Women, Water Management, and Health1

omen play a major role in domestic water management in areas where safe water and drainage are not available in the house. In these settings, women are typically responsible for collecting, storing, and using water and for disposing of wastewater (1,2). Most studies of women's water management and the health benefits of safe water and sanitation examine the effect of protected water sources, such as covered wells or pumps, and basic sanitation (3). However, water management may also be a health issue in large villages and periurban communities that are supplied with piped water but have inadequate sanitation or drainage facilities. For example, in Egypt's Nile Delta, tap water is available in most rural communities (although not in every house), and no absolute shortage of water exists. However, safely disposing of wastewater and toilet effluent often remains a problem; this problem is exacerbated by the high water table associated with the irrigation system. We conducted a study on Schistosoma mansoni in two Nile Delta villages (each with a population of ≈8,000) from 1991 to 1998. During this period, villagers risked infection with S. mansoni when they came into contact with water in irrigation canals; women were especially at risk when washing laundry and utensils in the canal. In our 1992 survey, both study villages had access to piped water; 78% of households in al-Garda and 39% in al-Salamuniya had household connections. Al-Garda village had a pipeborne sewage system, but only one third of households were connected to it. Although 98% of households in al-Garda and 94% in al-Salamuniya had toilets, many of those households not connected to the sewage system did not safely dispose of effluent. In some cases, effluent in sewage vaults contaminated the subsoil water, and 25% of the toilets in al-Garda and 65% of these in al-Salamuniya had to be emptied periodically, usually with a bucket. A few toilets in both villages illegally emptied directly into a canal or drain. Unsafe disposal of latrine effluent was implicated in schistosomiasis transmission. Examining water management in these two villages, we asked what choices women had and why they made decisions that continued to expose them to the risk for schisto-somiasis. They found that advice to " Keep away from the canal! " was not relevant to their situation. A number of factors influenced women's water management choices, and hence, their use of the canal: effort involved, water quality and …