*

202.1—4891

Prepared For:Office of Health

Bureau for Science and TechnologyU.S. Agency for International Development

C — Task No. 310

WATER AND SANITATIONFOR HEALTH PROJECT

ICA~ 7J*~~A IA ii~:~ h~I&IAV~~IEbJNI ~L1~v.u~ww vi~ w w w

COORDINATION ANT~INFORMATION CENT~W

Operated by The CDM~Associates ~-—

Sponsored by the U S. Ag~n~yfor International Developm~it

1611 N. Kent Street, Room1002Arlington, Virginia 22209 USA

Telephone: (703) 243-8200Telex No. WUI 64552

Cable Address WASHAID

WATER AND SANITATION-RELATEDHEALTH CONSTRAINTS ON

WOMEN’S CONTRIBUTIONS TO2 0 2. 1 THE ECONOMIC DEVELOPMENT8 2 W A OF COMMUNITIES

WASH TECHNICAL REPORT NO. 17

OCTOBER 1982

LIBRARYINTERNATIONAL REFERENCE CENTREFOR CCMMUNHTy WATER SUPPLY ANDSANITATION (IRC)

The WASH Project is rn4nagedby Camp Dresser & MCKee.,Incorporated. PrincipalCooperating Institutiori~ andsubcontractors are: inlerna—tionalSçience ~ I~ch~J9gyInstitute; k~sear~hTriangleInstitute; University of NorthCarolina at Chapel Hill;Georgia Institute of Tech-nology — Engineering Experi-ment Station. -

S

~VASHTECHNICAL REPORTNO. 17

WATERAND SANITATION-RELATED HEALTH CONSTRAINTSON WOMEN’SCONTRIBUTIONS TO THE ECONOMICDEVELOPMENT

OF COMMUNITIES

Prepared for the Office of HealthBureau for Science and Technology

U.S. Agency for International DevelopmentUnder C—Task No. 310

Prepared by:Mary Elmendorf, Ph.D.

andRaymond B. Isely, M.D., M.P.H., D.T.M.

October 1982

Water and Sanitation for Health Project

Contract No. A1D/DSPE—C—0080, Project No. 931—1176

Is sponsored by the Office of Health, Bureau for Science and TechnologyU.S. Agency for International Development

Washington, DC 20523

LIBRARY, INTERNATIONAL REFERENCECEN IRE FOR COMMUNItY WATER SUPPLYAND ~3ANlTAII’)N ~I~C)P.O. Box 93I~0,2L09 AD The HagueTel. (070) 314911 ox~.141/142

RN:LO:

L~9(

This paper was presented at the conference on Women, Health,and International Development, held at the Kellogg Center forContinuing Education, Michigan State University, East Lansing,Michigan, October 22—23, 1982.

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TABLE OF CONTENTS

Page

1. INTRODUCTION 1

2. ROLES OF WOMEN 1

2.1 Public and Private Roles 2

2.2 Women and Water 2

2.3 Why is Water so Important? 2

2.4 Women’s Roles and Water 3

2.4.1 Women as Acceptors of Improved Waterand Sanitation Technologies 3

2.4.2 Women as Users of Improved Water andSanitation Technologies 3

2.4.3 Women as Managers of Water andSanitation Facilities 4

3. WATER AND NUTRITIONAL STATUS 4

4. HEALTH CONSTRAINTS 7

4.1 Pregnancy 10

4.2 Breastfeeding 11

4.3 Occupational—Related Health Constraints 12

5. CONCLUSIONS 12

5.1 Redefinition of Roles and Tasks 14

REFERENCES 15

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1. INTRODUCTION

If women are to achieve their potential as contributors to theeconomic development of their communities, regions, and na-tions, they must be freed somehow from the burden of diseaseand disability that impinges on their ability to contribute. Ananalysis of these health constraints reveals that many are re-lated to their roles as women, not the least of which is therole of water fetching and transporting. Some of the problemsassociated with obtaining water such as long distances andhilly terrain or water of poor quality result in still otherproblems of personal hygiene and the spread of diarrheal dis-ease. Improvements in water supply and sanitation not only makepersonal hygiene more feasible but lighten the burden of womenand children, freeing up additional calories and time for otherproductive tasks, and resulting in higher levels of energy andactivity for pregnancy, lactation, and child care. Likewisethese improvements may lessen the exposure to infections as-sociated with the locality where water is drawn.

