The present study analyzed, from several complementary points of view, the issue of women's lives and access to sanitation in Brazil. The study investigated how the lack of sanitation compromised the health of Brazilian women. The occurrence of these diseases not only affected the productivity of women in their economic activities but also caused a decrease in their potential for performance in studies. The study addressed how the lack of sanitation directly affected the lives of women with regard to how they organize their time between activities. Estimates have also been drawn that quantify the potential welfare gains that could be obtained with the advancement of sanitation, that is, indicating the increase in income and the greater availability of hours of rest or leisure that the Brazilian women would have if access to sanitation was universal.
Following this executive summary, the main conclusions of the study are presented. In addition to the unprecedented approach of a joint discussion of gender and sanitation issues, there are some statistics that are new and that, for that reason, may be highlighted. These points are noted with (*). Regarding the analysis of women's access to basic sanitation and the incidence of infectious gastrointestinal diseases associated with lack of sanitation, it was concluded that:
In 2016, according to PNADC data (IBGE, 2017), 90.8 million women reported living in households that received water through a general distribution network. In that year, there were still 15.2 million women who reported not receiving water in their homes, that is, 1 in 7 Brazilian women had no access to water.
The lack of treated water was concentrated in the youngest women (between 0 and 14 years of age), in the self-declared multiracial and indigenous Brazilians, in the female population with the lowest levels of schooling and in the poorest income classes.
In addition to the lack of access to the water distribution system, the lack of regular water supply also affects the quality of life of the population.
Statistics showed that in 2016, 12 million women lived in houses connected to the general water distribution network, but water was not regularly delivered to their residences. This corresponded to 13.2% of the Brazilian female population. According to PNADC data, in 40% of these cases water was distributed between 4 and 6 days a week, in 45.7%, between 1 and 3 days a week and in 14.2% of the cases, the regularity was less than 1 day per week. *
Women who did not receive regular water were concentrated in the age group of 20 to 59 years of age (56.6% of women with access to the general network). The incidence of irregular deliveries is higher among self-reported multiracial women (17.5% of the total) and black women (15.7%). It was also higher among women with lower levels of education and from lower income groups. *
Consideration of irregular receipt of services as a deficit corrects estimates of the number of women with access to treated water services to more realistic levels. The number of women in the water deficit reached 27.2 million in 2016. This indicates that 1 in 4 women either had no access to treated water or did not receive regular water. *
The lack of a bathroom at home is the most primary of the problems associated with sewage. This problem afflicted 1.585 million Brazilian women in 2016 (1.5% of all women). Women without a bathroom at home lived mostly in homes that belonged to the first quintile of the per capita household income distribution of 2016.
In 2016, only 79.1 million women (or 74.6% of the 105.9 million Brazilian women) lived in housing where the sanitary disposal system was considered adequate. This indicates that 1 in 4 Brazilian women did not have an adequate system, a frequency similar to that of inadequate water (due to lack of access to the system or by interruption).
The deficit of sanitary depletion has affected mostly women living in the urban areas of the country and in the North (67.3% of the population) and Northeast (39.0% of the population).
Sanitary sewage deficits were higher among self-reported multiracial, indigenous, and black women: In these groups, the incidence rates of inadequate sanitary disposal were 24.3%, 33.0% and 40.9% of the respective female populations.
As in the case of access to treated water, the lack of proper disposal conditions has further afflicted poorer women and women with low levels of education.
Lack of sanitation has immediate implications on the health and quality of life of women living in environmentally degraded areas. The rate of incidence of absences from diarrhea or vomiting measures the ratio of the number of cases to the total population, that is, it measures absences in relative terms. The incidence rate is expressed in cases per thousand inhabitants. In this indicator, there were 76.0 absences per thousand women in the country in 2013 according to data from the National Health Survey (IBGE, 2015).
In the average of the capitals of the Federation units, the incidence rate was higher: 83.1 cases per thousand women. In regional terms, the highest incidence occurred in the Northeast of the country, with 88.7 cases per thousand women. The states with the highest incidences of absences due to diarrhea and vomiting were: Ceara, Rio Grande do Norte, Paraiba, Pernambuco and Alagoas, all with rates above 100 absences per thousand women.
Absences from diarrhea or vomiting were concentrated in younger women. In the age group of up to 14 years of age, the incidence of withdrawals from routine activities reached 132.5 cases per thousand women. It is worth noting that for almost all age groups, the incidence of absences due to diarrhea or vomiting is greater in the female population than in the male population.
The incidence of absences because of diarrhea or vomiting was extremely high in the female indigenous population (175.9 cases per thousand women in 2013).
The incidence rate was also higher among uneducated women, a category that recorded 92.4 cases per 1,000 women.
According to the National Health Survey (IBGE, 2015), absentee women were far from their activities for 3.48 days on average.
According to information from the Unified Health System (SUS) database, there were 1.801 hospitalizations per thousand women in 2013. For all age groups, with the exception of the younger age group (up to 14 years of age), hospitalization rates were higher among women. The data also show that the women were, on average, 3 days hospitalized, indicating a total of 563.2 days of hospitalization in SUS network hospitals in 2013.
Also, according to DATASUS statistics, 4,809 deaths by gastrointestinal infections were recorded nationwide in 2013. Of this total, 2,614 deaths were of women (54.4% of the total). In the majority, these deaths occurred in the older population, despite the fact that these diseases are more frequent in the young: 73.7% of deaths were in women over 60 years of age, while 15.2% of deaths were in girls up to 14 years of age.
