Bridging the health equity gap: examining the effects of water, sanitation and hygiene (WaSH) gender-based violence on health and wellbeing in Ghana

Access to water, sanitation and hygiene (WaSH) is widely recognized as an important pathway to promoting human health and wellbeing. Despite the progress in access to water and sanitation in Low-and Middle-Income Countries (LMIC), there are significant inequalities and disparities across space and place. Inequalities in WaSH access heighten women’s vulnerability to violence when meeting their WaSH needs. This represents a significant barrier to achieving the Sustainable Development Goals (SDGs) by 2030. For instance, it will not be possible to achieve health and wellbeing for all (SDG 3) without safe water and sanitation for all (SDG 6), and neither is it possible without empowering women (SDG 5). However, WaSH practitioners and researchers are yet to adequately conceptualize the gendered vulnerability to violence in WaSH for informed policy. This thesis draws on an integrated theoretical framework to explore the relationships between WaSH access and gendered dimensions of vulnerabilities to violence in LMICs. The research focused on three broad objectives: first, to develop an integrated theoretical framework for framing our understanding of WaSH gender-based violence in Low-and Middle-Income Countries (LMICs); second, to characterize the dimensions of WaSH gender-based violence (WaSH-GBV) in LMICs; and finally, to explore the WaSH-GBV experiences of Ghanaian immigrants in Canada over the life course. A qualitative research approach – involving conceptual review, scoping review, and in-depth interviews –was used in the research. The conceptual review proposes an integrated theoretical framework for understanding intersectional vulnerabilities such as gender-based violence and water insecurity in LMICs. This framework emphasizes the role of place and scale in the conceptualization of WaSH-GBV in LMICs. It argues that WaSH-GBV is a relational outcome, and our understanding of it is tied to how individuals, communities and institutions envision place and how their interactions are maintained over time. Results from the scoping review reveal four interrelated dimensions of WaSH-GBV in LMICs, including structural, physical, psychosocial, and sexual violence. Structural violence is mutually constitutive with the other dimensions of violence. Further, the in-depth interviews (n=27; 16 women and 11 men) reveal that individual understanding and perceptions of WaSH-GBV are complex, socially constructed and context-dependent. Participants’ narratives indicate that while WaSH-GBV may occur in one place, the psychosocial impacts are not bound to place and time. This research makes significant contributions to knowledge, policy, and practice. Theoretically, the research demonstrates the utility of incorporating feminist political ecology with political ecology of health to form an integrated theoretical framework – feminist political ecology of health (FPEH) for a broader understanding of the multidimensional nature of WaSH-GBV and how contextual factors produce and reinforce experiences of violence across space and place. The framework is a useful tool for exploring how structural factors at different scales interact to shape gendered WaSH vulnerabilities in LMICs. The framework provides a robust platform for understanding the relationship between health in place and how health outcomes across scales (i.e., micro, meso and macro) are gendered. While the framework focuses on WaSH inequalities and vulnerabilities in LMICS, it is also useful in the context of developed countries and other research areas concerned with exploring health inequalities among populations. Methodologically, the research contributes to the conceptualization of WaSH-GBV in LMICs. The research also highlights the strengths of employing multiple qualitative methods such as scoping reviews and in-depth interviews for a broader understanding of WaSH-GBV in cross-cultural settings. In terms of policy, understanding WaSH-GBV as a relational outcome will facilitate global efforts on achieving SDGs: 3 – ensure good health and wellbeing for all; 5 – achieve gender equality and empower all women and girls; and 6 – ensure water and sanitation for all. The research also highlights the need for policies that are tailored and integrate community perspectives and experiences for promoting collective social change and community-led mobilization efforts that promote gender equality

Progress and gaps in climate change adaptation in coastal cities across the globe

Coastal cities are at the frontlines of climate change impacts, resulting in an urgent need for substantial adaptation. To understand whether and to what extent cities are on track to prepare for climate risks, this paper systematically assesses the academic literature to evaluate climate change adaptation in 199 coastal cities worldwide. We show that adaptation in coastal cities is rather slow, of narrow scope, and not transformative. Adaptation measures are predominantly designed based on past and current, rather than future, patterns in hazards, exposure, and vulnerability. City governments, particularly in high-income countries, are more likely to implement institutional and infrastructural responses, while coastal cities in lower-middle income countries often rely on households to implement behavioral adaptation. There is comparatively little published knowledge on coastal urban adaptation in low and middle income economies and regarding particular adaptation types such as ecosystem-based adaptation. These insights make an important contribution for tracking adaptation progress globally and help to identify entry points for improving adaption of coastal cities in the future

A global assessment of actors and their roles in climate change adaptation

An assessment of the global progress in climate change adaptation is urgently needed. Despite a rising awareness that adaptation should involve diverse societal actors and a shared sense of responsibility, little is known about the types of actors, such as state and non-state, and their roles in different types of adaptation responses as well as in different regions. Based on a large n-structured analysis of case studies, we show that, although individuals or households are the most prominent actors implementing adaptation, they are the least involved in institutional responses, particularly in the global south. Governments are most often involved in planning and civil society in coordinating responses. Adaptation of individuals or households is documented especially in rural areas, and governments in urban areas. Overall, understanding of institutional, multi-actor and transformational adaptation is still limited. These findings contribute to debates around ‘social contracts’ for adaptation, that is, an agreement on the distribution of roles and responsibilities, and inform future adaptation governance

