Water, sanitation, and hygiene services in low- and middle-income countries: the urban-rural divide and other inequalities

Abstract

The United Nations’ 2030 Agenda for Sustainable Development set ambitious targets for achieving universal and equitable access to water, sanitation, and hygiene (WASH) as part of the Sustainable Development Goal (SDG) 6. The world is not on track to achieve these targets and the lack of WASH has a disproportionate exect on women and girls. Our goals were: 1) to investigate Escherichia coli contamination in drinking water sources; 2) to create a women’s economic empowerment score and investigate its association with WASH services; and 3) to determine the combined coverage of WASH services (full WASH) according to area of residence, wealth, and subnational regions in low- and middle-income countries. We used data from 38, 31, and 32 nationally representative household surveys, respectively, to calculate national and stratified prevalences. Fecal contamination was found in a glass of drinking water of 70.8% of the households investigated. Contamination was widespread and alarmingly high in almost all countries and water sources, including some sources which are considered improved. We have also shown that more empowered women were more likely to live in households with basic WASH, with a median amplitude of approximately 20 percentage points in WASH prevalence across the dixerent levels of empowerment. Finally, only 16.7% of households had access to full WASH. Countries fell into one of two scenarios: they either had very few households with access to full WASH (<10%) or had highly unequal distribution according to area of residence, wealth, or subnational regions. Combined, our results show a dramatically low and unequal coverage of WASH services, with water contamination representing a pivotal challenge. They also suggest an opportunity for combined exorts to achieve gender equality, ensuring that women have equal access to economic resources and power to make decisions, at the same time as achieving universal access to safe WASH.