Inga T. Winkler & JoAnn Kamuf Ward

The United States—and many other wealthy nations—are facing an invisible but profound crisis of sanitation coverage that disproportionately affects poor and rural communities.

The United States has adopted a Water for the World Act and a Global Water Strategy. Together they recognize the importance of Water, Sanitation and Hygiene (WASH) and prioritize resources for countries including Ethiopia, Haiti, and Indonesia. Unfortunately, these policies reflect US exceptionalism par excellence: the long standing (and long discredited) idea that socio-economic rights, while relevant in other parts of the world, have little place shaping policy in the United States. Though the stated goal is to “leave no one behind” these programs have no domestic complement. By failing to meet the needs of its own residents, the US is entrenching the marginalization of disadvantaged communities. This reflects a broader global context in which water and sanitation are predominantly envisaged as concerns in the global South. This is a false premise that unfortunately leads decision-makers, engineers, and funders to ignore the lack of adequate sanitation and wastewater that spans the global North, including in Sweden, Canada, and Slovenia, among other countries.

The US is generally assumed to have universal sanitation coverage but is actually facing an invisible yet profound crisis. In 2017, the American Society of Civil Engineers gave the United States a D+ grade for its national wastewater infrastructure. While there is no accurate and comprehensive data, a recent studyestimates that 540,000 households lack complete plumbing. As a result, many individuals endure chronic exposure to feces, environmental contamination, and diseases such as hookworm.

It is true that most people across the United States have the privilege to flush and forget. However, inadequate, failing, and non-existent sanitation infrastructure plague many rural households. Communities marginalized on the basis of socio-economic, racial, ethnic, and indigenous identity bear a disproportionate burden. Sewage and feces flow into backyards and back up into living rooms. At a recent briefing in the US Congress, California resident Ralph Pierro II explained how residents in the community of Weedpatch have resorted to filling plastic bags with their feces rather than using their toilets because the ground becomes boggy due to failing systems.

The outcome is a picture of extreme inequalities in the enjoyment of the right to sanitation. At the briefing, Nina McCoy explained that in Martin County, Kentucky, poor system design and installation leaves an entire community behind. A flawed sewage system has hooked up only 20% of the homes and this small number of users cannot afford to sustain the system, let alone address the initial design flaws. Deep disparities often exist in close proximity. National census data from 1990 indicates that in Lowndes County, Alabama, 10.5% of black households lacked full plumbing while only 0.4% of white households did. Comprehensive data has not been collected more recently.

These are not isolated instances. As our recent report Flushed and Forgottendocuments, the sanitation crisis is nation-wide. The report provides snapshots of disparities in Alabama, Alaska, California, Kentucky, Louisiana, Michigan, Mississippi, the Navajo Nation, North Carolina, Ohio, Texas, Virginia, West Virginia, and Puerto Rico—and it is just scratching the surface. Similar circumstances exist in Florida, New York, and Minnesota.

Yet, all too often discussions of the sanitation crisis focus solely on the global South, as is evident in the Water for the World Act. When discussions elide the reality that the problem is universal, they reinforce a false perception separating the global North and global South. The conditions in Weedpatch, California, bear striking similarity to the infamous “flying toilets” of Kibera. And when these are characterized as “global South conditions”, we fail to acknowledge the avoidable, inexcusable, deep-seated inequalities in the global North. The US has the resources to improve wastewater infrastructure, but at present neglect and disinvestment are the defining features of the domestic approach, coupled with deliberate exclusion. These are, in fact, global North conditions.

In rural communities, on-site systems are common—and often costly. Yet, state and local laws place the financial burden of wastewater solutions on those most in need. When residents cannot afford these systems, they resort to straight-piping—makeshift channels that run sewage from homes to yards and ditches. Because straight-piping does not comply with regulations, homeowners often face fees, fines, and even criminal penalties, compounding cycles of poverty and marginalization and fueling distrust in public authorities.

Calls to improve WASH often elicit the response that it is too much to take on, followed by the question “can we really afford to provide sanitation services for everyone?” The question we ask is how can we afford not to? The human, environmental, and health impacts of inadequate sanitation have tremendous costs—in lives and in dollars. As one of the wealthiest countries in the world, the United States has the resources and the capacity to address this crisis. Political will has long been lacking, but there are some recent glimmers of hope. National leaders have begun to acknowledge the crisis and target federal funding for small systems to address the need in rural communities. This is necessary, but insufficient for the structural change required to eradicate the sanitation crisis.
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While the US presidential administration disengages from the international human rights arena, civil society groups, elected officials, and companies increasingly recognize the human right to sanitation. Operationalizing this right will require a paradigm shift, which upends the notion that individuals should bear sole responsibility and holds government accountable to human rights standards. A new approach requires:

• Prioritizing the needs of disadvantaged communities to mitigate inequalities that result from discrimination or neglect.
• Placing communities long on the periphery of decision-making in the center of addressing persistent challenges and acknowledging their expertise.
• Centering affordability in sanitation law, policy, and technology. This includes eliminating policies that place the financial burden for systems on individuals without the ability to pay and penalizes them when systems are inadequate.
• Shaping government institutions that are accountable and transparent and see it as their mission to support access to sanitation for all—just as the US does around the world.

