotional labour on female members of borewell-dependent households. Women sacrificed other uses of their time, like education, employment, or leisure, to collect and store borewell water, in line with research from other contexts (Biswas, 2021;Choudhary et al., 2020;Das & Safini, 2018;Dickin & Caretta, 2022;Kayser et al., 2019). Although we did not attempt to quantify the time costs of water access, studies from other Indian cities suggest they could be between 4% and 13% of household cash income (Zozmann et al., 2022). ...
Off-grid, decentralised water infrastructures are increasingly being promoted to help cities meet their water delivery targets and build resilient water systems in the face of changing water availability. Against this background, this paper examines how integrating off-grid, decentralised groundwater systems with centralized piped supply helps water utilities and urbanites achieve transformative resilience under conditions of chronic water scarcity in the secondary city of Tiruppur, India. Empirical findings on users' water access practices from off-grid systems like municipal or private borewells to remain resilient, their role in the everyday governance of these systems, and the costs of building resilience through borewells—obtained through a participatory action research project where 94 households recorded month-long water access using a ‘water and waste calendar’—reveal that Tiruppur's public borewells are an affordable and mostly inclusive resilience building measure but are far from being transformative. Moreover, diverse arrangements for their everyday governance unevenly enable user participation, impose invisible costs on female members of borewell-reliant households, and create differentiation in service quality across the city. The paper argues that the potential to achieve transformative resilience through off-grid sources like borewells remains untapped in Tiruppur and concludes with some reflections to pursue just and inclusive resilience.
... Women's health can be improved and mortality risks can be decreased by promoting gender equality, giving women access to education and economic opportunities, and fighting for their rights in marriage partnerships. [26] ...
Introduction: This unique essay conducts a thorough investigation into the causes of female mortality within thefirst seven years of marriage. Despite substantial improvements in healthcare and women’s rights, many countriescontinue to experience early female death after marriage. For establishing successful interventions and policiestargeted at lowering this troubling trend, understanding the underlying causes is essential.Aims and objectives: The purpose of this study is to analyze the underlying factors that contribute to early femaledeath after marriage by combining quantitative and qualitative approaches, drawing on a multidisciplinaryapproach.Methodology: All cases of “unnatural deaths of females within seven years of their marriage” brought to theMortuary, over the one year from January 2017 to December 2017, totaling 152 cases, served as the basis for thecurrent study.Results: The study found several important characteristics that were linked to a higher risk of female mortalityduring the first few years of marriage. Socioeconomic inequalities, poor access to healthcare, gender-basedviolence, cultural norms and expectations, mental health issues, and restricted marital autonomy are some of thesereasons. The findings underscore the intricate interplay between societal, structural, and individual elements thatfuel this worrying trend.Conclusion: This study reveals that the age group of 18-22 years experiences the highest casualties due to earlymarriage in India. The majority of victims lack the maturity to handle marital responsibilities. Husband’s behaviorplays a key role in these deaths, with cooperation and love being scarce. Lower middle-class women are at higher risk, and low education levels are influential. Addressing early marriage, promoting education, and raising awareness are crucial steps to protect the well-being of young women and create a safer environment within marriages.
... In a setting where no preference is given to the gender of a child and both male and female child are treated equally, this may not be applicable. This review has also identified the association between IPV and food insecurity which mirrors the finding from the global context too (Bloom et al., 2020;Choudhary et al., 2020). IPV due to food insecurity is suggested to have intergenerational effects meaning children born from such parents are also likely to be impacted (Murray et al., 2018). ...
A systematic review was conducted to examine the factors that put women at risk of domestic violence in Nepal. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed, Cochrane, MEDLINE, CINAHL, and PsycINFO were searched supplemented by searching of the reference list manually. Of the 143 studies identified 24 were included in the final review. Search strategy was developed, and studies were included if they considered female participants (age 15–49 years) in heterosexual relationship, with exposure of different factors and whose outcomes were the magnitude of any form of violence (physical, sexual, and emotional/psychological). The Mixed Methods Appraisal Tool was used to assess the quality of the studies included. The findings are categorized based on the four levels of the ecological framework. At the individual level, the alcohol consumption level of husband, education level of both women and men, women’s age at the time of marriage and childhood exposure to violence were found to be highly prevalent risk factors. At the relationship level, most prevalent risk factors were controlling husband and decision-making capacity of women. At the community level, belonging to underprivileged community or low caste system and living in Terai region were the risk factors. At the societal level, patriarchal belief and norms supporting violence were the risk factors. The complex nature of violence against women in Nepal requires culturally sensitive interventions along with organized efforts from the local and intra government to improve the status of Nepalese women at all levels of the ecological framework.
... Further, intimate partner violence is associated with household water insecurity in many water scarce contexts-including India, our case study here-and is highly feminized. The general explanatory mechanism is predominantly male violence toward women in the household, linked to both gendered expressions of frustration and anger and targeting of women for failing to meet cultural expectations to manage water for the home (e.g., Choudhary et al., 2020). ...
Introduction
Household water fetching elevates physical and emotional harms, and these are generally assumed to accrue to women due to gendered labor assignments. But even in cases like India where fetching remains a highly feminized task, there are households where the primary responsibility is assumed by men.
Methods
We test the proposition that men's responsibility for water fetching is predicted by greater gender equity, reflected in measures of wives' empowerment. We used an extremely large, nationally representative Demographic and Health Survey dataset from India (2019–2020), narrowed to only households in which spouses co‐reside with off‐plot water sources ( N = 10 616), and applying a multinomial regression approach.
Results
In >20% of households, men are the primary fetchers. They are more likely to have primary responsibility when water is more distant, privately purchased, or transported by vehicle. Contrary to predictions, men assume greater responsibility for household water fetching as their wives' empowerment measures decrease and when they want to control their movement.
Conclusion
Married men in India sometimes assume responsibility for water fetching, but this is not explained by greater household gender equity. The findings also suggest that when men are responsible for fetching they have heightened risk of some forms of physical trauma but less relative psychological harm. Detailing why men fetch water matters for identifying and mitigating the physical and emotion harms of bearing responsibility for water labor, with implications for how gender should be conceptualized in water interventions intending to improve health and well‐being.
... One clear existing line of evidence relates to water insecurity and intimate partner violence. Research shows that when women do not adhere to gendered expectations of water acquisition, water use, hygiene, and so on, they may be at significantly elevated risk of both physical and emotional abuse within their own households (Choudhary et al., 2020;cf. Cooper et al., 2021;Nunbogu & Elliott, 2022;Tallman et al., 2022). ...
Informed by decades of literature, water interventions increasingly deploy “gender‐sensitive” or even “gender transformative” approaches that seek to redress the disproportionate harms women face from water insecurity. These efforts recognize the role of gendered social norms and unequal power relations but often focus narrowly on the differences and dynamics between cisgender (cis) men and women. This approach renders less visible the ways that living with water insecurity can differentially affect all individuals through the dynamics of gender, sexuality, and linked intersecting identities. Here, we first share a conceptual toolkit that explains gender as fluid, negotiated, and diverse beyond the cis‐binary. Using this as a starting point, we then review what is known and can be theorized from current literature, identifying limited observations from water‐insecure communities to identify examples of contexts where gendered mechanisms (such as social norms) differentiate experiences of water insecurity, such as elevating risks of social stigma, physical harm, or psychological distress. We then apply this approach to consider expanded ways to include transgender, non‐binary, and gender and sexual diversity to deepen, nuance and expand key thematics and approaches for water insecurity research. Reconceptualizing gender in these ways widens theoretical possibilities, changes how we collect data, and imagines new possibilities for effective and just water interventions.
This article is categorized under: Human Water > Value of Water
Engineering Water > Water, Health, and Sanitation
Human Water > Water as Imagined and Represented
Human Water > Methods
... Post-pubescent girls and women have the added difficulty of menstruation, which for a number of days per month increases their daily needs for water and sanitation 4 . Household water insecurity may increase the vulnerability of women to IPV as a penalty for failure to fulfil household activities dependent on water such as cooking and cleaning 7 . ...
We provide the first comprehensive analysis of the association between two key household resources (drinking water and toilet access) and both non-partner violence (NPV) and intimate partner violence (IPV) experienced by women. We use data from a nationally representative household survey for India obtained from the latest (fourth) round of the National Family Health Survey conducted in 2015–16. We employ logistic regression method and also use inverse-probability-weighted regression adjustment to control for selection bias. We find that NPV decreases with access to drinking water, while IPV decreases with provision of toilets. These results are found to be robust to an alternative method viz. propensity score matching and selection on unobservables using the Rosenbaum bounds approach.
... Using data collected through geographically randomised surveys in three high-poverty communities in Haiti, Brewis et al. (2019b) established a robust association between inadequate household water insecurity and depression and anxiety among women in both rural and urban areas. Another study using a large, nationally-representative sample of households in Nepal (Choudhary et al., 2020) found that limited household water access resulted in women's increased exposure to intimate partner violence, both physical and emotional, likely causing a decline in women's psychosocial health and creating another mechanism linking water insecurity with stress among women. Nearly all of these studies investigate and highlight women's mental health and emotional distress in relation to their failures to meet social and familial obligation towards water-related roles and responsibilities when living with water insecurity. ...
An emerging body of literature examines multiple connections between water insecurity and mental health, with particular focus on women’s vulnerabilities. Women can display greatly elevated emotional distress with increased household water insecurity, because it’s them who are primarily responsible for managing household water and uniquely interact with wider water environments. Here we test an extension of this proposition, identifying how notions of dignity and other gendered norms related to managing menstruation might complicate and amplify this vulnerability. Our analysis is based on systematic coding for themes in detailed semi-structured interviews conducted with twenty reproductive-age women living in two water insecure communities in New Delhi, India in 2021. The following themes, emerging from our analysis, unfold the pathways through which women’s dignity and mental health is implicated by inadequate water: ideals of womanhood and cleanliness; personal dignity during menstruation; hierarchy of needs and menstruation management amidst water scarcity; loss of dignity and the humiliation; expressed stress, frustration and anger. These pathways are amplified by women’s expected roles as household water managers. This creates a confluence of gendered negative emotions – frustration and anger – which in turn helps to explain the connection of living with water insecurity to women’s relatively worse mental health.
... A growing body of work has documented the links between WASH access and gender-based violence (Abu Sharekh, 2021;Pommells et al., 2018) and intimate partner violence (Choudhary et al., 2020;Mushavi et al., 2020). Recent work has connected water insecurity with community-level and intra-household conflict, and how these relationships may be shaped by regional conflict and exacerbated by climate change (Caridade et al., 2022;Mack et al., 2021). ...