In speculating about how these needed improvements in watersupply and sanitation and the associated health benefits couldbe realized, one is immediately confronted with the issue ofwomen’s roles in traditional societies. Water and sanitation—related roles are but a subset of these larger considerationsand the health constraints arising from the latter but afunction.

The paper thus looks first briefly at women’s overall roles,then at their water supply and sanitation roles, then at thehealth consequences of these roles, and finally at the processof bringing about improvements.

2. ROLES OF WOMEN

Women form a large part of the work force in most countries andconstitute a substantial economic resource. The labor contribu-tions of women to the economy of their countries go unreportedin many national statistics, whether those contributions are inthe form of supports for wage earners and learners in familiesor as the cultivator of foodstuffs and other agricultural pro-ducts for home consumption or sale. Despite the participationof women, their status is often disadvantaged. Although statusvaries from country to country depending on the cultural frame-work or the level of development, basic similarities do exist.

A fundamental concept in social science is that of sex role:expected attitudes and behaviors connected with sex—determinedstatus positions (Linton, 1936). This differentiation of rolesis universal but locally highly variable (Mead, 1949). Females

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in all communities have specific but different rights, dutiesand expected norms of behavior, and populations have beliefsabout what women as mothers, wives, and daughters ought to do(Elmendorf, 1982).

2.1 Public and Private Roles

Oppong (1981) has designed a framework in which women haveseven discrete roles. A woman as individual, mother, wife, andkinswoman on the one hand and as worker, producer (of income,goods, and services), and community member on the other, movesinto and out of the private and public spheres, but finds allthese roles, even the latter three, usually concentrated in theprivate domain. In domestic roles women are more Involved thanmen in the “grubby and dangerous stuff of social existence:giving birth and mourning death, feeding, cooking, disposing offeces and the like” (Rosaldo and Lamphere, 1974).

2.2 Women and Water

In traditional societies, women are the primary drawers, car-riers and users of domestic water supply (Obeng, 1980). In mostcases in fact, women’s emotions, energy, and attention arefocused on meeting these and other basic needs. Children sharein these responsibilities. Women and children are caught, as itwere, in a complex web of responsibilities that saps theirphysical and emotional energy, with implications for theirhealth and social well—being (Russel, 1979). And water supplyis one of the most demanding of these needs. It has been saidthat “man is a slave to water” because all civilizations dependon it for survival, but it is really women who have literallybecome slaves to water. It is “on her back or head that waterreigns supreme” particularly In the rural areas of the devel-oping countries (UNICEF—UNDP, 1982).

2.3 Why is Water so Important?

First we must remember that water is a nutrient——the most basicof all, without which death results In a few days. Adequatewater to support basic biological processes is essential tosurvival. Without food humans can live for several weeks, butdeath comes in days without water.

Secondly as a number of researchers have reminded us ‘themalnutrition problem’ is not due solely to an insufficient foodavailability. MeJunkin (1982) notes that studies indicate thatimproved water supply is related to measurable improvements innutritional status, especially growth of children, and suggeststhat the “water supply—nutrition linkage” needs more attention.The heavy burden of infections and infestations, especially

—2—

among children retards growth, physical and mental development,and may, under some circumstances precipitate or exacerbatefrank clinical malnutrition (Scrimshaw, 1970; Chen, 1980;McjunkIn, 1982).

2.4 Women’s Roles and Water

The roles women play in relation to domestic water and house-hold sanitation draw on all seven of Oppong’s role classifica-tions (ibid.). In fact four functions of women world—wide de-monstrate that any planned change in water availability orexcreta disposal should be based on information about theirpresent knowledge, attitudes, practices, perceptions andbeliefs regarding water preferences, hygienic practices, anddefecation behavior.

These four functions are:

— Women as acceptors of new technologies— Women as users of existing or improved facilities— Women as managers of water supply and sanitation

programs— Women as agents of behavioral change in the use of

facilities.

2.4.1 Women as Acceptors of Improved Water and SanitationTechnologies

It is primarily women that use any water system whether new ortraditional. Their domestic managerial role means that in foodpreparation, washing, and bathing, women are the primary usersand the mediators between the water source and householddemand. The choice of water for drinking, cooking, laundry,bathing, and other household functions is a result of women’scareful decisions, based on what they have learned from theirmothers and grandmothers, and- on their observations of thecosts and benefits, both social and economic, of any change ofsystem, and are often based on sensory or macroscopic percep-tions——color, taste or smell——rather than microscopic qualitiesof technical purity.