The human rights framework focuses on eliminating the underlying structural causes of sanitation and wastewater failures. While soil conditions, geography, and infrastructure play an obvious role in access to sanitation, the most significant barrier is the lack of political will. The Water for the World Act emphasizes “The United States should be a global leader in helping provide sustainable access to clean water and sanitation for the world’s most vulnerable populations.” We could not agree more. It is time to lead by example with a strategy that addresses the needs of marginalized communities throughout the US.

This post was originally published on openGlobalRights on June 26, 2019.

Sydney Amoakoh & Inga T. Winkler

If 2015 was the year the period went public, 2018 was the year menstruation won its spotlight at the United Nations. From the Commission on the Status of Women to the High Level Political Forum and the Human Rights Council, menstruation has become part and parcel of conversations between delegates, resolutions and outcome documents that address the importance of menstrual health and its impact on development and human rights.
Now we need to ask ourselves – how can we seize on this current momentum to ensure that menstrual health is comprehensively integrated into the human rights and sustainable development agendas of 2019? How can we turn the momentum into a movement? What needs to come next?

Read the full post on Impakter.com

Have you recently heard someone speak about menstruation or menstrual health? As in speaking about menstruation publicly, not a whisper asking a friend for a tampon? The chances are better than ever. Cosmopolitan labelled 2015 as the year in which the period went public. And Newsweek proclaimed in 2016 that the fight to end period shaming is going mainstream. More and more people feel comfortable speaking about menstruation thanks to advocates such as Jennifer Weiss-Wolf bringing the issue to the forefront.

Today, on May 28, is as good as ever to do so. It is Menstrual Hygiene Day, a global day for awareness raising and advocacy. Menstrual health is fundamentally about (sexual) health and gender equality, and has close links to education, work and a host of other human rights. Recognizing the importance of this fundamental, everyday, but previously largely invisible issue, countries all over the world are making progress on menstrual health, and so is the United States.

In most states in the US, feminine hygiene products are subject to standard sales tax rather than being exempt as many other items that cover basic daily necessities such as many groceries. During an interview with Ingrid Nilsen, former President Barack Obama explained that he does not understand why states tax sanitary products as luxury items and continued: “I suspect it’s because men were making the laws when those taxes were passed.”

Assembly members in several states have started to address the tampon tax. "Basically we are being taxed for being women. […] You can't just ignore your period, it's not like you can just ignore the constant flow," Cristina Garcia, an assemblywoman in California, explained.  While the efforts in California have not (yet) been successful, New York , Connecticut and Illinois recently de-taxed menstrual products and similar efforts are underway in many other states.

However, putting an end to the tampon tax is just the tip of the iceberg. It is an important step that states can (and should) take which ensures great visibility. Still, de-taxing menstrual products does not ensure that they are affordable to all. And a human rights perspective on menstrual health goes far beyond this. One advantage of the human rights framework is that it draws attention to intersectional discrimination based on gender, race, ethnicity, disability, socio-economic status and other factors. Homeless women face particular challenges on the days they menstruate, experiencing difficulties in ensuring hygiene often due to a lack of menstrual products in shelters. Women in detention face a scarcity of menstrual products, in many instances having to request products which often results in humiliation. Transgender men, intersex and gender non-conforming persons are often overlooked in the discussion on menstrual equity.

New York City recently passed a package of legislation spearheaded by Julissa Ferreras-Copeland that seeks to guarantee access to menstrual products to all female inmates, all persons residing in city shelters and all students in public schools. Mayor de Blasio stated: “There should be no stigma around something as fundamental as menstruation. […] Students should be able to concentrate on their studies, New Yorkers in shelter should be able to focus on rebuilding their lives, and women in our Correction Department should be able to work toward rehabilitation and release without the indignity of inadequate access to tampons and pads. As a father, husband and feminist, I am proud to sign these bills into law.”
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While a lot remains to be done, these measures are promising steps in the right direction to ensure menstrual health and dignity for every person who menstruates.

This piece was originally published on 28 May 2017 on the Human Rights At Home Blog.

Hà Lê Phan & Inga T. Winkler

When it comes to LGBTIQ rights, bathroom politics reflect and are often linked to much broader questions of inequality and empowerment.

Societal attitudes on the rights of LGBTIQ persons are progressing in countries around the world. From marriage equality in the US to the recognition of a third gender in Nepalese passports, we have witnessed many steps towards more liberal and inclusive societies. At the international level, the UN Human Rights Council recently appointed an Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity (SOGI Expert). Vitit Muntarbhorn, an international human rights expert and professor at Chulalongkorn University in Bangkok, is going to monitor and promote the realization of human rights of LGBTIQ individuals. 

