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December 2016, Vol. 11, No.

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Sanitation Services Improves Health and Lives of i-Kiribati Women
By Imrana Jalal
Kiribati has one of the highest infant mortality rates in the Pacific due to diarrhea. An Asian
Development Bank (ADB)-supported sanitation project, the South Tarawa Sanitation
Improvement Sector Project (STSISP), aimed, amongst other things, to improve health and
reduce women’s time burdens from looking after the sick. The project was designed as an
“effective gender mainstreaming (EGM)”1 project under ADB’s gender mainstreaming system.
Overall, about 34,427 people in South Tarawa households (HH) have potentially benefitted from
improved sanitation, at least 51.8% of whom are female.
Rianako Imota, a professionally trained nurse for 16 years, said that as a result of the project,
“there has been more than 50% reduction in diarrhea especially for the under-five year olds.
When this happens, women’s work and time they spend looking after the sick is greatly
reduced.” 2 Imota speaks highly of the sanitation awareness campaign under the project, clearly
linking the work of the community sanitation mobilizers and campaigners to the reduction of
diarrhea.
Box 1: Improved sanitation creates improved health and
time savings for the women of the community of Temakin

Rianako Imota, Nurse, Temakin
Clinic

“My name is Rianako Imota. I am a professionally trained nurse and
have been a nurse for 16 years. I am the Nurse/Medical Assistant at
this clinic in Betio-Temakin which looks after 37 communities, a total
population of 6,357, of which 3,274 are female. There are 920 HH.
This clinic is staffed by two nurses and one volunteer. The main
health issue we face is diarrhea. I have kept data to show that the
Sanitation Awareness program of the project works, from 2013 to
date. There has been more than a 50% reduction in diarrhea
especially for the under-five year olds. When this happens women’s
work and time they spend looking after the sick is greatly reduced. I
work closely with the Mothers’ Groups and I see this. The reduction
in this disease over the last three years can be directly attributed to
the project.

Improved time poverty as a result of reduction in illness
Komera Kateari, and Kaokatekai Tanginako, Mothers’ Group members, said that the unpaid
burden of work caring for the sick takes its toll on their lives. They and other Mothers’ Group
members spoke of their losses in time as a result of poor sanitation, which included their own
1

ADB. 2011. Report and Recommendation of the President to the Board of Directors: Proposed Loan and Administration of Grant
Republic of Kiribati: South Tarawa Sanitation Improvement Sector Project.
2
ADB gender review mission comprised of the Team Leader, Jude Kohlhase (Infrastructure Specialist, ADB), Alexandra Conroy
(Young Professional), and Imrana Jalal, Senior Social Development Specialist (Gender and Development), Social Development and
Climate Change Department.

sickness, traveling to a health facility or accompanying family members to health facilities, the
additional care of sick members (sometimes whilst they were themselves sick), boiling water for
drinking, and carrying clean water for drinking if the water supply was polluted, as well as
collecting extra water for pour flush toilets. Women
working in paid employment also tended to leave
their sick children with women who were doing
unpaid work at home. This further additional
responsibility
increased
their
burdens
and
psychological stress, particularly if the children
became sicker under their responsibility or, worse,
died whilst under their care.
The project had reduced this overall burden of care
and time poverty, with the sample study of the
Temakin community showing month by month data
and the reduction in diarrhea by more than 50% from
Komera Kateari and Kaokatekai Tanginako 2013–2016. There is anecdotal evidence of a
Mothers’ Group members interviewed at Temakin
reduction in time poverty of 1–2 hours per day when
Clinic
there was no illness. Women related that the project
had reduced the burden of labor for women in collecting water to flush toilets as a result of
reduced diarrhea.
Gender features in the project
The gender action plan in the project included designs to improve sanitation and hygiene
practices among South Tarawa’s population through an extensive community engagement plan
with a hygiene awareness campaign, as well as to improve the infrastructure and efficiency of
the water and sanitation agencies. Some of the designs were to train community mobilizers to
deliver the gender and hygiene awareness campaign, with 50% targets for women; to use
existing health or church sub-committees, focus groups sessions, or other feedback
mechanisms to assist in monitoring effectiveness of community engagement and awareness
programs with 50% targets for females; to provide technical and gender training of staff at water
and sanitation agencies; and to collect of sex-disaggregated data.
Improved health for women
Anecdotal evidence suggests that open defecation, practiced by 57% of HH in the project area
at the commencement of the project, has reduced. Several women expressed satisfaction with
sanitation services saying that it was significantly improved the quality of their lives.
Box 2: Tirae’s Toilet and the Flow-On Effects
Tirae has a new functioning toilet which is shared between five to six families, showing how HH may
benefit from village improvements in sanitation without having private connections. She chooses with
whom to share her toilet. It is “a big problem” to keep her toilet clean, but she is slowly training the users,
who are family and her community members. The other families sometimes help keep the toilet clean
(including assisting financially with toilet cleaning products, paper, etc.), but even if they do not help, Tirae
says she is happy to keep the toilet clean because she understands the flow-on effect of proper functioning
toilets, especially for women and girls. If she allows them to use her toilet they won’t have to go to the
beach and put themselves at risk. Other women who need to go at night are forced to use the ground
outside their homes, posing hygiene and security risks. The gender sensitization training also encourages
men to help keep the community toilet blocks clean.