Progress toward achieving Sustainable Development Goal 6, clean water and sanitation for all, is behind schedule and faces substantial financial challenges. Rigorous water, sanitation, and hygiene (WASH) interventions have underperformed, casting doubt on their efficacy and potentially undermining confidence in WASH funding and investments. But these interventions have leaned on a narrow set of WASH indicators—linear growth and diarrhea—that reflect a 20th‐century prioritization of microbiological water quality as the most important measurement of WASH intervention success. Even when water is microbiologically safe, hundreds of millions of people face harassment, assault, injury, poisoning, anxiety, exhaustion, depression, social exclusion, discrimination, subjugation, hunger, debt, or work, school, or family care absenteeism when retrieving or consuming household water. Measures of WASH intervention success should incorporate these impacts to reinforce the WASH value proposition. We present a way forward for implementing a monitoring and evaluation paradigm shift that can help achieve transformative WASH.
This article is categorized under: Engineering Water > Water, Health, and Sanitation
Human Water > Value of Water
Human Water > Methods
... Water-insecure households, particularly those headed by women, have been found to have higher rates of stress, Anxiety, and psychological distress compared to water-secure households [30]. Stigmatization and feelings of worthlessness may also affect the emotional state of women unable to meet the water needs of their households [10,44]. ...
In response to water insecurity and its associated socio-environmental consequences, households develop and use
diverse coping strategies, including water storage, water reuse, rainwater harvesting, water treatment, water sharing and borrowing from social networks, illegal connections to public networks, buying water from private vendors, consumption of beverages in place of water, and fetching water from distant sources to meet their daily water needs. However, some of these strategies are associated with adverse health impacts on households. This review aims to examine the health implications of water insecurity coping strategies. The results indicate that
coping strategies such as prolonged water storage is associated with diarrheal diseases and non-communicable diseases; diabetes is more prevalent in households that use sugary beverages as a coping strategy. In addition, water-sharing and borrowing from social networks exacerbate water-related psychosocial stress, including Anxiety, worry, and anger. Finally, fetching water from long distances is associated with muscle-skeletal pains
and injuries. Future studies are needed to understand water insecurity coping mechanisms’ biomedical and psychosocial consequences. These would help practitioners develop programs and policies that could be implemented to improve coping mechanisms while limiting their biomedical and psychological effects.
... Post-pubescent girls and women have the added difficulty of menstruation, which for a number of days per month increases their daily needs for water and sanitation 4 . Household water insecurity may increase the vulnerability of women to IPV as a penalty for failure to fulfil household activities dependent on water such as cooking and cleaning 7 . ...
... Recurrent injuries from water collection can also lead to disability (Geere et al., 2018). Water fetching after dark increases the risks of rape, sexual harassment, gender-based violence, and other physical attacks (Caruso et al., 2015;Choudhary et al., 2020). Water collection is also linked with higher emotional distress and reduced daily functioning (Tomberge et al., 2021). ...
Water insecurity is a critical public-health challenge in Africa's urban informal settlements, where most of the population often lacks access to household taps. In these settings, water fetching is disproportionately performed by women. While water fetching is physically laborious and exposes women to multiple risks, the water-insecurity literature has predominantly focused on household experiences, ignoring women's water-collection journeys. This paper uses the water journey as a window into embodied dimensions of water insecurity. Combining theoretical insights from embodiment, embodied political ecology of health, and time geographies, we use video-recorded walking interviews to analyze women's everyday water journeys in Ntopwa, an urban informal settlement in Blantyre, Malawi, from initial decision making through exposure to water-fetching risks and household practices regarding use and storage. We identify three principal sources of environmental risk— terrain, built environment, and human behavior—that present challenges for water collectors. Using the walking interview as a heuristic, we show how the seemingly simple practice of water fetching is compounded by complex decision making, constant spatiotemporal trade-offs, and exposure to diverse risks, all of which have embodied health consequences. Based on our findings, we conclude that interventions seeking to improve household water insecurity must consider the embodied effects of water-fetching journeys. This study also provides methodological insights into using walking interviews and videos for water and health research.
... According to Choudhary et al. (2020), household water management is often considered women's responsibility due to the gendered nature of household roles. The groundwater scarcity can increase women's exposure to physical and emotional forms of domestic violence for failing to complete domestic tasks, such as cleaning and cooking, that require water. ...
Groundwater will be a critical future resource for rural India, given climate change and increased competition for water, especially for drinking water supplies, agriculture, and livelihood. The possibilities of groundwater resource development, use, and management have been widely discussed in the global and Indian contexts. However, most studies so far focused on scientific perspectives and not many on understanding the societal and gender aspects. Women are the providers of drinking water in rural India and also carry with them a quest for equality and respect. It is important to examine how the government policies, power, and responsibility for rural women in a traditional patriarchal society are impacted by the availability and access to groundwater. The main aim of this article is to examine the water challenges of Indian rural women in their routine life and discuss the impacts of depleting groundwater resources on their education, health and livelihood of their families. It also examines government policies, initiatives, and strategies that can potentially involve women in achieving sustainable water futures. The study indicates that poverty can impose gender roles in the family and society. Women's dilemmas differ not only in respect of monetary costs, but the challenges they face in terms of education, health, safety, and well‐being due to water scarcity. There is often a lack of suitable policies to overcome gender inequality. In some instances, policies might be reasonably good, but inequality continues because of weak policy implementation and other factors. Therefore, we need to devise policies and strategies that can be effectively implemented, raise awareness of gender equality, and create opportunities for women in decision making, program development, and implementation at all levels of government.
... Additionally, the incidence of diarrhea was higher in households experiencing water insecurity and the difference was statistically significant. Our study specifically focused on drinking water access, but other previous studies have shown that water insecurity has been associated with domestic violence [42]; food insecurity [10,43]; depression and anxiety [44,45] and limited social capital [46]. ...
Water is a physiological need, key for survival. In limited water access situations, health, well-being, and productivity of households are negatively affected. Water insecurity refers to when access to adequate amount of clean water does not occur all the times for household members to lead a healthy and active life. A cross sectional study was conducted with 121 women from three rural communities in the West-Cameroon, to assess water insecurity experience and its correlation with related indicators. Specifically, this study aimed to: examine drinking water access by time spent on collection and distance to the water source, determine the prevalence of household water insecurity, and examine the relationship between water insecurity and diarrhea as well as drinking water access-related indicators. The main sources of drinking water included boreholes (69%), wells (13%), and rivers (12%). Each household spent an average total amount of 3 hours on water fetching. The mean duration of the drinking water stored was 4 days, after which the process was repeated. The majority of households (94.2%) were water insecure (total WATINE-17 score ≥1). About 61% reported drinking less water than they felt they should and 32% of them, said they had to drink dirty water. Water insecurity mean score was higher in households who reported diarrhea among their 0–5 years old children than their counterparts (p = 0.008). This study highlights the problem that good access to improved water source still represents in low-resource households of rural areas, with the subsequent complex interactions on women and children’s health. Future research on water management and storage is warranted to understand the sources of cross-contamination and to identify the potential points of intervention to ensure safe drinking water for rural households. Policies should be designed in order to incorporate systematic household water insecurity measurement in monitoring advancement towards 2030 SDG.
... Water insecurity can also contribute to increased anxiety and depression, and also stress domestic relationships with the burden disproportionately falling on women (Choudhary et al., 2020;Stevenson et al., 2012;Wutich et al., 2020). It can also limit food preparation and increase water costs, leaving less disposable income for food, and the stress that engenders Stoler et al., 2020). ...
Water has always been a driver of human mobility, migration, and displacement. But water is increasingly central to explaining environmental migration in the context of climate change. Most studies of the relationship between water and environmental migration are framed around punctuated, extreme weather events and disasters that either limit agricultural or livestock productivity or make a community physically unlivable. The chronic experiences of household water insecurity and poor water governance also shape migration decision‐making through a variety of social, political, and economic factors, but these relationships have received considerably less attention. This article provides an overview of punctuated and chronic water‐related triggers of environmental migration at the household level. We also offer a conceptual framework based on multiphasic response theory that highlights water's multiple roles in migration decision‐making. We close by reflecting on key gaps in the climate‐water‐migration literature, identifying research questions that might help us better understand these relationships, and considering the implications for sustainable development policies that could potentially ease pressures on water‐related displacement. A livestock trough beside a shrinking watering hole during a drought in southwest Uganda. Photo by Amber L. Pearson.
... Our findings add to the body of literature documenting the associations of inadequate living conditions and their characteristics with IPV in LMICs. Evidence from DHS data in Nepal suggests that unimproved household water sources elevated women's risk of experiencing physical and emotional IPV [28]. A study conducted in Brazil suggests that 20-59-year-old women living in households with more than two people per bedroom were more likely to report experiencing IPV compared with those living in less crowded housing [29]. ...
Intimate partner violence (IPV) against women is a major public health problem and is widespread in sub-Saharan Africa (SSA). However, little is known about its environmental determinants. This study aimed to investigate whether inadequate living conditions are associated with IPV victimization in women in SSA. We analyzed cross-sectional data for 102,714 women in 25 SSA countries obtained from the Demographic and Health Surveys Program. Logistic regression was used to estimate the country-specific effects of inadequate living conditions (housing with at least one of four characteristics of unimproved water, unimproved sanitation, insufficient space, and unfinished materials) on multiple forms of IPV. Random effects meta-analysis was used to combined the country-specific estimates. We found an association between inadequate living conditions and a higher likelihood of experiencing any (OR = 1.12, 95% CI 1.03 to 1.23, p = 0.012), sexual (OR = 1.18, 95% CI 1.05 to 1.34, p = 0.008), emotional (OR = 1.12, 95% CI 1.02 to 1.23, p = 0.023), and physical (OR = 1.15, 95% CI 1.03 to 1.28, p = 0.010) IPV. The associations were stronger for rural and less-educated women. These findings suggest that future research to establish a causal link between living conditions and IPV and to elucidate the underlying pathways is crucial to design IPV interventions in SSA.
... Relevant to the analysis of drought and IPV, a specific body of the literature focuses on the effects of water insecurity on mental health. Studies from parts of Asia [24], Africa [25], and Latin America [26] have shown that water insecurity is associated with worse mental health, and other studies have shown that there a number of pathways through which water insecurity can affect mental health and well-being [27,28]. While these studies have primarily focused on women's mental health, an analysis from Uganda showed that water insecurity is more strongly associated with depression in men than in women, with implications for IPV [29]. ...