However, any progress seems to be accompanied by backlash. A group of states in the UN General Assembly contested the legitimacy of the SOGI mandate and sought to postpone it indefinitely. The vote in the GA’s Third Committee on November 21 upheld the mandate, but it took enormous civil society mobilization to achieve this, and the vote was extremely close (84 to 77 with 17 abstentions). This conflict reveals the extent of the controversy and divide among states—the battles on LGBTIQ rights are far from won.

Among the many experiences of discrimination against LGBTIQ individuals, one relates to an everyday need as basic as sanitation. While access to sanitation might seem minor when compared to questions of legal recognition and violence against LGBTIQ individuals, bathroom politics reflect and are often linked to broader questions. 

Toilets remain one of the spheres where gender roles, gender binarism and sex segregation remain widely unchallenged, and users are presented with the option of male or female? Ladies or gents? Urinal or stall? But not everyone has this choice. 

In March 2016, the State of North Carolina adopted a law known as “House Bill 2”, which has generated a heated debate on transgender rights in the US and led to boycotts of the state by businesses, sports organizations and celebrities. The bill aims at determining access to public bathrooms based on a person’s biological sex as stated in their birth certificate. This means that a transgender woman might be required to use the men’s room, whereas a transgender man might find himself relegated to the women’s room.

LGBTIQ civil society organizations have denounced the discriminatory effect of the bill on individuals whose gender identity does not correspond to their sex assigned at birth. The bathroom bill stigmatizes transgender people and complying with the law renders them vulnerable to harassment, assault and abuse in bathrooms. By disregarding the personal security of transgender persons, the bill excludes them from access to safe sanitation. While the bathroom bill was adopted under the pretext of protecting women and girls’ security based on irrational fears of assaults in public facilities, in fact, it is transgender persons who are those most likely to experience violence in restrooms, as powerfully illustrated in a recent report to the UN Human Rights Council. 

On October 28, the US Supreme Court announced that it would review the case of Gavin Grimm, a 16-year-old transgender student who was excluded from the boys’ restrooms at his school in Virginia. In August, the Gloucester County School Board appealed a decision by a Court of Appeals, which sided with Gavin Grimm and requested the school grant the student access to the boys’ bathroom. After a series of differing judgements handed down by other US courts on transgender bathrooms, the Supreme Court’s decision in Gavin Grimm’s case will likely set a nationwide precedent. The Court will have to determine whether Title IX of the US Education Amendments of 1972 banning sex discrimination includes the prohibition of discrimination based on gender identity, as argued by the Obama administration in a comprehensive guidance letter to state-sponsored educational institutions in May 2016. The incoming US administration and expected appointment of a conservative leaning Supreme Court candidate to replace Justice Scalia cast doubt as to whether this progressive interpretation will be upheld.

At the same time, all-gender bathrooms will be introduced in public buildings in California as of March 1, 2017 based on Assembly Bill 1732. Gender-neutral facilities might redress some of the existing inequalities, but by themselves they will not be the end of the road towards adequate access to sanitation for everyone. Many transgender individuals prefer using the (binary) restrooms that correspond to their gender identity, highlighting the need for participation of those most concerned in deciding what measures to take. 

At the international level, different human rights bodies have provided guidance on access to toilets and the right to sanitation for all persons, including LGBTIQ. The UN General Assembly has recognized that “the human right to sanitation entitles everyone, without discrimination, to have physical and affordable access to sanitation, in all spheres of life, that is safe, hygienic, secure, socially and culturally acceptable and that provides privacy and ensures dignity.” For transgender persons, access to an acceptable sanitation facility that ensures dignity requires being able to make a choice according to one’s gender identity. Ensuring dignity is of even greater need where “the use of public bathrooms, which are often sex-segregated, has been associated with exclusion, denial of access, verbal harassment, physical abuse and sometimes even the arrest of transgender and intersex individuals.” In her report on stigma, the UN Special Rapporteur on the Human Rights to Water and Sanitation called on states to address socially entrenched stigma as a root cause of discrimination, including through the revision or amendment of laws perpetuating stigma, as is the case with the North Carolina bathroom bill. 

Of course, bathroom politics represent but a fraction of the broader struggle for LGBTIQ rights. The deprivation of something as basic as sanitation is just a symptom of the underlying structural forms and causes of discrimination and marginalization. However, precisely because toilets affect all of us daily, they become a powerful tool to galvanize public attention. Intervening in discriminatory toilet politics can open up further avenues for overall societal change. 

