Sanitation For Women
By Andrea Bruce
In our heavily populated world, poor sanitation contaminates water and food supplies, making it one of the deadliest issues humans face today. In 2015, the United Nations called for an end to open defecation by 2030. India is trying to change that following the steps of countries like Vietnam who desperately want to change the health of their country’s workforce and children.
Photographer Andrea Bruce travelled to India, Vietnam and Haiti to document how communities around the world still suffer or have overcome open defecation.
Today, open defecation is on the decline, but nearly a billion people still practice it daily. More than half of them are in India: nearly half-a-billion Indians – or 48% of the population – lack access to basic sanitation and defecate in the open. Open defecation and lack of access to clean drinking water are the top reasons for child mortality in the world for children under five. Every year, 200,000 children in India die from diseases caused by faecal contamination. Moreover, women appear to bear the brunt as they are mostly attacked and assaulted when they step out early in the morning or late in the evening. Open defecation is also a leading cause of rape for women in India, where women in rural areas seeking a private place to relieve themselves go out into the fields alone very early in the morning or at night.
In 2014, two girls were found hanging from a tree in Katra Sahadatganj. They had gone out to use the field as a toilet; they had been gang-raped and lynched. There was a brief outcry and were articles linking their murders to the lack of toilets. Lack of access to private toilets and clean water also hinder school participation. In India, only 58.82% of schools have separate toilets for girls. Some schools have only a single toilet, which is not clean. Single toilets increase the risk of not only disease transmission, but also sexual harassment. Many girls opt to drop out of school due to the lack of proper toilet facilities. It is especially true in the case of adolescent girls who skip school for five to six days every month, during menstruation. This hampers their education and leads them to drop out of school completely. The school completion rates are just 34% for girls, compared to 49% for boys. Proper sanitation facilities in schools are critical for improving the rate of completion of studies at school for the girls.
When girls drop out of school at an early age, they are less likely to return to education, leaving them vulnerable to early marriage, violence and forced sexual relations. “Girls lack access to clean, safe private toilets. There is no clean water within or near the toilets, which means there is nowhere to clean up and discreetly dispose of used menstrual products,” said Plan International USA’s Director of Water, Sanitation and Health, Darren Saywell.
India, Peepli Kheera, 22 September 2016 In the village of Peepli Kheera, population around 800 people, there is only one toilet which is kept under lock and key. The entire community defecates outside. Men in the fields on one side of the village, women on the other. About half of Indians defecate outside without using toilets. The result is that children pick up parasites and chronic infections that impair the ability of the intestines to absorb nutrients — and 117,000 Indian children die each year from diarrheas, according to Unicef. Andrea Bruce / NOOR
India, Peepli Kheera, 23 September 2016 Like most villagers in Peepli Kheera, India, Kishore, 40, wakes up in the morning and goes to the fields of sugar-cane to defecate in the open. He carries a plastic container full of water to clean himself. In the village of Peepli Kheera, population around 800 people, there is only one toilet which is kept under lock and key. The entire community defecates outside. Men in the fields on one side of the village, women on the other. Andrea Bruce / NOOR
India, Peepli Kheera, 24 September 2016 In the village of Peepli Kheera, population around 800 people, there is only one toilet which is kept under lock and key. The entire community defecates outside. Men in the fields on one side of the village, women on the other. About half of Indians defecate outside without using toilets. The result is that children pick up parasites and chronic infections that impair the ability of the intestines to absorb nutrients — and 117,000 Indian children die each year from diarrhea, according to Unicef. Andrea Bruce / NOOR
India, Uttar Pradesh, 25 September 2016 In a village in Uttar Pradesh, girls line up for school. The school doesn’t have a working toilet and so the students must defecate in the nearby fields. Many girls throughout the world drop out of school around the age of 13, when they start their period, because of a lack of toilets and privacy. Andrea Bruce / NOOR
ndia, Peepli Kheera, 25 September 2016 In the village of Peepli Kheera, population around 800 people, there is only one toilet which is kept under lock and key of one resident. The entire community defecates outside. Men in the fields on one side of the village, women on the other. The feces contaminates their well water, causing a high child mortality rate and high rates of stunting. Andrea Bruce / NOOR