2.4.2 Women as Users of Improved Water and Sanitation Tech-nologies

A central question confronting each new water and sanitationproject at the threshold of its execution is whether or notthose for whom they are intended will use the new facilitiesonce installed. Even the most sophisticated sanitation tech-nology will not bring health improvements unless it is properlyused and combined with good personal hygiene habits (Feachem et

—3—

al, 1978). Women as the primary users of water the world overand as frequently the first to use sanitary installations oftenare not singled out for the intensive user education so neces-sary for project success.

2.4.3 Women as Managers of Water and Sanitation Facilities

Women are usually the managers of household water supplies.Whether it is recognized or not, they also have a strong po-tential role as managers of community water supplies. Women arebound more tightly to the household than their male counter-parts, who must often leave the home or community in search ofwork. Women who are usually responsible for obtaining water andseeing that it is available for daily use, also select watersources, and in some instances play key roles in seeing thatfunds and/or labor are available to maintain them.

2.4.4 Women as Agents of Behavioral Change In Water and Sani—tation

In the process of behavioral change the importance of women,both those within and outside the community, becomes evenclearer when we consider that changing traditional behaviordepends on an understanding of the reasons why change is ben-eficial. Furthermore women in their roles as mothers andhomemakers must receive such information in t~erms which areclosely related to their current beliefs and customs and theavailability of water.

Although in most communities men exercise positions of author-ity in the public domain, women often have a great deal ofpower in decision—making, particularly decisions that impingeon the domestic domain (Chinas, 1973; Elmendorf and Isely,1983; Rosaldo and Lamphere, 1974; Oppong, 1981). In fact,within their confined roles women, individually or in groups,develop strategies to reach valued goals. In order to exercisethis decision—making power effectively and make consideredchoices about changes in traditional activities, knowledgeabout alternatives must be available.

3. WATER AND NUTRITIONAL STATUS

A conceptual framework developed by Lincoln Chen (1980) (Figure1) demonstrates the multiple routes through which water supplyand sanitation improvements can influence the health of womenand children. In the first place the amount of energy availableto any individual is basically determined by the balance ofenergy intake and energy output or loss. Household food avail-ET1 w378 107 m524 107 lSBTability, including water and mothers’ milk, reflects the abil-ity of the family economically and physically to provideadequate quantity and quality of food for individual members.

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Figure 1

Outcomes/Benefits ofWater Improvement

Determi nantsNutritional Status

(Crop production increase)(Animal husbandry increase)(Cash income increase)

Time Saving

(Infections Reduction)~(Infestations Reduction)(Malabsorption Improvements)

nergy Savings

Nut riti onal

Status

Woman/Child

EnergyExpendi ture I

Taken from Chen, L. (1980)

Household FoodAvil a b iii ty

HouseholdFood Efficiency &

Distribution

4

•1

—5—

Household food efficiency and distribution depend primarily onthe ability of the household managers, usually women, tooptimize available inter— and intra—family food distributionand determine how much food each individual receives. Foodincluding water is required for basic metabolic functions.Other energy expenditures are for work, leisure and otherpersonal activities. Additional energy is lost because ofnutrient wastage due to infections and infestations. Unneces-sary wastage of nutrients is caused by the malabsorption ofingested nutrients and catabolic losses through fever andtissue destruction. As shown in Figure 1, the first twomechanisms——domestic food availability and household foodefficiency and distribution——are seenprimarily as regulatorsof the inflow of nutrients. Therefore interventions thatincrease either of these could be expected to result in im-proved nutritional status and increased energy. On the otherhand, actions that reduce the energy expenditure for performingthe same task, such as water carrying, or limit the energylosses through infections or infestations would be expected todiminish nutritional status and available energy.

The magnitude of the nutritional effects will vary widely de-pending on many variables including the sociocultural charac-teristics of the community, geographic and climatic conditions,systems of water improvements, and parallel programs in sanita-tion and health education. Of significance are the mediatingroles of savings in women’s time and energy and increases infood production occasioned by these improvements. Althoughdiminution In infectious disease, especially diarrhea, plays asignificant role in mediating improved growth and survival ofchildren, these intermediate changes in women’s roles aregaining increased support in the literature (Isely, 1981; Viset al, 1981; Elmendorf and Isely, 1981, 1982).