Gender identity-based discrimination must be understood and addressed in conjunction with other intersecting forms of disempowerment that tend to be relegated and rendered invisible. Only by acknowledging and addressing structures of exclusion and marginalization that pervade our societies along the lines of race, class, gender and disabilities can we achieve transformative change towards inclusive societies. Given the recent surge of hate crimes against minorities after the Brexit vote and the US elections, we must speak out even more forcefully against all intersecting forms of discrimination.

​This post was originally published on openGlobalRights on December 2, 2016.

The stigmatization and “othering” we’ve seen in Trump’s campaign will perpetuate systemic inequalities.

Without downplaying the potential impact of a Trump presidency on foreign policy, renewed acceptance of torture as well as the potential impact on climate change, I fear for society at large. A president-elect who ridicules and denigrates migrants, Muslims, Hispanics, women, persons with disabilities and others sets an example. He gives the impression that such behavior and such attitudes are acceptable. His remarks promote ideas of the superiority of some and inferiority of others, based on a socially constructed divide between “us” and “them”.

There is nothing new about racism, sexism and fear of the “other” in US society. It is deeply entrenched. What is new is that the man elected to the highest office institutionalizes and formalizes such attitudes. He legitimizes “othering” and stigmatization. One of the possible explanations for the misleading polls is that voters who declared they were undecided were in fact planning to vote for Trump. They might have felt it was socially unacceptable due to societal norms that condemn xenophobia and misogyny. That “discomfort” is now gone—xenophobia and misogyny have gained more formal and societal acceptance.

We already witness how these attitudes are being acted upon in anti-Muslim, anti-Semitic and racist assaults and attacks. Trump’s half-hearted attemptcalling for a stop of such attacks means nothing when at the same time he appointed Steve Bannon, a white supremacist, as chief strategist in the White House.

International human rights law addresses the link between discrimination and prejudices, stereotyping and stigmatization. The Convention on the Elimination of Discrimination against Women calls for appropriate measures to “achiev[e] the elimination of prejudices and customary and all other practices which are based on the idea of the inferiority or the superiority of either of the sexes or on stereotyped roles for men and women.” The Convention against Racial Discrimination and the Convention on the Rights of Persons with Disabilities contain similar provisions.

However, these norms do not get the necessary attention in the context of human rights advocacy. We need to devote much more attention to the role stigmatization and “othering” plays in perpetuating discrimination and human rights violations—not just in obvious ways but also in hidden and subtle prejudices. Human rights reach into society and even into the private sphere. Stigmatization and “othering” provide a rationale and antecedent to discrimination. They are often insidious and not directly visible, but they produce and perpetuate systemic inequalities. Human rights advocates and scholars have started to pay more attention to these processes, and this is now more urgent than ever.

This needs to happen at all levels, from the inter-personal and local to the use of international mechanisms. To me, it is not about domestic vs. internationalmechanisms as debated between Hopgood and Sikkink, but about using all the tools we have depending on the context.

Human rights in the private sphere start by addressing racist and other degrading comments in our personal relationships, whether in face-to-face conversations or on social media. It starts by responding to harassment we witness in public spaces. It includes responding to media outlets that spread prejudices and stereotypes. In particular, we need to identify and point out how institutionalized, societal and “everyday” racism, misogyny, xenophobia and other forms of stigmatization reinforce each other. International human rights bodies can play an important role in this regard by making the above mentioned norms more concrete and applying them to particular situations. We need to acknowledge the new realities, but we must not accept them as the new normal.

We also need to realize that although the result of the election is new, the realities of many people who voted for Trump are not. The fact that hardly anyone of the liberal elite expected this result shows how deep the divide is. People who perceived voting for Donald Trump as the best choice, as a result—even if not voting for him because he is racist—are condoning his racism. At the same time, Trump voters—as everyone else—have multiple, intersecting identities that a party system with only two choices may fail to represent.

Racism—and condoning racism—is deeply deplorable. But dismissing an entire demographic as “deplorable”, or using deeply derogatory terms such as “white trash” or slightly more subtle terms pointing to the insignificance of vast regions such as “flyover country”, is also stigmatizing. Such behavior also fails to offer an alternative to the fear of the “other” and scapegoating. Acknowledging and addressing that white communities feel left behind, alienated and disaffected, and seeking to understand their motivations does not mean taking racism, xenophobia and misogyny any less seriously. It means that we leave our bubble and start working on addressing the causes that may lead people to vote for a populist. Above all, this must include policy responses that address very real inequalities and disadvantages. I agree with Moyn that human rights do not have all the answers for addressing inequalities. However, human rights understood in a comprehensive way that encompasses substantive equality and socioeconomic rights can go a long way in doing so.
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At the same time, a focus on addressing economic inequalities falls too short. Commentators have suggested that middle and upper class white voters were significant in Trump’s election and that resistance to social and demographic change had a substantial influence on their votes. This makes resistance to any form of intolerance, stigmatization and hatred all the more important. When we can no longer count on the president of the United States to call out racism, sexism and other forms of hatred, it is upon all of us to do just this to a much larger extent. A “rape culture” on US college campuses is not acceptable despite the president-elect’s comments on sexual assault. Nor can we tolerate suspecting people of crimes because of their race or ethnicity. Racism and other forms of hatred against certain groups are violations of human rights in themselves, and lead to further human rights violations. In a way, the fact that there is nothing subtle and invisible anymore about racism and sexism makes it easier to call it out. We must not be silent. We will not be silent.

