5.
The Impact of Universalization of Sanitation on Women

This study analyzed, from several points of view, the issue of women and sanitation in Brazil. Firstly, the profiles of contemporary Brazilian women and their access to basic sanitation equipment according to the National Survey by Household Sample Continuation (PNADC) were shown. It was identified the existence of still high deficits. About 1.6 million women were still living in homes without exclusive-use bathrooms in 2016. This was an extreme situation that exposed women's health and safety. In the same year, more than 15 million Brazilian women still did not receive treated water in their homes and there were 12 million women who had access to the general water distribution network, but the frequency of water delivery was unsatisfactory. Therefore, there were 27 million women who did not receive regular water in their homes. In 2016, the number of women residing in housing without sewage collection reached a similar figure (26.9 million). This means that one in four Brazilian women still lived in a precarious situation from the point of view of access to basic sanitation.

The deprivation of sanitation has compromised women's health and has had unfolding effects on their lives. Lack of sanitation has led to the occurrence of infectious gastrointestinal diseases that, depending on severity, have caused women to move away from their routine activities, bedridden or hospitalization. In extreme cases, these infections associated with poor sanitation led to death. In 2013, as indicated in the chapter that analyzed data from the National Health Survey (PNS), 7.9 million cases of women's withdrawal due to diarrhea or vomiting were identified. Of this total, 3.6 million women were bedridden because of these infections. In that same year, according to data from the Unified Health System, there were 353,5 thousand admissions of women in the network and almost 5 thousand deaths due to gastrointestinal infections associated with lack of sanitation.

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. In a broad sense, the lack of basic sanitation has limited the well-being of women, compromising their health, education and domestic and economic activities.

In this final chapter of the study, we present estimates of hours of Brazilian women which are wasted due to gastrointestinal diseases and, in the case of women engaged in economic activities, the income they no longer receive due to diseases associated with lack of sanitation. Viewed from a different angle, these estimates also quantify the potential welfare gains that could be obtained with the advancement of sanitation, that is, indicate the increase in income and the greater availability of hours of rest or leisure that the Brazilian women would have if the access to sanitation were universal.

+ Rest and Leisure Time

Based on the determinants factors of absences from routine activities due to diarrhea or vomiting, it is possible to estimate the time Brazilian women lost with these diseases in 2016. For that, data from the PNADC of that year were also used, which allowed to infer the weight of those hours in the allocation of hours of the female population of the country. According to methodology detailed in the Methodological Annex, it is estimated that there were 9.309 million absences due to diarrhea or vomiting in 2016, which indicated an incidence of 81.4 cases per thousand women. This estimate of incidence rate is higher than that estimated in 2013 (76.0 cases per thousand women) due to the increase in the proportion of women living in houses with irregular water supply. This increase occurred both in the Southeast and in the Northeast of the country, areas that were severely affected by the water crisis from 2014 to 2016.

The statistical model developed to estimate days of leave due to diarrhea or vomiting, which is detailed in the Methodological Annex, indicated that, on average, each leave compromised 3.86 days of the affected women in 2016. In the younger age group (0 to 4 years of age), it was estimated that they were almost 5 days away from routine activities. This number fell to less than 3 in the range of women between the ages of 20 and 29 and then increased again, reaching a maximum of 5.12 days in the age group of women between 60 and 79 years old. Thus, 9.309 million cases of diarrhea or vomiting leave meant 35.945 million days of absence of women from routine activities due to infectious gastrointestinal diseases. In total, it is estimated that 862.7 million hours of absence or 8.1 hours per Brazilian.

The questions that naturally arise from this observation are: what was compromised on those days and hours of absence? Which women lost more hours? What did they fail to do? The answers to these questions go through the observation of how women have distributed their time between activities in the different phases of their lives. Women who were students lost hours at school or home-based student activities. Women who worked outside the home lost hours of production. In the case of women who cared for their relatives, if they became ill and unable to care for them, relatives suffered, and if the relatives were sick, caregivers spent more of their rest, leisure, or personal activities time taking care of the rest of the household.

Figure 5.1 shows the allocation of Brazilian women's hours between different activities in 2016. PNADC data do not allow to detail all the activities carried out by women during the course of a day, but give a very accurate distribution of economic activities and unpaid work. The hours of one week were spent with: (i) paid work, including the length of time from home to work; (ii) unpaid activity, including the time spent on production for consumption by the family, time devoted to voluntary work, and that spent on household chores and people care; (iii) the time devoted to the study (1 The calculation of the time devoted to the study took into account the minimum journey in elementary and high school education of 800 hours over 200 days in the year - Federal Law 9.394 / 1996. A similar load was assumed for higher education. The transportation time from home to the school was estimated based on PNAD data); and (iv) time spent with rest, leisure, and personal activities - including food, personal hygiene, personal shopping, sports, entertainment, dating, sleeping, time spent with health, etc.

Figure 5.1
Allocation of hours of Brazilian women between different activities, by age group, 2016

Statistics show that the time spent with education decreases as the age increases, and the time spent with economic activities increases up to a certain age and then decreases. Girls, for example, spent most of their time between rest, leisure, and personal activities and studies. Women between the ages of 30 and 39 were the most economically engaged and women between the ages of 40 and 59 were the most engaged in unpaid activities.

