WOMEN AS MANAGERS OF HUMAN WASTE
(TRAINING FOR NEW ROLES AND RETRAINING FOR OLD ROLES)
Mary Elmendorf, Ph.D.*
The International Seminar on Human Waste Management
Bangkok, Thailand, January 16-22, 1983
*601 Tyler Drive, Sarasota, Florida 33577, USA.
The support of the Water and Sanitation for Health (WASH) Project in the
preparation of this paper is gratefully acknowledged.
Water and Sanitation for Health Project
Contract No. AID/DSPE-C-0080, Project No. 931-1176
is sponsored by the Office of Health, Bureau for Science and Technology
U.S. Agency for International Development
Washington, DC 20523
This paper goes beyond the rhetorical issue of women's participation as a key
to improving projects and suggests ways that training and education can make
this potential a reality in achieving Decade goals.
The goals of the Decade are more and safer water not just more wells; more and
better sanitation, not just more latrines. Engineers know how to design ap-
propriate systems. But, how to assure that they are used, maintained and con-
tinue to operate is still the problem. Account must be taken of the human
elements the operators of the systems, the designers and planners, and most
importantly, the users of the systems. We must go beyond access to improved
water and sanitation systems to the sociocultural factors which influence
their acceptance, rejection or misuse. In order to understand these con-
straints and motivations, we must have access to women and women must have
more than access to the new facilities.
COMMUNITY PARTICIPATION AND INVOLVEMENT OF WOMEN
The need for community participation for successful improvements in water
supply and sanitation is well known and increasingly accepted,' but the
importance of women's involvement as a part of community participation in
order to achieve program objectives is less evi dnt. How to relate training
to these two objectives is even less understood." In the beginning, we should
say that our objective is not to segregate the women but to search for ap-
propriate models for adult learning which will be most effective in increasing
total participation of men and women to increase effective utilization of im-
provements in water and sanitation. By recognizing women as primary managers
of water and human waste, special training materials and workshops can be
designed which will give them needed information to perform their old roles
better and their new roles more effectively. The training itself will enhance
their status by giving importance to their many sanitation related tasks as
mothers, wives, kinswomen and community members.
The tasks women carry out in relation to domestic water and household sanita-
tion draw on four key roles: 4
Women as acceptors of technologies traditional, old and new.
Women as users of improved facilities.
Women as managers of water supply and sanitation programs.
Women as agents of behavioral change in the use of improved facilities.
WOMEN, CHILDREN AND THE MANAGEMENT OF EXCRETA
The widely held belief that children feces are "harmless" 5) can be a con-
tinuing link in chains of reinfection whether the feces are thrown on a nearby
garbage heap or baby diapers are washed with dishes in an urban home with a
newly installed standpipe. These practices and perceptions should be under-
stood and analyzed as part of the preparation of messages for communication
and training. Evidence shows that as mothers begin to understand the dangers
of infant feces -- not necessarily the "germ theory" -- but the cause/effect
relationship between sanitation and diarrhea they will change their habits, if
acceptable options are available.
In the Yucatan as in many developing countries no diapers are used so diaper
washing is not the problem. Mothers there are so attuned to their children's
needs, that they merely hold the babies away from them, uslly over the dirt
floor of the hut or just outside to urinate or defecate. The contaminated
soil continues the reinfection of everyone, especially other children.
In many parts of the world children defecate on the floor or ground because
they are afraid of falling through the large opening of latrines or because
the latrines are far away and the interiors are dark. These two problems have
been solved in a very innovative way in Sri Lanka where especially designed
low cost small water-seal latrines are available. These squatplate latrines
are installed without any walls under the eaves of the home just outside the
kitchen door so that mothers can easily train todlers to use it. Bath water is
used to fush the latrine, which doubles as an informal bathing area for
children. Is this a model which could be adapted to other areas?
WOMEN AND SANITATION: THE FECAL/ORAL ROUTE OF INFECTION
Even though the oral-fecal reinfection route is well known, there has been
very little designing of facilities and effective health education to help
break this vicious circle. Until women's involvement as a part of total
community participation is applied to breaking the oral/fecal route of
infection, we cannot expect much improvement in health even with new facil-
ities in the poverty areas of the world.
Village mothers will not know how to break this vicious circle until they have
some important bits of information and equipment -- primarily soap and a hand
basin, adequate carrying and storage containers, along with conveniently
located non-malodorous, safe latrines. Water alone does not bring sanitation
or health. Nor do latrines alone.