Droughts are associated with several societal ills, especially in developing economies that rely on rainfed agriculture. Recently, researchers have begun to examine the effect of droughts on the risk of Intimate-Partner Violence (IPV), but so far this work has led to inconclusive results. For example, two large recent studies analyzed comparable data from multiple sub-Saharan African countries and drew opposite conclusions. We attempt to resolve this apparent paradox by replicating previous analyses with the largest data set yet assembled to study drought and IPV. Integrating the methods of previous studies and taking particular care to control for spatial autocorrelation, we find little association between drought and most forms of IPV, although we do find evidence of associations between drought and women’s partners exhibiting controlling behaviors. Moreover, we do not find significant heterogeneous effects based on wealth, employment, household drinking water sources, or urban-rural locality.
... Women have also reported feeling embarrassed for being unable to welcome visitors with safe water and often have to make trade-offs in order to provide household water needs [34,35]. Recent studies have also shown water insecurity is associated with higher prevalence of women's reports of domestic violence [35][36][37]. The role of perceived water inequalities (as violations of informal institutions) can possibly be sufficiently emotional to create not just domestic but also community schisms. ...
Climate change is now considered a primary global driver of migration, with water insecurity theorized to be a key determinant. Most studies have focused on large-scale climate migration events triggered by extreme weather events such as droughts, storms, or floods. But there are few studies of how climate change, interacting with background social, economic, and political processes, shapes the everyday household-level experience of water insecurity and subsequent migration decision-making beyond the contexts of disasters and agricultural livelihoods—an invisible ‘slow drip’ of migration. This review proposes a complementary, alternative framework for linking climate change, household-level water insecurity, and environmental migration by positioning household water insecurity as a critical pathway for shaping migration decision-making in the context of socio-environmental change. We present evidence that household water insecurity is a push factor that motivates household members to migrate due to water-related disruptions to physical and mental health, livelihoods beyond agriculture, and social relationships. We close with implications for anti-poverty and development initiatives, and for water interventions to mitigate forced climate migration.
... Women are considered as second class citizens in this patriarchal society. Thus, most of the families are men-headed and treat the women as commodities and child producing machines (Choudhary, Brewis, Wutich, & Udas, 2020). Some of the common forms of violence against women in Nepal identified are: traditional violence (Deuki, Jhuma, Badi, Chaupadi); violence based on misbelieve (torture given for allegedly practicing witchcraft); sexual violence (trafficking, forced intercourse and sexual harassment); family violence (domestic violence, polygamy, childhood marriage); dowry related violence (mental and physical torture) (Adhikari, & Tamang, 2010). ...
A study was carried out the domestic violence against Dalit women of Kalika, of Pokhara Metropolitan City, Gandaki Province, Nepal. Domestic violence is a social issue of inquiry. In this context, this study was made a comprehensive effort to explore the forms, factors and consequences of married Dalit women in the study area. Twenty victim women were chosen as respondents for this study. Using different tools for data collection like in-depth interview, observation as well as different sources of secondary data. this study was more guided by Marxist feminism and more qualitative. There are so many incidences of domestic violence against Dalit and vulnerable married women that blocked the progress and prosperity. Unfortunately, women are even neglected by their husbands and in-laws and their families. Study found that majority of husbands' alcoholic habit, their feeling of superiority, patriarchal social structure, re-marriage and extramarital affair were the main reasons that kept women as victims of the society. Physical, psychological and unwanted sexual abuse of husband, along with unproductive engagement of women in household activities, unwanted pregnancy and deprivation of various needs are major areas of women's subordination among the Dalit married women.
... Water insecurity precipitates significant conflicts both within households and across communities. Within households, conflicts tend to center on financial worries and water shortages, with women often bearing the brunt of blame and experiencing higher risk of intimate partner violence (Choudhary et al., 2020). Within communities, water insecurity produces conflict as people argue over access to water sources (Sultana, 2011). ...
In March 2020, the World Health Organization (WHO) issued a set of public guidelines for Coronavirus Disease 2019 (COVID-19) prevention measures that highlighted handwashing, physical distancing, and household cleaning. These health behaviors are severely compromised in parts of the world that lack secure water supplies, particularly in low- and middle-income countries (LMICs). We used empirical data gathered in 2017-2018 from 8,297 households in 29 sites across 23 LMICs to address the potential implications of water insecurity for COVID-19 prevention and response. These data demonstrate how household water insecurity presents many pathways for limiting personal and environmental hygiene and impeding physical distancing, exacerbating existing social and health vulnerabilities that can lead to more severe COVID-19 outcomes. In the four weeks prior to the survey, 45.9% of households in our sample either were unable to wash their hands or reported borrowing water from others, which may undermine hygiene and physical distancing. Further, 70.9% of households experienced one or more water-related problems that potentially undermine COVID-19 control strategies or disease treatment, including insufficient water for bathing, laundering, or taking medication; drinking unsafe water; going to sleep thirsty; or having little-to-no drinking water. These findings help identify where water provision is most relevant to managing COVID-19 spread and outcomes.
... COVID-19 could aggravate the different forms of violence associated with WASH insecurity. Water insecurity is widely known to trigger intimate partner violence, emotional and physical violence, and other forms of gender-based violence (Choudhary et al. 2020). Competing water needs at home, including spousal water requirements, can heighten tension at home. ...
The novel coronavirus disease (COVID-19) pandemic is having a significant global impact on livelihoods, health, and general well-being. This policy brief argues that in low-income countries (LICs) where water, sanitation, and hygiene (WASH) insecurity is widespread and closely entangled with poverty and other vulnerabilities, COVID-19 will have a particularly devastating impact on women and girls because they bear the disproportionate burden of water collection, sanitation, hygiene, and family welfare ‒ responsibilities embedded in longstanding sociocultural norms. WASH insecurity refers to the physical and relational inequities in WASH access. Using three pathways ‒ reproductive and perinatal health, cultural norms and the risk of COVID-19 infections, and physical and mental health ‒ we discuss how WASH insecurity will worsen the impact of COVID-19 on women and girls in LICs.
... For example, in Lesotho, women identified waterbased development projects as a priority for helping them maintain peace with their spouses, because it meant being able to complete expected household chores (Cairns, Workman, & Tandon, 2017). Studies are starting to observe associations between household water insecurity and risk of intimate partner and other domestic violence (e.g., Choudhary, Brewis, Wutich, & Bhushan, 2020;Stevenson et al., 2012)-itself a well-known risk factor for depression and other common mental illness. ...
There is a well‐established connection among water quality, sanitation, and physical health. The potentially important relationship between water and mental health is considerably less studied. Reviewing evidence from ethnography, geography, folklore, indigenous studies, rural medicine, drought research, and large‐n statistical studies, we argue there is now good theoretical rationale and growing evidence of water insecurity as a possible driver of mental ill‐health. Furthermore, some nascent evidence suggests that emotionally meaningful interactions with water might improve mental health outcomes. Leveraging these literatures, we address the many ways in which mental health outcomes are conceptualized and operationalized in water research, including as emotional distress, perceived stress, depressive symptoms, anxiety symptoms, somatic symptoms, and quality of life. We outline arguments supporting seven possible (and likely interlocking) mechanisms that could explain such a relationship: (a) material deprivation and related uncertainty, (b) shame of social failure, (c) worry about health threats, (d) loss of connections to people and places, (e) frustration around opportunity losses and restricted autonomy, (f) interpersonal conflict and intimate partner violence, and (g) institutional injustice or unfairness. However, we explain that as most existing studies are ethnographic, qualitative, or cross‐sectional, a causal relationship between water and mental ill‐health is yet to be confirmed empirically. More research on this topic is needed, particularly given that poorly understood connections may create barriers to achieving Sustainable Development Goals 3 (health) and 6 (water). We further suggest that tracking mental health indicators may provide unique and as‐yet underappreciated insights into the efficacy of water projects and other development interventions.
This article is categorized under:
• Engineering Water > Water, Health, and Sanitation
• Human Water > Water as Imagined and Represented
... Resource stress is a major trigger for interpersonal violence, and many households are already beginning to experience resource stresses related to job loss, food insecurity, medical bills, and other economic impacts of COVID-19 [12]. Recent research has shown that women in water-insecure households are more likely to suffer intimate partner violence [13], and this is likely to be intensified in the contexts of the COVID-19 pandemic and related economic downturn. Given that pandemic-related stigma is already emerging, we should expect and plan for such stigmas to be intensified among groups that are experiencing water insecurity, poverty, ethnic discrimination, and other forms of social exclusion [14]. ...
Rapid urbanisation has become one of the greatest threats to urban health, particularly among low-income urban areas in the Global South. One of the key aspects of urban health is access to water and sanitation for all as stated in the Sustainable Development Goal (SDG) 6. While substantial progress has been made in increasing access to clean drinking water and sanitation, billions of people, mostly in developing countries, still lack these basic services. Cholera outbreaks and the COVID-19 pandemic demonstrated the critical importance of sanitation, hygiene, and adequate access to clean water to create environments, which are conducive to preventing and containing diseases. Women and girls, especially those living in urban poverty, are disproportionately affected by access to water and sanitation. This chapter explores the gender disparities and implications of inadequate water and sanitation in Mangaung Metropolitan Municipality. We explore local water and sanitation coping strategies among women in selected communities in Mangaung. Data for this study is based on qualitative surveys and key informant interviews. We conclude that gender equality with regards to access to water and sanitation in African cities should be emphasised as basic human rights and are fundamental in achieving other SDGs. We suggest prioritising women’s participation in water governance in their communities, increasing the availability of sex-disaggregated data on water, sanitation, and hygiene, challenging social norms around women’s leadership, and gender-based violence in water and sanitation issues.
In this study, we use water quality tests, epidemiological data, and ethnographic interviews gathered in Kathmandu in 2017, to provide an interdisciplinary analysis of water insecurity, illness, and targeted responses. Our findings fit the pattern of the past 20 years: the concentration of coliform bacteria across water sources remains unsafe. Our epidemiological data documents high rates of water-borne infectious diseases consistent with fecal contamination of water sources. Our ethnographic interviews suggest that social marginalization, poverty, and dislocation are major drivers in the incidence of illness. Evaluating some of the collective responses to water insecurity and contamination, we argue that effectively addressing water pollution, scarcity, and health outcomes in Kathmandu requires redirecting the focus of programs and the primary methods of implementation. Instead of large-scale top-down infrastructural interventions such as the Melamchi Water Supply Project, programs should target women's leadership and subsidize funding for small-scale, community-managed interventions.
