Gender inequalities and women's health in South Sudan
Content warning: this article mentions gender and sexual based violence
South Sudan is in a vulnerable position, as it has a low capacity to cope with the global COVID-19 pandemic. The pandemic, in combination with existent poverty, high illiteracy rates, and an ineffective public healthcare system, has resulted in a battle in South Sudan for its people. Moreover, heavy rain, floods, waterlogging, and displacement have impacted rural communities in remote provinces in the Jonglei state. Floods have also caused shelter and water, sanitation, and hygiene (WASH) challenges. These challenges are a key public health issue within international development, as they are part of the first two targets of Sustainable Development Goal 6 by the United Nations General Assembly in the year 2015.
While the world is battling with the deadly virus, people in South Sudan are grappling with floods and heavy rain. “We are more worried about lack of food than we are worried about COVID-19,” said a respondent from our project titled ‘Process Learning of Christian Aid’s DEC COVID-19 Appeal in South Sudan’. This article discusses our research, which sheds light on the humanitarian response programme to both COVID-19 and floods, and explores the response in the context of women’s needs specifically. The study aims to understand the role of local communities and marginalised groups in Christian Aid’s Integrated COVID-19 Response Programme. Additionally, it offers recommendations for long-term recovery actions. The research was conducted through in-depth interviews and focus group discussions, along with household surveys in two provinces in Jonglei state, Fangak and Ayod.
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“While the world is battling with the deadly virus, people in South Sudan are grappling with floods and heavy rain.”
During these surveys, we were exposed to different risks that impact the lives of women in their communities, including patriarchal norms, lack of menstrual hygiene products, and the collapse of WASH facilities. These examples illustrate that the humanitarian response needs to take gender dynamics into consideration in order to implement equitable and effective programmes.
Gender
Food is crucial to communities, yet the process and responsibility to obtain it is dictated by patriarchal norms. Women in these communities, known as Neur, are imposed with the responsibility of bringing food to the plate under any circumstance. While the entire community is submerged under water due to floods and waterlogging, food accumulation becomes a tough task for everyone—not just women. Men expect women to look after “the food aspect” because according to them, they are usually “far away from home” to “earn money” or to let the cattle graze. Women tend to pick water lilies, weeds, and water grass from the swamps, and convert them into flour by drying and grounding, providing food for their families. They are also responsible for catching fish from the flood water, which are boiled or made into stews. Unlike men, who tend to have equipment for farming and cultivation, women have nothing of the sort and usually use what they have available, such as their bare hands and their clothes. According to female respondents, they use their frock or clothes to catch fish while squatting in the swamps.
The health outcomes observed from these practices include skin infections, vaginal infection, and skin rashes—attributable to the unhygienic flood waters in which they sit for prolonged hours to hunt food. In our household survey, 95% of the total respondents were female. While interviewing them, it was evident that there are gaps in community participation and gender inclusivity.
In a further workshop that we conducted, participants shared that women in this community have no rights over their own sexual reproductive health, as they could not decide who they marry, or when they get pregnant. There have also been instances where a man rapes a woman and she is forced to marry the perpetrator. Patriarchal attitudes along with the flooding has led to destructive impact on the sexual and reproductive health of females in these communities.
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“Patriarchal attitudes along with the flooding has led to destructive impact on the sexual and reproductive health of females in these communities.”
Menstrual Hygiene
Menstrual hygiene emerges as a growing need—the survey shows that 60.1% of the female respondents do not use any materials for maintaining menstrual hygiene, while 17.6% use old clothes or rags as a substitute for sanitary pads. During interviews with several women in the community, the participants mentioned that they “let it flow” or simply “avoid going near men”, as they either don’t have access to menstrual pads or have not been informed about menstrual hygiene products.
“We do not have sanitary towels, most women here don’t even know what that is,” said a female member during a focus group discussion. In the survey, 41.4% of respondents viewed “talks on menstrual hygiene” as something that should not be publicly discussed. However, 23.2% suggested that if menstrual hygiene awareness was provided to their spouses as well, it could help them to handle menstrual hygiene “culturally and respectfully” within their family circles.
In the context of these taboos about public displays of menstrual hygiene, 40.8% of respondents stated that when disposing of menstrual hygiene products they “hide them away” from men instead of disposing of them in a hygienic manner. 25.7% bury them, while 12.8% “wash them for re-use” and 1.9% throw them away in open spaces. As such, sanitary products are seen thrown away in the flood waters.
While diving deeper into the challenges faced by women in the community on a day to day basis, it’s evident that factors like floods, rains, and waterlogging can’t be the only reason for these problems. Lack of community participation programmes by both the government or humanitarian agencies, and the absence of counselling and awareness programmes all contribute to a lack of knowledge. Female respondents stated that the presence of these might be useful to better manage their menstrual hygiene needs.
Collapse of WASH
The floodings have changed the dynamics of hygiene practices. Several respondents claimed that people in the community drink the same (flood) water that they defecate and bath in. Every situation here is connected to one another: lack of toilets leads to open defecation and lack of dry land due to floods leads to defecation in the flood waters. According to our survey, only 6% had access to a latrine. However, existing toilet facilities do not work, so most people continue to defecate in the open, usually in flood waters.
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In the absence of clean water for drinking and domestic use, people had no option but to use the logged water in front of their houses. There are limited practices of boiling or filtering water, so in most cases they consume or use it directly. This contributed to several water-borne diseases among people along with skin infections and Urinary Tract Infection (UTIs). In case of UTIs, people manage by “praying to God” for protection as they either shy away from seeking help or simply lack medical assistance.
COVID-19
Christian Aid in partnership with Africa Development Aid (ADA), a local Non-Governmental Organisation (NGO), implemented the DEC Coronavirus Appeal from August 2020 to January 2021 in these two counties. They aimed to increase knowledge amongst communities and healthcare providers on protection from COVID-19. Moreover, they focussed on improving the negative economic impact of COVID-19 on household food security and livelihoods.
To advance preventive actions against the virus, the project partners established 100 handwashing stations in Fangak. However, during our household survey, it was found that 93.1% did not have access to hand washing stations. Instead, 36% of people used ash or mud and 50.3% flood water to wash their hands, while only 13.7% used soap to prevent COVID-19 infection. During the interviews, respondents explained that soap was either stolen or out of stock. Moreover, in many cases, these hand washing stations were located far away from people’s homes.
Like one of the key informants said in an interview, “Flooding, hunger, health care, clean drinking water, and toilet facilities are the highest gap and urgently need a response”. Indeed, our findings suggest that the humanitarian response programmes should address these multiple risks and needs at the community level, including shelter, water and sanitation, menstrual health, gender-based violence, and education. Lastly, there are gender dynamics and traditional roles for women and men which should be considered when making equitable and responsive future programmes. Humanitarian response programmes and governments must work together to equitably and effectively improve facilities in these communities through conscientious attention to women’s needs.
“There are gender dynamics and traditional roles for women and men which should be considered when making equitable and responsive future programmes.”
The evaluation work discussed in this article was conducted by Environment Technology Community Health (ETCH) Research Consultancy, India. Special thanks to our partners in this project: Christian Aid (UK), Africa Development Aid (ADA), and everyone involved on and off field, amid floods and pandemic.