Along with the introduction of improved community facilities there should be
provision for new appropriate household equipment to maximize effective use.
If there is only one pail and no money to buy another of course it will be
used for everything. If there is no top for the pail, a covering with leaves
is a poor substitute. If there has been only a minimum of water available,
there will be no tradition of hand washing. If latrines are not appropriately
designed to fit customary habits they will be unused. If used followedd by
handwashing their positive health report can be greatly increased.
BREAKING THE ORAL/FECAL ROUTE
Making available ancillary kitchen, laundry, bathroom equipment and soap at
inexpensive, subsidized prices or even as rewards in recognition of graduation
from a short training course, will make it possible for women to take advan-
tage of the improved interventions in water and sanitation. Audio-visual
messages and health information should be related specifically to local custom
as well as the effective use of the new equipment -- both community and house-
hold -- so that people can efficiently use new facilities with pride and
pleasure, and enjoy better health and productivity.
As more water is made available from pumps or standpipes, there will be a need
for appropriate vessels and patterns of use or reuse of water to enhance the
health aspect. When women have washed their clothes on stones in a running
stream what will they need and/or want with piped water? If water is being
used for laundry and bathing, can it be reused in an aqua-privy? Do we only
think of bathroom planning for elite urban areas?
How can water for handwashing be made easily available to the latrine? How
might people be successfully motivated to adopt hygienic practices such as
handwashing? How can hands be washed adequately with a minimum of water? A
minimum of soap? No brushes? Where dried? What are the usual local behavior
patterns? Can there be more dialogue with the women with respect to where they
wash clothes/dishes/hands/children/themselves? Why? All of these activities
can be a part of the reinfection route unless adequate precautions are taken.
With respect to the introduction of excreta disposal facilities, limited
attention has been given to matters of pride and aesthetics, and the related
cleanliness. A case study of water supply and excreta disposal in Colombia
revealed that families preferred brightly colored cement stools and slabs over
drab gray facilities. And in Yucatan, women also cited their preference for
an aesthetically attractive latrine with a shiny porcelain seat or a brightly
painted cement floor or stool. Not only were these choices less drab than the
rough, gria) cement stools usually installed, but easier to keep clean and
WOMEN AS CHANGE AGENTS
Behavioral mapping, as well as participant observation, are needed as we work
with women on designing culturally acceptable solutions and appropriate
training materials. If water supply and sanitation facilities are to have
successful impact, considerable attention must be paid to the sociocultural
patterns at the community level. Basic equipment as well as training in the
use of community and household facilities must be made available to the women
so they can become better "managers of human waste". It is important to
recognize that the community may accept facilities without altering their
personal hygienic behavior. For this reason, planners must stress the re-
levance of creating participatory educational programs which focus upon the
"intended" as well as "perceived" benefits if development efforts are to
exceed the mere acceptance of the new facilities.
The "germ" theory is not enough. If women are to be successful as change
agents they must have a reason and be willing and able to make the desired
changes. Until planners, agencies and leaders involve women who accept the
importance of good sanitation, we can expect limited acceptance. Once the
women understand, they can play key roles in household decisions relating to
changing behavioral patterns and to socializing children in similar behavior
and attitudes in areas such as personal hygiene and sanitation.
WOMEN AS TRAINERS
Parents, fathers and mothers, but especially mothers, will make sacrifices,
even change their traditional habits to prevent illness and death of their
children. Attendance of mothers at maternal child clinics shows clearly that
women will come early and stay late to get help for their sick children
although not as often for themselves. Women may continue their traditional
healing practices but they will supplement these with modern medicines if
there is any evidence of success.
At the November 1982 meeting of the IDWSSD Steering committee, James Grant,
Director of UNICEF, opened the session by commenting on the two greatest
health breakthroughs in the last century Handwashing and Oral Rehydration!
Both of these need water. Both of these need women. We should dramatize some
of the new techniques, such a simple thing as handwashing, which can be linked
to increased availability of water and sanitation. Both of these are simple
procedures which will require many changes in basic beliefs, perceptions and
habits. Both require learning and training. The women are the ones who are the
trainers, the socializers of the children, the food and water handlers, the
managers of human waste. We need to have trainers trained to train these
HOW TO FIND TRAINERS OF TRAINERS
Women trainers are needed as are appropriate techniques. There must be
trainers of these trainers and preparation of special health information,
communication and audiovisual materials. All training of women should relate
to their existing roles, help in alleviating unnecessary burdens and improve
the quality of life for them, their households, and communities.
