Water Insecurity, Hygiene & Food Insecurity in Amhara, Ethiopia

Several HWISE RCN Member researchers and collaborators are examine many dimensions of WASH, water and food security, and gender in Amhara, Ethiopia.

These studies are conducted as part of a parent research project‒ Andilaye project: The impact of enhanced, demand-side sanitation and hygiene promotion on sustained behavior change and health in Ethiopia, PI: Matthew C. Freeman, funded by the World Bank (WB), the International Initiative for Impact Evaluation (3ie), and the Children’s Investment Fund Foundation (CIFF).

Women’s demands for water amidst chronic water insecurity and hygiene behavior-change interventions in rural Amhara, Ethiopia

Yihenew Tesfaye (Oregon State University), Roza Abesha (independent researcher), Matthew C. Freeman (Emory University), Mulat Woreta (Emory Ethiopia), Kenneth Maes (Oregon State University)

Water, sanitation and hygiene (WASH) behavior change interventions in low-income countries attempt to get impoverished people to adopt hand and face washing, latrine construction, and other behaviors to reduce the incidence of infectious disease. In many places where such interventions are implemented, households experience chronic water insecurity, while women maintain primary responsibility for household water management yet remain marginalized from local water governance.  This raises a key question: how do WASH interventions impact women’s struggles with daily water access, participation in local water governance, and efforts to make demands for clean water? This project aims to answer this question through ethnographic research methods conducted alongside a WASH randomized control trial (RCT) testing a behavior change protocol in rural Amhara, Ethiopia. Through intensive participant observation in intervention and non-intervention communities, and interviews with local government officials, health workers, and women heads of household, we find that the intervention reinforces women’s concerns about access to clean and safe drinking water, which may influence their demands for such water. Because women have grown up in a society in which they are not supposed to make demands, women make only very tentative demands for water access, mainly to local government-salaried community health workers, their most trusted contacts with the health system. Rural women know little about their right to water, which partly results from a lack of acknowledgement of this right in local government and NGO discourses. WASH RCTs have potential to further shape the ways in which women raise demands for more secure access to water, however such projects tend to be focused on biomedically focused behavior change and outcomes.

Key words: water insecurity, right to water, WASH, women, behavior change, Ethiopia  

How do rural Ethiopians rate the severity of water insecurity scale items? Implications for water and food insecurity measurement and interventions

Yihenew Tesfaye (Oregon State University), Kenneth Maes (Oregon State University), Roza Abesha (independent researcher), Sera Young (Northwestern University), Jedidiah S. Snyder (Emory University), Abebe Gebremariam (Emory Ethiopia), Matthew C. Freeman (Emory University)

This study advances efforts to measure household water insecurity (WI). Existing scales consist of multiple items that index WI experiences of varying severity, which is often assumed to be inversely related to the item’s prevalence: items that are commonly experienced are less severe than items that are more rarely experienced. We test this assumption against the subjective perceptions of people who experience WI. Survey data from 259 women in rural Ethiopia show that the subjective severity of most WI scale items is towards the high (severe) end of a pictorial rating scale used by participants, and that there is substantial variation in perceptions of item severity within a rural population. We also find an important exception to the assumed alignment between item severity, as defined by the item’s prevalence, and average perceptions of item severity: drinking water that might not be safe is both commonly experienced (38%) and perceived as highly severe. This highlights a serious unintended impact of education about the risks of drinking contaminated water in the absence of efforts to ensure access to clean water. More broadly, our data suggest that while summary water insecurity scores derived from unweighted scale items can underestimate the actual severity experienced by a household, using data on perceived severity to assign weights to items is complicated due to the variation that exists within a population. 

Key words: Household water insecurity, measurement, item severity, Ethiopia.