Improvement of water supplies could theoretically affect nutri-tion and/or energy availability through all four mechanisms.Increased household food can become available through homegardens, animal husbandry, and in cash income. With more acces-sible water sources, women can use their time saved for moreefficient household management or storage, processing, dis-tribution of food and more attention to child feeding. Energyexpended by women and children in water drawing and carryingcould be reduced by more accessible water sources, leavingadded calories for growth, fetal development and lactationrespectively, and last but not least the reduction of chronicand acute infections and infestations could reduce the wastageof nutrients with resulting lowered energy availability.

These nutritional effects of intestinal infections and longarduous searches for water and conversely the possibility oftheir mitigation through improvements in water supply andsanitation may be the key to the entire group of healthconstraints we are about to discuss. As we shall see, forpregnant and lactating women nutritional effects are primary.

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4. HEALTH CONSTRAINTS

Given the importance of water supply and sanitation activitiesin the overall situation of rural women in developing coun-tries, it is useful to analyze the health constraints Impingingon their roles from the point of view of the influence of watersupply and sanitation. Just as improved water supply can beshown to have a direct positive impact on nutritional status——so lack of improved water increases the health hazards to whichwomen are exposed in their expected roles.

Women encounter unique health conditions in pregnancy, inlactation, and in certain selected diseases. We shall examine afew of the tasks primarily carried out by women and girls,shown graphically In Figure 2 (O’Kelly).

The classification of water—related diseases provided byBradley (1972) helps to define further the possible healthconstraints on women’s roles (see Figure 3). Health constraintsmay be derived from any of four categories of disease: amongthe waterborne diseases both cholera and typhoid fever areimportant causes of morbidity and loss of time from householdand agricultural activities in certain regions of the world.Water—washed diseases are those related to lack of personalhygiene when water is scarce. Women play a key role in thetransmission of these infections (Smith, 1980) and by the sametoken are at increased risk of disease themselves because ofthe great numbers of pathogens to which they are exposed(Capparelli and Mata, 1975).

Children are not only the chief sufferers from sanitation/water—related diseases, but they are also the main source ofinfection. Since many of these diseases affect childrenprimarily, a large proportion of these children are excretingsubstantial quantities of pathogens. The Importance of under-standing attitudes toward children’s excreta cannot be over-emphasized. The widespread perception that they are “harmless”or the failure to perceive their infectious potential (Feachemet al, 1978; Elmendorf, 1980; Isely, 1981), can contribute to acontinuous chain of infection and re—infection, wherein fecesmay be thrown on a nearby garbage heap or diapers washed withdishes in an urban home with a newly installed standpipe. Andit is the women who care for the infants who become carriers ofinfection and whose time, emotions, and energy are expended incaring for ill and dying children.

Water—based diseases are those encountered in direct contactwith contaminated water (schistosomiasis) or when swallowingwater containing the intermediate hosts of parasites, as inguinea worm infection.

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Figure 2

• a.

~ Blackfly— (river blindness)

I

Cyclops host toguinea worm

Conta’minated water(gastroenteritis, diarrhoea,dysentery, cholera, typhoid)

Water.related ths~asos

Source: O’Kelly, Elizabeth. Water and Sanitation for All. LondonAssociated Country Women of the World, 1982.

S Tsefse fly(sleeprng sickness)

0

Mosqwto(malaria, filoriasis, .

dengue fever, yellow ~

fever)

~~-~---

Damp soil site far ~- -

hookworm

Latrine

Contaminatedbucket

Snail hosts(schistosamiasis)

Contaminated food(gastroenterit~s,diarrhoea.dysentery, cholera, typhoid;

/

/,

•0/

Stagnant water— mosquito(dengue fever, yellow fever)

-8-

Figure 3

Mechanisms of Water-Related Disease Transmission and Contol Strategies

MechanismsIllustrative

Diseases Control Strategies - Involve Women

I. Water-borne, choleratyphoidhepatitis

Improve water qualityPrevent casual use of other

unimproved sources

II. Water-washed~

shigellosisscabiesascariasis

Improve water quantityImprove water accessibilityImprove personal hygieneProvide Information and Instruction

III. Water-based schistosomiasisguinea worm

Decrease need for water contactControl population of acquatic hostImprove qualityProtect access to water source

IV. Water-related malariaonchoceriasissleeping sickness

Improve surface water managementDestroy breeding sitesDecrease need to visit breeding sitesImprove water storage

Adapted from Bradley (1974) and Feacham (1975).

