rheal disease. Women do not always have the financial resources to pay for water purchases, treatment, or new investments. However, it is not just access to water that is a problem. The lack of sanitation means that, in some places, women and girls must wait until nightfall to defecate, while in some nations more than 50 percent of girls drop out of school due to the lack of toilets. These disparities have additional implications for health, education, and human rights.

Thus women and children place a higher value on water and sanitation. A study showed that microcredit loans provided to women in Bangladesh increased the presence of latrines in their household from 9 to 26 percent over three years; the control group showed a slight decrease in latrine presence during the same time period (Husain, 1998). A group of schoolgirls in Kenya demonstrated that children are thinking about sanitation. When asked about the type of preferred sanitation, they provided a detailed drawing depicting the location and construction of a latrine for their school (Dickman, 2008). Much work must be done in order to reach a global goal of increasing access to improved sanitation in many parts of the world.

The first collaborative international effort to create significant impacts on the global water and sanitation situation came from the First International Drinking Water Supply and Sanitation Decade (1981–1990) which ultimately met with limited success. However, new innovations exist that may lead to greater success in the second decade International Decade for Action: Water for Life (2005–2015), such as increases in public-private partnerships, investments by large corporations, and more community-based organizations and nongovernmental organizations that work on improving access to water and sanitation. A greater focus on microfinancing and local initiatives, along with new discussion of ecological sanitation and culturally appropriate initiatives, is led by empowered community members. Other trends include the consideration of global water scarcity in sustainable planning and a move from simple water quality monitoring to the development of a more holistic water safety plan approach by the World Health Organization (WHO) as well as greater use of various household water treatment approaches.

With regard to standards for improved water and sanitation, it is important to recognize that improved water is not necessarily safe drinking water. Improved water access includes household connections, public standpipes, rainwater collection, boreholes, and protected wells, but not water vendors, unprotected wells, unprotected springs, rivers or ponds, or tanker truck water. Improved sanitation includes connections to public sewers, septic systems, pour-flush and improved pit latrines, but not shared, traditional, or open pit latrines. Results have been mixed—between 1990 and 2002, the number of people with improved water gradually increased (Figure 5-1).