If current trends of water insecurity continue, nearly two-thirds of the world’s population will live in water-scarce conditions by 2025. Nevertheless, qualitative studies on barriers to water access, particularly in informal settlements, remain limited. This study used in-depth interviews to examine the daily barriers to water access faced by urban poor households in Ghana. A total of 30 (n = 30) semi-structured in-depth interviews were conducted with residents in water-insecure areas in Tamale and Accra, Ghana. Four themes emerged from our analysis: lack of financial resources, distance and travel time, land and topography, and poor water infrastructure. Sustainable Development Goal Six cannot be achieved if the water needs of the urban poor, particularly those who dwell in informal settlements, are unmet. Thus, governments and systems must implement measures to eliminate inequalities and inequities in water distribution.
One of the most pressing and immediate climate concerns globally is inadequate and unsafe household water. The livelihoods of smallholder crop and livestock farmers are especially vulnerable to these challenges. Past research suggests that water insecurity is highly gendered, and women are theorized to be more aware of and impacted by water insecurity than men. Our study re-engages this literature through a livelihood lens, comparing gendered perception of household water insecurity across crop and livestock subsistence modalities in a semi-arid region of Burkina Faso in the Sahel region of West Africa where water insecurity is closely intertwined with both seasonality and rainfall unpredictability. Our mixed-methods ethnographic study sampled matched men and women in households with water insecurity data collected from 158 co-resident spousal pairs who engaged primarily in pastoralism or agriculture. Contrary to predictions from the existing literature, men engaged in livestock husbandry perceived greater water insecurity than matched women in the same household. We suggest this reflects men’s responsibility for securing water for the animals—which consumes most of the household’s water among livestock farmers. In contrast, men engaged in cropping perceive less water insecurity than women in the same household, aligning with predictions from past research. Our findings suggest that the relationship between gender and water insecurity is more highly nuanced and related to livelihood strategies than previously recognized, with significant implications for how water insecurity is conceptualized theoretically and methodologically in the contexts of people’s everyday management and experience of the most immediate and proximate climate-related challenges.
It has long been acknowledged that many aspects of Water, Sanitation, and Hygiene (WASH) are highly gendered and that women face an increased risk of violence when access to WASH services is not adequate. However, not enough studies explore where these incidents of violence occur or document the different forms of violence. This research paper will add to the newly emerging research on sextortion as a form of violence that women and girls encounter disproportionately in accessing WASH. This form of violence that takes place at the intersection of corruption and sexual violence has dire social, economic and health consequences, yet little is known as of what increases vulnerability to sextortion. Analyzing original data from a standardized survey with adult women (n = 1,200), interviews (n = 21) and focus group discussions (n = 5), this paper examines the factors that make women vulnerable to sextortion in accessing WASH services. The study was conducted in 2 rural and 2 urban areas in Bangladesh between September and December 2021. The analysis shows that those women living in poverty, in water insecure households and in rural areas are especially vulnerable to experiencing sextortion. The research also shows that the vulnerability factors, while overlapping are not the same as those making women vulnerable to experiencing sexual and gender-based violence, highlighting the importance of studying sextortion separately. The findings contribute to an emerging evidence-base around sextortion, which remains an understudied phenomenon posing an obstacle to the achievement of safe access to water and sanitation for all.
Intimate partner violence (IPV) and food insecurity are global health issues that affect millions of people worldwide. Numerous studies show that IPV and food insecurity are linked; however, there is a lack of synthesis of this research. Using a systematic search and review, we examined the international quantitative and qualitative research published on the link between IPV and food insecurity. We searched for peer-reviewed, English-language articles with participants above the age of 16 in 4 large online databases. Fifty-six studies were included from around the world that discussed the link between food insecurity and IPV perpetration and/or victimization. We found evidence in both qualitative and quantitative studies for a meaningful connection between these two global health isues. We also reviewed the literature on moderators and mediators (e.g., mental health). Our findings indicate the importance of implementing IPV prevention strategies which also address household food insecurity, and the potential for food insecurity resources to provide IPV resources. Future research should focus more frequently on IPV perpetration as opposed to victimization, and further examine the moderating and mediating mechanisms that inform the link between IPV and food insecurity.
This chapter explores how acknowledging water as a human right affects government, business, and local communities in tourism. Tourism businesses have the responsibility to respect and protect the right to water, which aligns with the SDGs, particularly SDGs 5, 6, and 10. When the human right to water is not protected and respected, multifaceted violations occur and the potential for tourism to contribute to sustainable development will be undermined. The chapter suggests ways to improve tourism water management and prevent human rights abuses. By adopting responsible water management practices and engaging in partnerships with local communities, the tourism industry can help to promote the realization of the human right to water while also contributing to sustainable tourism.
We extend the conceptualization of the social and health burdens of household water insecurity on children beyond the traditional narrow lens of microbiological pathogens and diarrhea. The global burden of disease associated with water insecurity has traditionally focused on diarrheal disease as the most significant driver of infant and child mortality. However, there are many other pathways through which children experience adverse health and social consequences from inadequate or unsafe household water. We synthesize evidence of a broad range of health impacts, affecting children from infancy to late adolescence, across four domains: exposure to unsafe water; interruptions to growth and development through poor nutrition and hydration; negative social effects such as school absenteeism and interpersonal violence; and other non‐communicable health issues such as mental health, injuries, and reproductive health. The growing burden and urgency of these issues is implicated by forecasted increases in climate‐ and conflict‐induced water scarcity, human displacement, and environmental contamination in the decades ahead.
This article is categorized under: Engineering Water > Water, Health, and Sanitation
Human Water > Rights to Water
This analysis of the human rights to safe drinking water and sanitation (HRtWS) uncovers why some groups around the world are still excluded from these rights. Léo Heller, former United Nations Special Rapporteur on the human rights to water and sanitation, draws on his own research in nine countries and reviews the theoretical, legal, and political issues involved. The first part presents the origins of the HRtWS, their legal and normative meanings and the debates surrounding them. Part II discusses the drivers, mainly external to the water and sanitation sector, that shape public policies and explain why individuals and groups are included in or excluded from access to services. In Part III, public policies guided by the realization of HRtWS are addressed. Part IV highlights populations and spheres of living that have been particularly neglected in efforts to promote access to services.
Water insecurity—the lack of access to sufficient, safe water to meet all household needs—is an escalating challenge in all world regions. It is also associated with unfavorable mental health outcomes, like anxiety and depression. Often situated in the context of drought or general water scarcity, connections between water and mental health often manifest out of the unique characteristics of water—as an important economic and household resource, and one managed primarily by women. This article identifies recognized and theorized pathways between water insecurity and common mental health conditions, as mediated by broader socioeconomic systems in which households are embedded. To this end, we synthesize and connect different literature sets, including limited economic studies in a resource insecurity framework and a small but authoritative body of ethnographic literature. Our review identifies multiple proximate candidate pathways connecting water insecurity with mental health outcomes including community conflicts and/or perceived injustice around water sharing and upkeep, agricultural decline and unemployment, food insecurity or distress migration, decreased water intake, non-exposure to blue spaces, and stress around water management. The gendered role of water management is an overlapping theme across pathways, exposing women disproportionately to forms of conflict, violence, and injustice associated with the risk of common mental illness. In general, there are varied forms of marginalization that people experience within water-insecure contexts. Greater engagement between economics and other disciplines can lend additional theoretical pathways to empirically test the water and mental health connections, associated with people’s water insecurity experiences.
Anthropological thinking on water security and scarcity can be traced through four scholarly approaches: political ecology of water scarcity, water insecurity, water economics, and human- water relationality. Political ecologists argue that water scarcity a sociopolitical process and not necessarily related to physical water availability. The political ecological approach is concerned with power, global-local dynamics, and how water scarcity is unevenly distributed within and across communities. Water insecurity research is concerned with how injustice and inequity shape household and individual variability in water insecurity. Inspired by biocultural research, water insecurity scholars have used systematic methods to advance theories of how water insecurity impacts mental health, food insecurity, dehydration, and other human biological outcomes. Economic anthropologists explore how economic dynamics—including formal and capitalist economies, noncapitalist and hybridized economies, reciprocity, social reproduction, and theft—shape water scarcity and insecurity. Research priorities in economic anthropology include water valuation, meanings of water, and water as an economic good. Building from Indigenous scholars’ insights, relational approaches argue that humans have reciprocal obligations to respect and care for water as a living being. Water justice, these scholars argue, requires restoring human-water relations and upholding Indigenous sovereignty and self-determination. All four of these research areas—scarcity, insecurity, economics, and relationality—are producing cutting-edge research, with significant implications for research agendas in the anthropology of water security and scarcity.
Research suggests that experiences of water insecurity may negatively impact the psycho-emotional wellbeing of water-insecure households. This paper examines how perceived inequalities in water access mediate the relationship between water insecurity and psychosocial distress. Data were collected among 1192 men and women in Ghana who were active water collectors within their households. We employed a binary logistics regression to identify the determinants of psychological distress. Sobel test was used to test the indirect effect of water insecurity and psychosocial distress through perceived inequalities. The results show that wealth (OR = 6.6, CI = 2.784–14.076), number of people in a household (OR = 1.07, CI = 1.002–1.145) and perceived inequalities (OR = 4.6, CI = 2.737–7.907) are significant predictors of psychosocial distress. Sobel test indicated that the point estimate (PE) of the indirect effect between water insecurity and psychosocial distress through perceived inequality is -0.136 (p = 0.000), meaning households were less likely to experience psychosocial distress if they felt that safe water facilities were equally distributed. The findings suggest that the distribution of water resources in cities with water challenges, no matter how scarce those resources are, has a profound effect on psychosocial distress. In resources constrained cities, there is a need for holistic water-related interventions that make inclusivity and fairness their primary focus.
Almost 800 million people lack access to basic water supply, and almost 2000 million lack access to sanitation. Therefore, achieving universal access remains a crucial goal of the global development agenda. In order to shed light on whether international aid might help accomplish that goal, this study evaluates its impact in a sample of 121 developing countries during 1990–2015. A new approach is adopted in which aid affects access not only through provision of infrastructure (supply) but also through health education (demand). Additionally, the long-held concern about the persistence of impacts over time is addressed by estimating panel vector autoregressive models (PVAR). The results show that both supply- and demand-side interventions financed by aid can contribute to promoting access to water, but consistent long-term investments are needed.
Introduction
The effects of climate change and associated extreme weather events (EWEs) present substantial threats to well-being. EWEs hold the potential to harm sexual health through pathways including elevated exposure to HIV and other sexually transmitted infections (STIs), disrupted healthcare access, and increased sexual and gender-based violence (SGBV). The WHO defines four components of sexual health: comprehensive sexuality education; HIV and STI prevention and care; SGBV prevention and care; and psychosexual counselling. Yet, knowledge gaps remain regarding climate change and its associations with these sexual health domains. This scoping review will therefore explore the linkages between climate change and sexual health.