Source: Chen, L. “Evaluating the Health Benefits of Improved Water Supplythrough Assessment of Nutritional Status in Developing Countries”,Unpublished paper. Harvard. School of Public Health, 1980.

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Lastly, a fourth group of health risks to women are disease,such as malaria, trypanosomiasis, and the filariases which aretransmitted by other types of intermediate_hosts that mustspend a part of their life cycle in or near water.

These conceptual frameworks of Chen and Bradley provide us witha helpful introduction to the health constraints impinging onwomen. As we have seen water supply and sanitation are centralto questions of personal time and energy, food supply andtransmission of infection. These considerations are particular-ly relevant for women in three aspects of their existence:

— in pregnancy— in lactation— in their multiple occupations.

4.1 Pregnancy

Maternal and fetal well—being during pregnancy are dependentupon an adequate intake of calories, at least 200 more than thenormal non—pregnant intake. This amount is needed to assurefetal growth and placental function. In addition mother andfetus alike need protection from noxious influences in theenvironment: malaria, certain viral infections, venereal dis-eases, and tuberculosis.

The distance traversed by a pregnant woman in the search forwater has an obvious influence on her caloric expenditure andtherefore her caloric reserve for fetal growth. In mountainousterrain this expenditure may be as much as 27 percent of intake(White et al, 1972) and on the average, about 9 percent. Isely(1981) E~s~alcu1ated the caloric reserve remaining after allhousehold and agricultural expenditures are accounted for:about 42 percent remain for the pregnant woman at the level of9 percent for water carrying; at a 27 percent level, only 24percent remains. Studies in Zaire and Gambia have demonstratedthe negative influence of distance to fields (and by implica-tion to water source) on maternal nutritional status, durationof breastfeeding, output of breastmilk, and infant mortalityfrom gastrointestinal disease.

Vis et al (1981) demonstrated that rural women in the Kivuprovince of Zaire gain an average of only 2—3 kg. in pregnancy,about one—sixth of the weight gain of European women. Thisdisparity is thought to be directly related not only to de-ficient food supply but also to the excess energy expended inagriculture because of the type of terrain worked. When oneextrapolates to women who must expend up to 27 percent of theirdaily calories and up to six to eight hours of their day in thesearch for water, similar effects on weight gain in pregnancyare not hard to imagine.

—10-S

The influence of malaria on pregnancy is well—documented(Bruce—Chwatt, 1958). Small blood clots in the placenta filledwith malaria parasites may compromise the circulation to anextent sufficient to deprive the fetus of oxygen and calories,and thus limit growth or even cause death. How the environmentfavors malarial infection is treated below.

4.2 Breastfeeding

The caloric demands of breastfeeding (1,000 additional caloriesa day) are even greater than those of pregnancy. Isely (1981)calculated a woman’s reserve to be only 17 percent of daily in-take at a level of 9 percent expenditure for water carrying.When that level becomes 27 percent a woman could conceivably gointo negative caloric balance.

The data of Vis et al (1981) on Kivu women are again demon-strative. Measuring quantities of milk produced, they calcu-lated variations among the seasons. In June and July just afterthe second bean crop, mean milk production is at its peak (6t1g/24h), whereas it is at its lowest point between February andJune after the first bean harvest (390 g/24h). These variationsare thought due to differences in food supply but also, andmore importantly, to the increased caloric demand of cultiva-tion and harvesting. Again by extrapolation long distances totraverse in fetching water coinciding with scarce food supplycould also bring about the same reductions in milk production.

In an area of the Kivu with a terrain particularly difficult tocultivate women are obliged to leave their breastfed infantswith their grandmothers or sisters in order to cultivatedistant fields. As a result they can feed their infants at thebreast only two or three times a day. During the day many ofthe infants are given various carbohydrate feedings, oftenheavily contaminated. Among these infants infections occurearlier in life and more severely, resulting in a highermortality. Of course with the infrequent breast feedings, thereis another cause for reduced milk production and an even moreprecarious situation for the infant.

Thompson and Rabman (1967) in the Gambia also observed theadverse consequences of long distances to fields on the growthand mortality of infants of weaning age.

For the breastfeeding woman, therefore, the health constraintsrelated to women’s roles are chiefly nutritional, and thesevary with seasons, with terrain, and with the distances tofields and water supplies.