This piece was originally published on 24 November 2016 on openGlobalRights.

Archana Patkar, Rockaya Aidara and Inga Winkler

Menstruation and menstrual hygiene are emerging as pivotal issues for gender equality, human rights and development.

In many parts of the world, menstruation tends to be taboo, surrounded by silence and shrouded in myths. Yet, menstruation and menstrual hygiene are emerging as pivotal issues for gender equality, human rights and development. Indeed, menstruation perpetuates humanity and should be celebrated todayand every day, rather than hidden behind shame and disgust. 

In 2012, the Water Supply and Sanitation Collaborative Council (WSSCC) spoke to 12,000 women and girls in five states of India over 56 days during the Nirmal Bharat Yatra, which was a massive national campaign around sanitation and hygiene. We created a safe space to talk about menstruation and the response was tremendous: women and girls gathered in large numbers with mothers, grandmothers, sisters and friends to discuss, share and ask the most intimate of questions. They tested simple training and communication tools and partnered in developing methodologies to break the silence and create safe menstrual hygiene management conditions together.

In 2014 WSSCC took this approach to West Africa and launched the Joint Programme ‘’Gender, Hygiene and Sanitation” with UN-Women. The programme undertook a series of studies aimed at breaking the silence on menstruation and menstrual hygiene in the region.

One of the most significant barriers for women is the social restrictions, beliefs and myths that influence the management of menstruation. The studies’ findings echo the silence and concerns from many countries around the world. A first—and very critical—problem is limited or incorrect knowledge and information. Many girls do not understand what is happening when they start menstruating and have limited knowledge on biological processes. As one girl in Cameroon explained: “My periods started when I was in the field with my mother. Since I was ashamed I didn’t say anything to her… when my mother realized that it was my period, she discreetly took me into her bedroom and took out a sanitary cloth and explained to me how to wear it. She also told me not to greet any boys anymore, because if I did I would fall pregnant straight away.” 
Due to a lack of facilities at school, at work and in public spaces, women often prefer to manage menstruation at home, meaning they are unable to participate in cultural, educational, social and income-generating activities. Poor practices and unsafe materials compound this problem. In addition, many women and girls lack access to safe and hygienic materials. They report drying menstrual cloths in private and dark locations, which does not guarantee the elimination of germs. In fact, inadequate cleaning and drying of materials is a major cause of infection. Where women use disposable materials, they usually dispose of used materials into toilets and latrines that cannot handle this waste, leading to clogging, overflowing and pollution.

One of the most significant barriers for women is the social restrictions, beliefs and myths that influence the management of menstruation and, as a result, affect the daily lives of women and girls. When menstruating, women and girls are subjected to various religious, food-related, domestic or sexual prohibitions, which often lead to further isolation or stigmatization. Finally, perceptions of menstruation affect how many cultures perceive girls. Starting to menstruate is often viewed as a sign of maturity, meaning girls have reached a potentially marriageable age. Yet early marriage significantly increases the risk of child pregnancy, repeated pregnancy without adequate birth spacing, and complications such as obstetric fistula.

Despite the veil of secrecy shrouding menstruation, menstrual hygiene management provides a powerful entry point to empower women and girls, dispel myths, change practices and remove restrictions. In fact, all participants in our studies were eager to discuss menstruation. They asked a wide range of questions about sexual and reproductive health and early pregnancy, highlighting the need for comprehensive sexuality education. It is especially imperative that adolescent girls be able to access correct, basic information before they have their first period. 

At the same time, WSSCC has witnessed great openness among policy-makers to address menstrual hygiene once they become aware of the broad implications it has for women’s and girls’ lives and see the urgent need to address it. For example, last year the Government of Senegal signed a memorandum of understanding to improve women’s and girls’ rights to water and sanitation. The agreement is an integral part of the Ministry of Water and Sanitation’s aim to include the issue of menstrual hygiene management in the updated national sanitation policy. 

To achieve such broad change, WSSCC calls on national and local governments to articulate clearly the need for menstrual management in policies. Policy reforms need to be bolstered by dedicated budgets and resources for policy implementation, as well as capacity development in institutions. This should include programme implementation officials working in the WASH, education, health and environment sectors. WSSCC will continue to support trainings on menstrual hygiene and develop capacity for outreach and awareness campaigns to demystify menstruation among women and men. It is essential to raise awareness among religious, community and other leaders to support the participation of women and girls in decision that concerns their lives, and it is also important to work with women and men as well as girls and boys.

