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Water insecurity and gender‐based violence: A global review of the evidence

October 2022
Wiley Interdisciplinary Reviews: Water 10(1)

DOI:10.1002/wat2.1619

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Authors:

Paula Tallman

Field Museum of Natural History

Shalean Collins

Tulane University

Gabriela Salmon Mulanovich

Pontifical Catholic University of Peru

Binahayati Rusyidi

Universitas Padjadjaran

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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. © 2022 The Authors. WIREs Water published by Wiley Periodicals LLC.

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ADVANCED REVIEW

Water insecurity and gender-based violence: A global

review of the evidence

Paula S. Tallman

1,2

| Shalean Collins

| Gabriela Salmon-Mulanovich

Binahayati Rusyidi

| Aman Kothadia

| Stroma Cole

Department of Anthropology, Loyola

University Chicago, Chicago, Illinois, USA

The Keller Science Action Center, The

Field Museum of Natural History,

Chicago, Illinois, USA

School of Public Health and Tropical

Medicine, Tulane University, New

Orleans, Louisiana, USA

Institute for Nature, Earth and Energy,

Pontificia Universidad Cat

olica del Perú,

San Miguel, Peru

FISIP, Universitas Padjadjaran, Jawa

Barat, Indonesia

Parkinson School of Health Sciences and

Public Health, Loyola University Chicago,

Chicago, Illinois, USA

University of Westminster, London, UK

Correspondence

Paula S. Tallman, Department of

Anthropology, Loyola University Chicago,

Chicago, IL, USA.

Email: paulaskyetallman@gmail.com

Funding information

The British Academy Knowledge

Frontiers, Grant/Award Number: 400136

Edited by: Alida Cantor, Associate Editor

and Wendy Jepson and Jan Seibert,

Co-Editors-in-Chief

Abstract

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 associa-

tions 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 phys-

ical violence for women who walked long distances to access water. This was

followed by intimate partner violence sparked by the inability to meet domes-

tic 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, par-

ticularly 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

Received: 11 January 2022 Revised: 19 August 2022 Accepted: 13 September 2022

DOI: 10.1002/wat2.1619

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any

medium, provided the original work is properly cited and is not used for commercial purposes.

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KEYWORDS

gender-based violence, intimate partner violence, water access, water adequacy, water

insecurity

1|INTRODUCTION

Water insecurity—the inability to access and benefit from affordable, adequate, reliable, and safe water (Jepson

et al., 2017)—has far-reaching adverse consequences for social and economic wellbeing, nutrition and health

(Rosinger & Brewis, 2020). These repercussions are disproportionately experienced by women and girls who globally

bear the brunt of water acquisition, distribution, and related household tasks (Sorenson et al., 2011). A small but grow-

ing number of studies indicate that water insecurity increases the risk of gender-based violence against women (see

Table 2). The United Nations defines gender-based violence as harm directed at an individual or group based on their

gender and highlights that gender-based power differentials place women and girls at risk for multiple forms of vio-

lence.

In this article, we review the global literature documenting associations between water insecurity and gender-

based violence, identify current gaps in knowledge, and recommend future avenues of research to address these grow-

ing and linked threats to public health.

2|BACKGROUND

Research and action to address water insecurity is growing (see reviews by Adams et al., 2020; Hadley & Wutich, 2009;

Rosinger & Young, 2020; Wutich, 2020; Wutich & Brewis, 2014), with accompanying developments in our understand-

ing of “what water insecurity is.”Simply put, water insecurity can be defined as the lack of sufficient water of good

quality to meet basic human requirements (Ray & Shaw, 2019) and can be broadly conceptualized across the domains

of access, affordability, adequacy, reliability, and safety (Jepson et al., 2017).

Drawing from the literature that expands on these water-related domains (Hadley & Wutich, 2009; Jepson

et al., 2017; Stevenson et al., 2012) and from the literature presented in this review, we define “water access”as the ways

in which individuals or households acquire water: such as through taps, wells, or water vendors. Access also involves

the physical conditions surrounding water acquisition and the time necessary to collect water. We conceptualize “water

affordability”as the ability to pay for water in ways that do not compromise other household resource needs and “water

adequacy”as having enough water, of high enough quality, to meet daily household needs. Finally, we define “water

reliability”as water sources that do not fluctuate in ways that inhibit access and use (e.g., unplanned water shutoffs,

droughts, and disruptions to water sources) and “water safety”as including both personal safety while acquiring water

and the safety (i.e., quality) of water for use and consumption.

A substantial literature is emerging that documents how the multiple dimensions of water insecurity are linked to

adverse social, economic, physical, and psychological consequences (Rosinger & Young, 2020; Wutich, 2020). For exam-

ple, water acquisition requires inherent opportunity costs, such as walking long distances, that disrupt income genera-

tion, especially for women (Sorenson et al., 2011). Water-related disasters (e.g., floods and droughts) destroy

livelihoods, decimate homes, infrastructure, and crops and create demands on already stressed resources (Calow

et al., 2010; Rashid, 2000). Such stresses can tax socially-reciprocal relations (Stoler, Pearson, et al., 2020) and translate

into intra-community conflict (Pearson et al., 2021). In terms of health, insufficient water causes dehydration

(Rosinger, 2015; Stoler et al., 2019), while consumption and use of poor quality water are associated with diarrheal

(Prüss-Ustün et al., 2014) and neglected tropical diseases (Downs et al., 2017), among others (Rosinger & Young, 2020).

Mental health is also affected; stress related to water acquisition, use, storage, and management is associated with

depression (Mushavi et al., 2020; Tallman, 2019), emotional distress (Cole, 2017; Ennis-McMillan, 2001; Sultana, 2011;

Wutich & Ragsdale, 2008), and psychosomatic symptoms (Tallman, 2019).

Water insecurity disproportionately affects women and children, who are responsible for the majority of water car-

rying, intra-household distribution, and water-related household tasks (Geere & Cortobius, 2017; Sorenson et al., 2011),

especially in rural and low-socioeconomic status households (Irianti & Prasetyoputra, 2019). The bulk of domestic

activities—including cleaning, cooking, washing, childcare, and small-scale agriculture—all require water and fall pre-

dominantly on women (Pommells et al., 2018). Because women bear the primary responsibility for water acquisition

2of19 TALLMAN ET AL.

and use, they are more vulnerable to adverse consequences associated with water carrying, such as physical strain

(Geere et al., 2010; Geere & Cortobius, 2017), miscarriage (Collins et al., 2019), and attack from animals and people

(Kirchner, 2007; Mugumya et al., 2017; Stevenson et al., 2012). Women are also more likely to be shamed and blamed

for the inability to meet standards of cleanliness for their homes, children, and families (Chipeta, 2009), even when

water shortages that restrict these activities are outside of their control.

Within the larger body of evidence documenting the mental and physical risks women face as they navigate water

insecurity, a number of studies indicate that water insecurity precipitates gender-based violence (see Table 2). While

anyone can experience gender-based violence, the highest risk groups are women, transgender, and gender non-

conforming individuals (WHO, 2016; Wirtz et al., 2020). Additionally, while gender-based violence can include a wide

range of harm, the most common categorizations of gender-based violence are physical, economic, sexual, and psycho-

logical violence (Heise et al., 1999). As described by Hossen (2014), physical violence includes hits, slaps, kicks, beat-

ings, burns, and the use of a weapon. Psychological violence can entail disparagement or scorn, the enforcement of

isolation and/or embarrassing behavior. Sexual violence includes sexual harassment, unwanted sexual touching, and

coerced sex. Finally, economic violence refers to the deprivation of access to a variety of resources including money,

health care, education, shelter, and food. Although concise, cross-culturally validated measures of gender-based vio-

lence are lacking, organizations such as the United Nations and USAID have published reviews and guides for indica-

tors used to measure gender-based violence in a variety of contexts (Janson, 2012; USAID, 2014).

