By Carmen Roebersen – Research Intern WASH and SRH at Simavi
It was another warm afternoon in Kabarole district in Uganda. In one of the eight small villages which are the stage of my research, the ‘health and pregnancy’ workshop for the village health team was taking place. “Should we ask her the questions about, uh, uh, you know what I mean, … sex” is what my translator whispers in my ear. She was looking at a woman at the other side of the room while making sure no one could hear what she was saying. This is one of the many moments which illustrates the silence surrounding sex, and how this appears in everyday life practices of women in Western-Uganda.
Bodily integrity in relation to WASH & SRHR
The aim of this research was to understand how women preserve their bodily integrity in relation to the topics of water, sanitation, hygiene, and sexual and reproductive health. This study was conducted in line with Simavi’s new theory of change, which aims to integrate the domains of water, sanitation, hygiene [WASH] and sexual and reproductive health and rights [SRHR]. Professionals target these policy domains often in isolated efforts. However, these domains do not appear as separated domains in women their everyday life practices, but appear as activities and practices throughout the day.
Limited access to water and sanitation
Uganda, otherwise known as ‘the pearl of Africa’, due to extensive green sceneries, heavy rainfalls and numerous rivers and lakes, would at first glance not be thought of as a country which experiences difficulties with water provision and water use. Nonetheless, nothing could be further from the truth. While I move around in the research area, I pass by many women wearing the most colourful dresses, walking around with their jerrycans to fetch water. Women walk long distances to fetch water for their families, putting themselves at risk of harassment’s and sexual assault. In this area, water is becoming more and more scarce, increasing the challenges women experience with fetching water.
Sanitation facilities lack privacy as can be seen in the picture, and turn a simple visit to the latrine into a stressful event. However, for women, water and sanitation facilities are indispensable in managing their menstrual hygiene, and preserving their bodily integrity.
Imagine yourself as a girl or woman, being on your period, and not having access to sanitary pads; or not having access to painkillers when necessary; or not being able to discuss menstruation openly with friends or family; or disposing your pads in the pit latrine instead of a trash bin to make sure no one notices you are on your period. This is how many girls and women in Western-Uganda take care of their menstruation. The need to keep menstruation private shapes menstrual hygiene management in Western-Uganda and enables them to stay part of (social) activities.
Sexual and Reproductive Health and Rights
In Western-Uganda, it is not normal to openly discuss the topics which I addressed. To enable women to be open about this I offered women the opportunity to ask questions to me as well. This opportunity was often grasped to ask questions about how I (and other women in Europe) manage menstrual health and family planning. This created an open environment in which everyone could talk and share their experiences. The open attitude and willingness of women to talk about their private issues, showed me their realities and helped me to understand why women do not bear all children by choice. Misconceptions about why and how to use contraceptives restrain the effectiveness of contraceptive use, and sometimes even have the opposite outcome. The expectation that women act faithful, subordinate and docile in sexual relations, does not enable women to decide on when, how and with whom (safe) sex takes place.
A lesson which can be learned from this is that on the one hand; professionals’ perceptions are led by the idea that development is reached by new knowledge, new practices, new behavioral norms and by providing access to technology, such as contraceptives and water and sanitation facilities. Initiatives and practices of women are not considered to be ‘development’, nor modern, since these practices are often not shaped by technology nor science.
On the other hand; women often gain agency through their practices, such as acquiring contraceptives in secret, or creating strategies to reduce risks of harassments when fetching water. Women their positivity, persistency and humour often enables them to take matters into their own hands. They experience challenges throughout their daily activities, but simultaneously turn these activities into situations in which they preserve their bodily integrity. The domains of WASH and SRH should therefore not be targeted in isolated efforts; how women preserve their bodily integrity touches upon everyday life practices such as fetching water, sanitation use, menstrual health management, sexuality and contraceptive use.