Water Currents: WASH and Gender


USAID recognizes that gender equality and women’s empowerment are vital to the success of any development intervention. The Agency incorporates a gender-related component into all its activities, including those outlined in the U.S. Government Global Water Strategy and the USAID Water and Development Plan in support of the Strategy.

Women and girls often bear primary responsibility for providing drinking water and sanitation to their families and are disproportionately affected when they have to travel to reach these services/facilities. Improved sanitation access is crucial to preserving the basic dignity of women and girls and reducing gender-based violence. Under USAID's Plan, water and sanitation programming will promote gender equality by increasing participation in leadership, consultation, education, and technical skills training. Menstrual hygiene management (MHM) is another critical way that water and sanitation activities can address women’s and girls’ empowerment by alleviating a major constraint to their participation in education and public life.
This issue contains gender-related studies and reports from 2017 and 2018 on MHM, gender issues related to water collection and water security, male participation in sanitation, and other topics. A special thanks goes to the Institute of Development Studies (IDS) for contributing content to this issue.

Call to Action: Supporting Women Through Water, March 21, 2019. In honor of both International Women’s Day and World Water Day, USAID will be co-hosting an event with the State Department, Global Water Challenge, and the Aspen Institute. Hosted at the George C. Marshall Center, this event will focus on the power of water access to improve livelihoods, particularly for women. The agenda will feature panels with diverse stakeholder representation, interviews and Q&A with sector experts, insight on innovative programming and cutting-edge research, as well as keynote remarks delivered by sector leaders. Please register here.

Sylvia Cabus on Gender Mainstreaming in Water and Sanitation, October 2018. This Global Waters Radio podcast explores the connection between gender and water with the help of Sylvia Cabus, the senior gender advisor for USAID’s Office of Gender Equality and Women's Empowerment. Cabus delves into the many ways women’s lives are uniquely burdened by water and sanitation insecurity.
The Ripple Effect: Empowering Women Through WaterWater and Development Alliance (WADA), August 2018. This video from a session at World Water Week 2018 features the WADA partners, the Coca-Cola Company, USAID, Gap, Ipsos, and the Global Water Challenge and highlights their efforts to empower women globally through water.
Gender Equality in the 2030 Agenda: Gender-Responsive Water and Sanitation SystemsUN Women, July 2018. This issue brief explains how the promotion of gender-responsive water, sanitation, and hygiene can be a catalyst for change across the 2030 Agenda for Sustainable Development.
Women as Change-Makers in the Governance of Shared WatersInternational Union for Conservation of Nature (IUCN), August 2018. The authors of this paper combine a survey of literature with a collection of case examples describing how women in Asia, Latin America, Europe, and Africa are leading change in governing shared waters.
Impact Story: Gender in Water and Sanitation–Empowerment by NumbersStockholm Environment Institute (SEI), June 2018. An SEI project in Burkina Faso is developing a new Empowerment in WASH Index that identifies imbalances in decision-making power between men and women, or between different ethnic and socio-economic groups.
Male Participation
Learning Brief: Men and Boys in SanitationIDS, October 2018. The engagement of men and boys can help achieve sustainable behavior change and new social norms, including specific approaches and methods to stop men and boys from practicing open defecation.
Engaging Men and Boys in Sanitation and Hygiene Programmes: Frontiers of CLTS 11IDS, August 2018. Current efforts to improve sanitation and change social norms may not always engage men and boys in the most effective way. Engagement strategies should be modified to make efforts more successful, but the issue requires further study.
‘We Do Not Know’: A Qualitative Study Exploring Boys Perceptions of Menstruation in IndiaBMC Reproductive Health, December 2017. Findings from this study revealed that boys were keen for knowledge about menstruation, were largely sympathetic to female peers, and that males in general can become advocates in moving forward the MHM agenda.
Menstrual Hygiene Management
How Changed Attitudes Towards Menstruation Hygiene Impact Girls’ RightsPlan International Cambodia, August 2018. This video from World Water Week discusses the lack of access to water for women and girls in many countries as well as the lack of resources and knowledge they need to manage their menstruation. For girls, the inability to deal with menstruation in school premises means they miss school each month or drop out altogether.