Numerous studies document an association between gender-based violence and water-hygiene related issues such

as sanitation (Sommer et al., 2015), open defecation (Belur et al., 2017), and menstruation (Cardoso et al., 2019). How-

ever, far fewer explore the relationship between water-specific causes of gender-based violence, especially within a

water insecurity framework (Cole, 2020; Jepson et al., 2017; Nunbogu & Elliott, 2021).Therefore, in this article, we

reviewed the existing literature documenting the association between water insecurity and gender-based violence with

two main objectives. Our first objective was to describe the characteristics and contexts of all available peer-reviewed

studies documenting water insecurity and gender-based violence in order to understand the types of studies that exist

(location, study design, methodology, and disciplinary perspective). Our second objective was to identify and classify

documented gender-based violence across domains of water insecurity (access, affordability, adequacy, reliability, and

safety). By pursuing these two objectives, we identify trends and gaps in the literature, which inform our recommenda-

tions for future research directions.

3|METHODS

3.1 |Search strategy

Literature searches were performed in PubMed, Web of Science, GoogleScholar, JSTOR, Scielo, Hinari, PsychINFO,

Embase, EBSCO (all databases), SCOPUS, eHRAF World Cultures (all months and years), and Neliti. There were no

language restrictions in any database. Co-authors searched Spanish, French, Indonesian, and Arabic manuscripts to

ensure global scope of the review. We did not restrict our search by publication date.

Boolean terms were used and search terms differed slightly across databases. Key terms included “Water insecurity”

OR “water scarcity”OR “water shortage”OR “water supply”OR “water stress”AND “gender-based violence”OR

“domestic violence”OR “intimate partner violence”OR “violence against women”OR “partner violence”OR “marital

violence”OR “violence against wife.”

3.2 |Eligibility criteria

We included all peer-reviewed studies that water insecurity and mentions of gender-based, spousal, or intimate partner

violence. Any study design was eligible to capture the full range of experiences documented in the literature. No restric-

tions were applied for population size, characteristics, study year, or geographic location. Any studies specifically cap-

turing water for sanitation and hygiene (WASH) or problems with water (e.g., drought, flooding) but not explicitly

addressing dimensions of water insecurity were excluded from the main review. Grey literature and book chapters were

excluded from the main review but incorporated into the discussion.

TALLMAN ET AL.3of19

3.3 |Screening

All co-authors were assigned a database to search but relied on the same search strategy and terms (see Figure 1). Each

individual conducted a title screen for all results from searches. After initial selection based on the title screen, each

individual conducted an abstract screen to determine if an article should be included in full-text review. Once articles

were identified for full-text review, authors screened full-text documents for inclusion.

3.4 |Quality assessment

Potential articles were assessed to determine if they met the eligibility criteria outlined by the authors at the onset of

the review. Specifically, discussions were conducted to determine whether particular studies on WASH/drought/

flooding studies were pertinent. The authors agreed to exclude studies that did not specifically address dimensions of

water insecurity. The screening and selection process resulted in 18 peer-reviewed studies that documented associations

between water insecurity and gender-based violence.

3.5 |Data coding and analysis

We developed a coding framework a priori from the literature that evolved iteratively while coding and based on

co-author feedback. Content coding was conducted using the qualitative and mixed methods analysis program,

Dedoose (Version 9.0.18.). We developed descriptors for items such as publication year, authors, journal name, study

type, and setting. The second-author did a first pass on coding and the first-author reviewed coding for consistency and

inter-rater reliability. Coded excerpts were read to identify illustrative examples of water insecurity and gender-based

violence.

4|RESULTS

4.1 |Search results

The initial search yielded 2460 studies (Figure 1). Title and abstract screening yielded 38 studies (1.58%), after

duplicates were removed, 18 studies were eligible for full-text review following the aforementioned outlined

criteria. Of these, 14 studies met the eligibility criteria. Identification of related studies (i.e., “hand-searching”)

resulted in the addition of four additional studies. Overall, 18 studies met our inclusion criteria and were included

in this review (Figure 1).

4.2 |Obj 1: Characteristics and contexts of all available studies

The 18 included studies were published between 2002 and 2021. Most studies were conducted in low- and low-middle

income countries, 13 of the identified studies (72.2%) were conducted in sub-Saharan Africa. Among these, eight studies

were conducted in rural sub-Saharan Africa, two were cross-country analyses, one was in a refugee context, and two

were in urban or semi-urban areas. The remaining studies were conducted in South Asia, with two studies conducted

in India, two in Bangladesh, and one in Nepal (Table 1). Figure 2maps the geographic distribution of the included

studies.

Over half of the studies (55.5%) were qualitative and used focus group discussions and interviews. Five studies were

mixed-methods. The remainder (16.6%) were quantitative. Studies spanned a broad range of academic disciplines,

including public health, medicine, economics, and the social sciences. There were two each in the journals of Social Sci-

ence Medicine and Violence Against Women. There were seven articles in health/global health journals, including those

that focus on the environment, conflict, and human rights. There were three articles in journals that focus on women/

gender studies. The remaining four were found in a variety of social science journals. All the articles were written in

English. No articles were found in French, Arabic, Spanish, or Indonesian language journals (Box 1).

4of19 TALLMAN ET AL.

4.3 |Obj 2: Water insecurity and gender-based violence across domains of water

insecurity

Gender-based violence was documented across all domains of water insecurity (i.e., access, adequacy, affordability, reli-

ability, and safety) and was often the result of insufficiencies spanning multiple water-related domains (Table 2, Box 2,

Figure 3). Eleven studies were conducted in areas with chronic water problems (e.g., unreliable access, regular water

shut-offs, seasonal shortages). One study was conducted in a refugee settlement, two were conducted after water-related

interventions were introduced into the study area, one study was within the context of known arsenic contamination at

water points, two occurred in drought or crisis settings, and one multi-site study captured varied water-related problems

(Table 2). Below, we draw examples from this literature that further elucidate how water insecurity is associated with

gender-based violence in these varying contexts.

4.3.1 | Access

Water access, conceptualized here as how an individual or household acquires water, was the most frequently men-

tioned 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. Similar feelings of fear and anxiety were expressed by young girls in

Cameroon, as they worried about the real threat of physical assault and rape while walking long distances. As a

participant in Cameroon stated, “Some children remain out of home right into the ‘unholy hours’of the night

just to fetch water. These children, who are most often young girls, are exposed to such vices as rape”(Thompson

et al., 2011; pg. 121).

Aspects of water access associated with gender-based violence included long distances to and isolation at water

sources, predictability of water gathering schedules, darkness, and other forms of cover (e.g., brush, grass, and trees)

that permitted the targeting of women (Assefa et al., 2021; Logie et al., 2021). Women and adolescent girls regularly

walked great distances to obtain water. In some of the studies conducted in sub-Saharan Africa, women reported walk-

ing 6 km (approx. 3.7 miles) per day in search of water, spending up to eight to ten hours round-trip collecting water

(Assefa et al., 2021; Chipeta, 2009; Mukuhlani & Nyamupingidza, 2014). Without accompaniment, “Girls are in danger

FIGURE 1 Screening and selection process for literature review of water insecurity and gender-based violence.