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4.3 Occupational—Related Health Constraints

Examination of the health risks arising from the multiple oc-cupations of women in the developing world reveals many thatare related to water and/or sanitation, particularly in ruralareas. If she goes to the river to wash clothes she may bebitten by Anopheles mosquitoes, Similium blackflies or Glossinaflies and acquire respectively malaria, onchocerciasis, ortrypanosomiasis. If she bathes or washes in a pond or canal shecan be infected with schistosomiasis. In drinking water fromponds while cultivating the fields she may acquire dracun—culiasis or guinea worm infection.

These diseases fall mainly in the categories of water—based orwater—related insect vectors. Even the hour of water collec-tion, dusk and dawn, before and after the draining heat of thesun often increases exposure to vectors such as mosquitoes.Water—borne diseases such as cholera or typhoid fever are pre-valent among women in some areas especially where water isdrawn from rivers and ponds. Water—washed diseases result fromscarce water for personal hygiene. Women who care for youngchildren have been shown to have increased numbers of pathogenson their hands, making them at risk for disease transmission toboth themselves and their families (Capparelli and Mata, 1975).Dysentery, gastroenteritis, roundworm infections, and hepatitisare among the most frequent. Lack of water for cleansing woundsalso favors the occurrence of tetanus consequent to injuriesthat happen both in the home and in the fields.

Whether through excess energy and time expenditures in waterseeking or through infections acquired in water contact, waterconsumption, and through lack of water for personal hygiene,multiple health constraints on the ability of women to con-tribute to the economic and social well—being of their familiesand communities arise. Water supply and sanitation are thus atthe center of the health question for women in development andmust be at the center of the development decisions affectingthem.

5. CONCLUSIONS

Improvements in water supply and sanitation are presented notas a luxury (for the poor and for women) but as a major pre-condition for economic development. —

Improved water has potential:

— as a basic food

— as an inhibitor of infections and infestations whichincrease caloric expenditures

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— as a link to improved nutrition through avoidingmalabsorptlon and decreasing caloric losses

— as a means to conserve the energy levels of women andchildren so as to allow their full participation indevelopment by eliminating the hours of heavy drudgeryspent in water collection

— as a component of village level projects, such asraising home gardens and small stock to increase foodconsumption and/or household income.

Women should be thought of not as passive recipients of im-proved water supplies but as active participants in the use andmanagement of household water, food, personal and familyhygiene practices, and training for technical tasks.

Women’s traditional roles as the primary water—drawers,haulers, carriers, and users should not limit their activeparticipation in changing and improving water supplies andsystems, both at the household and community levels.

New programs introducing improvements and modernization ofwater supply facilities should not, by sex stereotyping, over-look women as the obvious candidates for training in the main-tenance and operation of such facilities.

If “development’t projects were designed by and for women toutilize the time and energy released and the improved nutri-tional status resulting from improvements in water supply andsanitation, several things could happen:

— Support for the improved systems would be greatly in-ET1 w146 321 m527 321 lSBTcreased among the individual women and the communityat large.

— Resistance from husbands or mothers—in—law would de-ET1 w147 274 m527 274 lSBTcrease. Many men welcome extra family income from aWIfe. In some village communities “leaders” arguedthat women didn’t have anything else to do with theirtime, making more convenient water unnecessary.

— Decisions concerning acceptance and use of the newtechnologies will be made by women and their familieson the basis of what seems intuitively logical to themwith regard to benefits and costs.

— Changes in behavioral patterns related to the improve-ments in water supply and sanitation to be effectivemust be made by the primary users——the women. Socialcosts such as offense to custom, kin, or friend willbe considered

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along with economic costs. Convenience, privacy, orprestige may in fact be considered more beneficialthan the health improvements which often are ambiguousor not understood.

— Increased nutritional well—being with resulting higherlevels of energy related to improved environmentalsanitation and household hygiene can be channeledcreatively and productively into personal growth andcommunity development.

— Standard of living may be raised by economic benefitswhich simultaneously maximize health benefits.

— Better management of daily tasks can be made possiblesince improved water supply and sanitation shouldresult in easier tasks and in healthier more energeticchildren and mothers. Although many women are proud oftheir traditional roles as mothers and homemakers,they would like to be better managers and have moretime and energy.

- Participation by women and the community in develop-ET1 w144 439 m524 439 lSBTment programs will be increased. In fact, developmeiifproject planning which does not involve women andlocal groups in dialogue and problem solving islacking in essential data needed for implementation.

