Purpose: Significant attention has been paid to the untapped potential of supporting the education of girls as a strategy to improve health in low-income countries (LICs). Educational attainment for adolescent girls in LICs has been linked to delayed marriage and childbearing, improved employment opportunities and earning potential, and family-level outcomes including healthier children (e.g. Freeman et al., 2011; Oster & Thornton, 2011). However, the educational experience of adolescent girls is shaped by multiple contextual factors including socially defined expectations for gendered time use and environmental health conditions that disproportionately affect girls compared to boys. Time use in rural Kenya is traditionally differentiated by socially constructed gender expectations. For example, girls and women are primarily responsible for domestic labor and are excluded from paid labor opportunities (Mungai, 2012; Warrington & Kiragu, 2012). For girls, domestic labor, such as fetching water, collecting firewood, cooking, and washing, is done without the technological assistance found in more urban areas or higher income countries. Domestic labor is further shaped by environmental conditions and characteristics (Mungai, 2012; Warrington & Kiragu, 2012). Distance to accessing water, sources of fuel, and distance to school directly influence time use for adolescent girls. Other modifiable environmental factors also contribute to the health and well-being of adolescent girls and impact school absenteeism (Alexander et al., 2014). Over one-third of global disease burden among children is due to modifiable environmental factors. For example, 58% of diarrheal diseases and 24% of lower respiratory tract infections in low-income countries are attributable to environment conditions (Pruss-Ustun, Wolf, Corvalan, Bos, & Neira, 2016). Diarrheal disease is predominately related to unsafe drinking water and poor sanitation and hygiene while lower respiratory tract infections are related to indoor air pollution from household solid fuel use. Prevention and treatment of diarrheal and respiratory diseases is compounded by limited access to healthcare facilities and high rates of malnutrition present in rural settings (Pruss-Ustun, Wolf, Corvalan, Bos, & Neira, 2016). Domestic work required by adolescent girls creates a competing demand for time use for educational purposes. In addition, gendered domestic work may increase health risks. For example, girls are vulnerable to sexual assault and harassment while collecting water or firewood alone and have increased exposure to indoor air pollution while cooking. The purpose of this research was to describe the time use and environmental health barriers to school attendance for adolescent girls in rural Kenya.
Methods: Data were collected at primary schools in two small, remote villages in the Tharaka region of Central Kenya. Participants completed an oral interview survey to assess participant demographics, time use, health behaviors, and sanitation including questions from the WHO Harmonized Household Energy Survey and the WHO Drinking-water and Sanitation Survey (World Health Organization & UNICEF, 2006). Interviews were conducted by a trained local public health nurse in Kiswahili and Kitharaka according to the preference of participants. Participant responses were entered into an Excel database and descriptive statistics were generated.
Results: Sixty girls aged 11-19 (mean age 14 years) participated in the interviews who were in classes 4-8 in school. On average girls reported spending 2.2 hours cooking, 1 hour collecting water, and 1 hour collecting firewood daily. Most girls (88%) experienced eye irritation and burns (84%) related to cooking while at home in the past 2 weeks. More than two-thirds of participants reported surface water (e.g. river, stream) as their primary source of drinking water at home (69%) and 51% reported not treating the water prior to use. Girls reported that girls and women were responsible for fetching water most of the time (99%).
Conclusion: Increased understanding of time use and environmental health is important to tailor effective interventions that have the potential to improve girls’ school attendance, educational attainment, and ultimately health outcomes. The link between health and education is complex and requires multifaceted interventions that can address a myriad of social and environmental factors. Interventions that focus exclusively on school-level interventions without addressing other multi-level factors may be limited in reach and lack sustainability. Addressing social and environmental factors that are amenable to change has the ability to bolster the effectiveness interventions aimed at improving girls’ education and ultimately, their health.