Self-organisation in urban spatial planning: evidence from the Greater Accra Metropolitan Area, Ghana

There is growing interest among spatial planners to see spontaneous civic initiatives supporting urban development. The occurrence of self-organisation in two informal settlements in Greater Accra Metropolitan Area, Ghana is considered. The system theories of self-organisation (dissipative structures, synegertics and autopoietic) and actor-network theory were used to analyse the two cases. The findings indicate that actors in these informal settlements are triggered by certain contextual factors to undertake initiatives for their own survival and sustenance. At the regional level, these settlements jointly form patterns relating to self-organisation. We conclude that since self-organisation is context specific, planning rules should be reconstructed to guide actions of the various actors in the urban system

Factors Associated with Levels of Latrine Completion and Consequent Latrine Use in Northern Ghana

Open defecation is still a major health problem in developing countries. While enormous empirical research exists on latrine coverage, little is known about households’ latrine construction and usage behaviours. Using field observation and survey data collected from 1523 households in 132 communities in northern Ghana after 16 months of implementation of Community Led Total Sanitation (CLTS), this paper assessed the factors associated with latrine completion and latrine use. The survey tool was structured to conform to the Risk, Attitude, Norms, Ability and Self-regulation (RANAS) model. In the analysis, we classified households into three based on their latrine completion level, and conducted descriptive statistics for statistical correlation in level of latrine construction and latrine use behaviour. The findings suggest that open defecation among households reduces as latrine construction approaches completion. Although the study did not find socio-demographic differences of household to be significantly associated with level of latrine completion, we found that social context is a significant determinant of households’ latrine completion decisions. The study therefore emphasises the need for continuous sensitisation and social marketing to ensure latrine completion by households at lower levels of construction, and the sustained use of latrines by households

Attention to the needs of women and girls in WASH: An analysis of WASH policies in selected sub-Saharan African countries

There has been a push for understanding gendered violence in WASH in recent times. Attention is therefore shifting to how these issues are conceptualised, considering their embeddedness in context. One step primarily is to understand how existing policies in WASH acknowledge the needs of women and girls in WASH. In doing this, we conducted a summative content analysis of selected policy documents on WASH: five at the international level and five each from Ghana, Uganda and Kenya. Findings suggest that existing policies inadequately acknowledge WASH related gender-based violence and pay little attention to the complex ways gender and WASH relations are intimately connected. Generally, a holistic policy approach for addressing gender-based violence in WASH is needed. The paper recommends a system policy approach to address the unique needs of women and girls in WASH in sub-Saharan Africa

Spatial Planning in Ghana: Exploring the Contradictions

The purpose of this research is twofold: to explore the complexity of spatial plan preparation and implementation in Ghana using Kumasi as a case study; and second, to examine the contradictions of spatial plans and 'actual development' occurring in Kumasi. Using social science research methods (semi-structured interviews) and physical survey (land use plans), findings indicate that spatial planning in Kumasi is a bureaucratic process hijacked by urban planning agencies with limited involvement of urban residents. As a result, urban development is considerably influenced by spontaneous informal development patterns (i.e. self-organization). This phenomenon of self-organization is expressed in a context of uncertainty created by weak spatial planning system which encourages haphazard development. Regrettably, in Kumasi, self-organization is often overlooked by spatial planning agencies as they focused on rigid and exclusionary spatial plans. This paper advocates consideration and integration of self-organization processes in spatial planning efforts to respond adequately to the urban development challenges confronting Kumasi

City profile: Wa, Ghana

The UN-Habitat III has placed secondary cities at the centre of the new urban agenda, given their roles in global development trajectories in the future. Wa, though a small city, is an important growth pole in North-western Ghana. Wa emerged as a trading town in the colonial era and since independence in 1957 has become a key growth centre in the development of North-western Ghana. However, the confluence of environmental vulnerabilities and pre-existing social inequalities resulting from centuries of colonial and post-colonial neglects, have led to increasing contestations and socio-ecological challenges. We profiled Wa through the lens of Southern urbanism and highlight its socio-economic, ecological and spatial development dynamics as an ordinary city of the Global South. The dynamics reflect a disconnection between capital and labour as well as contested resource flows, and these have implications for a transformative and sustainable urban future. Through this profile, postcolonial urban studies of the Global South must reconsider deepening empirical methods and theories in addressing this unique problem-space. A transformative and sustainable urban future of Wa remains counterproductive if postcolonial urban studies do not engage with unique paradigms of the Global South in understanding and planning cities of the South

Adaptation to compound climate risks: A systematic global stocktake

This article provides a stocktake of the adaptation literature between 2013 and 2019 to better understand how adaptation responses affect risk under the particularly challenging conditions of compound climate events. Across 39 countries, 45 response types to compound hazards display anticipatory (9%), reactive (33%), and maladaptive (41%) characteristics, as well as hard (18%) and soft (68%) limits to adaptation. Low income, food insecurity, and access to institutional resources and finance are the most prominent of 23 vulnerabilities observed to negatively affect responses. Risk for food security, health, livelihoods, and economic outputs are commonly associated risks driving responses. Narrow geographical and sectoral foci of the literature highlight important conceptual, sectoral, and geographic areas for future research to better understand the way responses shape risk. When responses are integrated within climate risk assessment and management, there is greater potential to advance the urgency of response and safeguards for the most vulnerable