While some people are still reluctant to discuss it, menstrual hygiene has proven to be a powerful entry point to raise broader issues around gender equality and women’s and girls’ empowerment, including challenging issues such as sexuality education, sexual and reproductive health and rights, child marriage, fistula and female genital mutilation. With this in mind, countries must aim to eliminate all forms of discrimination against women, including discrimination based on social norms surrounding menstruation that harm the physical integrity and human rights of women and girls. Menstruation is a sign of female health and vitality and can no more be shrouded in fear, shame or embarrassment. Breaking the silence around menstruation is essential for women and girls to be able to reach their full potential.

This piece was originally published on 27 May 2016 on openGlobalRights.

Inga Winkler and Virginia Roaf

Much effort has gone into elaborating the Sustainable Development Goals (SDGs), and the human rights community has made significant strides in integrating human rights into the goals. The human right to safe drinking water and sanitation is explicitly mentioned in “Transforming Our World: The 2030 Agenda for Sustainable Development” but more importantly the SDGs address substantive human rights concerns.

SDG 6 on water, sanitation and hygiene holds significant promise and addresses many of the shortcomings of the former Millennium Development Goals (MDGs). Whereas the MDG target called for halving the proportion of people without access to water and sanitation, the new SDG 6 requires achieving universal access.

SDG 6 and its suggested indicators also reflect human rights criteria to a greater extent. The experience of the MDGs has shown that the devil is often in the detail, namely the indicators that are used to monitor progress towards the targets. The indicators for the MDGs were heavily criticized for not monitoring water quality, even though the target called for access to safe drinking water. In comparison, the SDG targets refer to safe water and adequate sanitation, and the WHO and UNICEF Joint Monitoring Programme for Water Supply and Sanitation (the body responsible for monitoring progress towards the targets) suggests monitoring whether water and sanitation are “safely managed.” Moreover, whereas the MDGs did not address the disposal, management and treatment of wastewater, SDG 6.3 now explicitly focuses on reducing pollution and treating wastewater. Finally, the water target (but not the one on sanitation and hygiene) also calls for affordable services, but it has to be acknowledged that developing robust indicators for monitoring progress on affordability is complex and unresolved.

The greatest challenge remains addressing inequalities in access to water and sanitation. Equality has been identified as the biggest blind spot of the MDGs due to their focus on average attainments. Disadvantaged individuals and groups, including ethnic minorities, persons with disabilities, and people living in informal settlements have not benefitted from gaining access to water and sanitation to the same extent as others. The last few decades have shown that there is no trickle-down effect. The most marginalized and disadvantaged in society continue to lose out; inequalities persist and grow.

The SDGs, in recognizing the shortcomings of the MDGs, attempt to tackle entrenched inequalities, by creating specific goals to achieve gender equality (SDG 5), and reduce inequality within and among countries (SDG 10). SDG 6 on water and sanitation focuses on ‘equitable’ access to water and sanitation, with women, girls and those living in vulnerable situations singled out for special attention in target 6.2.

However, to ensure that SDG 10 on equality is not just window-dressing and to keep it as a cross-cutting concern, equality must permeate all policy fields. The institutions responsible for implementing the SDGs must not be tempted to start with the ‘low-hanging fruit’ to achieve quick ‘progress’, and leave those who are living in vulnerable situations, the marginalized individuals and groups, and women and girls to wait their turn. Addressing the human rights of people who have been left behind for too long must take immediate priority. Real progress is progress that reaches the most disadvantaged people—in this case, those who experience discrimination and inequalities in access to water and sanitation.

To ensure accountability for eliminating these inequalities, it will be essential to strengthen the monitoring of inequalities through a combined reading of SDG 6 and SDG 10 on equality. One way to bring these goals together is at the technical level through indicators. Target 10.2 is, ‘By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status’. This is a rather broad target and the relevant indicator must ensure that inclusion is monitored from the outset. One proposal for an indicator to capture the elimination of inequalities as a cross-cutting concern is to ‘measure the progressive reduction of inequality gaps over time, disaggregated by groups […] for selected social, economic, political and environmental SDG targets’.5 The disaggregation by groups needs to relate to different factors such as ethnicity, language, religion, caste, gender, age, disability, nationality, place of residence, and others.

If we are to take the rhetoric of ‘leave no-one behind’ seriously, then monitoring the reduction and elimination of inequalities is imperative. Unless we start to identify who does not have access to water and sanitation, why certain groups of people often face systemic exclusion, and how the difficulties and bottlenecks can be overcome, the promise of equality will once again be an empty promise.

