By Mary Loftus
That’s what Eugene J. Gangarosa Professor of Safe Water and Sanitation Christine Moe, who directs Emory’s Center for Global Safe Water, is trying to understand: “Where does the shit go?” She asks this question straight out to underscore the importance of talking candidly about this universal need: dealing with human waste safely, efficiently, and with dignity.
Water and sanitation, or lack thereof, affects women disproportionately in many ways. “Some you’d expect and some you wouldn’t,” Moe says. Women and girls bear the burden of collecting water in most parts of the world, which translates into “a lot of time and a lot of kilocalories of energy taken away from other activities” like school and income-generating jobs.
The lack of latrines or toilets also affects women more than men. Because it is typically not socially acceptable for women to relieve themselves in the daylight, women must often go outside very early in the morning or late in evening to find a private location. “Can you imagine the discomfort of waiting, holding, then risking assault and rape, to have to go out in the dark and find a private place for defecation?” Moe says.
Around the world, about half of girls attending school go to ones that don’t have toilets. “This is why a lot of girls drop out of school when they are adolescents and start their menstruation,” Moe says. “They don’t go to school on the days they menstruate. They stay home for privacy and to avoid embarrassment.”
Women, Water, and the World
• A United Nations survey of 177 countries in 2006 revealed that women spent 40 billion hours per year collecting water. That's the equivalent of a year's labor for the entire workforce of France. "That's a huge amount of time and energy for women who may not have sufficient nutrition in the first place," Moe says. "And water is heavy."
• Girls are often unable to attend school due to water-collection duties, and those that do go to school often drop out when they begin menstruating due to inadequate sanitation facilities. Twenty-four percent of girls worldwide do not complete primary school, compared with 15 percent of boys.
• Globally, 37 percent of water and sanitation budgets go to sanitation, and investments in hygiene are minute. Even as water and sanitation problems affect women disproportionately, women also can be powerful, motivated local leaders who push forward sustainable solutions.
—Source: United Nations, World Bank, and World Health Organization statistics provided by Allie Huttinger, CGSW research project coordinator.
Finally, Moe says, lack of good water and sanitation leads to rampant diarrheal disease, which strikes mainly children under five. “It’s almost always the mother or grandmother or older sisters who take care of that child,” says Moe. “The consequences fall on women disproportionately from many different angles.”
Even where public latrines are available, they are often dirty, germ-ridden places without hand-washing options. When Moe visited Ghana recently, she spoke with a group of women using the public latrine. “Some of the ones we visited were really awful, and we were agreeing that it’s not proper for women to have these kinds of conditions,” she says. “Even though they are poor, they understood they deserve privacy and dignity. Disgusting public latrines, what type of solution is that?”
In an effort to find sustainable solutions, Moe leads an international team of researchers, graduate students, engineers, and community planners in tackling these enduring public health problems at the intersection of water, sanitation, and hygiene. The Center for Global Safe Water (CGSW) has grown rapidly in the last several years, with current staff and faculty totaling nearly 20. And with the Centers for Disease Control and Prevention, The Carter Center, CARE USA, and Georgia Tech nearby, it has committed, creative partners to assist in its quest.
This year, Moe and Emeritus Professor of Global Health Eugene Gangarosa taught a short course during the winter break on water and sanitation. “There has been huge growth in the number of students interested in these issues,” she says. “Some students tell us that the reason they came to Rollins was because of the Center for Global Safe Water.”
Several new center projects have been funded this past year. The largest, supported by a $2.5 million grant from the Bill and Melinda Gates Foundation, involves studying ways in which individuals are exposed to human waste in cities of the developing world. In summer 2011, the Gates Foundation formally made sanitation their top priority area, given that many groups already are working on water.
The pilot study is based in Accra, Ghana—the country’s capital and a rapidly growing city. “A lot of NGOs and sanitation/water work in the past has been in rural areas, because that’s where the greatest need and most unserved people were,” Moe says. “But a few years ago, the global population shifted to cities. Cities like Accra are the norm, not the exception, globally.” This results in huge slum areas with no water and sanitation services, she says. “There’s not a lot of research or funding in sanitation,” Moe says. Emory “has had a track record in sanitation for a number of years. Accra can serve as a model for other sub-Saharan African cities that are growing rapidly.”
Lack of sanitation in cities, she says, can lead to exposure of large numbers of people to fecal contamination through the environment, drinking water, and food. In urban areas, there are tiny portions of land with crops that are irrigated with raw sewage water.
Also, tanker trucks pump out septic tanks and public latrines and take the waste to the coast to dump. “They are discharging the excreta they suck up from public latrines directly into the ocean,” Moe says. “The beaches downstream have heavy contamination.”
Whether in the city or the countryside, the most sustainable water and waste solutions tend to be homegrown, taking into consideration the culture and the specific needs of the population, says Moe. “One of our alumni in Haiti, who is now with Deep Springs International, told us about a local woman, Madame Evelyn, who through sheer force of personality, gets everyone in her community to use chlorine to treat their drinking water,” Moe says. “That’s the flip side of women being most affected—they also have the knowledge, influence, and motivation to be the movers and the shakers behind these solutions.”
Mary Loftus is associate editor of Emory Magazine. She is a frequent contributor to Women’s News and Narratives.