TALLMAN ET AL.5of19

TABLE 1 Characteristics of studies included in review of water insecurity and gender-based violence (n=18)

Author, year Setting Study design Study type Participants

(Mushavi et al.,

2020)

Rural; Uganda Mixed-methods Cross-sectional Men and women

(Pommells et al.,

2018)

Rural; Rwanda,

Tanzania,

Uganda, Kenya

Qualitative: focus group

discussions, key informant

interviews

Cross-sectional Community health workers and

healthcare practitioners working in

maternal and child health

(Stevenson et al.,

2012)

Rural; Ethiopia Mixed-methods Two phases

(mixed

methods-

Phase 1;

survey Phase

Women

(Meyiwa et al.,

2014)

Rural; South

Africa

Qualitative: interviews,

workshops

Cross-sectional Women

(Collins et al.,

2019)

Rural; Kenya Qualitative: focus group

discussions, Go-along

interviews, pile sorts, and

photovoice

Cross-sectional HIVand HIV+pregnant and

postpartum women

(Assefa et al.,

2021)

Rural; Ethiopia Qualitative: key informant

interviews, focus group

discussions

Cross-sectional Government officials, school girls,

individuals with disabilities

(Logie et al., 2021) Refugee

settlement;

Uganda

Qualitative: focus group

discussions, interviews

Cross-sectional Teenage male and female refugees (16–

24 years)

(Thompson et al.,

2011)

Peri-Urban;

Cameroon

Qualitative: written and oral

competition to evaluate

impacts of water crisis and

possible solutions

Two phases Adolescent males and females, local

water decision-makers

(Mukuhlani &

Nyamupingidza,

2014)

Urban;

Zimbabwe

Qualitative: observation,

unstructured interviews,

and questionnaires

Cross-sectional City council officials from Bulawayo

engineering department, local clinic,

school heads and representatives of

residents associations and non-

governmental organizations.

Secondary data analysis of newspaper

articles, journals, and council minutes

(Barchi & Winter,

2020)

Mixed (DHS

data); 20

countries

across sub-

Saharan Africa

Quantitative Cross-sectional Men and women

(Asaba et al., 2013) Rural; Uganda Mixed-methods Cross-sectional Household heads (male- female-, and

child-headed households)

(Epstein et al.,

2020)

Mixed (DHS

data); 19

countries

across sub-

Saharan Africa

Quantitative Cross-sectional Men and women

(Chipeta, 2009) Peri-Urban;

Malawi

Qualitative: participatory

research

Cross-sectional Women

(Narang, 2014) Rural; India Qualitative: focus group

discussions, participatory

exercises, and key

informant dialogues

Cross-sectional Women

6of19 TALLMAN ET AL.

when they go to fetch water, if something wrong happens along the way, we won't be able to do anything for them, as

no one will help”(Narang, 2014; pg. 32).

In some settings, gender norms around non-partner sexual violence resulted in forced marriage following sex-

ual assault, rape, and/or abduction. Meyiwa et al. (2014) reported that adolescent girls in Eastern Cape,

TABLE 1 (Continued)

Author, year Setting Study design Study type Participants

(Karim et al.,

2012)

Rural;

Bangladesh

Mixed-methods Baseline and

follow-up

Male and female village leaders; farmers;

development workers; households;

and married women

(Shah, 2002) Rural; India Qualitative: focus group

discussions

Cross-sectional Women

(Choudhary et al.,

2020)

Mixed (DHS

data); Nepal

Quantitative Cross-sectional Household members

(Sultana, 2011) Rural;

Bangladesh

Mixed-methods Cross-sectional Adult men and women

FIGURE 2 Map of study sites for articles that mentioned gender-based violence and water insecurity. Uganda was the most-researched

site mentioned, included in six articles.

BOX 1 Recent, interdisciplinary attention to water insecurity, and gender-based violence

Almost half of the studies included in this review were published within the past 5 years. The recency and small

number of studies addressing water insecurity and gender-based violence indicate that serious attention to this

topic is still emerging. However, the use of mixed methods and interdisciplinary perspectives, demonstrate that

this topic is of interest across fields and for scientists and practitioners.

TALLMAN ET AL.7of19

TABLE 2 Studies of water insecurity and gender-based violence, specifying water context, and typologies of violence by domain of water

insecurity (n=18)

Citation Water context Types of violence reported

(Mushavi et al.,

2020)

Chronic, poor access Physical violence between individuals queuing at water points (access);

intimate partner violence due to insufficient water in households

(adequacy). Failure to meet prescribed gender roles around water

collection mentioned as a driver of GBV (reliability, affordability, and

access).

(Pommells et al.,

2018)

Chronic, poor access Rape and sexual assault while traveling to water sources, at water

points (access); transactional sex between water vendors and women/

adolescent girls (access and affordability); Physical violence by

intimate partners due to insufficient water in households (adequacy);

intergenerational violence related to water collection; poor

infrastructure and water quality associated with risk (reliability and

safety).

(Stevenson et al.,

2012)

Chronic Verbal disputes with intimate partners due to household water

insufficiency (adequacy).

(Meyiwa et al.,

2014)

Chronic, within context of discussions

around climate change concerns

Sexual assault and rape among women and girls at water points and

while walking to collect water (access); prior sources have dried up,

making communal taps unreliable; “bride”abductions–abductions of

girls leading to child marriage (access).

(Collins et al.,

2019)

Chronic Verbal disputes and physical violence with intimate partners due to

insufficiency of household water (adequacy); physical and sexual

violence while traveling to water sources at night (access).

(Assefa et al., 2021) Chronic Intimate partner violence due to opportunity cost of water collection

(adequacy); rape, abduction, psychological, and physical assaults

while collecting water (access).

(Logie et al., 2021) Refugee settlement, pervasive

resource scarcity

Sexual assault and rape while walking to water (access).

(Thompson et al.,

2011)

Chronic water problems Fighting between water gatherers at water points; sexual harassment,

assault, and rape while walking to water collection points (access).

Unreliable and intermittent water supply creating a crisis (reliability).

(Mukuhlani &

Nyamupingidza,

2014)

Introduction of water shedding project Sexual harassment and assault at waterpoints (access), water shortages

(reliability) driving long queues.

(Barchi & Winter,

2020)

Varied problems with water Open water sources were associated with non-partner violence in rural

sites across Mozambique, Burkina Faso, and Uganda and in urban

areas in Democratic Republic of Congo (access).

(Asaba et al., 2013) Chronic, poor access Verbal attacks/insults from male children directed at female children

while queueing or drawing water from water points (access)

exacerbated by water shortages (reliability). Physical fights between

male and female children at water points (access). Sexual assault,

rape, threats of rape, and attempted rape among children and women

at water points (access).

(Epstein et al.,

2020)

Drought Drought was associated with emotional, sexual, and physical violence

(access and reliability).

(Chipeta, 2009) Water scarcity crisis Women wake up early to fetch water and are more vulnerable to attack

and abuse (access); problems with access are driven by high water

charges (affordability), disconnections (reliability), and inconvenient

timing of openings of water kiosks.