Disaggregating data, monitoring the progressive reduction of inequalities and truly understanding equality as a cross-cutting concern is complex —but it is certainly feasible. For the water, sanitation and hygiene sector, there have long been efforts to improve the monitoring on inequalities. This has included monitoring rural vs. urban disparities in access, analysis according to different levels of wealth in numerous countries, some examination of gender inequalities in access, particularly with respect to the collection of water, as well as initial monitoring of disparities in access according to religious, linguistic and ethnic groups.8

However, there is far more that needs to be done. Many steps have been taken at the initiative of the Joint Monitoring Programme. It is now initiating a task force on inequalities, engaging the UN Special Rapporteur on the human rights to water and sanitation and other sector professionals, to consider options for improving the monitoring of inequalities. Among other areas, inequalities within the household need to be monitored: anecdotal evidence suggests that even where there is a toilet in the home, not everybody living within the household is able to access it. This is particularly true for children, but menstruating women, persons with disabilities, or people with particular (generally stigmatised) illnesses may also be excluded from using a household latrine.

Integrating processes for monitoring inequalities into the SDG framework will make inequalities more visible, increase political accountability and promote cross-fertilization between sectors.

In conclusion, we urge States, and others working on implementing the SDGs to set incentives to eliminate inequalities by focusing on the most disadvantaged people, and measuring progress against these targets. There is a need to redefine progress within the context of development—“progress” does not leave significant parts of the population behind.

This post was originally published on September 24, 2015 in the SDG blog series of the Health and Human Rights Journal.

Inga Winkler and Virginia Roaf

While human rights alone cannot solve sanitation problems, they play a critical role in keeping governments accountable.
The human right to sanitation is simply not optional; it is not a strategy that can be voluntarily adopted (or not). All countries in the world have recognized the human right to sanitation. These commitments are underpinned by legally binding obligations in human rights treaties such as the International Covenant on Economic, Social and Cultural Rights (ICESCR) which are almost universally ratified.

While human rights may sometimes seem narrow and rigid, they actually offer a flexible framework for ensuring adequate sanitation for all. The human right to sanitation does not call for conventional sewers or any other particular technology. The people who use, and often construct and finance, sanitation facilities determine what is an appropriate solution. Even more than for other human rights, participation is key for determining solutions for a service as personal as sanitation. Human rights do not ignore costs and other constraints—the notion of progressive realization (provided for in the ICESCR) allows for a phased approach of improvements over time.

But as Gordon McGranahan pointed out in a recent contribution, the real challenge is finding the most appropriate strategies for implementation. The handbook by the UN Special Rapporteur on the Human Rights to Water and Sanitation provides broad guidance, which, together with the involvement of sanitation professionals, can take the implementation of human rights to the next step.

The Orangi Pilot Project that McGranahan discusses may not have used the language of human rights, but it reflects human rights principles. A great part of the success was the focus on ensuring that municipal governments built the necessary trunk sewers to support the work done by the community.

Indeed, this project is a perfect example of how demand-led efforts and human rights are compatible. In the context of other human rights, such as food, it is accepted that individuals contribute to the realization of human rights with their own means: some people purchase food, others grow their own, whereas others may need assistance by governments. The same holds true in the context of the right to sanitation—states have a clear role to play in the realization of human rights, but individuals will generally be responsible for constructing their own latrines, or installing a toilet, and paying charges for these services.

So when it comes to sanitation, why do we really need human rights? Long before the explicit recognition of the right to sanitation, people, organizations and states contributed to its realization. Yet, these practices are far and few between. Malpractice, maladministration, and misallocation—indeed bad practices in general—persist. Human rights serve as a framework, a constant reminder that states need to ensure that people can access safe, affordable and acceptable sanitation, and to provide the necessary support for this to happen. They can be translated into checklists to ensure the integration of human rights in legislation, institutions, financing processes, service delivery and everywhere in between.

While the human rights framework is flexible, it does set important parameters for determining priorities. For example, human rights demand achieving substantive equality, which requires states to prioritize the most marginalized and disadvantaged. It is unacceptable if large portions of budgets are used to improve services in middle class areas while other areas, such as slums, remain without access to even basic services.

Many people rely on informal services and, ultimately, regulation can ensure better quality services in line with human rights standards. However, human rights also provide important guidance for the process of adopting such regulation. Above all, they require ensuring that people are not left with services they can no longer afford and experience retrogression in the realization of their human rights. Different countries have adopted different solutions to dealing with informal service provision. For instance, in Maputo, Mozambique, informal providers are tolerated and integrated into service delivery, whereas in Kenya, the government seeks to link informal service providers to the formal system in the long term.

As a framework, human rights are not only concerned with one person’s access to a latrine, but also with the effects the lack of adequate sanitation has on other people’s human rights: the human rights to health, housing, a healthy environment, among others address the challenges that “other people's shit” pose to the broader community and environment.

Though McGranahan cautions that a wave of litigation on the right to sanitation could cause more harm than good, this fear seems largely unfounded. Human rights are focused on more than just claiming rights in court—both in theory and practice. For the right to sanitation, there is very limited case law. However, experience from other sectors also shows that litigation can play a very useful role in advancing the realization of human rights, most often when combined with other advocacy strategies.

