Disparities in access to safe drinking water, sanitation, and hygiene by ethnicity in Bangladesh: Is it a result of structural racism?

Abstract

Introduction: Safe drinking water, sanitation, and hygiene (WASH) are crucial to human health. It is essential to reduce inequalities and ensure universal access to WASH to achieve the agenda of sustainable development. We aimed to measure access to WASH, understand the situation and factors affecting WASH practices among the ethnic minority population in Bangladesh, and whether it is related to structural racism towards them. Methodology: We utilized data from the multiple indicator cluster survey-2019. We used the chi-square test for bivariate analysis and multiple logistic regression analyses to identify the effect of ethnicity on WASH in Bangladesh after controlling education, wealth, religion, region, and place of residence. Furthermore, we systematically reviewed the WASH-related policies and programs of Bangladesh to identify structural racism. Findings: While 98.5% of Bengali had access to basic drinking water services, the percentage is 60.6% for the ethnic minority population. For improved sanitation facilities not shared with others, the difference between Bengali and ethnic populations was 22.3% (64.6% vs. 42.3%). On the other hand, 75% of the Bengali population had a handwashing facility with water and soap, and 50% of the ethnic population had them. Ethnicity appeared to be a statistically significant predictor of every component of WASH. Compared to Bengali, the ethnic population had 92%, 39%, 44%, and 18% less access to water (aOR=0.08, p≤0.001), sanitation (aOR=0.61, p≤0.001), and handwashing (aOR=0.56, p≤0.001), and WASH facilities aOR=0.82, p≤0.001), respectively. Among the policies of Bangladesh, only one identified actions for WASH rights of the ethnic, indicating structural inequality. Conclusion: Government should identify the issues of WASH among the ethnic minorities and represent them adequately in the policies for achieving the aim of ‘leaving none behind’ of sustainable development goals.