(Narang, 2014) Chronic water scarcity Sexual harassment, abduction, sexual assault, and rape while walking

to water collection points (access).

(Karim et al., 2012) Chronic water scarcity Physical intimate partner violence as punishment for exceeding time to

collect water and not having enough time to perform other domestic

8of19 TALLMAN ET AL.

South Africa, were regularly abducted and raped while walking to water collection points and coerced into child

marriage. The community accepted this as “bridal abduction”(Meyiwa et al., 2014). Pommells et al. (2018) found

similar phenomena in Uganda, where a female respondent stated, “It's like a process of marrying. So basically

you don't just accept a man like that, but he has to sort of wrestle with you, and so if he manages to put you

down, and kind of rape you, then you marry him. So it's like a culture”(pg. 5). The cultural normalization of

such violence was also expressed in Cameroon, where sexual assault of girls who were collecting water was attrib-

uted to female “promiscuity”(Thompson et al., 2011).

Finally, the type of water source accessed by a household influenced the risk of violence. A cross-national study

conducted in sub-Saharan Africa found that access to open water sources (in contrast with private sources, such as

a well or yard tap) was associated with non-partner violence in urban settings in Cote d'Ivoire, Sierra Leone,

Mozambique, Uganda, and Burkina Faso (Barchi & Winter, 2020). Public open sources, private sources not belong-

ing to study respondents, and improved water sources (i.e., protected from outside contamination) were also men-

tioned in some of the studies as sites for violence. For example, Indian women who accessed water from private

wells “narrated experiences of abusive treatment from well owners they have to put up with, as there are no other

options”(Shah, 2002; pg. 4418). Similarly, women in Bangladesh reported verbal disputes with water point owners

(Sultana, 2011). Improved water sources also had more congestion and longer wait times as many households tried

to access this safer source (Asaba et al., 2013). In several studies, improved sources were controlled by men, making

these access points sites of sexual violence, rape, and transactional sex (Meyiwa et al., 2014; Mukuhlani &

Nyamupingidza, 2014; Pommells et al., 2018).

TABLE 2 (Continued)

Citation Water context Types of violence reported

tasks (adequacy). Surface water drying, producing need to seek

groundwater (reliability), and many hand-pumps restricted because

of arsenic contamination (safety) Physical intimate partner violence

when asking for assistance with water carrying (access).

(Shah, 2002) After implementation of an irrigation

management project

Women suffered unspecified “abuse”while collecting water from

irrigation canals (access).

(Choudhary et al.,

2020).

Chronic water scarcity Sub-optimal water access is related to physical and emotional intimate

partner violence (access) due to challenges in meeting household

water-related tasks (adequacy).

(Sultana, 2011) Arsenic-contaminated water points Verbal disputes between women at water points (access); punishment

against daughters-in-law by in-laws for failing to provide sufficient

water on a reasonable timeline (adequacy); verbal disputes with water

point owners/gatekeepers (access); and arsenic contamination driving

disputes (safety).

BOX 2 Interconnection of water insecurity domains and links to gender-based violence

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 house-

hold water inadequacy. Despite these trends, the domains of water insecurity, and the types of violence experi-

enced by women, were often intertwined. For example, women who feared household violence (in relation to

not meeting water-related domestic duties), were more likely to engage in transactional and exploitative sex to

improve their chances of accessing water (Pommells et al., 2018). Figure 3showcases the types of violence

related to water insecurity and visualizes the spatial dimensions of this association, going from the household,

to the path back and forth to collect water, to access points.

TALLMAN ET AL.9of19

4.3.2 | Adequacy

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

(Collins et al., 2019; 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. Not meeting their

household obligations, like preparing food on time, led their husbands to insult and quarrel with them. Collins et al.

(2019) documented similar patterns in Kenya, with one woman stating, “When my husband comes home, he wants to

bathe, he will ask why there is no water and I tell him that I went and found a long queue…You will quarrel, and the

man will ask you what your importance is to the family if you cannot fetch water”(pg. 655). When water is inadequate,

FIGURE 3 Documented gender-based water violence across typologies of violence, place where it occurs, and domain of water

insecurity.

10 of 19 TALLMAN ET AL.

many women cannot meet their responsibilities or contribute in culturally meaningful ways, which motivates verbal

and physical abuse (Karim et al., 2012).

The risk for violence in response to water inadequacy extends beyond intimate partners and feeds forward to chil-

dren and extended family. In a study in Bangladesh, women were punished by their in-laws for failing to provide suffi-

cient water on a reasonable timeline because of the time spent collecting water (Sultana, 2011). In Uganda, Mushavi

et al. (2020) found that women created unreasonable water collection expectations for their children due to their own

fear of intimate partner physical abuse driven by insufficient household water. As a Ugandan mother stated, “And for

me because of the urgency of my chores sometimes I say to them, ‘I am going to spit on the ground and whoever finds

my saliva dry, I will beat them.’…And so for those who come back when it is late, beatings it is. They will come saying

that there was a long line of people …I feel angry and bad about it and then I wish that if I had water near here, these

things would not even happen”(Mushavi et al., 2020; pg. 11). Pommells et al. (2018) echoed these dynamics, stating

that if children spent too long collecting water, they were subjected to physical violence and that violence between male

and female household heads and toward children sets up an intergenerational pattern of violence, triggered in part by

problems with water.

Men appear to intensify water inadequacy, reducing the amount of water available for hygiene and consumption for

the household. Assefa et al. (2021) recorded women in Ethiopia, saying that “Males also consume huge quantities of

water. They don't save water and they don't want to hear advice from us about water saving. One man may consume

more than one jerry can for bathing, ahh they do not save and consume the water collected by females. Surprisingly, if

we couldn't make it ready, they may get disappointed or angry to the extent that they may beat us”(Assefa et al., 2021;

pg. 6). In Kenya, Collins et al. (2019) found that women tried to avoid verbal abuse by reallocating household water

stores to ensure their male partners had enough water for bathing and drinking. This was often to the detriment of their

own water consumption. One participant stated “[Your husband] can even use abusive words towards you if he needs

water to bathe and can't get it. To avoid chaos, you give him drinking water to bathe”(pg. 5). This dynamic holds even

during physiologically and emotionally vulnerable times, such as pregnancy and in the immediate postpartum period.

Expanding on this, a key informant working with Pommells et al. (2018) lamented that a pregnant woman “won't even

have enough water for herself so she might as well end up having maybe potatoes with a cup of water and that makes a

meal for the day, but she is expecting [pregnant] and so nutrition at this level goes down …because she spends so much

time [doing chores] rather than concentrating on her health or the health of the baby”(pg. 1856).

4.3.3 | Affordability

Although less commonly mentioned (17% of studies), affordability of water, which we conceptualize as the ability to

purchase water in ways that do not compromise household needs, also led to gender-based violence. In Malawi, high

water costs and inconvenient water kiosk operating hours inhibited access, driving women to seek water from alterna-

tive sources, and placing them at risk for violence while collecting water (Chipeta, 2009).

