Gender Equality Forum: We Know What Women Want
By Kristy Kade and Dr. Aparajita Gogoi
The Generation Equality Forum (GEF) will set the global agenda for women for the next 25 years starting at end of June. Convened on the anniversary of the historic Beijing Declaration and hosted in Paris and online by UN Women, with France and Mexico co-chairing, countries will start to make policy and financial commitments to improve the lives of women, with several countries making announcements at this kick-off event to inspire other nations. If healthcare – the area where women and girls around the world suffer persistent and inexcusable dangers and indignities — is excluded in the coming months of commitments, GEF will bypass the very women it seeks to empower.
When offered an opportunity to weigh in on their maternal and reproductive health needs, responses from 1.2 million women and girls from 114 countries poured in. Ranked second only to respect, what women want most is the fundamental dignity and safety provided by access to water, toilets, soap, hygiene, menstrual hygiene products and waste management in hundreds of thousands of healthcare facilities worldwide where these are desperately lacking.
The link between respectful care and this top demand for Water, Sanitation and Hygiene, called WASH, is clear. Women must haul their own water to a healthcare facility to give birth and can’t adequately clean themselves after giving birth. Maternity wards are overcrowded and dirty, posing risk of deadly infection to mother and newborn, and nurses and midwives can’t adequately wash their hands to keep themselves and their patients safe (including during COVID-19). Toilets are routinely scarce, broken and filthy; menstrual hygiene and post-partum hemorrhage and bleeding are impossible to care for without water and sanitary pads; and the lack of waste management finds facilities littered with used menstrual products alongside vast amounts of contaminated medical and human waste. Meanwhile, midwives and nurses remain underpaid and far too often live and work in squalor without the safety and dignity of sanitation and water for themselves.
The situation is dire: in low-resource settings 50% of healthcare facilities do not have basic water services; 63% do not have basic sanitation services; 26% do not have hand hygiene facilities at point of patient care.
For girls, the world talks a good game about prioritizing their education, but far too many girls still drop out of school simply because there are no toilet facilities or ways to take care of their menstrual hygiene health needs at school. That the demand for WASH ranks so high should come as no surprise given the majority of midwives, nurses, cleaners and those utilizing health and hygiene services are women and girls.
Only a dozen years ago, asking women about their health needs would have been an afterthought, even as maternal and newborn mortality rates soared. This overwhelming global demand for respectful care and WASH is the result of the landmark ‘What Women Want’ survey that took the revolutionarily simple step of actually asking women want they want. This resulting opensource dashboard offers an eye-opening breakdown of women’s healthcare experiences and demands by age, country, priority and more. It’s critical for gender equality that policymakers no longer turn a blind eye to these conditions; they’d be wise to take a moment to review this data.
History has shown that this most basic demand for WASH in healthcare will continue to be overlooked, which is precisely why WASH must help guide gender equity commitments to the GEF. It is incumbent upon policymakers — parliamentarians and ministers of health, water and finance — to prioritize budgets for WASH inclusion and maintenance in every hospital, primary healthcare center and maternity ward, including labor and delivery. Women are not making a request for 5-star healthcare. They are asking for toilets, water for bathing and drinking, access to soap, and hygiene so that basic healthcare is centered around safety with dignity for women, girls, newborns and staff.
Women are also not asking for the impossible. In 2020, White Ribbon Alliance, which leads the What Women Want campaign, packaged top demands by country. In Nigeria, for example, the demand for toilets led to installations in every primary healthcare center in Niger state. In Malawi, WASH facilities were constructed throughout an entire district; in Kenya, disability-friendly toilets in healthcare facilities were installed in two counties, and free quality sanitary towels are being made available to every girl enrolled in a public education institution. These efforts are moving in the right direction.
Women are not asking for luxuries—they want basic infrastructure and basic decency. As GEF seeks to set an effective agenda that will improve the lives of hundreds of millions of women, from inequality to basic equity, it must challenge the structures that maintain a stranglehold over dignity and safety in women’s health. Much need — and opportunity — remain. To do less is to fail to hear the 1.2 million women who have spoken.