Behind the papers: The burden and potential of women’s water access

By guest contributors Bethany Caruso (Hubert Department of Global Health, Rollins School of Public Health, Emory University) and Emily Ogutu (Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University)

With this year’s UN World Water Day focus on the critical relationship between water, women, and gender equality, we talk to Bethany Caruso and Emily Ogutu, both a part of the Evidence and Data on Gender and the Environment (EDGE) Research Group at the Rollins School of Public Health at Emory University, about their recent work focused on women and water access published in PLOS Global Public Health and PLOS Water.

Motivation for the studies

Imagine waking up before dawn, walking miles under a scorching sun, and hauling heavy containers of water—just to make sure your family can cook, clean, and drink. For millions of women, this is a daily reality. Yet, despite long established evidence showing that women and girls are largely responsible for shouldering the burden of water collection globally, research illuminating what this experience is really like has been lacking. Further, little is known about how women’s access to water may influence their economic engagement.

The invisibility of women is sadly unsurprising. Research and initiatives largely have focused on improving water access and quality to prevent diarrheal disease among children under age 5. As a result, few water-focused interventions have been designed specifically to improve the lives of women. Worse yet, some water interventions have used women purely for program gains–like ensuring  water treatment–ignoring the time and energy these additional responsibilities may entail.  

Bucking the trend, World Vision developed the Strong Women Strong World: Beyond Access (SWSW) program, intentionally integrating improved water access with women’s economic empowerment activities. The program hypothesized that (1) women in the program areas were expending substantial time and energy to retrieve limited quantities of water, and (2) improving water access, therefore, was essential to enabling women’s economic engagement and empowerment.

World Vision partnered with Emory University to lead research to test these hypotheses, resulting in two papers in PLOS journals: a multi-method study to document women’s water collection burden and a qualitative study exploring the role of water in women’s economic engagement.

How these studies were designed

Emory led the design of mixed-methods research to explore the hypotheses posed by the program in depth. The design process began with interactive workshops led by Emory University that engaged the World Vision country team members involved in implementing SWSW in Guatemala, Honduras, Kenya, and Zimbabwe. All four country teams independently expressed interest in research that would improve understanding of women’s water collection burden, beyond time alone, and would explore how water access influences women’s economic activities. Emory designed research approaches to meet these interests, which were presented at another round of workshops for feedback and refinement.

Image credit: by Bethany Caruso. All icons are from thenounproject.com and have a Royalty Free License.

Burden of water collection. To understand the burden of water collection, we deviated from previous approaches, which have typically focused only on the time required for water collection and relied on women’s self-reports of time. We decided to follow women while they collected water, enabling us to observe and ask about their journeys while also measuring actual time, distance, caloric expenditure, and elevation gain using smartwatches.  We used scales to weigh all women carried.

Role of water in women’s economic engagement. To understand the role of water in women’s economic engagement, we conducted focus group discussions with community members in program areas because they capture a diversity of opinions and allow participants to build on or even disagree with what others share. Given gender norms around water collection and economic activities, we held FGDs with both men and women.

Most striking results across studies

Water collection requires more intense labor than previously understood. While it was no surprise that water collection is demanding, we were struck by what women endured. In extreme cases, women spent over 4.5 hours going out, getting water, and returning home. Some walked over 15 km and expended upwards of 500, 700, even 900 calories, also carried children, laundry and/or spent tremendous effort digging holes at dry riverbeds just to access water.

Expending great effort did not guarantee retrieval of safe, sufficient water for households. Those who spent the most time and walked the farthest were doing so to get water from unsafe unimproved sources. Moreover, the volumes of water these women collected did not qualify per WHO standards as being sufficient to meet their family’s drinking and hygiene needs.

Water collection can harm health and well-being, hindering other aspects of life. Women reported fatigue, musculoskeletal pain, headaches, and injuries from water collection, which could reduce their participation in other facets of life, including their ability to engage in income-generating work.

Water presents economic costs and opportunities. Beyond physical burden, some women described the monetary burden of water, including costs at water sources, costs for storage containers, or costs at home or in their communities for pipes and maintenance. These expenses add up, preventing women from having capital to engage in or initiate economic activities. Women also discussed how improved water access opened opportunities, like for agriculture and livestock production, potentially enabling income generation.

How this research will be used and who will benefit

These research findings are already being used by World Vision country teams. Beyond World Vision, our research shows that those working to improve water access should center women to ensure they directly benefit. Those designing programs to increase women’s economic engagement should consider if improved water access is needed to reduce barriers and enable opportunities.

Further research questions that needed to be addressed

• If women’s water collection burdens are reduced, how do women use saved time and energy?
• If women no longer have to collect water, what are the specific impacts to their health and well-being? What are impacts to their families and communities?
• Do interventions that reduce women’s time and energy for water collection lead to increased economic engagement?

Why PLOS journals

We chose PLOS Water and PLOS Global Public Health as both seek research that is interdisciplinary, collaborative, and are concerned with inequities related to people and the planet. As PLOS Global Public Health seeks to ‘address the biggest health challenges and inequities facing our society today’, we felt it was the best journal to showcase the staggering health challenges and inequities we observed related to water collection. For our work exploring linkages between water and economic engagement, we specifically aimed to reach those working in the water sector and know PLOS Water is the best way to reach this audience.

Interested in submitting your own research to PLOS? Find out more about PLOS Water and PLOS Global Public Health.

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