Fear of not meeting household obligations and provoking violence within the home also increased the risk of sexual

violence. For example, Pommells et al. (2018) interviewed health and social care workers from Rwanda, Tanzania,

Uganda, and Kenya who reported that girls and women felt coerced into providing sex or sexual favors to gain access to

water or advance their position in a water queue. This sexual coercion was perpetrated by men “in good economic posi-

tions”who were often overseeing a “project of water wells”or were selling water. Individuals exposed to this violence

were young girls or women who did not have money for the water they needed and used sex to get into a better position

to obtain it. Themes of transactional and exploitative sex for access to water were reiterated by multiple respondents in

their study (Pommells et al., 2018). This example demonstrates that economic, sexual, and physical abuse are linked to

issues across domains of access, affordability, and adequacy.

4.3.4 | Reliability

Reliability, conceptualized here as the presence of water sources that do not fluctuate in ways that inhibit access, was

integrally connected to other aspects of water insecurity and was described as an upstream driver of problems with

access and adequacy in 61% percent of studies. As stated by Thompson et al. (2011), “The less certain the water supply,

the more likely it is that girls will need to travel further from home and later into the evening to find water. The

TALLMAN ET AL.11 of 19

participants identified that this uncertainty provides increased opportunity for the physical dangers of violence such as

sexual abuse, harassment, and rape”(pg. 13).

Unreliability of water, and its relationship to problematizing water access, is exacerbated by dry seasons, drought,

and high demand. In Eastern Cape, South Africa, Meyiwa et al. (2014) found that water sources that were previously

reliable had dried up, driving people to rely on communal taps that sometimes yielded only a trickle of running water.

Stated clearly by an informant, “when rivers close by our homes dry up; women and in particular young girls are sus-

ceptible to sexual abuse. Circumstances compel them to wake up as early as 3 am to search for water…”(Meyiwa

et al., 2014; pg. 102). Women in Kenya also fetched water at irregular hours during dry seasons to get water before it

was depleted and expressed concerns about the risk of violence during these times (Collins et al., 2019). In Uganda,

unreliable water flows resulting from overuse and natural factors also contributed to water shortages and fighting while

waiting in line (Asaba et al., 2013).

Reliability also intersected with adequacy and violence vis-a-vis increased opportunity costs for women within the

household. A woman in Bangladesh stated, “I went to fetch water from the deep tube well. It took a long time because

there was a long line …but when I came back, I saw that the man (husband) was home. He asked me to serve lunch …

I replied that it took a long time to collect water (as our nearest three handpumps had dried out). But he said that it

was my problem if other women can cook on time for their husbands! So when I told him to go to see the deep [deep

tube well] …he got angry and started beating me …I did not argue anymore; rather, I went to cook.”(Karim

et al., 2012; pg. 210). Thus, the reliability of water was the upstream driver of problems with access and adequacy,

which were the proximate causes of gender-based violence.

Beyond the aforementioned studies that made clear connections between water reliability and gender-based vio-

lence, other studies tangentially described unreliability as contributing to women being placed in risky situations to

obtain water from distant sources. For example, Thompson et al. (2011) described how imbalances in supply and

demand create a “severe, unreliable, and intermittent water supply”in Cameroon (pg. 5), leading women to walk fur-

ther to access alternative sources, exposing them to violence. Similarly, In Malawi, power outages contributed to

unreliability in water flow and the need to seek other sources (Chipeta, 2009).

Finally, Epstein et al. (2020) hypothesized that drought-related severe water shortages in sub-Saharan Africa created

stress that led men to want to control their partner's movements and behavior, which was a novel pathway proposed

that linked water unreliability to gender-based violence. Epstein et al. (2020) also stated that on a larger scale, drought

and related water unreliability pushed women to migrate, increasing their risk for emotional, sexual, and physical vio-

lence. Issues of climate change, water unreliability, and migration were also addressed by Meyiwa et al. (2014), but not

directly in association with gender-based violence.

4.3.5 | Safety

A number of studies discussed the consumption of unsafe water (Assefa et al., 2021; Chipeta, 2009; Mushavi

et al., 2020; Thompson et al., 2011), but the only study that directly linked the safety of water to gender-based violence

was Sultana's (2011) study of women in Bangladesh. In this case, arsenic-contaminated water resulted in overcrowding

and arguments at safe tubewells. These conflicts caused fear, stress, and anxiety. “As one woman put it, she would

rather die from arsenic poisoning than face constant insults and arguments in fetching safe water elsewhere”

(Sultana, 2011; pg. 171).

5|DISCUSSION

In this review, we identified 18 peer-reviewed studies documenting a connection between gender-based violence and

water insecurity. This body of research was predominantly conducted in sub-Saharan Africa with a heavy focus on risks

posed by walking long distances for water. The relationship between water inadequacy within the household driving

interpersonal violence was also salient, particularly in the studies situated in South Asia. Although issues with water

access and adequacy were most commonly mentioned, a number of studies cited water unreliability as an upstream

driver of water-related gender-based violence. Future research is needed to determine whether other aspects of water

insecurity, such as safety and affordability, are linked to increased risks of violence for women and girls, particularly in

areas outside of Africa and South Asia.

12 of 19 TALLMAN ET AL.

Our first objective was to describe the characteristics and contexts of all available studies documenting water insecu-

rity and gender-based violence. We found that almost half of the included studies were published within the past

5 years. These articles often used mixed methods and interdisciplinary perspectives. Many of the articles were published

in journals with an interdisciplinary scope, such as Social Science and Medicine. While the co-authors searched Spanish,

French, Indonesian, and Arabic manuscripts to ensure global scope, only articles in English were found that docu-

mented an association between water insecurity and gender-based violence. The recency (last 5 years) and small num-

ber of studies indicate that serious attention to this topic is still emerging in the literature. Addressing this gap is a high

priority, as gender-based violence is prevalent across all continents (Heise et al., 2002), and water insecurity is increas-

ing and extending globally (Boretti & Rosa, 2019). Additionally, while the journals publishing these studies indicated

that they are highly interdisciplinary, the bias toward English language publications suggests that more studies by non-

English-speaking scholars are needed. Research conducted by scholars from areas affected by water insecurity could

offer novel findings and powerful interpretations of those findings (Sultana, 2011).

Our findings that water-related gender-based violence was most commonly reported in sub-Saharan Africa, India,

and Bangladesh, supports the known implication that low- and middle-income settings are more frequently examined

for water insecurity in comparison to high-income settings (Venkataramanan, Collins, et al., 2020). Similarly, we found

that most of the studies included in this review were conducted in rural settings. This mirrors the predominance of

rural, in comparison to urban, studies of water insecurity (Venkataramanan, Collins, et al., 2020; Venkataramanan,

Geere, et al., 2020). While there are important studies of water insecurity, stress, and health in some urban settings in

low- and middle-income countries (Adams et al., 2020; Wutich, 2011), more research in high-income

(Eichelberger, 2018; Jepson & Vandewalle, 2016; Meehan et al., 2020) and high wealth disparity settings is needed, with

particular attention to the social and ecological drivers of insecurity.

The second objective of this review was to identify and classify documented gender-based violence across domains

of water insecurity. We found that gender-based violence occurred across access, adequacy, affordability, reliability, and

safety, but not evenly. Access was the most common domain addressed, followed by reliability and adequacy. Afford-

ability and safety were only rarely mentioned as directly associated with gender-based violence. However, it is clear that

these aspects of water insecurity are often closely tied to access and inadequacy, indicating that, in reality, the dimen-

sions of water insecurity cannot be fully separated into discrete categories. For example, a lack of reliable and/or safe

water led women to wake up earlier and walk further into remote areas to access water. These circumstances increased

the risk of rape and/or physical assault while collecting water (Pommells et al., 2018).