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For i-Kiribati families without access to improved
sanitation facilities, particularly for women and
girls with their traditional roles, the amount of time
needed each day to find a place to defecate or to
accompany children to do so is significant.
Additionally, when i-Kiribati women have to wait
until dark to defecate and urinate in the open,
they often drink less water during the day. This
causes additional health problems including
urinary tract infections, chronic constipation, and
other gastric disorders. The project has resulted
in a reduction of this practice although a
quantitative sample study is required as
evidence.

Sanitation awareness posters

Many women were able to teach their teenage daughters about proper menstrual hygiene and
safe sanitary disposal as a result of the community engagement campaign. i-Kiribati women
said that awareness of the issues facing women and girls, such as menstrual hygiene
requirements, are still not widely discussed and addressed in Kiribati, and it is still largely
“taboo”. School aged girls often spend up to a week each month at home during their menstrual
period as the toilet blocks are generally dirty. The sanitation program includes a focus on clean
school toilets and sanitation—water, sanitation, and
hygiene (WASH) in schools which is a joint effort
between the STSISP Community Mobilizers (CM)
team and the education department.
The aim was to provide gender-sensitive training and
awareness on sanitation, menstrual hygiene, and
CLTS benefits. They taught children through action
songs, skits, stories and drama, and using Tippy Tap
methods. “We teach the women to teach their
daughters not to put sanitary pads down the toilet.
We try to get them to use the ‘green bag’ for their
pads. However, there is a further problem when the
green bags are not collected”.

Berite Anterea, Community Mobilizer in discussions
at Buroon Teiaroo II works with the Church Groups in
hygiene practices. The Community is Te Nano
Teuana

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Box 3: Mothers’ Groups from Tenimanboutokaraoi Health Mothers’ Committee
(The Umbrella Organization)
Kemera Kateariki, Betio, community member: “Mothers are the main teachers of sanitation. The CM taught us
how to wash our hands properly using soap. I have five children. I have taught them how to use the toilet
properly, wash using the “Tippy Tap” system, and how to be clean. I have taught my daughter about menstrual
hygiene, to use the ‘green bag’ to dispose of sanitary napkins, and not to throw sanitary napkins down the toilet.
A big problem is the piling up of rubbish and the collection. Even if they collect rubbish in bags (not down the
toilets or manholes which is a big problem), no one collects it regularly. It stinks and becomes problematic.”
Kaokee Tangonako: “Since the CM has been engaging with our
community there has definitely been a reduction in diarrhea. Only
4–5 HH have inside toilets. Most people use the beach or dig holes
next to their houses. Soap is expensive.”
Another woman: “There is an unwillingness to use community
toilets amongst some Mothers’ Groups, it is ‘cleaner and better’ to
use the ground or beach or sea. Dirty people use community
toilets.”

Benateta Tibwere, Sanitation Community
Mobilizer

Another woman: “We use baby’s napkins as sanitary pads because
proper sanitary napkins are too expensive. Some girls throw them
down the toilets and so they block the pipes creating big problems.
This is why the menstrual hygiene awareness campaign is so
important. But if the rubbish is not collected, what is the point?”

