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Our view on the nexus: Sexual and Reproductive Health and Rights (SRHR) and Water, Sanitation and Hygiene (WASH)

Simavi believes that two factors are crucial in achieving health for all women and girls: sexual and reproductive health and rights (SRHR), and water, sanitation and hygiene (WASH). Women and girls face disproportionate challenges in achieving sexual and reproductive health rights as well as the right to water, sanitation and hygiene compared to men.

Women’s and girl’s needs are different from those of men, when it comes to both SRHR and WASH. Unfortunately, these needs are often overlooked, and women and girls are often excluded from, or not sufficiently represented in, decision making processes on these topics at household, community, national and even international level. At the same time, SRHR and WASH are not only crucial to ensure women’s health and well-being, the two actually strongly interlink. This is why, in addition to our focus on women and girls, Simavi aims to combine SRHR and WASH interventions in our programmes.

Human rights: the right to WASH & SRHR

Although the right to water, the right to sanitation, as well as sexual and reproductive rights may be universally recognised, they are not universally implemented. Many are denied these rights based on gender identity or sexual orientation. Fulfilment of the human rights to water and sanitation and sexual and reproductive health contribute to the fulfilment of the right to health. These rights also positively impact economic, educational and sustainable development outcomes for all, while poor economic, educational and sustainable development can negatively impact the fulfilment of these rights.

We support the idea that the realisation of the human rights to water and sanitation and the realisation of sexual and reproductive rights are interconnected. Especially when it comes to women and girls. Inadequate WASH services and non-inclusive infrastructure (e.g., a lack of public toilets or of gender segregated toilets) hamper the fulfilment of sexual and reproductive rights, including the right to health, the right to autonomy and bodily integrity, the right to privacy, the right to equality and non-discrimination, and the right to be free from sexual violence.

All of this underscores that WASH is not just an issue of service delivery, but one of health, rights, and dignity. On the other hand, water and sanitation is crucial in the attainment of sexual and reproductive rights, as these are crucial to obtain necessary hygiene standards during delivery, menstruation or when having sex. If WASH and SRHR interventions are better integrated, increased health and women’s rights outcomes can be achieved.

WASH SRHR

Sustainable Development Goals (SDGs)

The 2030 Sustainable Development Agenda gives a common ground for sectors to collaborate on sustainable development for all, and the SDGs related to WASH, health, and gender equality are mutually reinforcing and interdependent.
Combining SRHR and WASH interventions creates opportunities to bolster health. Two targets of the SDGs explicitly address sexual and reproductive health, target 3.7, under the health goal and, target 5.6 under the gender equality goal. Other targets, SDGs 3, 5 and 6 (clean water and sanitation) implicitly link to SRHR. By combining interventions to improve sexual and reproductive health outcomes with interventions to improve water, sanitation and hygiene in health facilities and communities, the two sectors will jointly contribute to achievement of several SDGs.

SRHR and WASH combined in our expertise areas

Simavi defines five expertise areas in which we combine SRHR and WASH and our focus on women and girls. When it comes to maternal health, women are often asked to bring their own water and hygiene products when delivering their babies as this is not available in clinics. Carrying such heavy loads during, or immediately after pregnancy, can for example worsen pelvic floor prolapse, which can affect the bladder, uterus, and rectum. In addition to that, unhygienic conditions in health care facilities and substandard infection prevention and control increase risks to women and new-borns. It might also delay or prevent people from seeking SRH care.

Menstrual health is another example where both SRHR and WASH interventions are a crucial part of the solution. Menstrual health is a core part of reproductive health. Understanding what menstruation is, and how it is part of the reproductive system, is crucial to girls’ and women’s understanding of their bodies and thus their SRHR. On the other hand, having access to safe water, soap and a clean and private space to wash and change menstrual products with dignity, are a crucial aspect of menstrual health.

When it comes to what Simavi defines as bodily integrity, women’s right to decide over their own bodies, there are many examples where SRHR and WASH interplay. For example, whilst fetching water, making use of a toilet or, when there is no toilet, defecating in a field or bushes at night, women and girls might become a victim of sexual harassment or rape. It is therefore crucial that women have access to gender-sensitive and inclusive WASH facilities. Medical abortion and post-abortion care in health facilities also require proper WASH to avoid risks of infection. And, although WASH is neither a treatment for, nor a way to prevent the spread of sexually transmitted infections (STIs) it is critical in addressing STIs.

Finally, it is important to ensure that WASH services are inclusive and to recognise that different groups have different needs with regards to WASH. When menstruating, women and girls might spend more time and require more water, soap and space whilst using a toilet. People living with HIV/Aids also require more water, amongst others to maintain higher hygiene standards and for the intake of medication. And there are many other groups that might be denied access to toilets, such as daughters-in-law living with their husband’s family or transgender, intersex, and gender nonconforming individuals. People living with a disability, sick and/or older women might require more assistance when using WASH facilities as well as special designs.

See also ‘A shared agenda’ that Simavi co-wrote with WaterAid, IPPF, Marie Stopes and the International Women’s Health Coalition.

Disclaimer

Unfortunately, integrated WASH and SRHR approaches are often not prioritised in global and national policy or practice. This is related to the fact that SRHR and WASH funding often comes in separate budgets, and as a result, programmes tend to focus on either SRHR or WASH. This also means that many of our programmes are predominantly SRHR or WASH focused. Where possible we will integrate WASH interventions in SRHR programmes and vice versa. We actively fundraise for (unrestricted) money that allows us to implement programmes that combine SRHR and WASH.

Our Ritu programme is a good example of a combined SRHR and WASH programme.

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Sexual and Reproductive Health and Rights (SRHR)

SRHR encompass the right of all individuals to make decisions regarding their sexual activity and reproduction free from discrimination, coercion, and violence. Access to SRHR ensures individuals are able to choose whether, when, and with whom to engage in sexual activity; to choose if and when to have children; and to access the information and means to do so. SRHR is an umbrella for a range of issues that affect men and women in relation to their sexuality. The term encompasses four separate areas: sexual health, sexual rights, reproductive health, and reproductive rights. See annex I for full definitions.

Sexual and reproductive health and rights is not merely the absence of disease or infirmity, but the ‘possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.‘ The broad range of issues encompassed by term include: access to prenatal and postnatal care, safe delivery, family planning, prevention and control of sexually transmitted infections (STIs) and reproductive tract infections. SRHR also refers to information and education about sexuality, safe abortion, female genital mutilation (FGM), fistulae, maternal and newborn mortality and morbidity. See annex II for a comprehensive list of relevant topics.

Water, Sanitation and Hygiene (WASH)

WASH is the collective term for Water, Sanitation and Hygiene. Due to their interdependent nature, Simavi uses a holistic approach where these three core issues are integrated, each is dependent on the presence of the other. The human right to safe drinking water and sanitation is derived from the right to an adequate standard of living and inextricably related to the right to the highest attainable standard of physical and mental health, as well as the right to life and human dignity.

Universal and equitable access to WASH for all requires that households and institutions, such as schools and health care facilities, have safe, affordable and adequate water, sanitation and hygiene services. Sustainable Development Goal (SDG) 6 — ensure availability and sustainable management of water and sanitation for all — has an explicit gender dimension, and calls for attention to the WASH needs of women and girls. The human right to water and sanitation requires services to be available in an acceptable, adequate, affordable, appropriate, and safe manner to all.

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