Loughborough University
Thesis- 2019-Bhakta.pdf (10.87 MB)

Opening the doors to the hidden water, sanitation and hygiene needs of women from the onset of the perimenopause in urban Ghana

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posted on 2019-06-26, 07:32 authored by Amita Bhakta
The Sustainable Development Goals provide a spotlight on the need to provide water and sanitation and hygiene (WASH) for all individuals by 2030. Recent debates on ensuring equity and inclusion in WASH provision in the Global South have begun to explore the needs of excluded groups of individuals. Yet, the WASH needs of perimenopausal (PM) women, who are making the transition to menopause, are neglected. An ageing population, particularly in the Global South, raises the importance of meeting the wide-ranging WASH needs of increasing numbers of PM women. The WASH needs of PM women are hidden knowledge, known to, but not shared by, PM women with other people, nor recorded in literature. Hygiene practices are performed privately by PM women, behind closed doors. This study explores this new field of research and aims to provide recommendations to meet the WASH needs of PM women.

Opening the doors to these needs warrants the use of adaptive, participative, feminist methodologies, placing PM women at the centre of the study to enable them to share their experiences. This research uses a six-stage case study methodology: a literature review, a phenomenological review, research design, case study selection, data collection, and data analysis. In the absence of literature on the WASH needs of PM women, a phenomenological review, using oral history narratives of PM women in the UK and USA, was used to set the research agenda. Oral history interviews, participatory mapping and PhotoVoice techniques complemented with ethnographic observations were used to identify the hidden WASH needs of PM women in two low-income urban communities in Accra and Kumasi, Ghana, where water and sanitation services are lacking. Hardware and software solutions for meeting PM women’s WASH needs were identified by environmental health professionals using a vignette method. Ultimately, after trialling NVivo software and theoretical models, a thematic approach was used to analyse the data.

This research identified several WASH needs as crucial to PM women’s health. Bathing and laundry are important hygiene needs, but are neglected by the WASH sector. Effective menstrual hygiene management for PM women as well as adolescent girls, and related sanitation needs, warrants greater attention. This research contributes to recently emerging debates through identifying the incontinence needs of PM women. Drinking is an important
need for good PM health. Whilst the WASH needs of PM women are new knowledge, they can be met through the adaptation of existing hardware and software WASH solutions.

This research concludes that the hidden WASH needs of PM women require participatory techniques to reveal them. Relationships with certain people allow PM women to discuss and meet the WASH needs to a degree. PM symptoms vary in nature, between women and day to day. This research demonstrates that the WASH sector needs to become more attentive to bathing and laundry issues overall, learning from the needs of PM women.



  • Architecture, Building and Civil Engineering

Research Unit

  • Water, Engineering and Development Centre (WEDC)


Loughborough University

Rights holder

© Amita Natiksha Bhakta

Publication date



A Doctoral Thesis. Submitted in partial fulfilment of the requirements for the award of the degree of Doctor of Philosophy at Loughborough University.


  • en


Julie Fisher ; Brian Reed

Qualification name

  • PhD

Qualification level

  • Doctoral

This submission includes a signed certificate in addition to the thesis file(s)

  • I have submitted a signed certificate