Thus, the dimensions of water insecurity that influence risk for gender-based violence are intertwined, as are the

types of violence women experience. For example, the most salient type of violence reported in relation to water insecu-

rity was the risk of sexual violence while accessing water. This was followed by physical violence, often perpetrated by

intimate partners, in response to water inadequacy in the household. Again, these are not necessarily dichotomized

experiences as fear of violence from not meeting domestic duties increased vulnerability to sexual coercion to gain

access to water (Pommells et al., 2018).

In the majority of the studies, violence against women was connected to gendered norms that rationalized violence,

made water and related household tasks the sole responsibility of women, and limited women's ability to ask for sup-

port (Aihara et al., 2016; Karim et al., 2012; Mushavi et al., 2020; Stevenson et al., 2012; Subbaraman et al., 2014;

Sultana, 2011). In Bangladesh, women were expected to manage household tasks on time and unconditionally obey

husbands, even in contexts of resource scarcity and severe time constraints (Karim et al., 2012). These limitations inter-

sected with norms that make all water-related tasks “women's work.”In Uganda, water collecting is a task that is tradi-

tionally reserved for women, no matter the level of physical exertion required. Traditional norms have deemed water

gathering as “unmanly,”shameful, and demeaning, with men facing ridicule that they have been “charmed”by their

partners to be submissive (Asaba et al., 2013). Mushavi et al. (2020) reported that in Uganda, even asking a male partner

for help is tantamount to witchcraft, and in Bangladesh, it was cited as a rationale for physical abuse (Karim

et al., 2012).

Additionally, gendered norms around sexual rites of passage such as “bridal abductions”and paying a “bride price”

or dowries serve to further excuse violence against women in connection to water (Meyiwa et al., 2014; Pommells

et al., 2018; Thompson et al., 2011). These issues are exacerbated by poverty, with some families accepting “bridal

abductions”to benefit financially from “bride price”(Meyiwa et al., 2014). In other cases, paying a dowry solidifies

women as “property”and serves as an excuse to abuse women when they cannot meet water-related domestic duties

(Karim et al., 2012). Such patriarchal systems justify men's aggression and dominance as “natural”(Choudhary

et al., 2020) and put women at further risk of violence when they are unable to fulfill gendered obligations due to water

TALLMAN ET AL.13 of 19

insecurity (Pommells et al., 2018). An important point linked to gender norms is that scholars and the public are

increasingly recognizing that gender is not binary (Dubois et al., 2021). There is serious concern, by both scholars and

practitioners, regarding the right to safe and accessible sanitation and hygiene for transgender communities

(Ganguly & Singh, 2021). However, more attention to transgender, non-binary, and other gender-fluid categories in

research on gender and water insecurity is needed (e.g., Wutich, 2020). Finally, the gendered risks associated with water

insecurity likely interact in syndemic ways. The term “syndemics”describes synergistic interactions among comorbid

health conditions (i.e., epidemics), especially under circumstances of structural and political adversity (Willen

et al., 2017). In this case, women who have experienced injuries or been subjected to violence are less physically able to

collect water, creating further risk for scarcity in the household and related repercussions for nutrition and health.

Water insecurity co-occurs and exacerbates food insecurity (Brewis et al., 2020; Wutich & Brewis, 2014), HIV

(Krumdieck et al., 2016; Nagata et al., 2021; Workman & Ureksoy, 2017), and COVID-19 (Adams et al., 2021; Staddon

et al., 2020; Stoler, Jepson, & Wutich, 2020). Water is also integral to sanitation and hygiene (Choudhary et al., 2020),

increasing the potential for deleterious, syndemic interactions between water-related infectious diseases, malnutrition,

and dehydration.

Indeed, there are multiple related bodies of research that connect problems with water to women's health that were

outside the scope of this review. Specifically, there is substantial water, sanitation, and hygiene (WASH) literature that

documents the ways that open defecation, unsafe latrines, and menstrual hygiene needs create risk for gender-based

violence (Assefa et al., 2021; Belur et al., 2017; Fisher et al., 2018; Khanna & Das, 2016; Mara, 2016; Mehta, 2013;

Truelove, 2011). Risks to women are amplified in post-disaster and humanitarian settings where mass unemployment,

migration, and suffering increase tensions and incidents of violence (Alston, 2012; Kirchner, 2007; Rezwana, 2017).

While we excluded studies of WASH, drought, and flooding that did not specifically address dimensions of water inse-

curity, the combined dangers of extreme weather events and poor infrastructure will undoubtedly increase with climate

change (Meyiwa et al., 2014; Resurrecci

on, 2019; Sultana, 2011; Watt & Chamberlain, 2011). In all these cases, women

and children tend to be the worst affected (Rashid, 2000).

6|CONCLUSION

In this review, we found that the studies investigating the relationship between water insecurity and gender-based vio-

lence conceptualized violence as harm inflicted on one person by another, typically with attention to “conventional”

categorizations of violence such as physical, economic, sexual, or psychological violence (Heise et al., 1999). In the

future, we suggest that the spectrum of what is considered “violence”in relation to water insecurity should be

expanded, with a particular focus on the dynamic relationship between women and children. For instance, water carry-

ing is physically demanding, particularly in areas with rugged terrain (Asaba et al., 2013; Geere & Cortobius, 2017;

Stevenson et al., 2012; Venkataramanan, Geere, et al., 2020). These physical demands create multiple manifestations of

embodied pain (Sultana, 2011) related to the labor involved in hand-lifting and/or head-loading jerry cans (Asaba

et al., 2013; Collins et al., 2019; Geere & Cortobius, 2017; Mushavi et al., 2020; Narang, 2014). Hauling water also places

women and girls at risk for injuries (Rosinger et al., 2021; Sorenson et al., 2011; Venkataramanan, Geere, et al., 2020)

and micronutrient deficiencies due to the high caloric expenditures of water collection and carrying (Sorenson

et al., 2011). Risks of injury, high caloric expenditures, and overall bodily strain are particularly problematic for women

who are pregnant, breastfeeding, and/or have small children (Collins et al., 2019; Mukuhlani & Nyamupingidza, 2014).

The physical demands of water acquisition create significant opportunity costs for pregnant and postpartum women,

putting them at greater risk of domestic violence (Mushavi et al., 2020; Pommells et al., 2018).

Thus, the relationship between water insecurity and conventional forms of violence against women only reveals the

“tip of the iceberg”. Underneath the surface is a wider “spectrum of violence”associated with water insecurity, which

include WASH-related stressors, extreme reproductive burdens, opportunity costs, and adverse biosocial effects on chil-

dren. We propose the term “gender-based water violence”to describe these water-related stressors, and others, that are

so extreme as to significantly threaten human health and well-being, particularly that of women and girls. Further, we

suggest that there is potential for syndemic interactions between these water-related stressors and poor health outcomes

that may contribute to the developmental origins of health and disease (DOHaD; Goldstein et al., 2017) and the inter-

generational transmission of social and health disparities (Hoke & McDade, 2014). We suggest that future work con-

siders these possible interactions, particularly in areas where water is under-researched. This is particularly important

14 of 19 TALLMAN ET AL.

as climate change, environmental degradation, migration, and emerging infectious diseases continue to exacerbate inse-

curities globally and widen the spectrum of harms producing “gender-based water violence.”