Methods and analysis
Five electronic databases (MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL) will be searched using text words and subject headings (eg, Medical Subject Headings (MeSH), Emtree) related to sexual health and climate change from the inception of each database to May 2021. Grey literature and unpublished reports will be searched using a comprehensive search strategy, including from the WHO, World Bank eLibrary, and the Centers for Disease Control and Prevention. The scoping review will consider studies that explore: (a) climate change and EWEs including droughts, heat waves, wildfires, dust storms, hurricanes, flooding rains, coastal flooding and storm surges; alongside (b) sexual health, including: comprehensive sexual health education, sexual health counselling, and HIV/STI acquisition, prevention and/or care, and/or SGBV, including intimate partner violence, sexual assault and rape. Searches will not be limited by language, publication year or geographical location. We will consider quantitative, qualitative, mixed-methods and review articles for inclusion. We will conduct thematic analysis of findings. Data will be presented in narrative and tabular forms.
Ethics and dissemination
There are no formal ethics requirements as we are not collecting primary data. Results will be published in a peer-reviewed journal and shared at international conferences.
Water scholarship has advanced considerably in recent decades. Despite this remarkable progress, water challenges may be growing more quickly than our capacity to solve them. While much progress has been made toward achieving Sustainable Development Goal 6 — water and sanitation for all — new stressors have emerged to threaten this progress. Far from being a problem of the Global South, recent research shows that water insecurity is very much a global phenomenon — and one that has been, until recently, seriously neglected in the Global North. This indicates a strong need for innovative measurement of who experiences water insecurity, new approaches for monitoring the efficacy of water interventions, and more effective management of complex, mobile, and multiple water infrastructures to achieve water security. In this paper, we introduce the Household Water Insecurity approach to addressing these concerns. First, we suggest ways to improve the measurement of water insecurity — pinpointing problems at the household and individual levels — in ways that can inform policymaking with improved precision. Second, we discuss ways that new information and communication technology can improve monitoring and indicate where water infrastructure repairs and investments are most needed. Third, we highlight the need for new approaches to managing complex water infrastructures in more inclusive and democratic ways.
Dietary diversity is a crucial pathway to child nutrition; lack of diversity may deprive children of critical macro and micronutrients. Though water along with hygiene and sanitation is a known driver of child undernutrition, a more direct role of household water in shaping dietary diversity remains unexplored. Existing literature provides a sound theoretical basis to expect that water could affect dietary diversity among young children. Here, we test the proposition that suboptimal household access to water and low regional water availability associate with lower dietary diversity among young children. Using the nationally representative 2015–2016 India Demographic and Health Survey data, we conducted a probit analysis on the sample of 69,841 children aged 6–23 months to predict the probability that a child achieves minimum standards of dietary diversity (MDD). After controlling for relevant socioeconomic and gender‐related covariates, we found that children in household with suboptimal household water access were two percentage points less likely to achieve MDD, when compared with those from households with optimal water access. Children in high water availability regions had nine percentage points greater probability of achieving MDD compared with children from low water availability regions, accounting for household water access. As dietary diversity is central to nutrition, establishing the role of water access in shaping early childhood dietary diversity broadens the framework on how household material poverty shapes child malnutrition—independent of sanitation and hygiene pathways. This provides additional window for nutrition planning and intervention wherein water‐based strategies can be leveraged in multiple ways.
Women's empowerment has gained attention as critical for child nutrition during the first 1000 days of life. However, the ways in which various women's empowerment measures are applied and the evidence for how they are differentially related to child nutrition is unclear. In this systematic review, therefore, we 1) systematically parse the many ways in which women's empowerment has been quantitatively measured in the context of child nutrition through the use of a theoretically driven application of dimensions and domains of empowerment; 2) summarize evidence for each of the various pathways between women's empowerment and child nutrition, based on dimensions and domains of empowerment; and 3) offer suggestions for future research to better articulate the relationship between women's empowerment and child nutrition. A search of evidence yielded 62 quantitative studies that used 200 unique indicators of women's empowerment, tested in 1316 associations with various child nutrition outcomes. Despite the large number of unique indicators, indicators for time resource allocation and reproductive decisions and indicators for men's engagement in child care and nutrition, all pertinent to child nutrition, were missing. Overall, the findings indicated an inconclusive relationship between women's empowerment and child nutrition: 379 out of 461 (82% weighted) and 217 out of 258 (84% weighted) associations found with stunting and wasting outcomes, respectively, were not significant. The current lack of evidence is likely not due to the absence of an underlying relationship between women's empowerment and child nutrition, but rather limitations in study design. Future research should carefully select women's empowerment indicators in context-specific ways, aggregate them meaningfully, and use a longitudinal study design to conduct pathway and lifecycle analysis in appropriate populations to clarify the relationship between women's empowerment and child nutrition.
Adaptation programs and policies that acknowledge contextual understanding of gender-based vulnerabilities are effective to build the resilience of the most vulnerable. However, the challenge is to derive lessons from micro analysis of differential vulnerabilities caused by unequal power relations among different gender groups belonging to various social strata and take it to a broader policy level. Based on gender analysis of vulnerable populations living in different stretches of Gandaki river basin in the Hindu Kush Himalaya region, this paper presents issues on gendered vulnerabilities and suggests possible adaptation measures. Evidence based on a participatory assessment of socioeconomic drivers and conditions leading to vulnerabilities and gender analysis of 107 Focus Group Discussions with homogenous groups of women and men belonging to various vulnerable social groups at up, mid and downstream of the basin form primary data source. The analysis concludes that there are changes in gender space, i.e. roles, responsibilities and domains to cope stressors. These include an increasing trend of women's presence in the local market and men's involvement in distant markets, both as labourers or small entrepreneurs. However, there are insufficient corresponding institutional and policy responses on social security and protection measures to address these changes. As a result, extreme of vulnerabilities such as violence against women and children have increased.
Worldwide, 844 million people still lack access to basic drinking water, especially in the rural areas of low and middle income countries. However, considerable progress has been made in recent years due to work on the Millennium Development Goals and Sustainable Development Goals. Nevertheless, countries’ national characteristics have often impacted on this progress. This paper analyzes whether specific socioeconomic factors affect access to improved water sources in the rural areas of developing countries. In particular, we analyze access to ‘total improved’, piped on premises, as well as other improved sources of access in rural areas for low income, low-middle income, and high-middle income countries. Our results suggest that gross national income (GNI); female primary completion rate; agriculture; growth of rural population; and governance indicators, such as political stability, control of corruption, or regulatory quality are variables related to water access, although specific associations depend on the source of water and income group examined. Understanding these interrelations could be of great importance for decision makers in the water sector as well as for future research on this topic.
Increasing trend of the burden of household water management is exemplified by recent literature as the effect of climate change on women. The current study explores a gender role in household water management in the context of climate change in the Melamchi watershed area of Nepal. The study shows that decreasing water volume compounded with the geographical proximity of water sources determines workload women have to bear regarding distance cover, time spent, and frequency for water collection. Search for new water sources is potential risk perceived by women, whereas scarcity of household water is the apparent perceived risk at the community level. Climate change effect is gradual and hence perceived as less important over other immediate problems by individual and community. Sensitization over awareness at individual, household, and community level is hence indispensable attitudinal and motivational capacity for climate change adaptation to increasing water stress borne by women.
A composite metric assessing water security’s physical dimension at the micro/ community level is lacking but is essential for setting priorities for program and policy implementations. We prepared an objective index (OI) of water security to measure the physical dimension using a model centered on household water-use behavior in developing countries’ urban areas. A cross-sectional household survey (n = 1500) with multi-stage cluster design was conducted from December 2015 to February 2016 in the Kathmandu Valley, which has faced long-term, severe water shortage. A structured questionnaire probed socio-demographic characteristics, water sources, frequency and quantity of water use, cost related to water, etc. A 15-item water insecurity scale was used to measure subjective and experiential dimension of water insecurity. The World Health Organization Quality of Life – BREF was used to measure quality of life (QoL). The QoL has been considered as proxy of well-being in this study. The OI measured differential water security within small cities, the utility’s service areas for instance, and identified area-specific key dimensions that need improvement. Overall, the OI and its key dimensions can be useful measures to design water-scarcity averting programs and policies, specific to a particular community’s needs. The increased OI values were significantly and positively associated with better physical and psychological health and better social relationship domains of QoL suggesting health implications of water security.
This paper draws on participatory research with 47 household water managers over the dry, pre-monsoon, and monsoon season, alongside expert knowledge of water management in Nepal's Kathmandu Valley. Doing so, it presents the perspectives of water managers to highlight three dimensions of water security that existing approaches often overlook. First, experiences of water security vary greatly between households over the year, even within a relatively small geographic area. Second, social connections and landownership play an important role in mediating these experiences. Third, coping with poor water supply places a burden on certain household members. This paper argues that addressing water inequities and insecurities demands research, development and policy responses to look beyond the main pipe network and engage with the variety of ways in which households secure water.
Intimate partner violence (IPV) against women and food insecurity are an ever growing public health concerns in Ethiopia. However, the connection between the two is not yet well investigated. Therefore, this study compares IPV by household food security status and examines the association between IPV and food insecurity and among currently married women in childbearing age in Arba Minch town, South Ethiopia. A community based comparative cross-sectional study was conducted among 696 currently married women (15-49). A quantitative data was collected using a pretested and structured questionnaire on randomly selected women. Logistic regression was done using IBM SPSS version 20. Statistical significance was declared at p-value of less than 0.05 and odds ratio with its 95% confidence interval was used to show the degree of association. Lifetime and current IPV were 62.4% and 50%, respectively. Sixty-three (23.6%) and 285 (66.4%) women who experienced current IPV were from food secured and insecure households, respectively (P-value<0.001). The odds of experiencing current IPV were higher among women from food insecure households (AOR=6.59,95% CI(4.54,9.57)) and who were in the age range of 30-39 (AOR=2.16, 95% CI(1.34,3.56)) and it was lower among women with 10 and more years age difference with their husband (AOR=0.52, 95% CI (0.31,0.88)) and with high decision-making power (AOR=0.61, 95% CI (0.38.0.96)) than their reference groups. The prevalence of current IPV was significantly higher among women from food insecure households as compared to their counterparts. The odds of experiencing current IPV were higher among women from food insecure households. Policy makers and programme planners should consider improving urban women’s household food security status in order to improve gender inequality and empower women. Multisectorial effort is needed to improve women education and other behavioral factors.