India, near Bhubaneswar, 29 September 2016 Without proper sanitation, good water is hard to fine. Most villages receive their water from wells which are often contaminated through open defecation. Gram Vikas is an aid organization that works with villages to supply toilets and tap water. If a household splits the cost of building a toilet, then Gram Vikas gives them a faucet of running water inside their home. Andrea Bruce / NOOR
India, New Delhi, 01 October 2016 Open defecation may happen in India's villages more often, but it has a deeper impact on the water supply in India's slums. Organizations like Water Aid work to provide toilets in the slums of cities like New Delhi. But they are a small fraction of what is necessary to maintain a healthy water supply and sanitary living conditions. Water is often supplied by the government for one hour every morning causing a mad rush to the taps. About half of Indians defecate outside without using toilets. The result is that children pick up parasites and chronic infections that impair the ability of the intestines to absorb nutrients — and 117,000 Indian children die each year from diarrhea, according to Unicef. Andrea Bruce / NOOR
India, New Delhi, 02 October 2016 Community toilets are one answer to India's lack of toilets. But without a system for maintenance and cleaning, defecation remains a health problem. These four are waiting for the one open, working stall to open for use. Open defecation may happen in India's villages more often, but it has a deeper impact on the water supply in India's slums. Organizations like Water Aid work to provide toilets in the slums of cities like New Delhi. But they are a small fraction of what is necessary to maintain a healthy water supply and sanitary living conditions. Andrea Bruce / NOOR
India, near Bhopal, 05 October 2016 Santoshi Tiwari, a field worker with Smarten, a local nonprofit, explains how feces circulates through the town on the legs of flies, in water and in dust, triggering disgust in order to convince the community to stop defecating in the open. Community Led Sanitation (CLS) is sometimes used in villages to stop open defecation. Through shaming and using a hair placed in shit (this is the term researchers use) and placing it in a glass of drinking water, the instructor demonstrates how open defecation infects their water supply. Andrea Bruce / NOOR
Haiti, Port-au-Prince, November 2016 A working make-shift toilet outside of Port au Prince. Andrea Bruce / NOOR
Haiti, Les Cayes, 14 November 2016 Yphemie Luc holds her daughter, Bernaida Augustin's, 11, face while getting ready for their first day back at school since Hurricane Matthew. Their homes were destroyed during Hurricane Matthew, forcing them to flee to this makeshift displacement camp near Les Cayes. Two weeks ago Bernaida contracted cholera and was taken to a Cholera Treatment Center in Les Cayes to recover. A resurgence of cholera, which first appeared after the 2010 earthquake, has reappeared in the form of outbreaks in the hurricane-effected areas. Andrea Bruce / NOOR
Haiti, Les Cayes, 15 November 2016 Aftermath of hurricane Matthew. Andrea Bruce / NOOR
Haiti, Les Cayes, 15 November 2016 Hurricane Matthew battered Haiti with 145 mile an hour winds, halting the slow reconstruction that’s been under way since 2010’s devastating earthquake. Some 175,000 people were displaced in the immediate aftermath of Matthew, as homes, health clinics, and schools were toppled. From the rubble and murky water, a familiar enemy returned: cholera. Rose Dena, 85, attempts to clean what is left of her home in the mountains of southern Haiti weeks after Hurricane Matthew. The storm killed an estimated 1600 people in the country. Andrea Bruce / NOOR
Haiti, Moron, 16 November 2016 Bricthone Tabeline, 11, and Isadora Joseph, 10, study on the foundation of their home which was destroyed in October's Hurricane Matthew. Only the door frame remains. They live in a quickly-built shack behind their home. Andrea Bruce / NOOR
Haiti, Les Cayes, 20 November 2016 Hurricane Matthew caused mass destruction in Haiti the first week of October, flooding rivers and villages and making it difficult to reach many remote areas in the mountains of the south. Due to poor sanitation and cholera, many faced death. Andrea Bruce / NOOR
Haiti, Les Cayes, 20 November 2016 Hurricane Matthew caused mass destruction in Haiti the first week of October, flooding rivers and villages and making it difficult to reach many remote areas in the mountains of the south. Due to poor sanitation and cholera, many faced death. Andrea Bruce / NOOR
Haiti, Les Cayes, 22 November 2016 Hurricane Matthew caused mass destruction in Haiti the first week of October, flooding rivers and villages and making it difficult to reach many remote areas in the mountains of the south. Due to poor sanitation and cholera, many faced death. Andrea Bruce / NOOR
Haiti, Cap Haitian, 24 November 2016 A family in the Sada II reads directions for their new composting toilet (seen in the corner) supplied by the aid organization SOIL. SOIL collects the refuse from their composting toilets, distributes new composting toilets in Sada II and waste to the compost site in Limonade. Andrea Bruce / NOOR
