Gender variations in access, choice to use and cleaning of shared latrines; experiences from Kampala Slums, Uganda

For data collection, four graduate research assistants who knew most of the local languages (Luganda, English, Swahili, Lusoga and Runyakitara) in the slums of Kampala were recruited. In addition, these research assistants had experience in conducting focus group discussions and interviews. The research assistants were trained for two days and also participated in pre-testing the data collection tools. Daily field review meetings were held to clean the data and capture emerging issues for follow up and to provide guidance for further data collection. Both manual and electronic backups were used.

Data were analysed manually using content thematic approach, following a framework advanced by Graneheim and Lundman [39, 40] to identify manifest and latent content in the discussion and interview scripts. Reports from FGDs and interview scripts were independently read several times to identify emerging themes and sub-themes. Joint discussions with research assistants were held to compare themes and sub-themes identified; a process that led to development of a unified list of codes for use in data analysis. The identified themes and subthemes were used to code data. Sub-group analysis was done, which involved examining the themes and sub-themes in relation to FGD data (men, women) and key informants. The data coding process began during data collection and went on until after data collection. This enhanced continuous analysis while also serving as an analytic method for coding and analysis [41]. Raw data consisting of interview transcripts, participant observation, field notes and photographs were coded. In first cycle coding, data were bigger in magnitude with the coding outcome ranging from a single word to a full sentence and sometimes to a set of sentences covering an entire page. In first round coding, data on access, choice and cleaning were separated in preparation for the second round of coding. In second cycle coding, the portions coded were based on the first cycle codes of access, choice and cleaning. The coding process proved heuristic and served as an exploratory technique to the gender variations in sanitation. Because of this systematic approach, the coding was not just labeling, it enabled the initial understanding of the sanitation problems in Kampala slums. Subsequently this process became sort of cyclic; from the data to the idea, and from the idea to all the data pertaining to gender variations in access, choice and cleaning of shared latrines. This served the purpose of compressing the analytical framework further based on patterns and filters [33].

The study protocol was approved by the Research Committee for the School of Social Sciences, College of Humanities and Social Sciences Makerere University. This committee considered all technical and ethical issues of the study. Clearance was also obtained from local leaders in the respective slum zones. An introductory letter issued by Makerere University was presented to local leaders in addition to explaining the purpose of the study, confidentiality, voluntary participation; anonymity and freedom to withdrawal from the study were clearly explained [42]. Verbal consent to participate in the study was obtained from all study participants. Participants were free to withdraw from the study if they felt uncomfortable. No persons lacking capacity to consent were enrolled or involved for the study. In addition, study participants’ identifiers are not presented. The need for confidentiality was emphasized during training of research assistants prior to conducting of the study [43]. With the study findings being published, this shall reduce further resource wastage, for instance; by not conducting other studies in the same area without first benefiting from these findings. Publishing and information sharing minimizes community research fatigue and wastage of valuable resources [44, 45].

The main themes identified and coded were; open defection, time of day, sexual harassment, affordability and cost of sanitation, alternative methods of excreta disposal, cleanliness, easy access, self-respect, catching infections, self-esteem and privacy. Verbatim quotations were identified and are part of the study findings. The study found that, access to a sanitation facility affects the use of a facility and its surroundings. When a latrine could not be easily accessed, the surroundings were usually littered with human waste.

Open defecation:

“When you find the latrine locked, you quickly go behind it and ease yourself before someone finds you…” Male FGD participant Jjuko Zone

Accessibility challenges:

“It is not appealing to climb a strip of stairs near children who are playing before you can access a latrine. On many occasions, these children have seen our underwear which they talk about the whole day. ..because of this, I only use the latrine when the children are not near or when I have no alternatives. For us elderly women, that latrine is not the first choice when we are in need of relieving ourselves.” Elderly Female FGD participant, Kisenyi I Zone

Photo 1 shows a typical slum location in Kampala city.

Even when a facility may be near, clean and private but challenging to enter and use, it serves no utility to some groups especially women and girls. The mode of accessing a facility such as the one in photo 2 renders a facility unattractive and unsafe to many females.

Time of day and sexual harassment:

“After dark, these latrines are mainly used by men. Women fear going out especially when it is raining, because, even if you shouted when under attack, no one will hear you. Here when it is dark and raining women do not use latrines”. Local leader, White Nile zone

Access to a sanitation facility is the first interface point and is crucial in providing sustainable sanitation. The other accessibility themes identified were; few latrines in slums that were not easily accessible. Accessibility challenges related to filth on the way, narrow paths and steep inclines that made access a challenge especially to female users. In as far as conceptualizing sanitation is concerned, findings show few areas of convergence between women and men. For instance, while many women mentioned access to latrines being constrained during the night because latrines are far and locked; in comparison, men generally did not experience such a limitation. This finding is consistent with other studies conducted in the developing world [13, 46‐48] . In coping with the problem of accessing latrines that are far at night, women had to find someone to company them in view of the possible dangers of assault or rape in the night. Although latrines were not far in the sense of long distances, they were not located within the yard of the dwelling unit. What made this distance unappealing was where one had to pass; through back alleys and meandering in a congested neighbourhood rife with filth. The distance being discussed is not more than 50 metres on average. It is such realities that discourage women from accessing the few available sanitation facilities. Photo 3 shows the gendered challenges in a bid to access a sanitation facility.

The reported modes of coping in an attempt to mitigate the above challenges include using buckets or plastic bags as makeshift toilets inside their shelters. This finding is in agreement with Feachem et al [17]. Pictorial evidence in photo 4 is typical of the embedded gendered strategies in coping with the sanitation challenge in the slums of Kampala. The potty on the roof of the makeshift dwelling unit shown in photo 4 had a dual utility; it was officially and conveniently a waste management accessory for the ‘baby’ even when there was no baby in the household.