Aakar Innovations Expands Innovative Sanitary Products to South AfricaAsia Gender Network News, November 2018. The Millennium Alliance, in which USAID is a partner, awarded funds to Aakar Innovations, a social enterprise that enables women and self help groups to produce and distribute affordable high-quality sanitary napkins within their communities while raising awareness of MHM. Aakar has now expanded to Africa and recently installed a biodegradable and low-cost sanitary pads manufacturing unit in South Africa.

The Relationship Between Household Sanitation and Women’s Experience of Menstrual Hygiene: Findings from a Cross-Sectional Survey in Kaduna State, Nigeria. International Journal of Environmental Research and Public Health (IJERPH), May 2018. Findings suggest household sanitation influences women’s choices for MHM, but that existing indicators for improvement are not sensitive to menstrual needs.
Menstrual Hygiene Management and Waste Disposal in Low- and Middle-Income Countries: A Review of the LiteratureIJERPH, November 2018. The review showed that disposal of menstrual waste is often neglected in MHM and sanitation value chains, leading to improper disposal and negative impacts on users, the sanitation systems, and the environment.
Access to Pads: Five Takeaways from Menstrual Hygiene Management (MHM) Research with Adolescent Girls and Young Women in India and EthiopiaPopulation Services International (PSI), October 2018. With support from the Bill and Melinda Gates Foundation, PSI sought a deeper understanding of access to MHM products for girls and young women. This blog post discusses the findings from research that was conducted in two states in India and four cities in Ethiopia.
A Qualitative Exploration of Menstruation-Related Restrictive Practices in Fiji, Solomon Islands and Papua New GuineaPLoS One, December 2018. Participants in this study described a range of attitudes and beliefs that restrict the behavior of menstruating women and girls. Education initiatives guided by women and girls, implemented by local stakeholders, and grounded in a sound understanding of specific contexts are needed to help shift these attitudes.
A Toolkit for Integrating Menstrual Hygiene Management into Humanitarian ResponseColumbia University, Mailman School of Public Health, October 2017. An extensive desk review and field research helped shape this toolkit, which provides guidance to organizations and agencies seeking to integrate MHM into existing programming across sectors and phases.
New Book Busts Myths about Menstruation Spread by Public Health GroupsNPR Goats and Soda, January 2019. Author Chris Bobel discusses the surprising amount of misinformation about menstrual hygiene management from charities and nonprofits in the health sector.

Sanitation/Community-Led Total Sanitation
Female-Friendly Public and Community Toilets: A Guide for Planners and Decision MakersWaterAidWater and Sanitation for the Urban PoorUNICEF, October 2018. This guide explains the importance of making toilets female-friendly, detailing the essential and desirable features needed to make them so. It also suggests ways to increase gender sensitivity in town planning on sanitation.
Shared Latrines in Maputo, Mozambique: Exploring Emotional Well-Being and Psychosocial StressBMC International Health and Human Rights, July 2018. Shared sanitation presents specific stressors to users, specifically those related to disgust, privacy, safety, and management. Properly managed and maintained shared sanitation can reduce these stresses.
Gender, Women and SanitationGlobal Water Pathogen Project, August 2018. The main objectives of this report are to explain the nexus among gender, women, and sanitation, and discuss how to decrease inequalities between men and women in the sanitation sector.
Toilets Not Taxes: Gender Inequity in Dar es Salaam’s City MarketsInternational Centre for Tax and Development, November 2018. Researchers examined market taxation in Dar es Salaam from a gender perspective, finding an unexpected gender issue—toilet fees. Female traders pay up to 18 times more for their daily use of the market toilets than they pay as market tax.
Innovations for Urban Sanitation: Adapting Community-Led ApproachesIDS, June 2018. This report offers guidance for practitioners to move toward safely managed sanitation services, citing examples from Africa, South Asia, and Southeast Asia.
Out of Order: The State of the World's Toilets 2017WaterAid, November 2017. Almost one in three people lack access to a toilet. This report explores how the lack of decent toilets around the world prevents women and girls from fulfilling their potential.
Gender and the Sanitation Value Chain: A Review of the EvidenceBill and Melinda Gates Foundation, February 2018. The current understanding of gendered differences in sanitation is limited by a lack of research and data. Emerging evidence, however, clearly shows how gender differences along the sanitation value chain result in disproportionately negative outcomes for women. 
Assessing Women’s Negative Sanitation Experiences and Concerns: The Development of a Novel Sanitation Insecurity MeasureIJERPH, July 2017. Researchers developed a sanitation insecurity measure to evaluate how sanitation insecurity affects health and to determine if and how sanitation interventions ameliorate women’s concerns and negative experiences associated with sanitation.

