Sanitation as a dimension of poverty

In 2010, the United Nations General Assembly explicitly recognised the right to sanitation as a basic human right, essential to the realisation of all human rights (Resolution 64/292, United Nations, 2010). SDG 6 is to ‘ensure availability and sustainable management of water and sanitation for all’. SDG Target 6.2 aims to ‘achieve access to adequate and equitable sanitation and hygiene for all and end open defecation’ by 2030. This goal involves targets and indicators that give special attention to fulfilling the needs of women, girls and those living in vulnerable situations, as well as aiming to ensure that people use safely managed sanitation services and have access to a handwashing facility with soap and water.

What the research reveals about access to sanitation

Access to sanitation is imperative for leading a dignified life, while also improving health, access to education and work opportunities. The use of safe toilet facilities – where excreta are safely disposed of – helps to prevent contamination arising from the spread of human faecal waste. The use of unsafe toilet facilities is largely responsible for spreading infectious diseases including diarrhoea, intestinal diarrhoea, intestinal helminths, schistosomiasis (worms) and trachoma (Epstein, 2015; Raso et al., 2018). Globally, this results in millions of disease episodes and hundreds of thousands of deaths each year (Legros, 2018). Conditions originating from and spread through poor sanitation facilities, such as anaemia and chronic malnutrition, have chronic and diffuse impacts (Ravirajan et al., 2018).

An increasing trend in the proportion of the global population using shared sanitation facilities has been observed since 1990 (Heijnen et al., 2014). Shared facilities are more likely to be poorly managed and unhygienic; hence, they are classified as unimproved. However, WHO suggests a further categorisation in the shared status, such as privately shared, publicly shared and institutional toilets (Rheinländer, 2015). Handwashing properly after defecation is a cost-effective intervention that helps to reduce the burden of infectious diseases, including diarrhoea, lower respiratory infections and soil-transmitted helminths (Bartram and Cairncross, 2010). More than 80 percent of the global population do not maintain hygiene by washing their hands properly after the use of toilet facilities (Freeman et al., 2014).

Due to gender-specific needs, women and girls require sanitation facilities that are safe, are private (i.e. with lockable door) and have clean running water, as well as a means of disposing sanitary products. Inadequate facilities can result in unequal gender outcomes in terms of school attendance and performance (Agol and Harvey, 2018), as well as an increase in sexual and gender-based violence (Sahoo et al., 2015).

What the IMMP reveals about sanitation

In the participatory phase of the IMMP, sanitation was associated with different levels of poverty and discussed in terms of access to different types of toilets or sanitation facilities. Poor households were sometimes described as having poor hygiene levels, and their occupants identified as those who could not afford to buy soap for bathing and washing. Thus, the focus of the module is on access to sanitation facilities at the home only, excluding the workplace.

All indicators related to sanitation are measured at the individual level, recognising that not all dwelling residents will have access to all sanitation facilities. Hygiene is examined in this module with specific relation to handwashing (i.e. the availability of water and soap). Access to sanitation facilities is gendered when it relates to personal hygiene and menstruation, and involves having access to sanitary products as well as a private place to change, wash and dry, and/or dispose of sanitary products.

What the IMMP Sanitation dimension measures

The sanitation dimension of the IMMP is constructed with three themes: toilet facilities, washing facilities, and access to a private changing place during menstruation.

Theme 1: Toilet facilities

The first theme, toilet facilities, is constructed using two indicators – the type of toilet facility, and ownership status of that facility.

The toilet facility indicator includes two variables. The first classifies the type of toilet facility, and the second assesses (for flush and flush–pour type toilets) whether there is enough water to flush the toilet.

The second indicator, toilet ownership, is constructed using information from two variables about whether the facility is private or shared with other households, and whether a shared facility is public and can be used without asking permission.

Theme 2: Handwashing facilities

The second theme, handwashing facilities, refers to the availability of handwashing facilities in the dwelling, and combines information from three variables in one indicator. The first variable determines whether the respondent has a place in their house or yard to wash their hands. Those who have a handwashing place are then asked if they have water for handwashing, and about their use of soap or soap substitutes for handwashing.

Theme 3: Private changing place during menstruation

The third theme is relevant for menstruating women and examines available sanitation infrastructure. The theme considers whether menstruating women have a private place to wash and change at home (for recent instances of menstruation), improving the gender sensitivity of this dimension.

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