The potty was one of the highly regarded household devices since it was used by the stay home female adults in substitution for a latrine to save money. In slums, clean latrines were ‘pay per use’ facilities costing between US$ 0.12 –US$ 0.2 per use, therefore expensive for the non- working adults, especially females. This made such facilities unaffordable. On the other hand, most of the shared latrines were free but filthy. This finding is consistent with Rutstein [49].

Lack of affordability:

“It is not possible to pay for a latrine before I find food for my children. Unless I am sure about what to eat; I cannot pay to defecate. For us here we live from meal to meal. That is why I do not use pay per use latrines even when I know that they are very clean.” Female FGD participant White Nile zone

Findings indicate that sanitation access, expectations and roles were varied along gender lines, with some roles being perfomed by both women and men while other roles; especially cleaning seen as specifically a women’ role. Overall, women preferred privacy and convienence more than men. Table 1 shows the varied gender roles in access to a sanitation facility with a presentation of general enablers and constraints.Beyond the physical availability of sanitation facilities, is access to a given facility; by time of day, by age, physical abilities and gender. The mode of access to a sanitation facility then determines choice and use against the ease or difficulty embedded by each prospective user category, but more specifically for women and men. Choice and use of a given sanitation facility is then sustained by the hygiene and cleanliness levels of the facility in question, which altogether increase user satisfaction. Study findings showed that generally, women had less access capabilities than men. It is this continuum presented in Figure 2 that constitutes the sanitation utilization ladder.

One of the key themes in this study was respondent considerations on choice of a sanitation facility and how this choice varied between women and men. Findings indicate that women were more inclined to a facility that was close to the dwelling unit, accessible during day and night time, a facility with cubicles big enough for entering with a child as well as for changing menstrual materials, a facility with adequate lighting and one that was lockable. Although a latrine with a lock was seen as secure, women were skeptical and suspicious about being locked in the latrine by malicious people. Some women reported that they would rather use a polythene bag or bucket than risk being locked inside a latrine facility especially at night. This is similar to findings of other studies [50, 51]. Women also feared that they would contract an illness due to the lack of cleanliness in the shared latrines. Interestingly, women rarely mentioned illnesses usually associated with poor sanitation such as diarrheal diseases. Instead, they (women), feared what they perceived to be the risk of catching a sexually transmitted infection (STI) from a dirty sanitation facility, the kind of illness which could raise the suspicion of a spouse or sexual partner. Some latrines were doorless (see photo 5), this posed varying challenges especially among females (women and girls) than males.

Such doorless facilities were usually used by men at night which was not the case with women. This aspiration has a resource implication that makes sanitation a wider issue than previously thought.

One female FGD participant in Kisenyi rejoined;

“When the latrine is far from your home by the time you get there it is too late. At least for a man; he can just go anywhere and urinate so long as he turns his back on people; this is not the case for us women. We have to walk until we find a latrine. That is why we prefer to use basins at home”.

In order to understand the gender variations in choice of latrines, women and men were taken through a participatory process where each gender’ concerns were discussed. Table 2 shows the analysis of these variations along enablers and constraints of choosing a given sanitation facility.

A female FGD participant in Gogonya asserted that;

“A woman cannot feel safe walking to the latrine at night. Men can rape you. Even during the day, you have to be careful given the narrow and slippery paths –you can easily fall in the dirty water”.

Choice of a facility, self-respect and privacy:

“You cannot use a sanitation facility where people outside hear and see you while you defecate. At least when you use a container in your house, you are alone. This type of latrine can only be used by young children and not an adult”. Female tenant Kisaasizi zone.

Hygienic latrines were mostly accessible on a ‘pay per use’ basis which turned out to be unaffordable to the majority of the women.

Lack of cleanliness and fear of catching infections:

“Our latrine lacks a cleaner and cleaning material, so when someone misuses the facility while in her periods and does not clean it afterwards, it becomes unusable. To avoid getting an infection, when I am in my period, I choose not to use the latrine”. Land Lady, Gogonya.

Sanitation generally refers to the safe separation and disposal of urine and feaces, and also the management of garbage and wastewater [37]. The adequacy of sanitation facilities is often evaluated solely based on the extent of containing the waste and how the user is free from contamination. This section undertakes a gender understanding of cleaning the available shared sanitation facilities.

Focus Group Discussions with women and men as well as key informant interviews indicated gender variations in shared latrine cleaning. The analysis shows that females had more inclinations to keep latrines clean than men. Women had more cleaning roles and responsibilities than men, and not necessarily capabilities. This serves to show the overarching male World view as subsuming female needs, concerns and roles. See Table 3 for a detailed gender disaggregated variation of shared latrine cleaning between women and men.

Men needed less privacy, and usually only needed a latrine to defecate, while women required a latrine both to urinate and to defecate. This situation was also found in previous studies that indicate the secrecy and stigma of sanitation among women [52, 53]. These gender variations meant that, men needed the use of a toilet less and therefore were not faced as often; with the problem of high latrine user fees or with the grim prospect of resorting to a dirty shared latrine. Findings also showed that, men were more likely to leave the community for work during the day, and thus potentially have access to more and better sanitation facilities at the place of work or elsewhere. Because of this, the status of shared sanitation facilities at home did not usually concern men. On the other hand, women found themselves in a sapping position with no clean sanitation facilities to use. Although the practices surrounding sanitation and hygiene are largely debilitating to women, there is a wide spectrum of different practices and taboos that vary from region to region, from culture to culture and country to country in different contexts [54].

Anatomically female and male differences cause more barriers for women compared to men. Despite the differences between women and men, the implications of these differences are many times overlooked and gender considerations sacrificed for convenience in construction and cost saving [16, 21, 37].