03318nas a2200289 4500000000100000008004100001260001600042653005700058100001600115700001200131700001200143700001600155700000900171700001200180700001900192700001600211700001000227700001500237700001300252700001400265245013600279856015300415300001100568490000800579520242700587022001403014 2023 d bElsevier BV10aPublic Health, Environmental and Occupational Health1 aDe Guzman K1 aStone G1 aYang AR1 aSchaffer KE1 aLo S1 aKojok R1 aKirkpatrick CR1 aDel Pozo AG1 aLe TT1 aDePledge L1 aFrost EL1 aKayser GL00aDrinking water and the implications for gender equity and empowerment: A systematic review of qualitative and quantitative evidence uhttps://www.sciencedirect.com/science/article/pii/S1438463922001274/pdfft?md5=d85adc28cec74dee209e7ac3f35364c2&pid=1-s2.0-S1438463922001274-main.pdf a1140440 v2473 a

Background

Safe drinking water is a fundamental human right, yet more than 785 million people do not have access to it. The burden of water management disproportionately falls on women and young girls, and they suffer the health, psychosocial, political, educational, and economic effects. While water conditions and disease outcomes have been widely studied, few studies have summarized the research on drinking water and implications for gender equity and empowerment (GEE).

Methods

A systematic review of primary literature published between 1980 and 2019 was conducted on drinking water exposures and management and the implications for GEE. Ten databases were utilized (EMBASE, PubMed, Web of Science, Cochrane, ProQuest, Campbell, the British Library for Development Studies, SSRN, 3ie International Initiative for Impact Evaluation, and clinicaltrials.gov). Drinking water studies with an all-female cohort or disaggregated findings according to gender were included.

Results

A total of 1280 studies were included. GEE outcomes were summarized in five areas: health, psychosocial stress, political power and decision-making, social-educational conditions, and economic and time-use conditions. Water quality exposures and implications for women's health dominated the literature reviewed. Women experienced higher rates of bladder cancer when exposed to arsenic, trihalomethanes, and chlorine in drinking water and higher rates of breast cancer due to arsenic, trichloroethylene, and disinfection byproducts in drinking water, compared to men. Women that were exposed to arsenic experienced higher incidence rates of anemia and adverse pregnancy outcomes compared to those that were not exposed. Water-related skin diseases were associated with increased levels of psychosocial stress and social ostracization among women. Women had fewer decision-making responsibilities, economic independence, and employment opportunities around water compared to men.

Conclusion

This systematic review confirms the interconnected nature of gender and WaSH outcomes. With growing attention directed towards gender equity and empowerment within WaSH, this analysis provides key insights to inform future research and policy.

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