In Mukuru, Nairobi, women have mobilized to draw attention to the entirely inadequate sanitation conditions due to insecure tenure, overcrowding, lack of planning, and poor drainage. They have documented the gendered dimensions of the lack of access to sanitation and have gained support from the Akiba Mashinani Trust. While considering litigation, they are currently focusing on compelling the government to conduct a public health inquiry. The case demonstrates that there is no blue-print for the best strategy. Communities will decide how they can best address the specific barriers they face. It also shows that there are issues such as a lack of planning or the lack of security of tenure that are very difficult for a community to resolve on its own, but require government accountability.

While the focus of the human right to sanitation is not necessarily on litigation, it is ultimately about accountability. Communities sometimes achieve amazing progress, and it is essential to draw on their experiences and to ensure meeting their preferences. But communities must not be forced to “muddle through” on their own, and governments be let off the hook. Governments must create an enabling environment for the realization of everyone's human rights, and they must ensure that human rights are realized for the poorest, regardless of ability to pay. Putting human rights front and center means putting people front and center, and the human right to sanitation reminds us that governments are accountable to the people.

This piece was originally published on 8 June 2015 in openGlobalRights.

Virginia Roaf and Inga Winkler

Menstruation is a taboo subject for too many people, male and female alike, leading to misunderstanding, confusion, and prejudice. Menstruation has long been a signifier of Otherness; difference – but not an acceptable difference, a difference that stigmatises and silences. Such embarrassment and stigma around menstruation not only affects how women and girls feel about menstruation, but also makes it difficult to cope at a very practical level. It hinders finding adequate solutions for menstrual hygiene management, giving the issue a low priority. While women and girls experience the challenges in different ways and to varying degrees, menstruation remains a taboo all over the world.

The framework of substantive equality as articulated by Sandra Fredman provides a basis for addressing gender inequalities that are fuelled by this taboo. Using the four dimensions of substantive equality, in this post we show how a more honest and direct understanding of menstrual hygiene, can contribute to ensuring substantive equality for women and girls not only when menstruating, but at all times.

Redressing disadvantage 
Menstruation and the onset of puberty is one of the leading causes of the gap in school attendance and education between boys and girls. The reasons for girls stopping their education may be cultural: girls are perceived not to need an education, and it may be no longer acceptable for them to mix with boys. Or the reasons may be practical: the lack of access to a safe and clean toilet to manage their menstruation hygienically and in privacy. The outcome is the same – girls do not gain the same level of education as boys. The pattern of disadvantage continues when women lack adequate facilities at work. Redressing such disadvantage requires, for instance, the promotion of girls’ education and/or the construction of toilets at school. But until menstruation is understood as a cause of disadvantage, there can be no redress.

Addressing stigma and stereotyping 
Menstruating women and girls in many cultures are seen as ‘dirty’ and ‘impure’, and menstruation is to be hidden from view – and this is largely internalised by girls and women. Even in countries where managing menstruation is straightforward, women and girls do not openly discuss their periods. Menstruating women are stereotyped as aggressive and emotional. This makes way for prejudice against women’s ability to work on an equal footing with men. Such deeply entrenched socio-cultural norms open the door for discrimination. Educating not only girls, but also men and boys on the intricacies of menstruation provides opportunities for discussions that can shed light where there is currently shame and confusion.

Embracing difference and achieving structural change
To achieve substantive equality, it is essential to understand and explore the biological differences between men and women, between girls and boys, the process of puberty, menstruation and reproduction and their physical, emotional, social and cultural impact. But these must not be understood only as difference and not as devaluation. To achieve structural change, the need for menstrual hygiene management must be addressed at all levels, from legislation and policies, to financing and tax reforms, to institutions, down to the very practical necessity of disposal units for menstrual materials.

Enhancing voice and participation 
Women and girls’ voices are often silenced and marginalised, and this is accentuated in cultures where it is usual for menstruating women and girls to withdraw from social and household activities. Yet, for something as personal as menstruation, women’s and girls’ voice and participation is key. Women and girls must be able to decide how they want to cope on the days they menstruate, what activities they want to engage in or not, what materials or products they want to use to catch the flow. Substantive equality requires enabling women and girls to take these decisions in an informed way and not to be judged for them.

Menstrual Hygiene Day, 28 May, provides an opportunity for women and girls to give voice to their experiences, their worries and fears about managing their menstrual flow, and to find ways of normalising menstruation within society. An international conference takes place next week for women and men to debate the socio-cultural aspects of menstruation. More must be done to remove the stigma and discrimination against women and girls. We would all benefit from discussing these issues more openly. Celebrate Menstrual Hygiene Day!

This post was originally published on 26 May 2015 on the Oxford Human Rights Hub Blog.