Water, Sanitation, Hygiene, and Reproductive Health Access Barriers in Rural Cambodia: Issues in Gender and Disability Open Access

Abstract

Background: Approximately 4.7% of Cambodia’s population lives with disability.²⁸ Disabled women are particularly marginalized due to pervasiveness of stigma and gender-based violence (GBV).⁸ The interaction between disability and gender in the water, sanitation, and hygiene (WASH) sector has important implications for global public health scholarship and program implementation.

Purpose: This study was conducted in June and July of 2017 with support from WaterAid Cambodia in Phnom Penh. It was intended to describe and address the barriers that disabled women face regarding WASH and menstrual hygiene management (MHM) in rural areas of Kampot Province, Kratie Province, and Kampong Thom Province. Further literature review was intended to develop a greater understanding of the social, cultural, and historical forces that shape the experiences of disabled women living in rural areas, specifically regarding access to WASH and a range of health services, including sexual and reproductive health (SRH).

Methods: Twenty-five women aged eighteen to seventy participated in the study, which involved fourteen in-depth interviews (IDIs), two focus group discussions (FGDs), and narrative photography.

Results: Barriers were identified in three categories: physical/environmental, economic/financial, and social. Physical/environmental barriers included uneven terrain, inaccessible facilities, lack of facilities, lack of privacy, distance to water sources, distance to health clinics, and difficulty carrying water. Economic/financial barriers included inability to afford improved infrastructure, clean water, adequate food stores, and MHM supplies. Social barriers included discrimination, isolation, misinformation about menstruation, exclusion from the workforce and from community gatherings, and physical, psychological, and sexual abuse.

Conclusion: Experience of inequalities in access to WASH and healthcare is impacted by a range of factors. Improved access requires a multidisciplinary approach. There is a need for distribution of accessible WASH technologies, for promotion of rights-based WASH education that emphasizes GBV prevention, and for mainstreaming of inclusive income-generating activities (IGAs). There is a need for cross-disciplinary engagement in addressing environmental, financial, and social barriers, and for innovation in building mechanisms through which disabled women living in rural areas of Cambodia may enjoy full agency.

Table of Contents

CHAPTER I: INTRODUCTION................................................................................................. 1

LANGUAGE AND TERMINOLOGY: AUTHOR’S NOTE..........................................................1

PURPOSE OF RESEARCH………................................................................................................ 4

CHAPTER Ii: REVIEW OF THE LITERATURE................................................................... 5

CONTEXT: CAMBODIA AFTER GENOCIDE…………..……...………………………….…..5

INTERSECTIONALITY: GENDER, DISABILITY, GEOGRAPHY, AND CLASS..........…...…6

WATER, SANITATION, AND HYGIENE…………………...……………………………..….11

REPRODUCTIVE HEALTH………………………………………………………………...….13

OVERVIEW OF INTERVENTIONS………………………………….......……………….……17

CHAPTER III: METHODOLOGY….......................................................................................19

DESIGN.........................................................................................................................................19

PARTICIPANTS AND RECRUITMENT.....................................................................................20

         Figure 1: Study Sites……………………………………......…………………..………….……..21

         Figure 2: Age Distribution Among Participants………………………………..….…….…...22

         Figure 3: Disability Representation Among Participants …...……..…………………..……23

MEASURES..................................................................................................................................23

DATA COLLECTION .................................................................................................................24

DATA ANALYSIS .......................................................................................................................25

CHAPTER IV: RESULTS……..................................................................................................26

AGGREGATE DATA………………………………………...…………………………,,……..26

         Environmental/Physical Barriers……………………………………......……………………..26

         Economic/Financial Barriers……………………………....…………………………………...28

         Social Barriers……………………………………………….……………………………………29

         Positive Deviance………………………………………………………………….......………….31

CASE STUDIES…………………………………………………………………………………32

         Participant 1..…………………………………………..………………......……………………..33

         Participant 2………………………………………………....……………………………….…...35

CHAPTER V: DISCUSSION.....................................................................................................36

OPPURTUNITIES AND RECOMMENDATIONS.....................................................................38 

         Environmental/Physical Opportunities..............................................................................38

         Economic/Financial Opportunities………………………………………………………40

         Social Opportunities………………………………………………………………………………41

         Figure 4: Key Recommendations…...………........…………………………………………….42

LIMITATIONS……………………………………………………….………………………….44

IMPLICATIONS…………..…………………..………………………………………………...45

REFERENCES.............................................................................................................................48

APPENDIX I: NARRATIVE PHOTOGRAPHY COMPONENTS ………...…….…………52

APPENDIX II: DOCUMENTATION OF PROJECT APPROVAL.......................................61

APPENDIX III: IN-DEPTH INTERVIEW GUIDE……..……………………..……..….…..63

APPENDIX IV: FOCUS GROUP DISCUSSION GUIDE........................................................71

APPENDIX V: CONSENT FORMS…………………………………..…….…...……………79

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Women's Studies
Keyword	Cambodia Menstrual Hygiene Water Gender Stigma Sanitation Reproductive Health Disability
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University
Committee Members	Comeau, Dawn L., Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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