The Relationship between Access to Safe Water and Sanitation and Women’s Health in the Self-produced Settlements A Case Study of Mathare in Nairobi
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Abstract
Access to safe water and sanitation in self-produced settlements is a significant societal problem. Yet, there is a notable gap in understanding and evaluating the impact on women’s health, and how this intersects with public space. In Sub-Saharan Africa, nearly half of the urban population lives in self-produced settlements. These are complex environments that are continuously growing and are home to almost two-thirds of the population in cities such as Nairobi. Mathare, one of the largest self-produced settlements in Nairobi, exhibits notably poor health outcomes, with women experiencing diarrhoea at twice the average rate of Nairobi. In such a precarious context, the health of its inhabitants requires a specific approach.
This paper devises a multidimensional framework for analysing and evaluating the key spatial and socioeconomic factors affecting women’s health in these self-produced settlements. It connects women’s health and well-being to broader structural disadvantages, such as insecure tenure, poor housing conditions, low monthly income and a lack of access to basic services. This case study emphasizes the critical importance of access to safe water and sanitation. Women's daily routines often revolve around water, exposing them to heightened risks of waterborne diseases such as diarrhoea or typhoid fever. Moreover, many women can only access water and sanitation in public spaces in Mathare, where they are particularly vulnerable to violence. This research also concludes how these risks perpetuate a cycle of poverty and vulnerability among women in these communities and emphasises the critical importance of implementing multidisciplinary policies and tailored approaches to enhance the health and well-being of women living in self-produced settlements.
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References
Abad, J. (2020) Co-Production of the space. Case Study of Mukuru Special Planning Area. Master's thesis. Universidad Politécnica de Madrid.
African Population and Health Research Center (APHRC) (2014) Population and Health Dynamics in Nairobi’s Informal Settlements. Nairobi: African Population and Health Research Center.
Amnesty International (2009) Kenya: The Unseen Majority. Nairobi’s Two Million Slum-Dwellers. London: Amnesty International.
Anyamba, T.J.C. (2006) Diverse informalities: Spatial transformations in Nairobi. A study of Nairobi’s urban process. Oslo: Oslo School of Architecture and Design.
Anwar, N.H., Sawas, A. & Mustafa, D. (2020) ‘Without water, there is no life’: Negotiating everyday risks and gendered insecurities in Karachi’s informal settlements. Urban Studies, 57(6), pp.1320–1337. Available at: https://www.jstor.org/stable/26959510 [Accessed 30 June 2024].
Bird, J., Montebruno, P. & Regan, T. (2017) Life in a slum: Understanding living conditions in Nairobi’s slums across time and space. Oxford Review of Economic Policy, 33(3), pp.496-520. doi: 10.1093/oxrep/grx036.
Chant, S. (2013) Cities through a ‘gender lens’: A golden ‘urban age’ for women in the global south? Environment and Urbanization, 25, pp.9–29.
Corburn, J. & Hildebrand, C. (2015) Slum sanitation and the social determinants of women’s health in Nairobi, Kenya. Journal of Environmental and Public Health, 2015, pp.1-6. doi: 10.1155/2015/209505.
Corburn, J. & Karanja, I. (2016) Informal settlements and a relational view of health in Nairobi, Kenya: Sanitation, gender, and dignity. Health Promotion International, 31(2), pp.258-269. doi: 10.1093/heapro/dau100.
Corburn, J. & Riley, L. (2016) Slum Health: From the Cell to the Street. Oakland: University of California Press.
Corburn, J. & Sverdlik, A. (2017) Slum upgrading and health equity. International Journal of Environmental Research and Public Health, 14(4), pp.342. doi: 10.3390/ijerph14040342.
Country Economy (2012) Kenya—Minimum Wages 2012. Country Economy. Available at: https://countryeconomy.com/national-minimum-wage/kenya [Accessed 30 June 2024].
Darkey, D. & Kariuki, A. (2018) A study on quality of life in Mathare, Nairobi, Kenya. Department of Geography, Geoinformatics and Meteorology, University of Pretoria.
Dianati, K. et al. (2019) Household air pollution in Nairobi’s slums: A long-term policy evaluation using participatory system dynamics. Science of The Total Environment, 660, pp.1108-1134. doi: 10.1016/j.scitotenv.2018.12.430.
Dianova (2017) En Kenia, los retos y el potencial son tan grandes como en África. Dianova. Available at: https://www.dianova.org/es/advocacy-articles/en-kenia-los-retos-y-el-potencial-son-tan-grandes-como-africa/ [Accessed 30 June 2024].