As we have said above, women, as wives and mothers, play key roles in water
use and management, as well as basic hygienic practices. The many women who
are heads of households, de facto or real, are especially important to be
reached. They, with their "25 hour days", will be especially motivated to
accept improvements that save them time and energy. Any training/learning for
women must be compatible with their demanding schedules. Many husbands migrate
for work part of the year or, even when they are stationary agriculturalists,
leave the details of home budgeting and management to their wives.
RETRAINING OF TRAINERS
Along with training at the regional and community level for field staff there
needs to be retraining and refresher courses for planners and engineers in the
supervising agency, with the promotion of reorientation and attitudinal
changes on issues related to women in health and development. Linkages with
support for community participation and retraining of existing field staff to
increase communication skills with women is also needed. In order to effect-
ively communicate with village women, particularly in traditional societies
where personal habits such as bathing and excreta disposal are often taboo
subjects, training of women from the local region is preferable to having
outside women or men.
One of the greatest problems in going beyond access to new facilities is
access to women who must understand how to use the new technologies and have
incentives for changing behavior in order to break the tragic oral--fecal
route of infection with its accompanying diarrhea, continuing illness and
death for many children. And along with access there must be appropriate
training methods and materials.
TRAINING MODULES IN WATER SUPPLY AND SANITATION
First a survey of existing training programs procedures and information
modules is needed, then an evaluation of their techniques and an assessment of
their materials. Special supplementary modules should be prepared to be used
to extend the learning into the homes. Other modules can be prepared to be
used in existing programs to train other outreach workers, such as nutrition
agricultural extension, and especially as part of the school curriculum or
primary health programs.
Training modules in household management of water supply and sanitation should
include, among other things, the following:
Water Washing Vegetables
use \ Children
Bathing < Anmal
Actual and preferred practices
Defecation<, Sex, Age, Class, Prohibitions
/ Infant Care Diapers, nappies, or nothing
Training Laundry of soiled clothing
Excreta Handwashing How
Care of Toilet Monthly
Reuse-: -Casual: pigs, dogs, fish, other
WOMEN AS TRAINEES
Effective training of women will require an adaptation of training methods to
the traditional ways in which new skills are acquired in local systems of
learning. 1 The degree to which women can assume roles within the management
of community facilities will depend of course on the degree to which the local
culture can adjust to a more public role for women. However, within their
homes, as the household managers of water and sanitation, women nearly every-
where need and want training in use of the new facilities which should be part
of planning for improvements in water supply and sanitation. The training
period is only the beginning. Women can be introduced to problem-solving
skills and new tasks, but provision should be made for support and supervision
after training so that the trainees can continue to learn and the new behav-
iors are reinforced, become habits and are rewarded in some way.
Certain sites may also lend themselves for more effective communication with
and education of women than others: markets, clinics, hospitals, washing
sites, grain grinding sites, etc. At each of these sites where women gather,
user education including health information can be shared with a group,1 ich
will provide the individual woman with peer support in her new learning.
SCHOOLS AS DEMONSTRATION SITES
Care also needs to be taken that rural schools have adequate hand-washing and
excreta disposal facilities. In fact, schools should be demonstrations of ap-
propriate technologies. Instead the school latrines are often less sanitary
than the primitive facilities used by the community even if it is only the
open air. Through a process of education and example, children can learn the
importance of washing their hands after defecation and before eating. A simple
facility, such as a barrel with a spigot, can be placed near the school la-
trine, or a special dipper can be used.
Teachers and other community-level agents should use these public facilities
to reinforce the hygienic messages being promoted within a classroom setting.
Hopefully, the same behavior would be repeated in the home, and reinforced by
community health and sanitation programs with parents, especially mothers.
Teachers, particularly those in rural areas, nearly everywhere in the world
are overworked, underpaid, and without adequately prepared educational units
in sanitation even though it is a part of most primary school curriculum. For
an exceedingly well organized national program in environmental sanitation
which was decentralized but locally coordinated see Margarita Cardenas' de-
tailed description of3 he SENASA (The National Service of Environmental Sani-
tation) in Paraguay.
