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Stories from the Ground: Ethiopia

Holiding it in Until the Sun Goes Down: Women's Silent Struggle for Sanitation

By Andrea Helfer, Communications and Public Engagement Coordinator

The average Canadian will spend approximately 205 full days and nights of their lives sitting on a toilet. Quite an investment of our time, it would seem, for such an inconsequential action. True, with a good book in hand it can be quite pleasant and considered time well spent. The truth is, however, that for the 2.6 billion people worldwide who continue to live without access to basic sanitation facilities, like toilets and latrines, time spent defecating is amongst the most unpleasant, socially and physically challenging part of the day. This is the case for women, in particular, who quite literally have to “hold it in” until the sun goes down.

I was recently trapped in a car barreling full-speed down the highway with no rest area in sight and in desperate need of a toilet. The gut-wrenching, nauseating feeling was compounded by Cat Steven’s crooning “Oh, can’t keep it in, can’t keep it in, I gotta let it out” over the radio. What a cruel twist of fate, I thought to myself, but then it struck me. I spend my days writing and talking about the plight of women throughout eastern Africa whose lives are tragically complicated by a lack of toilets and latrines. Now this visceral reaction was leading me to a whole new level of understanding and empathy. I didn’t have to go any further than a Honda Fit on Highway 401 to “get it”.

Although a lack of sanitation facilities has tremendous impact on the health and economic development of entire communities, women and girls are unquestionably the hardest hit by an absence of toilets. Not only do they care for those who fall ill from prevalent sanitation-related diseases like cholera, typhoid and diarrhea, but they are also in greatest physical contact with human waste themselves.


In crowded urban slums women go through the entire day without relieving themselves and also risk harassment or even rape when defecating at night under cover of darkness. In rural areas, shame, embarrassment and the great desire for privacy force women to defecate in secluded areas where they risk assault. Needless to say, menstruation, pregnancy and postnatal periods add further complications and discomforts.

This humiliating daily routine dominates women’s lives, not only places them at risk of health problems like urinary infections, chronic constipation and psychological stress, but also hinders their full participation in the social and economic lives of their communities.

It is estimated that worldwide, 190 million school days could be gained if the Millennium Development Goal for sanitation were met. The sanitation target is dangerously off-track; at the current rate of progress, the 2015 target will be missed by 700 million people. Many of these are young girls, for whom access to sanitation facilities on school grounds means the difference between getting an education or not; being able to read or not; and having a chance to escape from poverty or not.

Parents will oftentimes not allow their girls to attend schools that do not offer basic sanitation facilities, particularly during menstruation. This results in an ever-growing disparity between female and male primary school graduation rates. Currently one in four girls worldwide do not complete primary school, compared to one in seven boys.

WaterCan believes that sanitation is a vital investment for health, dignity, development and gender equality. WaterCan’s projects support the construction of communal toilet facilities in rural communities, urban slums and primary schools. Although these facilities are communal in nature, they do provide separate and private stalls for men and women/ boys and girls. Many projects also promote the construction of household-level latrines comprised of a pit in the ground, a cement slab or platform and a superstructure constructed from locally available materials to provide privacy.

WaterCan’s observations over the past decade mirror the findings of a recent World Bank report which concluded that of 122 water and sanitation projects reviewed, those that involved women in planning and implementation of the projects were six to seven times more effective than those that did not. When women are involved in every step of the process from the design and planning to maintenance and operation, there tends to be a higher level of transparency, better financial management and a greater sense of community empowerment. Within the communities there is at times opposition to placing women at the centre of water and sanitation resource management, because they appear to be stepping outside of traditional female roles. However, in WaterCan’s opinion and experience they are perfectly suited and qualified to assume these leadership positions.

For WaterCan, gender equality is not something that is arbitrarily “added-on” to our international programs. Gender considerations form an integral part of all the work that we do. With your assistance we will continue to take steps toward alleviating women’s silent struggle to gain access to sanitation, and to ensure that they are considered and treated as a vital part of finding sustainable solutions.

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