Ezeh, A. et al. (2017) The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet, 389(10068), pp.547-558. doi: 10.1016/S0140-6736(16)31650-6.
FAWCO, n.d. What is life like for women and girls in Mathare? Federation of American Women's Clubs Overseas. Available at: https://www.fawco.org/global-issues/human-rights/human-rights-articles/4855-what-is-life-like-for-women-and-girls-in-mathare [Accessed 30 June 2024].
Harris, L.M. et al. (2017) Intersections of gender and water: Comparative approaches to everyday gendered negotiations of water access in underserved areas of Accra, Ghana, and Cape Town, South Africa. Journal of Gender Studies, 26(5), pp.561-582. doi: 10.1080/09589236.2016.1150819.
Harvey, D. (2008) The right to the city. New Left Review, (53), pp.23-40.
Heise, L., Ellsberg, M. & Gottmoeller, M. (2002) A global overview of gender-based violence. International Journal of Gynaecology and Obstetrics, 78, pp.S5-S14.
Sakketa, T.G. (2023) Urbanization and Social Cohesion: Theory and Empirical Evidence from Africa. IDOS. Available at: https://www.idos-research.de/fileadmin/migratedNewsAssets/Files/DP_16.2023.pdf [Accessed 30 June 2024].
International Labour Organization (ILO) (2015) Recommendation No. 204. ILO. Available at: https://normlex.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:12100:0::NO::P12100_INSTRUMENT_ID,P12100_LANG_CODE:3243110,es [Accessed 30 June 2024].
Kamau, N. & Njiru, H. (2018) Water, sanitation, and hygiene situation in Kenya’s urban slums. Journal of Health Care for the Poor and Underserved, 29(1), pp.321-336. doi: 10.1353/hpu.2018.0022.
Kenya National Bureau of Statistics (KNBS) (2015) Kenya Demographic Health Survey 2014. Nairobi: KNBS.
Kenya National Bureau of Statistics (KNBS) (2019) 2019 Kenya Population and Housing Census: Volume I: Population by County and Sub-County. Nairobi: KNBS.
Kinyanjui, M.N. (2014) Women and the Informal Economy in Urban Africa: From the Margins to the Centre. London: Zed Books.
Matamanda, A.R., Mphambukeli, T.N. & Chirisa, I. (2024) Exploring water-gender-health nexus in human settlements in Hopley, Harare. Cities & Health, 8(1), pp.44-58. doi: 10.1080/23748834.2022.2136557.
Ministerio de Sanidad (2020) Indicadores de Salud 2020: Evolución de los indicadores del estado de salud en España y su magnitud en el contexto de la Unión Europea. Madrid: Ministerio de Sanidad. Available at: https://www.sanidad.gob.es/estadEstudios/estadisticas/inforRecopilaciones/docs/Indicadores_de_Salud_2020.pdf [Accessed 30 June 2024].
Ministry of Health (2014) Kenya Health Policy 2014-2030: Towards Attaining the Highest Standard of Health. Nairobi: Ministry of Health. Available at: https://www.ncikenya.or.ke/documents/kenya-health-policy.pdf [Accessed 30 August 2024].
Mitullah, W, (2003) Urban slums reports: The case of Nairobi, Kenya.
Miraftab, F. (2009) Insurgent planning: Situating radical planning in the global south. Planning Theory, 8(1), pp.32-50.
Muugano Support Trust (MuST) (2011) Slum Dwellers International, University of Nairobi, & University of California, Berkeley: Mathare Valley Collaborative Upgrading Plan. Nairobi.
Mwau, B. (2020) Urban transformation and informal shelter actors, interests and change in Mathare Valley: City Briefing. IIED.
Nuissl, H. & Heinrichs, D., 2013. Slums: Perspectives on the definition, the appraisal, and the management of an urban phenomenon. Journal of the Geographical Society of Berlin, pp.105-106.
Organización Panamericana de la Salud, 2018. Indicadores de salud: Aspectos conceptuales y operativos. Washington, D.C.: OPS.
Obermayr, C., 2017. Informal housing and marginal settlements. In: Sustainable City Management. The Urban Book Series. Springer. doi: 10.1007/978-3-319-49418-0_3.
Population Matters (2024) Urbanisation challenges in Kenya's Nairobi: A tangled web of issues. Population Matters. Available at: https://populationmatters.org/news/2024/01/urbanisation-challenges-in-kenyas-nairobi-a-tangled-web-of-issues/. (Accessed 30 June 2024)
Ren, H., Guo, W., Zhang, Z., Kisovi, L.M. and Das, P. (2020) 'Population Density and Spatial Patterns of Informal Settlements in Nairobi, Kenya', Sustainability, 12(18), p. 7717. doi: 10.3390/su12187717.
