What does the water in your glass have to do with the health of mothers and babies around the globe? Quite a lot actually. Without access to safe drinking water and basic sanitation -- like safe toilet facilities -- women face dangerous health risks in pregnancy, during childbirth and in the postpartum period. A woman faces both the direct consequences of contaminated water and a lack of facilities, like infection, and indirect consequences, such as the violence she might encounter if she has to venture into unsafe territory to collect water or to relieve herself. In global health, we're too accustomed to dividing the health of a population into compartments -- compartments too small to fully address key risks to health. Instead of looking at water, sanitation and hygiene (WASH) as a separate problem from maternal health, we must take a systems approach to recognize, and then treat, the complex factors that affect a woman's health.
Infection
Infection -- the third most likely killer of women in pregnancy and the 42 days that follow -- kills approximately 31,700 women every year during this vulnerable time. Without clean water and basic sanitation, a woman's ability to fight infection is compromised. With poor sanitation at home, pregnant and postpartum women are three times more likely to die than women who have basic sanitation. However, home isn't the only place where women may lack clean water and sanitation; many health facilities where they give birth also lack these resources. Can you imagine how difficult it would be to prevent infection during a C-section, cord cutting and the healing process after birth if there was no clean water or toilets at a health facility?
While a woman is most likely to develop an infection at the time of birth and the immediate period afterward, chronic infection also affects pregnant women. Around the globe, 44 million pregnant women have hookworm infections due to a lack of clean water and sanitation. Hookworm, an intestinal parasite, puts a woman and her fetus at risk for poor birth outcomes, like anemia in the woman, low birthweight and congenital defects in the newborn, and death. While the link between infection and a lack of clean water and basic sanitation is quite clear, there are other ways poor sanitation can affect a woman.
Violence
In many places where basic sanitation and clean water are not available, gender inequality forces women to venture long distances to collect water and also to defecate. In fact, in many places, women can only defecate during night time hours. After the sun has fallen, a woman will venture through the dark to a communal defecation area. In addition to the biological health risks this poses, it makes the woman incredibly vulnerable to violent attacks, including rape. Last year, NPR reported on the death of two Indian girls who were raped and hung during a nighttime trip to relieve themselves.
But how common does something like this occur? Doctors Without Borders (or Médecins Sans Frontières [MSF]) reported that in a period of five months in 2004 and 2005, they treated 297 rape victims in West Darfur, 82 percent of whom reported they were raped while going about daily activities such as collecting water and defecating.
Not only is violence against women a social injustice and tremendous health risk, but it is also a contributor to maternal mortality. At Maputo Central Hospital in Mozambique, violence is the fourth most common cause of maternal death, occurring at similar rates as deaths due to hypertension (the second most common cause of maternal death worldwide). In three cities in the United States, violence is responsible for 20 percent of maternal deaths.
As we work to improve women's health, we can't forget about the critical interplay between access to WASH, violence and maternal health.
Education
Without WASH, girls and women spend the majority of their days collecting water. Sixty-nine percent of women and girls are primarily responsible for collecting water for their household, a chore that results in walking over ten miles a day on average. With this burden, a girl rarely has the time to receive an education. Like many other social factors, a lack of education carries with it the consequence of poor health. According to an analysis done of the WHO Global Survey on Maternal and Perinatal Health, a woman with no education is three times as likely to die during pregnancy than if she had finished secondary school. WASH is an issue of health, empowerment, education and preventing maternal death.
Target 10 of Millennium Development Goal 7 (dedicated to halving the proportion of people without sustainable access to safe drinking water and basic sanitation) has brought WASH to more than 2 billion people, but we have yet to reach the remaining 2.5 billion who currently lack basic sanitation. As we approach the post-MDG era, let's look forward to the future of health where we stop working in silos and see once and for all that our efforts and impact can only reach their full potential if we integrate and collaborate across disciplines.
This blog post is part of the "WASH and the MDGs: The Ripple Effect" blog series, in partnership with WASH Advocates, addressing the importance of water, sanitation and hygiene (WASH) to global development. To see all the other posts in the series, click here. To learn more about WASH, visit the WASH Advocates website, and for more information about the Millennium Development Goals, click here.