Women working on the project in non-traditional jobs
There is a typical occupational gender segregation of jobs in Kiribati in general which is
reflected in the water sector at the Ministry and Public Utilities Board (PUB), with men generally
holding engineering and technical water positions and women doing administrative and clerical
work.
Renate, a female engineer at the PUB, was unable to obtain
confirmed data for the numbers of males/females at PUB, and
Ministry of Public Works and Utilities (MPWU) in the technical
trades (not administrative or clerical). Unconfirmed information
suggests that there are 143 staff altogether at the PUB, as well
as more on workplace attachments. Of the 18 technical
electrical staff, there are four females who are on temporary
work attachments. There are no permanent female staff in this
category. Of the 19 technical water and sewerage staff there is
only one female who is a permanent staff member. Thus, about
Melekate – auto engineer and
3% of overall permanent technical staff at the PUB are female.
CCTV operator
The project hired two females in non-traditional gender jobs, a water technician and an energy
technician, both trained at the Kiribati Technical Institute. Both women demonstrated their
competency in doing typical “men’s jobs” and explained how it had empowered them.

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Box 4: A Tale of Two Women—Getting training,
new skills in project jobs in non-traditional sectors
Taberauea (Tebby) Atanimarewe is an electrical technician. She
acquired her electrical certificate at KIT after three years of training.
There were 2 females and 10 males in her electrical training class.
“I am a single mother with two children. When I qualified it was
really hard to get a job. For a long time I could not get work. Then I
started working in this project from November 2015. I love this job
and the fact that I am actually using my training skills, and am
learning so much from the men in the project. I believe I am getting
equal pay. I also really like the fact that I am getting new training in
plumbing so when I leave the project I will also have plumbing
skills.”
Melekate Bunua is a CCTV operator on this project and uses the
specialized camera equipment to find damaged pipes or pipes in
need of repair underground. She spent three years at KIT getting
qualifications in engineering. “I had a supportive grandfather who
always allowed me to repair cars with him. That’s how I got interested in engineering. I love engines. I
started working for the STSISP six months ago. The males on
the project treat me very well and I have learnt a lot from them,
especially the expatriate technical experts. I am a single mother
of two children. The pay is really good and the guys treat me
with respect. I used to work in ATH doing a marketing job. I
learnt to use this new technology to locate sanitation pipes
underground and the guys taught me how to use the excavator.
So I have also acquired new skills through the project. I don’t
think this is ‘dirty work’ at all. It pays me much more money than
office work and that’s what is most important. I did not know that
the project gender action plan required the project to hire
women technicians.”
Taberauea (Tebby)

Atanimarewe is an electrical
technician

“Melekate is a great operator and isn’t afraid to have a go at
anything. Although she usually operates the CCTV equipment,
she’s the first to jump out and grab a shovel, etc., when
needed,” says Noel Biltris, one of the project supervisors.

Melekate, operating an excavator, a
new skill she acquired while working
for the project team

Improved self-esteem

Health household data boards - a tool for HH to monitor
improvements over a number of dimensions in the
household. This is monitored by the community and the
Mothers’ Groups and are put up in the health clinics.

Poor toilet access for women and girls results in
the loss of time used to seek privacy and security,
missed school or work if facilities are inadequate
to deal with menstrual hygiene, and loss of time
accessing open defecation sites and shared
toilets. I-Kiribati women lose significant time
accompanying children to toilets and to openly
defecate. Women with access to new toilets in
their HH or shared toilets from improved
sanitation (functioning toilets that had previously
not been functioning) incurred intangible benefits
of improved sanitation, such as improved selfesteem and confidence and increased personal
security.

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Decreased risk of sexual assault and violence against women
Violence against women poses a visible threat to women’s human security, particularly the risk
of sexual assault. Most women go to the open sea at night and avoid going by themselves to
reduce the risk of assault. Kiribati has a 10% rate of sexual violence from a non-partner,
suggesting that when women and girls look for privacy at night to go to the toilet outside their
homes, one female in 10 runs the risk of sexual assault. At 67%, it also has the third highest
prevalence rate of intimate partner violence against women amongst ADB regional member
countries which have been surveyed. Again, access to new or shared toilets from improved
sanitation incurred intangible benefits of increased personal security.
Disclaimer: The Asian Development Bank provides the information contained in this article, its
Gender Network Newsletter, and links to its web site solely as a resource. While ADB tries to
provide high-quality content on its web site, it does not guarantee the accuracy, reliability, or
timeliness of this information; and therefore, will not be liable in any capacity for damages or
losses to the user that may result from the use of this information. ADB and its affiliate offices,
likewise, will not be responsible for any errors, omissions, or inadvertent alterations that may
occur in the disclosure of content in this article, the newsletter, or on its web site.

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