Roy, A. (2011) Slumdog cities: Rethinking subaltern urbanism. New Delhi: Aakar Books.
Sphera Association (2018) Sphera Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response (4th edn). Geneva, Switzerland: The Sphere Project. doi: 10.3362/9781908176226.
Statista (2022) 'Informal sector employment in Kenya by activity', Statista. Available at: https://www.statista.com/statistics/1134287/informal-sector-employment-in-kenya-by-activity/. (Accessed: 30 June 2024)
Sultana, F. (2020) 'Embodied intersectionalities of urban citizenship: Water, infrastructure, and gender in the Global South', Annals of the American Association of Geographers, 110(5), pp. 1407-1424. doi: 10.1080/24694452.2020.1715193.
The New Humanitarian (no date) 'Kenya’s waste management challenge', The New Humanitarian. Available at: https://www.thenewhumanitarian.org/report/97638/kenya%E2%80%99s-waste-management-challenge. (Accessed: 30 June 2024)
UN Habitat (2007) UN HABITAT and the Kenya Slum Upgrading Programme. Available at: https://unhabitat.org/sites/default/files/download-managerfiles/UNHABITAT%20and%20the%20Kenya%20Slum%20Upgrading%20Programme%20%28KENSUP%29.pdf. (Accessed: 30 June 2024).
UN Habitat (2016) Participatory Slum Upgrading Programme Fund. Available at: https://unhabitat.org/participatory-slum-upgrading-programme-fund#:~:text=The%20bottom%20line%20is%20that,40%25%20of%20the%20world%20population. (Accessed: 30 June 2024).
United Nations (2015) Transforming our world: The 2030 Agenda for Sustainable Development, Resolution adopted by the General Assembly on 25 September 2015. A/RES/70/1. Available at: https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf. (Accessed: 30 June 2024).
United Nations (2022) 'Specific country data, Kenya', Human Development Reports. Available at: https://hdr.undp.org/data-center/specific-country-data (Accessed: 30 June 2024).
UNAIDS (2020) Global and regional data. UNAIDS Data 2020. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS).
UN-Habitat (2003) The challenge of slums: Global report on human settlements. London: Earthscan Publications.
UN-Habitat (2006) UN Habitat State of the world’s cities. London: UN Habitat.
UN-Habitat (2020) Informal settlements’ vulnerability mapping in Kenya: The case of Mathare.
UN Water (2019) UN World Water Development Report 2019: ‘Leaving no one behind’. Available at: https://www.unwater.org/world-water-development-report-2019-leaving-no-onebehind/#:~:text=In%20Sub-Saharan%20Africa%2C%20only,the%20rich%20and%20the%20poor. (Accessed: 30 June 2024).
UN-Habitat (2007) UN HABITAT and Kenya Slum Upgrading Programme (KENSUP). Available at: https://unhabitat.org/un-habitat-and-kenya-slum-upgrading-programme-kensup. (Accessed: 30 June 2024).
Vecino, E. (2020) Maji na mbegu (agua y semillas). Trabajo Final de Máster, Universidad Politécnica de Valencia.
Water and Sanitation Program (WSP) (2012) Economic Impacts of Poor Sanitation in Africa.
West, B.S., Hirsch, J.S. and El-Sadr, W. (2013) 'HIV and H2O: Tracing the Connections Between Gender, Water and HIV', AIDS and Behavior, 17(5), pp. 1675-1682. doi: 10.1007/s10461-012-0219-9.
World Health Organization (2010) Hidden cities: Unmasking and overcoming health inequities in urban settings. Available at: https://apps.who.int/iris/handle/10665/44439 (Accessed: 30 June 2024).
World Population Review (no date) 'Nairobi population 2024', World Population Review. Available at: https://worldpopulationreview.com/world-cities/nairobi-population. (Accessed: 30 June 2024).
Winter, S., Barchi, F. and Dzombo, M.N. (2018) 'Drivers of women’s sanitation practices in informal settlements in sub-Saharan Africa: A qualitative study in Mathare Valley, Kenya', International Journal of Environmental Health Research, 28(6), pp. 609-625. doi: 10.1080/09603123.2018.1497778.
Yiftachel, O. and Mammon, N. (eds.) (2022) theoriSE: Debating the southeastern turn in urban theories. Cape Town: African Centre for Cities.