5.1 Redefinition of Roles and Tasks

Even though understanding the many traditional roles of womenas primary users of water is important, the more importantproblem now is how to use this potential so that women can beresponsible for the overall operation and maintenance of thenew systems in their communities and in their homes. All toooften there is a tendency to underestimate the extent to whichwomen’s roles can be increased and changed to bring greaterbenefits to women and entire communities. Sex—stereotypingoften restricts women’s full participation. What can be donethrough education, consciousness—raising and training, so thatthe traditional roles of women are incorporated into newsystems in new ways? Obviously there are no simple answers.

Traditional roles will vary and appropriate new systems will benecessarily widely divergent. We cannot discuss roles, po-tential and needs of women outside the cultural and socialmilieu in which they exist, nor the modernization process, butthe many hours formerly spent carrying water from source tohome can now be devoted to income raising from small industriesand handicrafts or to training for new work, perhaps for rolesspecially related to the improvements in the water systems aspump “doctors”, barefoot engineers, mechanics, plumbers, andtechnicians of all kinds.

—14-

REFERENCES

Bradley, D., “A Classification of Infective Diseases Related toWater,” Drawers of Water, Chicago, University of ChicagoPress, p.163, 1972.

Bruce—Chwatt, L.J., “Malaria and Blackwater Fever”, in Trowell,H.C. and B.B. Jelliffe (eds.), Diseases of Children in theSubtropics and Tropics, London, Edward Arnold, 1958.

Capparelli, E. and J. Mata, “Microflora of Maize Prepared forTortillias”, Applied Microbiology, 29:802, 1975.

Cardenas, Margarita, “Community Participation and SanitationEducation in Water Supply and Sanitation Programmes inParaguay,” Assignment Children, 49/50, 1979.

Chen, L., “Evaluating the Health Benefits of Improved WaterSupply through Assessment of Nutritional Status inDeveloping Countries,” Unpublished paper, Harvard Schoolof Public Health, 1980.

Chinas, B. The Isthmus Zapotec, Women’s Roles in CulturalContext, Flolt Rinehart and Winston, New York, 1973.

Elmendorf, Mary, “Women, Water and Waste: Beyond Access”, Pre-sented at the EPOC Forum of the Mid—Decade Conference ofWomen, Copenhagen, Arlington, Virginia: Water and Sanita-tion for Health Project, 1980.

_____ Women and the Decade, WASH Technical Report #6,A~FflngT~ñ, Virginia: Water and Sanitation for HealthProject, 1981.

________ “Women: the Underused Human Resource.” EducacionMedicaySalud, Volume 16, No. 4, Washington, Pan AmericanHealth Organization/World Health Organization, 1982.

Elmendorf, Mary and Patricia K. Buckles, Sociocultural Aspectsof Water Supply and Excreta Disposal, Appropriate Tech-nology for Water Supply and ~initation, Volume 5,Washington, D.C., The World Bank, December 1980.

Elmendorf, M. and R.B. Isely, “The Role of Women as Partic-ipants and Beneficiaries in Water Supply and SanitationProgrammes”, Arlington, VA, Water and Sanitation forHealth Project, Technical Report No. 11, 1981.

_________________ “The role of Women in Water Supply andSanitation Programmes”, World Health Forum (in press),1982.

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Elmendorf, M. and R.B. Isely, “Public and Private Roles ofWomen in Water Supply and Sanitation Programs”, to bepublished in Human Ox’ganization, Fall 1983.

Feachem, Richard G., “Environmental and Behavioral Approachesto Diarrheal Disease Control”, Acute Enteric Infections inChildren: New Prospects for Treatment and Prevention, TheNetherlands, Elseview/North—Holland Biomedical Press,1981.

Feachem, R.G. et al, Water Health and Development: An Inter—diciplinary Evaluation, Tn—MedBooks, London, 1978.

Isely, R.B., “The Relationship of Accessible Safe Water andAdequate Sanitation to Maternal and Child Health — LookingForward to the Drinking Water and Sanitation Decade”,Water Supply and Management, 5(6) 417—424, 1981.

Linton, R., The Study of Man, Appleton—Centiry Co., New York,1936.

McJunkin, F. Eugene, Water and Human Health, Prepared byQ~( ~~National Demonstration Water Project for U.S. AID

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