Graph 5.1
Distribution by age group of hours of absence from diarrhea or vomiting, female population, 2016

Combining the information in Figure 5.1 with estimates of days of absence by age group, we reach the distribution of the impacts of diarrhea or vomiting distress in the activities carried out by women in their various phases of life. It is estimated that the majority of absences 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 30-59 age group accounted for 30.4% of diarrhea or vomiting leaves and women over 60 years of age, accounting for 14.0% of the total. In per capita terms, young women were also the ones who spent the most hours on leave. In the female population up to 4 years of age, it is estimated that in 2016 almost 20 hours per girl were wasted because of the lack of sanitation. In the group of girls between 5 and 14 years old, the loss was also great, of more than 14 hours per girl. After this age group the incidence of absences and the number of lost hours fall, returning to grow in the age groups of the elderly.

Graph 5.2
Hours per capita wasted with absences from diarrhea or vomiting, by age group of women, 2016

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% were concentrated in these activities, compromising the well-being of the female population that would be obtained with the activities as eating, personal hygiene, personal shopping, sports, entertainment, sleep time, time spent caring for their health or simply with rest. In addition, 83.358 million hours of study and 172.410 million hours of paid or unpaid labor activities of the Brazilian female population were wasted due to diarrhea or vomiting. These sums corresponded respectively to 9.7% and 20.0% of total hours of absence associated with lack of sanitation.

Graph 5.3
Distribution of hours of leave by diarrhea or vomiting of the female population, by activity, 2016

In per capita terms, there were 2.4 hours of paid work per year of the 39.254 million women employed in the country's labor force and 0.9 hours per year of the 84.870 million Brazilians who performed unpaid activities - voluntary work, domestic activities and personal care with family members. For each of the 25.554 million Brazilian women studying in 2016, there was a loss of 3.3 hours of study in the year. The almost 106 million Brazilian women lost, on average, 5.7 hours of rest, leisure and development of personal activities.

Graph 5.4
Hours per capita wasted with absences from diarrhea or vomiting, by age group of women, 2016

If access to sanitation were universal, on the other hand, Brazilian women would stop wasting part of those hours away from their routine activities. Based on the statistical models developed in this study, it is estimated that total absent 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 into welfare gains for Brazilian women. Of this total, there would be 7.248 million hours of work, 7.471 million hours of study, 6.026 million hours of unpaid activities and 51.451 million hours of rest, leisure and personal activities. The most important of all: half the reduction in wasted hours would be appropriated by young women up to the age of 19.

Graph 5.5
Distribution by age group of reduction of leave due to universalization of sanitation, female population, 2016

+ Income and - Poverty

Women lost more than time due to the lack of access to sanitation. In 2016, women lost income in economic activities, and girls ended up with more school lag than would exist if access to sanitation were universal, as discussed in Chapter 4 of this study. 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 wages of women by 6.1% and the lack of a bathroom in the house decreased it by 23.0%. Women living in housing without regular access to water, without restroom and without sewage collection had their income diminished by almost 1/3 in relation to women with full access to basic sanitation.

Considering the sanitation deficits presented in Chapter 2 and the remuneration structure analyzed in Chapter 4, it can be inferred that universal access to basic sanitation would bring a rise in income of 1.5% on average. The average remuneration of Brazilian women would increase from R$ 1,826.35 per month to R$ 1,853.10 - considering 2016 prices. This is equivalent to an increase in income of R$ 321.03 over a year by Brazilian woman. This increase comes from productivity gains that women would have due to a lower incidence of absences caused by infectious gastrointestinal diseases associated with lack of sanitation.

The individual amount seems small, but when multiplied by the number of women in the country, its impact would be enormous. As shown in Table A.15 of the Statistical Annex, the earnings of Brazilian women would reach R$ 12.127 billion per year. More than half of these gains would occur in the North and Northeast of the country, where access to basic sanitation was more precarious in 2016. In these regions there were, respectively, 19.7% and 32.8% of women's income gains that could be obtained with universal access to sanitation. Of this income, almost 1/4 would be in the capitals of the Brazilian states and in Brasilia. But a large portion (49.3%) would arise in the urban areas of the Brazilian medium-sized cities that are not capital cities and do not belong to metropolitan regions. It would therefore be a gain with great capillarity, which would favor the reduction of regional inequalities.

Map 5.1
Number of women who would leave poverty due to universalization of sanitation, in thousand people, 2016

Given that the lack of sanitation was concentrated in the poorest groups 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 Chapter 1 of this 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 thanks to the universal access to sanitation. This indicates that 635,300 women would leave poverty condition because sanitation would bring productivity gains. It is important to note that estimates indicate that universalizing sanitation would have a greater impact on reducing poverty among women than among men. In the case of the male population, the universalization of sanitation would enable 601,200 men to leave the poverty condition.

Map 5.1 regionally distributes the potential number of women who would leave the poverty condition with universalization of sanitation. It is noted that almost half of the 635,300 women leaving poverty were living in the Brazilian Northeast. Maranhao, Bahia and Pernambuco would be the states of this region with the greatest poverty reductions among Brazilian women. The Brazilian North has also a large number of women who would leave the poverty condition - about 20% of the total -, especially in the state of Para, where a reduction of 77,600 women in the poverty condition is projected.

Another important fact with regard to the effect of reduction in poverty is the concentration on self-declared black and multiracial woman. It is estimated that 3 out of 4 women leaving the poverty condition would be black, which highlights the inclusive nature of universal sanitation. The impacts are small in the self-declared female populations of Asian descent or indigenous, but are considerable in the self-declared white population, which would account for almost 25% of women to leave the poverty condition.

Graph 5.6
Self-reported race distribution of women who would leave poverty due to universalization of sanitation, 2016

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 old. 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 to leave the poverty conditions belong to the future generations of the country. This fact qualifies as perennial the effects of the universalization of sanitation.

Graph 5.7
Distribution by age group of women who would leave poverty due to universalization of sanitation, 2016

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.