Water: an essential reproductive health commodity
by Jay Gribble and Angela Mutunga
This week, the Reproductive Health Supplies Coalition meets in Accra for its General Membership Meeting to discuss issues related to manufacturing, supply chain, procurement, and a host of other topics related to the many important commodities needed to support health programs that allow women to have the best reproductive health possible. The Coalition does not shy away from the more challenging topics, such as financing supplies, the availability of menstrual products, and how to shape the market for the private sector to take on a greater role in different endeavours. While focused on these important topics, we also want to raise the importance of another critical commodity to improving the reproductive health of women and girls: water. We may take it for granted, but as we listen to the experiences of women and girls around the work, water plays a vital role in their reproductive health and wellbeing. Reflecting on the role of water as an essential reproductive health commodity, we consider three distinct pathways that it contributes to better reproductive health outcomes: through removing gender-based barriers to improving the lives of girls and women; through facilitating improvements in the hygiene of clinical facilities where reproductive health services are provided; and through the importance of water and hydration to human reproduction. Here we reflect on these three diverse pathways that are so often taken for granted but that reinforce the role of water as an essential reproductive health commodity.
Fostering gender-based barriers. In many countries, it is the responsibility of women and girls to fetch water because their communities do not have available access to it. For young girls, this situation poses a number of challenges — the physical burden of carrying water for long distances leaves them physically exhausted so that they have little time or energy to do their homework — if they are lucky enough to be in school. In addition, as climate changes leave more areas with higher temperatures and increased draughts, the physical burden on girls becomes exacerbated. The gender-based norm that this is girls’ responsibility also means that they cannot attend school to learn to read and write, think critically, and with less opportunity to challenge the male-dominant social and economic norms. Fetching water is symptomatic of a broader set of gender norms that leave girls at risk of not achieving their potential, such as child marriage. The lack of access to water and sanitation also increases the personal safety of women and girls; outside toilets increase the risk of sexual abuse and assault, which also have adverse outcomes to the reproductive health of women and girls.
Inhibiting use of facility-based services. While one of the best practices in maternal and child health is facility-based delivery with a skilled provider, the lack of access to water in those facilities undermines women’s interest and willingness to deliver in these places. UNICEF estimated in 2019 that 1 in 4 health services around the world lack access to basic water services, and in least developed countries, lack of access to basic water services in facilities increases to 45 percent. WHO and UNICEF researchers also estimated that approximately 1 million deaths occur each year due to unclean births. Lack of water and soap impede the cleanliness of health facilities and increase the risk of infection. This situation is estimated to contribute to 26 percent of neonatal deaths and 11 percent of maternal deaths. In recent facility visits, we (Angela) saw how women and girls, who due to lack of water at the health facilities, swore never to seek facility-based delivery care again due to lack of water to bath. In fact, it is not unusual for women and their families have to buy water from vendors or fetch from nearby sources for their newly delivered mothers. Due to lack of this essential commodity, it is not unusual for these women to report having no choice but to rely on traditional birth attendants for ‘quality and accessible care’ in the future. For these women, water is an essential supply; it’s being “out of stock” undermines best practices for safe delivery.
Impeding human physiology and reproduction. If approximately 60 percent of the human body is water, then staying hydrated with potable water is essential to ongoing health. Without adequate hydration, the body does not function properly. Hydration plays an especially important role in reproductive physiology. Hydration helps regulate hormonal balance that keeps the endocrine system operating well. Insufficient hydration can also contribute to thicker cervical mucus that makes it more difficult for sperm to reach the egg. In men, insufficient hydration also contributes to poor semen volume and sperm count, which also impedes fertilization. For the uterine environment, insufficient hydration can interfere with implantation and contribute to uterine contractions. While access to potable water is critical to the human body working effectively, it plays an especially important role in the sexual and reproductive health and wellbeing of women and girls.
Water may not be in the pantheon of supplies that are highlighted by the RHSC. As much as we may understand why it is not, is it time we re-examine our list of essential supplies and include water? As we ponder on this question, we need to remember that achieving optimal sexual and reproductive health requires more than manufactured commodities and supplies. Water plays a critical role in reinforcing gender biases, such as burdening girls with fetching water; it plays a vital role in infection prevention and healthy deliveries — and can motivate women to increase use of skilled care; and it is critical to the optimal working of our bodies. We talk about reproductive health and family planning as a right and a development strategy — and we wholeheartedly agree with that positioning, but because of inadequate access to water, women of all ages experience barriers to their own overall and reproductive health and wellbeing, and consequently face gender-related challenges to achieving their potential. While water is an essential reproductive health commodity, it’s also far more than that.
Jay Gribble is senior director at Palladium and deputy project director of PROPEL Health; and Angela Mutunga is the Global Secretariat of The Advocacy and Accountability Collaborative. Views expressed here are their individual perspectives.