Background:
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provides an up-to-date analysis of the burden of diarrhoea in 195 countries. This study assesses cases, deaths, and aetiologies in 1990-2016 and assesses how the burden of diarrhoea has changed in people of all ages.
Methods:
We modelled diarrhoea mortality with a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We modelled diarrhoea incidence with a compartmental meta-regression tool that enforces an association between incidence and prevalence, and relies on scientific literature, population representative surveys, and health-care data. Diarrhoea deaths and episodes were attributed to 13 pathogens by use of a counterfactual population attributable fraction approach. Diarrhoea risk factors are also based on counterfactual estimates of risk exposure and the association between the risk and diarrhoea. Each modelled estimate accounted for uncertainty.
Findings:
In 2016, diarrhoea was the eighth leading cause of death among all ages (1 655 944 deaths, 95% uncertainty interval [UI] 1 244 073-2 366 552) and the fifth leading cause of death among children younger than 5 years (446 000 deaths, 390 894-504 613). Rotavirus was the leading aetiology for diarrhoea mortality among children younger than 5 years (128 515 deaths, 105 138-155 133) and among all ages (228 047 deaths, 183 526-292 737). Childhood wasting (low weight-for-height score), unsafe water, and unsafe sanitation were the leading risk factors for diarrhoea, responsible for 80·4% (95% UI 68·2-85·0), 72·1% (34·0-91·4), and 56·4% (49·3-62·7) of diarrhoea deaths in children younger than 5 years, respectively. Prevention of wasting in 1762 children (95% UI 1521-2170) could avert one death from diarrhoea.
Interpretation:
Substantial progress has been made globally in reducing the burden of diarrhoeal diseases, driven by decreases in several primary risk factors. However, this reduction has not been equal across locations, and burden among adults older than 70 years requires attention.
Funding:
Bill & Melinda Gates Foundation.
Background
A dietary imbalance or a disregard for the nutritional needs of children during early childhood can affect their growth. From the age of six months, breast milk is no longer able to meet the energy and micronutrient needs of children; the consumption of adequate complementary foods is therefore essential. Various indicators have been used to assess the quality of children's diets, and the dietary diversity score is a good indicator of children's diets. The objective of this study was to describe the dietary practices of children in rural areas of Moramanga and Morondava, Madagascar, and to identify the determinants of low dietary diversity to prioritize nutritional interventions.
Methods
We collected dietary data in 2014 on children aged 6–59 months in a study on the determinants of chronic malnutrition using the 24-hour recall method. Data on the characteristics of households and mothers were also collected. We carried out bivariate and multivariate analyses to identify the determinants of low dietary diversity scores for children.
Results
We included 1824 children: 893 from Moramanga and 931 from Morondava. Approximately 42.1% [95% CI: 39.0–45.4] of the children from Moramanga and 47.6% [95% CI: 44.4–50.8] of those from Morondava had a poorly diversified diet, consisting mainly of foods rich in carbohydrates and poor in meat products. Poor maternal education was associated with a high likelihood of having a non-varied diet in both study areas; the adjusted odds ratios were 2.2 [95% CI: 1.3–3.8] and 4.0 [95% CI: 2.5–6.4] for children from mothers with lower education levels for Moramanga and Morondava, respectively. For children recruited in Morondava, having low household socioeconomic status (adjusted OR: 1.8, 95% CI: 1.2–2.8) and belonging to a household without livestock was associated with a low dietary diversity score (adjusted OR: 1.8, 95% CI 1.2–2.7).
Conclusion
Our results show the need to improve girls' education, adapt nutrition education programs for mothers based on their level of education, and strengthen poverty reduction programs.
This research is an attempt to examine the everyday experiences of water insecurity among poor women in urban India. Their everyday living around a limited amount of water was captured visually to exhibit local idioms of struggling. There is empirical evidence that the narratives of becoming a global city often exacerbate the presence of social polarization and inequality in cities of the Global South. This includes unequal access to water, especially among subordinate groups. Drawing from fieldwork conducted in Hyderabad and Bangalore on water insecurity, the findings show that the impacts of water insecurity are highly gendered and contentious. It is in the landscape of gender division of labour that women have to negotiate their everyday lives around water. Deploying photography as the primary method, this article demonstrates the social dimension of water insecurity and the impact on women’s lives who bear the majority of domestic water issues. It is concluded that lack of efforts by the state and its agencies to improve understanding of the lived experience of water insecurity would aggravate the water issues in urban India and leave poorer urban women to be highly water insecure.
In West Africa, polygyny remained a common type of marriage. However, in spite of numerous studies exploring polygyny, the relationship between polygyny and access to resources for empowerment and equality is not well-ascertained in West Africa. This study addresses this gap by raising the question: to what extent does polygyny explains access to resources for empowerment and equality among married women? Data were extracted from 2013 Demographic and Health Surveys in The Gambia, Nigeria and Sierra-Leone. The outcome variable is access to resources for empowerment and equality measured by access to education, employment and barriers to accessing health care. The key explanatory variable is type of marriage with specific attention to polygyny. Multivariate multiple regression was applied using Stata 12. Results showed that polygyny was negatively associated with access to education in the studied countries; positively associated with access to employment in the studied countries; and negatively associated with access to health in Nigeria and Sierra Leone. It is important to refocus national attention to improving the capabilities of women because economic empowerment will not only improve women’s well-being, it will also translate to the reduction of childbearing pressures among women.
Introduction
The work of carrying water falls mainly on women and children, particularly in sub-Saharan Africa and rural areas. While concerns have been raised, how water carriage is associated with health of the water carrier is not clear. The aim of this review is to summarise evidence on whether, and how, water carriage is associated with the water carrier’s health.
Methods
A systematic review of literature was conducted, searching Embase; Medline; Web of Science Social Sciences Citation Index; Web of Science Arts and Humanities Citation Index; International Initiative for Impact Evaluation website; WHO Virtual Health Sciences Library and WHO African index medicus, from inception to 8 November 2017.
Results
Forty-two studies were included. Their ability to demonstrate cause and effect relationships was limited by study design and fair or poor methodological quality. Overall, the studies suggest that water carriage is associated with negative aspects of the water carriers’ health. There is moderate quantitative and strong qualitative evidence that water carriage is associated with pain, fatigue, perinatal health problems and violence against vulnerable people, and inconclusive evidence of an association with stress or self-reported mental health and general health status.
Conclusion
In many circumstances, water carriage is a potential barrier to Sustainable Development Goal (SDG) 6 target ‘universal and equitable access to safe and affordable drinking water for all’ and SDG 3 ‘ensure healthy lives and promote well-being for all at all ages’. Efforts should focus on providing water on premises, and where this is not possible, providing water close to home and reducing risk of gender-based violence.
An assessment of water supply challenges and risks facing children in selected peri urban areas of Abeokuta (Akole-Oke Ata, Obatonko, Adigbe) in Ogun, southwestern Nigeria, was carried out during the dry season, in the months of November 2013 to February 2014. Recognizing that the yield of drinking water sources and water supply from the government were drastically reduced during the dry season, in this study, project
leaders aimed to determine children’s involvement in household water provision during the dry season in the peri-urban of Abeokuta Ogun State Southwestern Nigeria, and to further determine the gender distribution, risks and risk indicators, and occurrence of problems among the children during water provision. In the course of the study, a total of 100 water sources (piped water taps, boreholes, dug wells, burst pipes, streams) were visited, and focus group discussion/informal interview methodologies were adopted to gather data from the people at water points. Approximately 827 of the people met at the water points were children, with 800 of those children being girls between the ages of 5-15. The results from these interactions indicated that the girls from each household were responsible for scouting water sources, as well as transportation and storage of the
water for household consumption. Out of 800 girls interviewed, 722 reported being late to school, 712 recorded poor school attendance, 456 reported being sexually harassed and/or assaulted, 166 had experienced injury experienced neck and back pain from carrying an excessive load of water, 99 were physically punished by parents or guardians at home when containers got lost, misplaced, or exchanged at the water points, and
184 were punished by the parents or guardians who believed that the girls wasted the water. Some of the respondents (12) preferred going out to provide the water for the family to avoid other domestic work. The majority said they wanted the government and/or parents/guardians to be responsible for adequate water provision for household consumption.
Agency freedom is the process through which women can obtain power and control over making decisions about their own life choices. In this study, women’s agency freedom was measured based on women’s ability to make decisions and their help-seeking practices against domestic violence. We examined how women’s higher agency freedom prevented them from being victims of domestic violence. The study analyzed 3373 women from the 2011 Nepal Demographic and Health Survey (NDHS). The results revealed that women’s decision-making participation and help-seeking practices had a negative relationship with domestic violence. Women’s help-seeking practice had moderating effects on the relationship between women’s decision-making participation and domestic violence.
Kathmandu Upatyaka Khanepani Limited (KUKL) has planned to harness water from outside the valley from Melamchi as an inter-basin project to supply water inside the ring road (core valley area) of the Kathmandu Valley (KV). The project, called the “Melamchi Water Supply Project (MWSP)”, is expected to have its first phase completed by the end of September 2018 and its second phase completed by the end of 2023 to supply 170 MLD (million liters a day) through the first phase and an additional 340 MLD through the second phase. The area has recently faced a severe water deficit and KUKL’s existing infrastructure has had a limited capability, supplying only 19% of the water that is demanded in its service areas during the dry season and 31% during the wet season. In this context, this study aims to assess the temporal trends and spatial distribution of household water security index (WSI), defined as a ratio of supply to demand for domestic water use for basic human water requirements (50 L per capita per day (lpcd)) and economic growth (135 lpcd) as demand in pre- and post-MWSP scenarios. For this purpose, data on water demand and supply with infrastructure were used to map the spatial distribution of WSI and per capita water supply using ArcMap. Results show a severe water insecurity condition in the year 2017 in all KUKL service areas (SAs), which is likely to improve after completion of the MWSP. It is likely that recent distribution network and strategies may lead to inequality in water distribution within the SAs. This can possibly be addressed by expanding existing distribution networks and redistributing potable water, which can serve an additional 1.21 million people in the area. Service providers may have to develop strategies to strengthen a set of measures including improving water supply infrastructures, optimizing water loss, harnessing additional water from hills, and managing water within and outside the KUKL SAs in the long run to cover the entire KV.
Background
Proper feeding practices during early childhood is fundamental for optimal child growth and development. However, scientific evidences on the determinants of dietary diversity are scanty. Particularly, the impact of fasting on children`s dietary diversity is not explored in Ethiopia. The aim of this study was to assess dietary diversity and associated factors among children aged 6–23 months, whose mothers/care-givers were Orthodox Christians during the fasting season (Lent), in Dejen District, North West Ethiopia, 2016.
