Water, Sanitation and Hygiene – it’s What Women Want

Jun 24, 2019 | Blog, Global Secretariat, GS, News

White Ribbon Alliance joins 78 organizations in taking WASH commitment to women’s demands forward

By Kristy Kade, Deputy Executive Director, White Ribbon Alliance

When White Ribbon Alliance formed 20 years ago, it was out of the realization that too often the voices of women in countries with poor maternal health policies and systems were not being heard, resulting in inequitable and unacceptably slow progress. While many things have changed since 1999, one thing remains as true today—if not more so—as it did then: meaningful change can only be sustained through the will of the people.

As such, in April 2018, based on earlier work in India, WRA launched the What Women Want campaign. The campaign began with a simple idea: ask those who most use maternal and reproductive health services to tell us what they most need. Ask the clients, ask women.

Our open-ended question let women and girls set the agenda, as opposed to beginning with a premise of what is important or asking them to decide among a set of options. Women’s answers were often unexpected, challenging assumptions and shining new light on the realities of their daily lives.

The 1.2 million responses we collected came in many forms, many languages, from over 114 countries–the vast majority from 8 specifically. Underpinning the analysis was a commitment to ensuring every single voice was counted, every voice was heard. And their voices were very clear.

The number one response globally was respectful and dignified care. Women want to be listened to, to have an interpersonal connection with their health providers. They want compassion as much as any health outcome. 

The number two response was water, sanitation and hygiene. Women believe strongly that part of having a dignified experience includes having health facilities with running water, indoor toilets, clean beds and sheets. The third most popular response was simply demand for basic medicines and supplies. These three demands resonated across nearly all age groups.

Every year in the Least Developed Countries, 17 million women give birth in healthcare facilities without adequate water, soap and toilets. The risk to mothers and newborns is devastating. Simply washing hands with soap before touching babies can prevent more than 40 percent of neonatal deaths. But healthcare providers and parents can’t wash if they don’t have soap and water.

Women want – and are demanding – basic infrastructure, basic decency.  In a world where 1.5 billion people use health facilities with no sanitation facilities, responses from What Women Want demonstrates that despite best efforts, we are not meeting women where they are. We should continue to aim high, but if we cannot provide the most rudimentary needs, including water, sanitation and hygiene, we will never prevent women from dying during pregnancy and childbirth or create an environment where girls grow up empowered to understand and direct their own reproductive health.

As progress on maternal and reproductive health stalls and is even reversing in some countries, we need to do something different, something radical. We need to listen to women. Listening to women shouldn’t be radical, but it is. If we want women and girls to visit health centers, if we want them to adhere to recommended advice, if we want better health outcomes, their agenda needs to become our agenda.

With the voices of 1.2 million women and girls in support, WRA is proud to commit to engaging our vast membership of policy makers, health workers, journalists, implementers and of course advocates to place WASH high on the reproductive and maternal health agendas within our focus countries.

Specifically, as part of our commitment to Water, Sanitation, and Hygiene in Healthcare Facilities, we will dig deeper into women’s and girls’ responses in countries with more than 50,000 responses. The real power of this information lies in the detail of how health services work, or do not, from women’s and girls’ perspectives. For example, where a top request is WASH, we’ll let leaders know how many women want working toilets, clean bedsheets, soap, etc. And we will convene partners across sectors to develop joint agendas to act on what we have learned.

It’s obvious women and girls want and need public health organizations to work together. In answering the question “what is their number one want for reproductive and maternal healthcare,” they didn’t silo, so why should we? And to make sure we don’t, WRA will continue to mobilize the voices of women and girls to collectively hold not only their leaders, but our community, ourselves, accountable for meeting demands as they articulated them.

These are our next steps, but what are yours? I, of course, hope water and sanitation advocates use the What Women Want findings to advance WASH objectives, but I want them to consider also the number one request. If you are in a position of power, ask yourself “how can my work better help women get the respect they so much want and deserve when seeking health care? How can the health and development community make women’s demands the basis for our actions moving forward?” Remember always that respect goes hand in hand with WASH.

I hope you will join WRA and our partners in a call that cuts across – that transcends – all health and development topics, a call to listen to women. Let’s make it standard operating procedure to have women and girls actively and meaningfully involved in designing policies and programs which are meant for them—not just a talking point or worse a radical notion.