Water Collection and Security
Carrying Water May Be a Major Contributor to Disability from Musculoskeletal Disorders in Low Income Countries: A Cross-Sectional Survey in South Africa, Ghana and VietnamJournal of Global Health, June 2018. Cervical spinal conditions are globally one of the more common causes of disability. Findings suggest that water carrying, especially by head, is a major contributor to musculoskeletal disease in low income countries.
Gender and Community Mainstreaming in Fog Water Collection SystemsWater, October 2018. Fog water systems are implemented within or near communities, eliminating or reducing the need to travel far distances for the collection of water during times of scarcity, thus decreasing the burden of water collection on women and girls.
Gender Dimensions of Community-Based Groundwater Governance in Ethiopia: Using Citizen Science as an Entry PointCGIAR Research Program on Water, Land and Ecosystems (WLE), October 2018. The leading role played by women in obtaining and safeguarding water is not usually reflected at the institutional level. Addressing this imbalance could lead to the equal participation of men and women in sustainable groundwater management.
A Novel Household Water Insecurity Scale: Procedures and Psychometric Analysis Among Postpartum Women in Western KenyaPLoS One, June 2018. The lack of a standardized instrument for quantifying household-level water insecurity prevents an understanding of its prevalence and consequences. This gap prompted researchers to develop a household water insecurity scale for use in Kenya.
Water Insecurity and Gendered Risk for Depression in Rural Uganda: A Hotspot AnalysisBMC Public Health, September 2018. Residing in a water insecurity hotspot is associated with greater risk for depression among women, but not among men, pointing to the need for focused depression screening among women residing in water insecure households.

Other Studies/Resources
Impact of Social Capital, Harassment of Women and Girls, and Water and Sanitation Access on Premature Birth (PTB) and Low Infant Birth Weight (LBW) in IndiaPLoS One, October 2018. The relationship between adverse birth outcomes and sanitation access, domestic water fetching, crime, and gender-based harassment suggests stress as a possible mechanism by which WASH access affects PTB and LBW among Indian women.
Gender Dimensions of Community-Based Groundwater Governance in Ethiopia: Using Citizen Science as an Entry PointInternational Water Management Institute, November 2018. A study exploring gender aspects of community-based groundwater governance found that women place a high value on groundwater and could be motivated to play a greater role in its governance.
Toolkit: Understanding and Addressing Equality, Non-Discrimination and Inclusion in Water, Sanitation and Hygiene (WASH) WorkWaterAid, November 2018. This toolkit provides guidance on reducing WASH-related gender inequalities and includes practical activities, tools, and checklists.
Transgender-Inclusive Sanitation: Insights from South AsiaWaterlines, April 2018. Three case studies of recent initiatives to make sanitation inclusive for transgender people in South Asia provide insights that can help guide future practice.
What Women and Men Want: Considering Gender for Successful, Sustainable Land Management ProgramsCGIAR WLE, 2018. The Nairobi Water Fund (NWF) in Kenya is a public-private partnership designed by The Nature Conservancy as a payment for ecosystem services. This case study explores different barriers that men and women face when implementing sustainable land management under the NWF.
Frontiers of CLTS: Innovations and Insights – IDS has published eleven issues on a range of CLTS topics. Gender-related issues include:


Water Currents
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USAID Bureau for Economic Growth, Education and Environment (E3) Water Office