Methods
A community based cross-sectional study was conducted during the fasting season from March to April, 2016. The study sample were children aged 6–23 months, whose mothers/care-givers were Orthodox Christians. A systematic random sampling technique was used to select a sample of 967 children proportionally from all selected kebeles. Data was entered using Epi data and statistical analysis were done using logistic regression. P-value < 0.05 at 95% confidence interval was taken as statistically significant.
Results
Only 13.6% of children surveyed met the minimum requirement for dietary diversity. Unsatisfactory exposure to media [AOR = 5.22] and low household monthly income [AOR = 2.20] were negatively associated with dietary diversity. As compared to economic related reasons, mothers/caregivers who do not feed diet of animal origin to their children due to fear of utensil contamination for family food preparation were 1.5 times [AOR=1.5; 95% CI (1.05 – 2.53)] less likely to feed the recommended dietary diversity.
Conclusions
The findings of this study revealed that the diet of children in the study area lacked diversity. Promoting mass media and socioeconomic empowerment of women have positive contribution to optimal child feeding practice. Sustained nutrition education to mothers regarding proper infant and young child feeding practice in collaboration with the respective religious leaders is highly recommended.
Collective models identifying resource shares are promising tools to analyze intra-household welfare and poverty. However, their empirical application has proven difficult in practice as authors contend with large standard errors and unstable estimates. This paper uses a prominent framework to show how a common feature of the structure of these models makes the task so difficult and proposes an empirical strategy to stabilize the estimates.
Objective
Suboptimal nutrition among children remains a problem among South Asian (SA) families. Appropriate complementary feeding (CF) practices can greatly reduce this risk. Thus, we undertook a systematic review of studies assessing CF (timing, dietary diversity, meal frequency and influencing factors) in children aged <2 years in Pakistan.
Design
Searches between January 2000 and June 2016 in MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, CINAHL, Cochrane Library, BanglaJOL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CF practices in SA children aged 0–2 years and/or their families. Search terms: ‘children’, ‘feeding’ and ‘Asians’ with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence).
Results
From 45 712 results, seventeen studies were included. Despite adopting the WHO Infant and Young Child Feeding guidelines, suboptimal CF was found in all studies. Nine of fifteen studies assessing timing recorded CF introduced between 6 and 9 months. Five of nine observed dietary diversity across four of seven food groups; and two of four, minimum meal frequency in over 50 % of participants. Influencing factors included lack of CF knowledge, low maternal education, socio-economic status and cultural beliefs.
Conclusions
This is the first systematic review to evaluate CF practices in Pakistan. Campaigns to change health and nutrition behaviour are needed to meet the substantial unmet needs of these children.
Appropriate feeding practices are crucial for survival, growth, and development in childhood. This paper analyzes Pakistan's Demographic and Health Survey 2012–2013 to fill the knowledge gap in risk factors of poor complementary feeding practices in Pakistani children. Multilevel models were applied to fit the multistage cluster sample of 2,827 children aged 6–23 months from 489 communities. Introduction of solid, semi-solid, or soft foods (intro) was achieved in 67% infants aged 6–8 months. Among children aged 6–23 months, the proportion of children meeting minimum meal frequency, dietary diversity (MDD), and acceptable diet criteria were 63%, 22% and 15%, respectively. Consumption of legumes and nuts, flesh foods, and vitamin A-rich fruits and vegetables was low in all children (6–19%), even among children who met the MDD criteria (15–55%). Younger child age, especially between 6 and 11 months and delayed maternal postnatal checkup were significant individual-level risk factors that consistently increased the odds of not meeting all four criteria examined. Fewer antenatal care visits predicted the odds of achieving intro and minimum meal frequency while younger maternal age and household poverty predicted the odds of achieving MDD and minimum acceptable diet. Community-level factors included geographic region and general access to maternal and child health care services. The overall poor quality of children's complementary diets in Pakistani calls for stronger policy and program action to promote the consumption of key nutrient-dense foods while prioritizing interventions for the most vulnerable children and populations.
Background:
Insufficient quantities, frequencies, and inadequate quality of complementary feedings have a negative effect on child health and growth, especially in the first two years of life. Therefore, the aim of this study was to assess the minimum dietary diversity, meal frequency and its associated factors among infants and young children aged 6-23 months at Dabat District, northwest, Ethiopia.
Methods:
A community- based cross-sectional study was conducted from February 15 to March 10, 2016. The simple random sampling method was used to select study participants. An interviewer- administered structured questionnaire was used to collect data. Both Crude and Adjusted Odds Ratio with the corresponding 95% confidence interval were calculated to show the strength of association. In the multivariable analysis, variables with less than 0.05 P-value were considered statistically significant.
Results:
The proportion of children who met the minimum dietary diversity and meal frequency were 17% (95% CI: 14.9, 19.4%) and 72.2% (95% CL: 69.3, 75%), respectively. Satisfactory media exposure (AOR = 2.79; 95% CI: 1.74, 4.47), postnatal care visits (AOR = 1.96; 95% CI: 1.32, 2.88), participation in child growth and monitoring follow ups (AOR = 1.65; 95% CI: 1.14, 2.39), age of children (AOR = 2.34; 95% CI: 1.33, 4.11) and age of mothers (AOR = 1.89; 95% CI: 1.09, 3.27) were positively associated with dietary diversity. Similarly, age of children (AOR = 2.38; 95% CI: 1.56, 3.65), household wealth status (AOR = 1.84; 95% CI: 1.27, 2.68), residence (AOR = 3.02; 95% CI: 1.41, 6.48), sources of information (AOR = 1.72; 95% CI:1.14, 2.59) and participation in child growth monitoring folow ups (AOR = 1.57; 95% CI: 1.13, 2.19) were significantly associated with meal frequency.
Conclusion:
In this study, the proportion of children who received the minimum dietary diversity and meal frequency were low. Media exposure, age of children, postnatal care visits, and participation in child growth and monitoring follow-ups were significantly associated with dietary diversity. Likewise, wealth status and residence had a significant association with meal frequency. Thus, encouraging all mothers to participate in child monthly growth monitoring programs, intensive media advertising and strengthening counseling of mothers, and postnatal care visit are highly recommended for achieving the recommended dietary practices.
Background
Increased mortality is associated with poor household water, sanitation, and hygiene (WaSH) practices. The objective was to study the WaSH practices for under-five children among households of Sugali Tribe, Chittoor district, Andhra Pradesh, India.
Methods
A community-based cross-sectional study was conducted in four mandals in 2012. A total of 500 households with under-five children were identified. Data was collected from mothers/caregivers. A summary WaSH score was generated from four specific indices, water, sanitation, hygiene, and hand washing practices, and determinants were identified.
Results
Of the total households, 69% reported doing nothing at home to make the water safe for drinking. Over 90% of the households reported storing water in a utensil covered with a lid and retrieving water by dipping glass in the vessels. Open defecation was a commonly reported practice (84.8%). About three-fifths of the study's households reported using water and soap for cleaning dirty hands and one-third (37.4%) reported using water and soap after defecation. The median WaSH score was 15. In the hierarchical stepwise multiple linear regression, only socioeconomic variables were significantly associated with WaSH score.
Conclusion
WaSH related practices were generally poor in people of the Sugali Tribe in Andhra Pradesh, India.
Gender mainstreaming policies and programs, meant to be gender-sensitive or to target gender issues, are increasingly implemented by both governmental and non-governmental actors. However, these projects seem set to continually aim solely at women, despite more than a decade of work encouraging broader scope. Using recent case studies from Bolivia, Lesotho, and India, we address the tensions laden in three major questions about water, gender, and development: (1) Is mandatory inclusion of women in water governance and decision-making effective?, (2) Do water development projects provide equal benefits and burdens for women and men?, and (3) In what ways are water projects and their policies impacting and impacted by gendered enviro-social spaces? By providing triangulated data from ethnographic studies in three distinct local contexts, we are able to pinpoint major cross-cutting themes that serve to highlight and interrogate the gendered impacts of water development projects’ policies: public and private lives, women’s labor expectations, and managing participation. We find that gender mainstreaming endeavors continue to fall short in their aim to equitably include women in their programming and that geographic, environmental, and socio-cultural spaces are intimately related to how these equitability issues play out. We provide practical recommendations on how to address these issues.
Despite the central importance of water for human wellbeing and development, researchers and practitioners have few tools to quantitatively measure, assess, and compare the scope and scale of household and individual water insecurity across cultural and climatic variations. There are multiple definitions of water insecurity, and the analytical tools for measuring household‐level water insecurity are in their infancy. This paper provides an overview and systematic evaluation of current household and individual water in security metrics for human development. We seek to advance micro‐level metrics—attending to the considerations of dimensionality, temporality, unit of analysis, and comparability—because they will provide the research community with necessary tools to untangle the complex determinants and outcomes of water insecurity. Moreover, such metrics will support the translation of research outcomes into meaningful and useful products and results for stakeholders, communities, and decision‐makers. WIREs Water 2017, 4:e1214. doi: 10.1002/wat2.1214
This article is categorized under: Human Water > Methods
In this study, we report on the results of a trial of an intervention to improve five food hygiene behaviors among mothers of young children in rural Nepal. This novel intervention targeted five behaviors; cleanliness of serving utensils, handwashing with soap before feeding, proper storage of cooked food, and thorough reheating and water treatment. Based on formative research and a creative process using the Behavior-Centered Design approach, an innovative intervention package was designed and delivered over a period of 3 months. The intervention activities included local rallies, games, rewards, storytelling, drama, competitions linking with emotional drivers of behavior, and “kitchen makeovers” to disrupt behavior settings. The effect of the package on behavior was evaluated via a cluster-randomized before–after study in four villages with four villages serving as controls. The primary outcome was the difference in the mean cluster level proportions of mothers directly observed practicing all five food hygiene behaviors. The five targeted food hygiene behaviors were rare at baseline (composite performance of all five behaviors in intervention 1% [standard deviation (SD) = 2%] and in control groups 2% [SD = 2%]). Six weeks after the intervention, the target behaviors were more common in the intervention than in the control group (43% [SD = 14%] versus 2% [SD = 2%], P = 0.02) during follow-up. The intervention appeared to be equally effective in improving all five behaviors in all intervention clusters. This study shows that a theory-driven, systematic approach employing emotional motivators and modifying behavior settings was capable of substantially improving multiple food hygiene behaviors in Nepal.