Pushing forward conceptualizations of “gender-based water violence”and investigating the potential for this vio-

lence to have intergenerational effects is imperative to understanding the range and depth of harm inflicted by water

insecurity. This is particularly important for international organizations such as the United Nations (especially for SDG

5 on promoting gender equality and SDG 6 on promoting clean water and sanitation for all), global funders (USAID,

Beill and Melinda Gates Foundation etc.) and implementing partners (such as USAID, OXFAM, etc.), as the current

focus on conventional forms of violence obscures the range of harm that results from water insecurity. Without a more

complete framing of what constitutes “gender-based water violence,”implementing and monitoring activities will miss

the level of social protection that water interventions may yield. Yet the step from conceptual expansion to practical

implementation is far from being achieved and much more theoretical and methodological innovation is needed.

Anthropology, public health, and aligned environmental and biological sciences have a key role to play in this work

and in developing methods that can bring a quantitative component to these issues. Therefore, we applaud continued

interdisciplinary efforts to develop and refine cross-culturally validated tools to measure water insecurity (Jepson

et al., 2017; Young et al., 2019) and hope to see the emergence of similar cross-culturally validated measures of gender-

based violence. Such standardized measures can be deployed to monitor and evaluate community-based interventions

that target the linked threat of water insecurity and gender-based violence. Creating connections between science and

practice to address “gender-based water violence”is particularly important as rapid environmental and social changes

are producing an urgent need to find meaningful solutions.

AUTHOR CONTRIBUTIONS

Paula S. Tallman: Conceptualization (equal); data curation (lead); formal analysis (lead); funding acquisition (equal);

methodology (equal); writing –original draft (lead); writing –review and editing (lead). Shalean Collins: Conceptuali-

zation (equal); data curation (lead); formal analysis (lead); methodology (equal); visualization (lead); writing –original

draft (lead); writing –review and editing (equal). Gabriela Salmon-Mulanovich: Conceptualization (supporting); data

curation (supporting); funding acquisition (equal); writing –original draft (supporting); writing –review and editing

(supporting). Binahayati Rusyidi: Conceptualization (supporting); data curation (supporting); funding acquisition

(equal); writing –original draft (supporting); writing –review and editing (supporting). Aman Kothadia: Visualization

(equal); writing –review and editing (supporting). Stroma Cole: Conceptualization (lead); data curation (equal);

funding acquisition (lead); project administration (lead); writing –original draft (supporting); writing –review and

editing (supporting).

ACKNOWLEDGMENT

Thanks go to Dr. Julia Fleckman who reviewed the article, provided feedback on the coding structure, and informed

our understanding of forms of violence documented in the literature.

FUNDING INFORMATION

The writing of this manuscript was supported by a British Academy Knowledge Frontiers Grant (400136).

CONFLICT OF INTEREST

The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

ORCID

Paula S. Tallman https://orcid.org/0000-0003-2384-249X

Shalean Collins https://orcid.org/0000-0003-2991-8037

Gabriela Salmon-Mulanovich https://orcid.org/0000-0002-8918-7689

Binahayati Rusyidi https://orcid.org/0000-0003-4870-9177

Aman Kothadia https://orcid.org/0000-0002-8623-753X

Stroma Cole https://orcid.org/0000-0002-9135-9339

TALLMAN ET AL.15 of 19

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ENDNOTE

unwomen.org/en/what-we-do/ending-violence-against-women/faqs/types-of-violence

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Apr 2021

Water insecurity may precipitate interpersonal conflict, although no studies to date have rigorously examined these relationships. We examined relationships between household demographics, water insecurity, regional conflict, and interpersonal conflict over water. Using survey data from eight sub-Saharan African countries, we found that interpersonal conflict within and outside the home is associated with multiple domains of water insecurity, particularly accessibility. Furthermore, we found that higher levels of remote violence and protests are associated with greater within household conflict, whereas riots and violent armed conflict are associated with greater conflict between neighbors. Our findings expand upon the current literature by examining factors affecting interpersonal conflict over water, which may become increasingly important as precipitation patterns and land temperatures change in this region.

Gender Equality and Social Inclusion in Relation to Water, Sanitation and Hygiene in the Oromia Region of Ethiopia

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Full-text available

Apr 2021
Int J Environ Res Publ Health

The main purpose of the study was to deepen the understanding of gender and social inclusion in the context of water, sanitation, and hygiene (WASH) in the Oromia region of Ethiopia. An explorative qualitative study was conducted in three districts of the Oromia region using gender analysis frameworks. Twenty-one key informant interviews and nine focus group discussions were conducted. Findings showed 52% of households in the study area have basic service level water, 29% have basic service level sanitation, and 14% have basic service level hygiene. Women, girls, and people living with disability disproportionately experience poor access to quality WASH services. Women and girls participate in unequal domestic labor related to water management which often exposes them to discrimination and violence such as rape, abduction, and assault. Overall, women, girls, and other socially excluded groups are rarely consulted and engaged by local actors. This results in incongruent policy and political commitment which limits action at the grassroots level. Integrating gender equality and inclusion efforts into local governance agendas can help to increase access to and the quality of WASH services. These efforts must advocate for moving beyond gender parity to promote gender transformative approaches and inclusion to realize better WASH services for the communities they serve.

Water, sanitation, and hygiene (WASH) insecurity will exacerbate the toll of COVID-19 on women and girls in low-income countries

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Feb 2021

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.

Exploring resource scarcity and contextual influences on wellbeing among young refugees in Bidi Bidi refugee settlement, Uganda: findings from a qualitative study

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Jan 2021

Background Contextual factors including poverty and inequitable gender norms harm refugee adolescent and youths’ wellbeing. Our study focused on Bidi Bidi refugee settlement that hosts more than 230,000 of Uganda’s 1.4 million refugees. We explored contextual factors associated with wellbeing among refugee adolescents and youth aged 16–24 in Bidi Bidi refugee settlement. Methods We conducted 6 focus groups ( n = 3: women, n = 3: men) and 10 individual interviews with young refugees aged 16–24 living in Bidi Bidi. We used physical distancing practices in a private outdoor space. Focus groups and individual interviews explored socio-environmental factors associated with refugee youth wellbeing. Focus groups were digitally recorded, transcribed verbatim, and coded by two investigators using thematic analysis. Analysis was informed by a social contextual theoretical approach that considers the interplay between material (resource access), symbolic (cultural norms and values), and relational (social relationships) contextual factors that can enable or constrain health promotion. Results Participants included 58 youth (29 men; 29 women), mean age was 20.9 (range 16–24). Most participants (82.8%, n = 48) were from South Sudan and the remaining from the Democratic Republic of Congo (17.2% [ n = 10]). Participant narratives revealed the complex interrelationships between material, symbolic and relational contexts that shaped wellbeing. Resource constraints of poverty, food insecurity, and unemployment (material contexts) produced stress and increased sexual and gender-based violence (SGBV) targeting adolescent girls and women. These economic insecurities exacerbated inequitable gender norms (symbolic contexts) to increase early marriage and transactional sex (relational context) among adolescent girls and young women. Gendered tasks such as collecting water and firewood also increased SGBV exposure among girls and young women, and this was exacerbated by deforestation. Participants reported negative community impacts (relational context) of COVID-19 that were associated with fear and panic, alongside increased social isolation due to business, school and church closures. Conclusions Resource scarcity produced pervasive stressors among refugee adolescents and youth. Findings signal the importance of gender transformative approaches to SGBV prevention that integrate attention to resource scarcity. These may be particularly relevant in the COVID-19 pandemic. Findings signal the importance of developing health enabling social contexts with and for refugee adolescents and youth.