The SENASA progamme is based on community participation in preliminary
surveys, in the decisions as to the types of services provided in community
wide and school sanitation education programmes, all being carried on while
improvements in water supply and sanitation are being implemented. The members
of the locally elected Water Board, which is entrusted with the responsibility
for the management, receive a special training course, as do other members of
the community. The school teachers, the personnel of the health center, and
the members of the Water Board become instructors for the local courses.
Educational units, including drinking water, waste disposal, and fights
against parasites, are prepared for the schools which are presented to all
grades during a one month project, with community involvement at all levels.
HEALTH CENTERS AS DEMONSTRATION SITES
Just as in the village school, the sanitary facilities at the health clinic
should be appropriate, and used as demonstrations of behavior desired in the
homes. In some areas health clinics are built with flush toilets sometimes
without water! Such facilities might not be feasible or economically appro-
priate for the community. More thought should be given to low-cost demonstra-
tion facilities in health centers and how women can be given hands-on training
in use of them.
When mothers meet for innoculations or wait for special treatment at the
health center there is an opportunity for targeted training. Special groups,
such as mothers' clubs, are eager to learn how to manage their children's
health problems and special messages or demonstrations, can be prepared for
WOMEN'S ROLES: OLD AND NEW
Women should be thought of not as passive recipients of improved water
supplies but as active participants in the use and management of household
water, food hygiene practices and training.
Women's traditional roles as the primary water-drawers, haulers, carriers, and
users should not limit their active participation in changing and improving
water supplies and systems, both at household and community level.
Sex stereotyping of new roles with improvements and modernization should not
overlook women as the obvious candidates for training in their maintenance and
operation. Traditional roles will vary and appropriate new systems will be
widely divergent. We cannot discuss roles, potentials and needs of women
outside the cultural and social milieu in which they exist, nor the moderniza-
tion process. The many hours formerly spent carrying water from source to home
can now be devoted to income from small industries, handicrafts or to training
for new work, perhaps specially related to the improvements in the water
systems as pump "doctors", barefoot engineers, mechanics, plumbers, tech-
nicians of all kinds.
WOMEN AS COMMUNITY TECHNICIANS
Anecdotal material is available on cases where women have been trained and
have successfully operated, maintained and repaired pumps, (Bolivia) have
worked as water source monitors (Angola) have been selected for training as
mechanics 1(,ali) and have carried out monthly disinfection of wells
(Colombia). Perhaps women are not the best personnel everywhere but they
should be considered as primary human resources as we evaluate past failures
in operation and maintenance.
In order to analyze and evaluate these examples more details are needed so
that guidelines and/or materials can be prepared for use in other places.
Selection criteria, community support mechanisms, follow-up training, etc.
should be included in any study.
WOMEN AS PLANNERS
How would women in rural areas design a simple bathing area with a pour-flush
toilet? Would women be willing to carry extra water to flush with? In Yucatan,
the women were extremely interested, even the ones who had to carry water from
a village stand-pipe. They and their families bathe daily arnd)their hope was
to combine a porcelain pour-flush toilet with a bathing room.
Many planners assume that women do not want to carry extra water to flush
toilets with. Women should be allowed to make this decision. With more low-
cost piped systems being introduced into the rural areas, are women being
asked if they would prefer a pour-flush latrine to a pit latrine? If they
could have a water seal latrine where would they want it? Does it have to be
so far from the house that children are afraid to use it? How can it be
combined with handwashing and/or bathing so that "gray" water can be used for
flushing? Will communities support and maintain piped systems even though they
are expensive to build and require more care? Some commune ies particularly in
hot climates, feel the cost is worth the extra benefits.
WOMEN AS OPERATORS OF BIOGAS
And have women been adequately consulted about the possibilities of biogas?
This technology, which can be so appropriate under certain circumstances, has
often failed. Why? When we think of management of human waste, biogas is one
of the most demanding. Perhaps women could assume more responsibility for the
daily feeding of a methane producer if they were given adequate training. With
the fuelwood crisis in many parts of the world, the availability of gas for
cooking might be the needed incentive, but careful training is necessary as
well as local acceptability of this use of human excreta.
A REDEFINITION OF ROLES AND TASKS
Even though understanding the many traditional roles of women as primary users
of water and managers of human waste is important, the more important problem
now is how to use this potential so that women can be responsible for the
overall operation and maintenance of the new systems in their communities and
in their homes. All too often there is a tendency to underestimate the extent
to which women's roles can be increased and changed to bring greater benefits
to women, their families and communities.
