PROTOCOL: What is the impact of complex WASH interventions on gender and social equality outcomes in low‐ and middle‐income countries? A mixed‐method systematic review protocol

Abstract

BACKGROUND 1.1 | The problem: Limited evaluation of social and gender equality outcomes of water, sanitation and hygiene interventions Safely managed water, sanitation and hygiene (WASH) services are viewed as fundamental for human wellbeing, enabling a range of positive outcomes related to health, education, livelihoods, dignity, safety, and gender equality. Progress in providing WASH services and thus achieving these outcomes has not occurred equally, with a range of inequalities in who can access and benefit from WASH services across varying socio-cultural contexts, geographical areas and socioeconomic settings. For instance, among the 785 million people who lack a basic drinking-water service, and 2 billion who lack access to basic sanitation services, a greater proportion are poor and living in rural areas (WHO/UNICEF JMP, 2019). Further, unsafely managed water and sanitation disproportionately impacts a number of social groups, including women, girls, and sexual and gender minorities, people with disabilities, people marginalised due to ethnicity, caste, poverty or other factors, and those living in vulnerable situations such as displaced people or people who are experiencing homelessness. As the COVID-19 pandemic disproportionately affects particular groups of people, it has the potential to exacerbate many of these existing WASH inequalities (Howard et al., 2020).Gender inequalities related to WASH are particularly large, as women and girls have specific needs related to biological factors, and experience strongly gendered norms surrounding water and sanitation, such as expectations of carrying out water fetching, caregiving and hygiene roles within the household (Caruso et al., 2015). In many countries where women and girls are responsible for water fetching this contributes to a substantial burden of musculoskeletal disease (Geere & Cortobius, 2017). Additionally, women and girls are more negatively impacted by a lack of private and safe sanitation facilities,

Systematic mapping of gender equality and social inclusion in WASH interventions: knowledge clusters and gaps

“…Detailed methodology is available in a previously published protocol. 24 However, no critical appraisal and data extraction was conducted in this review. We undertook a systematic mapping of the primary research studies instead.…”

“…A list of definitions of each outcome is available in online supplemental table S4 . The protocol 24 includes a detailed overview of all the theoretical assumptions used to build our theory of change, including definitions of inclusive and transformative approaches.…”

“…To take into account policy, research and practice needs and priorities as well as to increase potential policy uptake of review findings, 41 international stakeholders (including representatives from academia, funding agencies and non-governmental organisations working in WASH implementation) were engaged throughout the review process. Together with these stakeholders (first via two workshops, followed by a public consultation process), we co-created a theory of change that facilitated review scope definition and later led a metadata coding exercise (more details in the protocol 24 ). Moreover, stakeholders were shown preliminary review findings during a dedicated event at the World Water Week in Stockholm (August 2021, https://www.sei.org/events/world-water-week-evaluating-gender-and-social-equality-in-wash/ ) and asked for input on the clarity and relevance of the findings.…”

“…These can be seen as accommodating gender or other social differences as they do not explicitly seek to redress gender inequalities or social exclusion. Transformative outcomes explicitly focus on how power relations are challenged, and how stereotypes, harmful gender attitudes and social norms are changed to promote GESI,22 23 such as through increasing women’s meaningful participation in WASH decision-making processes (see the review protocol24 for more details).…”

Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis

“…Their distant-reading analysis of the 155 included articles, which focused only on assessment of titles and abstracts, revealed that few engaged with gender transformational-aspects of gender equality [39]. A mixed-method systematic review protocol outlines another study's planned aim and approach to synthesize evidence on gender and social equality outcomes that are specific to complex WASH interventions [43]. However, the two reviews that have been completed (Dery et al and MacArthur et al) have used methods that are limited in their scope and rigor, [44] and a need has remained for a more comprehensive synthesis of the evidence.…”