Women’s Access to and Utilization of Rural Health Extension Service and Its Empowerment Effect: Focusing on Sanitation and Hygiene Services in East Gojjam Zone, Northwest Ethiopia

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Addis Ababa University


Access to sanitation and hygiene facilities and the practice thereof have become the most pressing development and human right concerns of the 21st. The global community has pledged to achieve universal access to sanitation and hygiene by 2030 under the umbrella of SDG. The Ethiopian government has also promoted safe sanitation and hygiene through its rural health extension program since 2004. The program has targeted women as both service providers and beneficiaries and aimed to empower them and the community at large. But, women’s level of access to and utilization of the said facilities is far from investigation. Women are disproportionately affected by poor sanitation and hygiene due to traditional gender roles and biological factors such as menstruation, pregnancy and nursing. The traditional gender division of labor makes women to conduct more sanitation and hygiene related works which in turn contribute to the burden of unpaid domestic work and limit their time for income generation, decision making and leisure. Despite such important links sanitation and hygiene have on women empowerment, empirical evidences are negligible. This study is, therefore, aimed to assess the availability of sanitation and hygiene facilities, the practice thereof by women and its effect on empowerment. The determinants of women’s sanitation and hygiene access and utilization are also other objectives of the study. The study used mixed method research approach and data was collected from Dec 2018-March 2019 in two districts of East Gojjam zone, Amhara region, Ethiopia. For the quantitative part, a total of 380 women have been selected using multistage cluster sampling technique and data was collected using questionnaire. Interview and observation methods were also employed to generate qualitative data that supplement the quantitative analysis. A total of 30 women have been selected using convenience sampling technique and data is analyzed using thematic analysis. The quantitative data collected through questionnaire is analyzed using IBM SPSS version 20 and Stata /SE 14.0. Descriptive statistics is used to analyze women’s level of sanitation and hygiene access and utilization while proportional odds model and partial proportional odds model are used to estimate the association between different factors and women’s sanitation and hygiene access and utilization level. The study found that a large number of women have high sanitation access (42.6%, n=162) but in terms of utilization a large majority of them (50.85%, n=193) have low sanitation utilization indicating a mismatch between sanitation access and utilization. In relation with hygiene access, however, a slightly larger number of women have medium hygiene access (46.6%, n=177) and utilization (53.2%, n=202) status. The PPOM estimation has identified marital status, district, occupation, household income and wealth, participation in women health development team, frequency of health extension contact, household size and dependency ratio as the key determinants of women’s level of access to sanitation facilities while the POM analysis shows that household size, access to sanitation facilities, and knowledge about the benefit of latrine utilization have significant association with women’s level of sanitation utilization. Sanitation and hygiene utilization are found to have statistically significant association with women empowerment. A woman who has high level of sanitation utilization is, on average, 36% more likely to be empowered than a woman who has low level of sanitation utilization. Similarly, a woman who has high level of hygiene utilization is, on average, 16% more likely to be empowered than a woman who has low level of hygiene utilization. On the contrary, statistical significant association is not found between sanitation and hygiene access and women empowerment; signifying that the mere presence of sanitation and hygiene facilities has no effect on women empowerment unless it is actually utilized. Therefore, it is recommended that the government should strengthen its work towards promoting and monitoring not only the access to sanitation and hygiene facilities but also their utilization.



Rural Health Extension