Sex-stereotyping of new roles often restricts women's full participation. Much
can be done about education, consciousness-raising and training, so that the
traditional roles of women are incorporated into operation, maintenance and
effective use of new facilities.
* Formulation and implementation of projects in water supply and sanitation
require the involvement of the whole community, men, women and children.
* Programs must emphasize the importance of women as an integral part of
* Women's involvement in the choice of culturally acceptable technologies,
in project preparation, implementation and evaluation is critical.
* The many roles of women in shaping family behaviors as the socializer
of children, the manager of the household, and a primary decision-maker
should be given special attention.
* The necessity to inform women and give them training to adopt new
patterns of behavior must be understood if the water and sanitation
services are to be properly used and maintained.
* A continuing dialog must be carried on with women within the broader
contexts of primary health care, and environmental sanitation, so that
they not only have access to the new facilities, but will effectively use
them within their households.
* The new attitudes and behaviors must become the acceptable norm, approved
by peers, sanctioned by leaders and reinforced by health workers,
teachers and other respected outsiders, as women become the ultimate
trainers and managers of human waste.
NOTES AND REFERENCES
1) For an excellent discussion see Participation and Education in Community
Water Supply and Sanitation Programmes prepared by WHO/IRC (International
Reference Center). The Hague, Bulletin Series No. 13, July 1979.
2) See the recent bibliography Community Participation and Woman's Roles in
Water Supply and Sanitation, available at WASH, (Water and Sanitation for
Health), Arlington, VA, Technical Report No. 18, November 1982.
3) The special Task Force on Women of the IDWSSD (International Drinking
Water Supply and Sanitation Decade) which was established in April 1982,
is exploring ways of extending the information and training modules being
prepared under INT/82/002 to incorporate appropriate materials for use
with women and women's groups.
4) Elmendorf, M. and R. Isely.
1981. The Role of Women as Participants and Beneficiaries in Water Supply
and Sanitation Programs, WASH Technical Report No. 11, Arlington, VA.
5) Imboden, N.
1968. "Induced Change in Health Behaviour: a Study of a Pilot Environ-
mental Sanitation Project in Uttar Pradesh", Publication No. 356,
Planning Research and Action Institute, Lucknow, India.
6) McGarry, M.G. and M.L. Elmendorf
1982. "What is Appropriate Technology? A Maya Village Asks," in
Elmendorf, editor. "Seven Case Studies of Rural and Urban Fringe Areas in
Latin Americas," Appropriate Technology for Water Supply and Sanitation.
Vol. 8 World Bank, Washington, DC.
7) Pineo, Charles
July 1960. Gov't. Sri Lanka Draft Plan Sri Lanka International Drinking
Water Supply and Sanitation Decade 1981-1990. Volume II, Annexes.
American Public Health Association, Washington, DC.
8) According to David Donaldson of WASH, the effectiveness of handwashing
was most effectively demonstrated during the Korean war when an extremely
high rate of diarrheal infections declined dramatically after each
soldier was made to scrub his hands after using the latrine. A soldier
stationed at the exit of the latrine area with a basin and soap super-
vised the handwashing. (Personal communication December 1982).
9) Elmendorf, M. and P.K. Buckles
1980. Sociocultural Aspects of Water Supply and Excreta Disposal, in
Appropriate Technology for Water Supply and Sanitation, Vol. 5, The World
Bank, Washington, DC. (originally released in mimeo, 1978).
10) McGarry, M. and M. Elmendorf Ibid.
11) Roark, P.
1981. The Role of Women in Successful Water Supply Projects, Agency for
International Development, Washington, DC.
12) Colle, R., and F. de Colle
1977. The Communication Factor in Health and Nutrition Programs: A Case
Study from Guatemala, World Health Organization, Geneva.
13) Cardenas, M.
1978. Community Participation and Sanitation Education in Water Supply
and Sanitation Programmes in Rural Areas of Paraguay, UNICEF/World Health
Organization, Joint Committee on Health Policy, Geneva.
14) Elmendorf, Mary
1980. Women Water and Waste: Beyond Access. Paper presented at the Forum
of the United Nations Mid-Decade Conference on Women, Copenhagen.
(Available from the WASH Coordination and Information Center, Arlington,
15) McGarry, M. and M. Elmendorf Ibid.
16) Dworkin, D. and B. Pillsbury
1980. The Potable Water Project in Rural Thailand, 1966-1972, AID Project
Impact Evaluation No. 3, Washington, DC.