Water worries: An intersectional feminist political ecology of tourism and water in Labuan Bajo, Indonesia

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Nov 2017
ANN TOURISM RES

Stroma Cole

Framed in feminist political ecology, this paper presents an intersectional analysis of the gender-water-tourism nexus. Based in an emergent tourism destination, Labuan Bajo, Indonesia, it goes beyond an analysis of how women bear the brunt of burdens related to water scarcity, and examines which women and why and how it affects their daily lives. Based on ethnographic research and speaking to over 100 respondents, the analysis unpicks how patriarchal cultural norms, ethnicity, socio-economic status, life-stage and proximity to water sources are intertwined to (re)produce gendered power relations. While there is heterogeneity of lived experiences, in the most part tourism is out competing locals for access to water leading to women suffering in multiple ways.

The embodiment of water insecurity: Injuries and chronic stress in lowland Bolivia

Article

Oct 2021

Water is critical to health and wellbeing. Studies have theorized that problems with water can become embodied, yet few studies have quantified this. Therefore, we first sought to understand the lowland Bolivian water environment of Tsimane’ forager-horticulturalists. We assessed the water environment holistically, using objective measures of water quality and water services (Joint Monitoring Programme's drinking water services ladder) and subjective measures, including perceived water safety and water insecurity experiences [Household Water Insecurity Experiences Scale (HWISE)]. We tested how water service levels, perceived water safety, and water fetching frequency were associated with HWISE scores using Tobit regression models among 270 households. We then tested if and how water becomes embodied via self-reported water-related injury and a chronic stress biomarker, hair cortisol concentration (HCC). Results demonstrated that, compared with households using surface water, households with basic water services had HWISE scores 1.59-pts lower (SE = 0.29; P < 0.001). Ingestion of water perceived to be “bad” and more daily water-fetching trips were associated with higher HWISE scores. Twenty percent of households reported prior water-related injuries, with women most commonly injured. In logistic regressions, each point higher HWISE score was associated with 28% (95%CI:1.16–1.41; P < 0.001) higher odds of injury. Basic water services compared to surface water was associated with 48% lower odds (OR = 0.52; 95%CI:0.33–0.82; P = 0.005) of injury. Finally, using linear regressions among 332 adults, HWISE scores were not associated with HCC. Past water-related injury was associated with higher HCC (Beta = 0.31; SE = 0.09; P = 0.029) among women, but not men. Relying on unimproved water services compared to surface was associated with 46.2% higher HCC for women (Beta=0.38; SE=0.14; P=0.048) and 55.3% higher HCC for men (Beta=0.44; SE=0.15; P=0.044), respectively. Overall, our findings demonstrate that water insecurity can become embodied through water-related injuries and elevated HCC. Improving water service levels through an equity lens may help ameliorate water insecurity and its accompanying negative health effects.

Towards an integrated theoretical framework for understanding water insecurity and gender-based violence in Low-and middle-income countries (LMICs)

Article

Sep 2021
HEALTH PLACE

Disparities in access to basic needs and resources such as water is largely borne out of power imbalance across scale. In examining these power dynamics in the context of health inequalities, scholars have deployed Feminist political ecology analytical framework to situate gender and other forms of vulnerability as emerging from unequal power relations, and political ecology of health to emphasise the health implications of inherent relational power in the distribution of resources. Although appealing, the two theoretical frameworks over time have proven to be limiting in the study of intersectional vulnerabilities such as gender-based violence and water insecurity which reflect multiple dimensions of unequal power structures. This study expands the theoretical space for the study of inequalities in health geography by demonstrating the utility of incorporating feminist political ecology with political ecology of health to form an integrated theoretical framework – Feminist Political Ecology of Health (FPEH). This proposed theoretical framework gives guidance for engaging with a suite of questions and methods related to multifaceted problems such as water insecurity and gender based-violence. The paper highlights these theoretical issues and then discusses how FPEH can enrich research on water security and gender-based violence in Low-and middle-income countries (LMICs).

The Transgender Humanitarian Crisis during the Covid-19 Pandemic in India

Article

Jun 2021

Kabhi mazdoor bhai, Kabhi doctors ke liye paani aaya Hamara naam bhi mooh pe na aaya Aise hum abhagye Bhookh hume bhi lagti hai, Hum bhi hai Insaan Marr hum bhi rahe hai, Ab to lo hume pehchan. Amit Sharma, Hamari Bhi Karlo Insaano Me Ginti (2020)[1] 1. Transgender or the third gender refers to people who transgress the rigid gender dichotomy. It is a political term encompassing a spectrum of atypical gender identities. In India, Hijra is the standard label used by the mass to refer to people who are seemingly 'born this way' and are categorised as the 'other.'[2] This catch-all term, however, hides the 'complexity and diversity of the various subgroups of gender-variant people in India.'[3] Transgender, in common parlance, is often synonymous with pre-, post-, and non-operative transexual people. However, it is incorrect to make this link as the transgender community in India is heterogeneous with its own complexity and cultural diversity. As Venkatesan Chakrapani explains, there are Aravanis, Kothis, Jogatas/Jogappas and Shiv-Shaktis in India.[4] In exclusively heteronormative societies such as India, where heterosexual integrity (the sex of the body aligning with the gender identity) is essential, individuals who do not conform to this straitjacket-like societal order are deprived of agency and empowerment.[5] 2. Stigma, on the basis of identity and its manifestation in exclusion and denial of basic human privileges is the everyday reality of the transgender community. Exclusion of members of the transgender community at social, political and economic levels and the interconnected issues of transphobia, internalised shame, abuse and neglect at state and community levels are contributing factors for the marginalization of transgender people. A study conducted by Deepika Ganju and Niranjana Saggurti, formulate a tripartite structure of stigma: 'felt stigma (shame/fear of rejection), internalised stigma (acceptance of negative feelings) and symbolic stigma (othering, blaming and shaming of marginalised groups/associated people).'[6] This framework helps provide a deeper understanding of the systematic oppression that leads to transgender communities' hardships. 3. A report by the National Human Rights Commission, highlights that '92% of transgenders are highly deprived of the right to participate in any form of economic activities in India.'[7] The study further highlights that '96% of transgender people are forced to take low paying work' such as begging or sex work (23 per cent) or the traditional badhaai which is demeaning and exploitative in nature. In addition, 29 per cent of transgender people have never attended school while 33 per cent have graduated with a degree. Furthermore, 1 per cent of the monthly income of transgender people is above Rs 25,000 while 26.35 per cent earn around Rs 15000. 4. Since the community largely exists in socioeconomically fragile settings and has low literacy levels, they are largely unaware of their healthcare entitlements. Studies suggest that members of the community suffer from chronic illnesses and are highly susceptible to HIV (17.5 per cent-41 per

Water insecurity and gender‐based violence: A global review of the evidence

Abstract

Recommendations

Water insecurity, self‐reported physical health, and objective measures of biological health in the...

Household Water Insecurity Will Complicate the Ongoing COVID-19 Response: Evidence from 29 Sites in...