Nairobi's Sanitation Struggle

Last week was World Toilet Day, which aims to draw attention to the 2 billion people who still lack access to basic sanitation. The purpose of this post is to explore how the persistent lack of adequate sanitation disproportionately affects the health and productivity of women and girls. Toilets are a basic human right, as outlined by SDG Goal 6: ‘water and sanitation for all’, yet the lack of access to toilets has direct consequences on health, drinking-water sources, and the spread of water-borne diseases. World Toilet Day is an effort to address the sanitation crisis. 

 

I am focusing on Mathare, a rapidly growing urban settlement in Nairobi, Kenya. The situation is most acute in Mathare, where 300,000 residents only have access to 144 shared and publicly available toilets (Figure 1). That is one toilet shared between approximately 2000 people.

 

 

 

Figure 1: Map of toilets in Mathare, Nairobi.

 

Why do so many people lack access to adequate sanitation?

Sanitation is an overlooked subject in development efforts. The discomfort and taboo associated with discussing defecation has meant that this issue has been largely ignored. Sanitation is usually underfunded, despite its vital links to improved health and wellbeing. It must be recognised that the most powerful step towards a community free of open defecation occurs when people no longer view conversations around defecation as disgusting, shameful or embarrassing. 

 

How does sanitation disproportionately affect women?

 

Where sanitation facilities are inaccessible or unavailable, it is typical for women and girls to resort to open defecation. However, cultural taboos make it inappropriate for women to be seen defecating openly. Women therefore must leave home before dawn or wait until nightfall to retain their privacy. The practice of open defecation is accompanied by fear, shame, and physical discomfort which manifests itself through other issues comprising women’s health and safety. For example, women restrict their water intake to avoid the urge to urinate, leading to chronic constipation and urinary tract infections. Being forced to defecate by rivers, bushes or fields puts women and girls at a greater risk of sexual violence, as highlighted by Winter (2018) who found that women in Mathare Valley who lacked access to sanitation were 40% more likely to be victims of sexual assault. However, the practice of open defecation is also a major public health concern. Two-thirds of Mathare’s population regularly use plastic bags, known as ‘flying toilets’, that are then tossed across the street, with women especially forced to use them due to the aforementioned reasons of personal safety and dignity. This practice pollutes the Mathare and Gitathuru rivers, contributing to the spread of water-borne disease. 90 percent of the 19,500 recorded annual deaths in Kenya were due to poor sanitation, and around 65 percent of those deaths were girls. Poor health among women results in economic hardships through increased healthcare expenditures, and prevents them from participating in economic activity. The slums, covered with human waste, are a symptom of the lack of sanitation. 

Furthermore, proximity to a toilet does not always suggest safety, cleanliness and easy accessibility. Mathare’s toilets, which tend to be pit latrines, are not designed to cater to the specific needs of women and girls, specifically menstruation. Inadequate school sanitation is significant enough to force girls to miss school to avoid the indignity of public bleeding, being ridiculed, or not finding a safe, private and clean place to change and dispose of sanitary pads. Outside of education, these gender-discriminatory practises persist, such as charging women to access a toilet while men have access to urinals free of charge can be viewed as unacceptable forms of systemic violence against women. Toilets can be faraway, and pathways tend to be poorly lit at night, making it dangerous to travel alone to the toilet. Male family members could accompany women, but this is not possible in female-headed households, and does not alter the fact that the facilities are usually ill-maintained, or even unusable.  

 

Figure 2: Pit latrine in Mathare

 

This blog post has brought to light the very real challenges women face daily as a result of a lack of access to sanitation. As a woman myself, I find it alarming how lack of access to sanitation is harming women's livelihoods, especially as many of us in developed nations take toilets for granted. ‘Water is life, but sanitation is dignity’ highlights the need to recognise the sanitation-related burdens placed on women, and that sanitation policymakers must begin prioritising women’s sanitation needs if they expect to achieve gender equity and unlock the potential of half the global society.