Haiti, Port-au-Prince, 19 December 2016 A working outhouse stands near a home on the outskirts of Port-au-Prince. Proper sanitation is an issue in Haiti which bring extreme health problems to the public, exacerbated by natural disasters and cholera. Andrea Bruce / NOOR
Vietnam, Dien Bien, 13 February 2017 A woman works in the rice paddy fields of northern Vietnam where villages are now open-defecation free. Andrea Bruce / NOOR
Vietnam, Na Tau, 13 February 2017 Lo Van Pho, 63, waters vegetables in his garden. The ethnic Thai minority village of Na Tau, in northern Vietnam. The five villages in Na Tau have made great efforts to stop open defecation and achieved a goal of 100 percent of households having their own latrines. The villages’ achievement is recognized by ODF verification and certification guidelines developed by the Health Environment Management Agency in 2013, which publicly declares communities’ success in achieving ODF status. Dien Bien is the first province in Viet Nam to apply these guidelines. The province hopes to further build of these impressive results by improving sanitation overall, as only 43 per cent of households in the province have access to latrines. There is a clear geographical correlation that exists here in Vietnam, between the lack of access to sanitation and the rates of poverty and stunting in the country. In the Northern Mountains and the Central Highlands regions, rates of stunting and poverty are high and access to sanitation is among the lowest in Vietnam. Approximately 21% of the rural population in these regions defecate in the open. However, in addition to these linkages, a further dimension of sanitation inequality exists in Vietnam, that of ethnicity. Andrea Bruce / NOOR
Vietnam, Ben Tre Province, 16 February 2017 Dao Thannh Lam, 5, uses the toilet in his school. ABT Nursury School, Tan Thach ward, Chau Thanh district, Ben Tre city, Ben Tre province, Much of Vietnam's success was spearheaded by the schools. In all schools built in the past 10 years, indoor plumbing and the rituals of hand-cleaning are mandatory. The ethnic Thai minority village in southern Vietnam, Ben Tre Province. There is a clear geographical correlation that exists here in Vietnam, between the lack of access to sanitation and the rates of poverty and stunting in the country. In the Northern Mountains and the Central Highlands regions, rates of stunting and poverty are high and access to sanitation is among the lowest in Vietnam. Approximately 21% of the rural population in these regions defecate in the open. However, in addition to these linkages, a further dimension of sanitation inequality exists in Vietnam, that of ethnicity. Andrea Bruce / NOOR
Vietnam, Tinh Bien District, Vinh Xuyen, 17 February 2017 Phham Thi Lan, 31, and her son, Vinh, 4 years old, at Vĩnh Xuyên village Outdoor toilets often exist over fish farms in southern Vietnam. The local population believes it is good for the fish and isn't detrimental to the health of those eating the fish. There is a clear geographical correlation that exists here in Vietnam, between the lack of access to sanitation and the rates of poverty and stunting in the country. In the Northern Mountains and the Central Highlands regions, rates of stunting and poverty are high and access to sanitation is among the lowest in Vietnam. Approximately 21% of the rural population in these regions defecate in the open. However, in addition to these linkages, a further dimension of sanitation inequality exists in Vietnam, that of ethnicity. Andrea Bruce / NOOR
Vietnam, An Giang Province, Chau Doc, 17 February 2017 Unlike most countries where open defecation is still widely practiced, teenage girls fill the high schools of Vietnam. In majority OD countries, teenage girls drop out due to a lack of privacy (no working toilets) to deal with menstruation. Young students at break time in the yard of Vo Thi Sau high school, at 88 Lê Lợi street, ward Châu Phú B, of Châu Đốc city, In Giang province. There is a clear geographical correlation that exists here in Vietnam, between the lack of access to sanitation and the rates of poverty and stunting in the country. In the Northern Mountains and the Central Highlands regions, rates of stunting and poverty are high and access to sanitation is among the lowest in Vietnam. Approximately 21% of the rural population in these regions defecate in the open. However, in addition to these linkages, a further dimension of sanitation inequality exists in Vietnam, that of ethnicity. Andrea Bruce / NOOR
Vietnam, An Giang Province, Chau Doc, 17 February 2017 Students play volleyball during gym class at Vo Thi Sau High School (88 Lê Lợi street ), Châu Phú B ward, Châu Đốc city, An Giang province, (Mekong Delta ) Vietnam. Unlike most countries where open defecation is still widely practiced, teenage girls fill the high schools of Vietnam. In majority OD countries, teenage girls drop out due to a lack of privacy (no working toilets) to deal with menstruation. Andrea Bruce / NOOR