This study aimed to identify the determinants of nutritional status of children in India with a special focus on dietary diversity at the state level. Household-level consumption data from three rounds of the Consumer Expenditure Survey of the National Sample Survey Organization (1993–2012) were used. Information on the nutritional status of children was taken from the National Family Health Survey (2005–06). Dietary diversity indices were constructed at the state level to examine diversity in quantity of food consumed and food expenditure. Multilevel regression analysis was applied to examine the association of state-level dietary diversity and other socioeconomic factors with the nutritional status of children. It was observed that significant variation in childhood stunting, wasting and underweight could be explained by community- and state-level factors. The results indicate that dietary diversity has increased in India over time, and that dietary diversity at the state level is significantly associated with the nutritional status of children. Moreover, percentage of households with a regular salaried income in a state, percentage of educated mothers and mothers receiving antenatal care in a community are important factors for improving the nutritional status of children. Diversity in complementary child feeding is another significant determinant of nutritional status of children. The study thus concludes that increasing dietary diversity at the state level is an effective measure to reduce childhood malnutrition in India.
Water insecurity (WI) is a serious and worsening problem worldwide, but its role in health outcomes among people living with HIV or pregnant women is unknown. We assessed experiences of WI in a cohort of 323 pregnant Kenyan women of mixed HIV status. The majority (77.7%) had at least one experience of WI in the previous month; it was associated with negative economic, nutrition, disease, and psychosocial outcomes. A standardized cross-culturally valid household WI scale would facilitate assessment of the prevalence and consequences of WI, and increased attention to WI could reveal an overlooked, but modifiable, cause of adverse HIV outcomes.
Abstract Background Stunting in early life has considerable human and economic costs. The purpose of the study was to identify factors associated with stunting among children aged 0-23 months in Indonesia to inform the design of appropriate policy and programme responses. Methods Determinants of child stunting, including severe stunting, were examined in three districts in Indonesia using data from a cross-sectional survey conducted in 2011. A total of 1366 children were included. The analysis used multiple logistic regression to determine unadjusted and adjusted odds ratios. Results The prevalence of stunting and severe stunting was 28.4 % and 6.7 %, respectively. The multivariate analysis on determinants of stunting identified a significant interaction between household sanitary facility and household water treatment (P for interaction = 0.007) after controlling for potential covariates: in households that drank untreated water, the adjusted odds on child stunting was over three times higher if the household used a unimproved latrine (adjusted odds ratio 3.47, 95 % confidence interval 1.73-7.28, P
Using a randomized experiment in Ecuador, this study provides evidence on whether cash, vouchers, and food transfers targeted to women and intended to reduce poverty and food insecurity also affected intimate partner violence. Results indicate that transfers reduce controlling behaviors and physical and/or sexual violence by 6 to 7 percentage points. Impacts do not vary by transfer modality, which provides evidence that transfers not only have the potential to decrease violence in the short-term, but also that cash is just as effective as in-kind transfers.
Stunting is a complex and enduring challenge with far-reaching consequences for those affected and society as a whole. To accelerate progress in eliminating stunting, broader efforts are needed that reach beyond the nutrition sector to tackle the underlying determinants of undernutrition. There is growing interest in how water, sanitation and hygiene (WASH) interventions might support strategies to reduce stunting in high-burden settings, such as South Asia and sub-Saharan Africa. This review article considers two broad questions: (1) can WASH interventions make a significant contribution to reducing the global prevalence of childhood stunting, and (2) how can WASH interventions be delivered to optimize their effect on stunting and accelerate progress? The evidence reviewed suggests that poor WASH conditions have a significant detrimental effect on child growth and development resulting from sustained exposure to enteric pathogens but also due to wider social and economic mechanisms. Realizing the potential of WASH to reduce stunting requires a redoubling of efforts to achieve universal access to these services as envisaged under the Sustainable Development Goals. It may also require new or modified WASH strategies that go beyond the scope of traditional interventions to specifically address exposure pathways in the first 2 years of life when the process of stunting is concentrated.
Water insecurity (WI), or the lack of safe and sufficient water for a healthy and productive life, likely has consequences that span many domains, from nutrition to economic productivity. However, consequences of WI beyond impacts on sanitation and hygiene have only recently begun to be explored, and to our knowledge, never in the context of HIV or among pregnant and postpartum women.
Therefore, we explored the lived experiences of WI in a cohort of Kenyan women of mixed HIV status. We used mixed methods, including Photovoice (a participatory photo elicitation method; n=20), Go‐Along interviews (accompanied in‐depth interviews; n=20), pile sorts (organizing illustrated cards around central themes; n=20) and surveys at 8 months gestation (8m) and 3 months postpartum (3pp) with women enrolled in our longitudinal pregnancy cohort (n=371). Qualitative data were coded and analyzed in Dedoose using Grounded Theory, and quantitative data were analyzed using Stata.
Our findings suggest that WI is harmful to women and their families in 5 domains: nutrition, childcare, economic productivity, and mental and physical health. Fetching water, which is calorically very costly, was the responsibility of the majority (78%) of women in our study, even in late pregnancy. They spent [mean (SD)] 4.5(6.7) hours per week traveling to, queuing, and drawing water.
Impacts of WI on nutrition included changing foods being cooked [reported by 46.4% of women at 8m and 37.8% at 3pp)] and having inadequate time to prepare foods due to fetching water (reported by 22.4%). Women also discussed diverting money meant for food to purchase water and reducing the frequency and diversity of foods for adults and young children when water was limited.
Fetching water prevented one quarter (23.7%) of women from caring for their children. In interviews, women reported leaving young children alone at home while fetching water. WI also impacted half of our cohort's ability to wash their children's hands and faces [51.4% (8m); 57.3% (3pp)].
Economic productivity was impacted when there was insufficient water for crops or livestock [40.6% (8m); 43.3% (3pp)] and [39.9% (8m); 42.3% (3pp)], respectively. Time spent fetching water prevented 23.3% of women from engaging in income‐generating activities, and water shortages prevented a range of small business activities (e.g. hair salons, washing and selling kale).
WI was a source of anxiety, with 65.5% (8m) and 69.7% (3pp) worried they would not have enough safe water to drink, and the majority (77.2%) feeling concerned for their personal safety while fetching water. During pregnancy, women mentioned fear of early labor and miscarriage from carrying water. Women experienced shame and stigma as a result of inadequate water for drinking, preparing foods, and bathing themselves and their children. WI also led to arguments [40.3% (8m); 34.3% (3pp)] and in some cases, domestic violence.
Physical health consequences of WI included women [64.1% (8m); 55.4% (3pp)] drinking water they thought to be unsafe and 55.7% (8m) and 59.6% (3pp) not being able to wash hands after defecating, changing diapers, or performing other “dirty” activities. Interestingly, the frequency and severity of water insecurity did not differ by HIV status.
In sum, these findings suggest multi‐faceted consequences of water insecurity that go beyond conventional associations of unsafe drinking water and poor sanitation and hygiene. We encourage further inquiry into the manifestations of WI globally.
Support or Funding Information
NIH‐NIMH K01 MH098902; NIH‐NIMH R21 MHI108444
p>Based on the findings of the research, a number of conclusions have been drawn. Some of those conclusions are as follows: i) Drinking water projects in Nepal are still concerned with meeting only the practical gender needs of community women and men but not with women's strategic gender interests since the water sector at all other levels - international, national, institutional, and project that affect the outcomes of projects at the community level - is gender weak. The NGO sector seems to be relative more gender sensitive than others though it also has to go a long way in order to be truly gender sensitive in its activities. ii) The community level framework of women' strategic gender interests, consisting of five indicators suggested in this research for a gender analysis of impact in the water sector, appears to be useful and relevant. However, the research findings suggest that these five indicators should be split into six to make the framework more realistic, user-friendly and comprehensive. The suggested framework should now include: women's physical presence in project activities, women's participation in decision-making, changes in the traditional gender division of labour, women's access to and control over income, equity in sharing of benefits, and women's increased status leading to new development initiatives. iii) The institutional level framework, consisting of eight indicators suggested in this research to study gender issues at the agency level, is quite useful and relevant. Nonetheless, the research findings suggest that some of these eight indicators should be split to make the framework even more relevant and comprehensive. The suggested framework now includes ten indicators as follows: policy-formulating mechanisms, objectives and strategies, personnel policies, organisational structure, organisational culture and management style, provision of gender training, provision of capital and human resources, sharing of power between women and men staff, role of change agents, and relationships with external agencies. Based on the findings of this research and these conclusions, some action plans have been developed to improve gender sensitivity at all these levels in the drinking water sector.</p
Data from the 2005 Ethiopia Demographic and Health Survey (EDHS) and the 2007 Zambia Demographic Health Survey (ZDHS) were analyzed to examine the association between World Health Organization (WHO) recommended IYCF indicators and nutritional status among children 0- 23 months of age in Ethiopia and Zambia. A total of 1810 and 2512 children within this age group from Ethiopia and Zambia , respectively , were included in the analysis. Exclusive breast -feeding among children 0- 5.9 months of age is low in both Ethiopia (43 % ) and Zambia (51 % ). Timely introduction of complementary food is lower in Ethiopia (61 %) compared to Zambia (90 %). Only 7 percent of children between 6- 23 months of age consumed diets that met the minimum dietary diversity requirement of four or more food groups consumed per day compared to 37 % in Zambia. Multiple linear and logistic regression analyses using appropriate measures to account for the complex survey design were applied to examine the associations between IYCF practices and child anthropometry. Linear regression results show that exclusive breast -feeding (EBF) is positively associated with weight -for -height z -score (WHZ) (effect size (ES) 0.65; p<0.001) and weight -for- age z -score (W AZ) (ES 0.28; p<0.01) in Zambia. In Ethiopia, EBF under 6 months of age is negatively associated with height -for- age z - score (HAZ) (ES 0.81; p<0.01). Timely introduction of complementary food between 6- 8 months of age was positively associated with HAZ (ES 1.19; p<0.01) in Zambia. Higher dietary diversity score was associated with higher HAZ (ES 0.23, p<0.001 in Ethiopia; ES 0.12, p<0.01 in Zambia) and WAZ (ES 0.17, p<0.001 in Ethiopia; ES 0.04, p<0.10 in Zambia) in both countries. The findings demonstrate the need to reinforce age - appropriate IYCF practices to address child undernutrition. Special attention is needed to improve the complementary feeding practices, particularly diet diversity for children 6 -23 months of age , while sustaining a focus on EBF among children under 6 months of age, in order to improve overall nutrition al status of young children in Ethiopia and Zambia.
Purpose
This research was intended to examine whether there is a relationship between household food security and domestic violence among households in rural Bangladesh.
Methods
The study uses data col