A promise is a promise. The world must do much better in the second half of the 2030 Agenda timeline to deliver on the 17 SDGs, not least to address the inequalities impacting women and girls by inadequate water, sanitation and hygiene.
In 2015, the United Nations set a visionary course for the world through the adoption of the 17 Sustainable Development Goals (SDGs). Through a 15-year plan, the goals were to be reached by 2030. Marking the midpoint of this timeline, the 2023 SDG Summit will be held in New York between 18–19 September to review the state of the goals and provide high-level political guidance for accelerated progress. And accelerated progress is indeed needed. According to the 2023 special edition of the SDG Progress Report1, about half of the 140 targets with data are either moderately or severely off track; and roughly 30% of the targets have either not progressed at all or regressed below the 2015 baseline.
‘Leave no one behind’ was a promise made by all countries in the 2030 Agenda for Sustainable Development. But leaving people behind is exactly what has happened. Recent reports on SDG 6, which aims for clean water and sanitation for all, point at significant income, gender, and rural–urban inequalities. According to the JMP 2023 progress update2, the coverage of basic drinking water, sanitation and hygiene (WASH) was more than twice as high among the richest compared to the poorest in 25%, 51% and 61%, respectively, of the 105 countries with comparable data. The same wealth disparity goes for drinking water quality, where the wealthiest quintiles experience much lower contamination rates than the poorest quintiles in almost all of the 35 countries with comparable data. And while WASH coverage in high-income countries is not perfect, it is far better than in low-income countries. According to the same JMP report, the current rate of progress in low-income countries would have to increase 20-fold and 21-fold to reach the targets of safely managed water and safely managed sanitation services, respectively.
While the rural–urban coverage gap is shrinking, the vast majority of people without adequate WASH services still live in rural areas. As of 2022, about 90% of the 419 million people worldwide practicing open defecation live in rural areas. This limited access, of both basic and safely managed WASH services, affects women and vulnerable groups the most. As pointed out in the JMP 2023 progress update, women are, for example, more likely to feel unsafe walking alone to shared facilities as well as more likely to face physical, sexual or verbal assault when practicing open defecation. In addition, women still bear a disproportionate burden of the time-consuming and labour-intensive task of water collection in many parts of the world. According to the JMP update, about two-thirds of all households, where water is collected from sources located off premises, rely on women and adolescent girls as the primary water collector, taking time away from education and employment.
Poor WASH services are also linked to a range of childhood health burdens, including stunting. To help guide future water and sanitation interventions in maximizing benefits, Leigh Hamlet and colleagues examined how improvements in household- and community-level water, sanitation and air pollution have affected child and adolescent growth faltering in China3. They found that growth faltering was associated with both community excreta levels and household toilet facilities, as well as household air quality, and recommend that interventions focusing on growth faltering prioritize community excreta management in particular.
Improving access to safely managed WASH services is absolutely critical for sustainable development. It is crucial for public health as well as for gender equality, economic growth and poverty reduction. But limited access to water resources and reliable infrastructure in parts of the world creates challenges for development and implementation. Doulaye Kone writes in his World View about some exciting new sanitation technologies that can operate off-grid and that do not rely on sewage infrastructure. However, he stresses the importance of not only focusing on technology development but also on the broader service system to ensure that implemented technologies can be maintained long term. He further emphasizes the crucial role that collaboration and good leadership play in making this happen.
The Sustainable Development Goals Report 2023: Special Edition (United Nations, 2023); https://unstats.un.org/sdgs/report/2023/The-Sustainable-Development-Goals-Report-2023.pdf
Progress on Household Drinking Water, Sanitation and Hygiene 2000–2022: Special Focus on Gender (World Health Organization and United Nations Children’s Fund (WHO/UNICEF) Joint Monitoring Programme, 2023); https://washdata.org/reports/jmp-2023-wash-households
Hamlet, L.C., Chakrabarti, S. & Kaminsky, J. Nat. Water 1, 736–749 (2023).
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Leave no one behind. Nat Water 1, 751 (2023). https://doi.org/10.1038/s44221-023-00137-x