Climate change is affecting water supplies around the world. Whether too little water in the form of prolonged and severe droughts or too much through flooding from heavy storms, extreme weather events are reducing the availability of surface water. Given the essential role of clean and safe water for sustaining life, lack of access to it has dramatic effects on sanitation, hygiene, nutrition, and health.
A USAID technical brief explores the links between nutrition and water, sanitation, and hygiene (WASH). The brief is one of nine documents in a technical series describing connections and recommendations for WASH programming, including rural and urban contexts, governance, gender equality, and financing.
Undernutrition is an underlying cause of 45 percent of child deaths globally and developmental stunting of 22 percent of children under 2 years old. While causes of undernutrition are many and complex, poor WASH practices, such as open defecation and inadequate handwashing, are often contributing factors that may affect child undernutrition through four pathways:
- repeated episodes of diarrhea;
- frequent and intense digestive infections that reduce absorption of nutrients;
- poor gut health; and
- effects from significant time spent accessing water and sanitation.
USAID recommends four intervention strategies to maximize improvements to health and nutrition:
First, community-wide sanitation is more effective at reducing diarrhea than interventions that target individual households- a hypothesis called herd protection. It is important that approaches to improving area-wide sanitation are well-grounded in the local context, incorporating information about the local sanitation market, social norms, demand, and availability of sanitation products and services. Only targeting households with pregnant mothers and children under 2 years is not recommended.
Second, in most contexts, effective water quality management over the long term is most successful when managed by professional service providers as opposed to relying on user-intensive household water treatment. To bring water closer to households, programs should make incremental progress toward piped water services by professionalizing the delivery of water services, strengthening policies and government capacity, and supporting the creation of small piped networks in densely populated areas.
Third, future programs should address the structural barriers to changing behaviors around WASH services. using one or more of three approaches:
- ensure provision of convenient and consistent access to sufficient water supplies—when household water is scarce, hygiene is often the first activity to be neglected;
- promote the use of WASH products that are aspirational, practical, and durable; and
- understand the social norms, emotional drivers, and economic motivators associated with household adoption of WASH products and services. For example, a study in Benin found that privacy, safety, and prestige were top drivers for latrine adoption, while a study in Ghana found that convenience and cleanliness were top motivators.
Fourth, USAID implementing partners with research capacity are encouraged to establish which transmission pathways are most important and test promising interventions to reduce the risk of exposure to contaminants. The household environment remains highly contaminated from multiple sources, including animal feces. In many contexts solely implementing basic household sanitation may not be adequate to reduce exposure to contamination. There is limited evidence on household fecal-oral contamination interventions that successfully affect child health and nutrition outcomes. Since more research is needed, the technical brief does not recommend full-scale interventions related to these fecal-oral pathways.
USAID recognizes that WASH interventions are only part of the solution to achieve global nutrition targets. Interventions must address the multiple complex and context-specific determinants of malnutrition including climate change. Holistic investment in all these sectors is critical to achieving health, economic productivity, and poverty reduction.
Christine Chumbler is a communications professional with more than 20 years experience in writing, editing, and publications design. She has expertise in every stage of publication production, from concept and writing to editing, design, and printing. In the mid-1990s, she was a Peace Corps Volunteer in Malawi. This experience led to a career using her writing and editorial skills with international development and foreign policy organizations, many of which worked to directly support USAID’s efforts. She has worked in a freelance capacity full-time since May 2016. Chumbler has a Master’s in journalism from the University of Michigan and a Bachelor’s in environmental studies from the University of California, Santa Cruz.