With regard to the effect of sanitation on women's lives and the impacts of universal sanitation, it was concluded that:
Young women receiving in their homes water distributed through the general network had lower averages of school delay. Those who lived in residences with sewage collection also had lower averages of school lagging. The biggest difference was seen in the case of the existence of bathroom for exclusive use in the household. On average, young women living in households with bathrooms had 1.2 years of school lagging less than those living in homes without a bathroom.
Women, children or young women without access to basic sanitation will be less educated than others when entering the labor market. Since schooling positively affects workers' productivity and income, lower schooling will mean a loss of productivity and lesser pay.
Of the total number of young people who completed the National High School Exam, 2.423 million were women (56.8% of the total) and 1.840 million were men (43.2%). The first fact that stands out is that women had lower scores on average than young men.
Once again access to sanitation is a determinant variable. Considering only the female population, all averages of women residing in households without a private bathroom were below the averages of women living in households with bathrooms. *
School performance is affected by sanitation conditions and interferes even more intensely with Brazilian girls and young women. As the national examination sources are used both for the selection of students in public higher education (SISU) and for the granting of scholarships in federal incentive programs, it can be concluded that lack of sanitation has a negative effect on the chances of women to progress to free public higher education. *
On average in the country, women received a 22.9% lower remuneration than men in 2016. It is worth mentioning that the pay gap between men and women is high in all areas (urban or rural, in the capitals or in the interior) and in all Brazilian states.
Considering only the female population, it was noted that there were strong differentials between the remuneration of women with and without children or stepchildren living in their homes.
According to data from the PNADC of 2016, access to sanitation was once again an essential variable to understand such differences. Estimates of the statistical model reveal that, with the other factors constant, a woman living in a bathroom household without exclusive bathrooms is expected to have a 61.3% lower income than a woman living in house with a bathroom for exclusive use. In the case of a woman living in housing without sewage collection, the expected remuneration is 21.9% lower than that of women residing in housing with access to the general sewage collection network. If the woman does not have treated water in her house, it is expected a remuneration of 26.5% less than that of the female population residing in households with regular water supply through the general network.
Lack of sanitation has directly affected women's lives, altering the way they have organized their time between activities and limiting their income potential in the economy. From the data of the PNADC of 2016 it was possible to analyze the allocation of hours Brazilian women spend with different activities. For example, time spent with education decreases as age increases, and time spent with economic activity increases up to a certain age and then decreases. Girls spent most of their time between rest, leisure, and personal activities and studies. Women between the ages of 30 and 39 years were the most economically engaged and women between the ages of 40 and 59 were the most engaged in unpaid activities. *
It is estimated that the majority of absences from diarrhea or vomiting occurred among young women, with 37.8% among girls aged up to 14 years old and 17.8% among girls aged 15-29 years old. Women in the age group between 30 and 59 years old accounted for 30.4% of absences and women over 60 years old, for 14.0% of the total.
As a consequence of this distribution, it is inferred that absences due to diarrhea or vomiting have affected the hours of rest, leisure and development of women's personal activities more intensely. Of the total 862.7 million hours of leave, 70.4% concentrated on these activities, compromising the well-being of the female population. In addition, 83.358 million hours of study and 172.410 million hours of paid or unpaid work activities of the Brazilian female population were compromised due to diarrhea or vomiting. *
If access to sanitation were universal, Brazilian women would no longer waste part of these hours away from their routine activities caused by diarrhea or vomiting. Based on the statistical models developed in this study, it is estimated that the total leave hours due to infectious gastrointestinal diseases associated with lack of sanitation would fall from 862.7 million per year to 790.5 million per year. This indicates a potential reduction of 72.2 million wasted hours with these health problems. The reduction of waste translates to welfare gains for Brazilian women, who would each gain 40 minutes of leisure, study or work over a year. *
The waste incurred by women with lack of access to sanitation was not only time wasted. In 2016, women lost income in economic activities, and girls eventually accumulated more school delay than they would have if access to sanitation were universal.
According to the statistical model of productivity determination, a woman living in a residence without regular access to treated water received an average of 3.6% less remuneration than a woman who had access to this service. The lack of sewage collection reduced the average wage of women by 6.1% and the lack of a bathroom decreased it by 23.0%. Women living in housing without regular access to water, without bathroom and without sewage collection had their income decreased by almost 1/3 in relation to women with full access to basic sanitation.
Given that the lack of sanitation was concentrated in the poorest levels of the Brazilian female population, the universalization of basic sanitation services and the increase in income associated with it would reduce the incidence of poverty.
Considering the poverty line defined in the study, which was R$ 350 per capita in 2016, it is estimated that the number of women living below the poverty line would decrease from 21.325 million to 20.690 million thank to universal access to sanitation. This indicates that 635,300 women would leave the condition of poverty because of productivity gains brought by sanitation.
It is estimated that 3 out of 4 women leaving the poverty condition would be black, which highlights the inclusive nature of universal sanitation.
It is worth noting that the effects on poverty would be concentrated in the young female population. Of the 635,300 women who would leave the condition of poverty, 281,100, or 44.3% of the total, would be up to 19 years of age. Considering also the young women between the ages of 20 and 29 leaving the poverty conditions, estimated at 103,900 women, it is concluded that 6 out of 10 women leaving the poverty conditions belong to the future generations of the country.
Finally, it should be noted that poverty reduction would not be the only effect for generations of Brazilian youth. Universalization would bring about a reduction of school delay and an improvement in the performance of women in the studies. These effects would also impact on the productivity of Brazilian girls, further increasing the income potential of Brazilian women in the future.