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Household survey data from 27 sites in 22 countries were collected in 2017–2018 in order to construct and validate a cross-cultural household-level water insecurity scale. The resultant Household Water Insecurity Experiences (HWISE) scale presents a useful tool for monitoring and evaluating water interventions as a complement to traditional metrics used by the development community. It can also help track progress toward achievement of Sustainable Development Goal 6 ‘clean water and sanitation for all’. We present HWISE scale scores from 27 sites as comparative data for future studies using the HWISE scale in low- and middle-income contexts. Site-level mean scores for HWISE-12 (scored 0–36) ranged from 1.64 (SD 4.22) in Pune, India, to 20.90 (7.50) in Cartagena, Colombia, while site-level mean scores for HWISE-4 (scored 0–12) ranged from 0.51 (1.50) in Pune, India, to 8.21 (2.55) in Punjab, Pakistan. Scores tended to be higher in the dry season as expected. Data from this first implementation of the HWISE scale demonstrate the diversity of water insecurity within and across communities and can help to situate findings from future applications of this tool. HIGHLIGHTS We present comparison scores of the Household Water Insecurity Experiences (HWISE) scale, a novel household water insecurity index validated for use in low- and middle-income countries.; These scores can aid interpretation of future implementation of the HWISE scale.; The HWISE scale should still be evaluated in new contexts, such as high-income settings.

Ending hunger and achieving food security is Goal 2 of the Sustainable Development Goals but will be difficult to achieve as many countries experience financial and political shocks. This study assesses changes in the status of food security in Latin America (LA) during the region’s recent economic recession (2014 to 2017). This cross-sectional study used Gallup World Poll data from 18 LA countries (n = 65,146) from 2014 to 2017. Food security status was measured by the Food Insecurity Experience Scale. Descriptive statistics were performed to analyze the changes in food security and logistic regression was applied to investigate associations between food security and socioeconomic and individual factors. Findings showed that LA suffered a significant decrease in food security (from 51% to 43%) and an increase in moderate (13% to 16%) and severe food insecurity (14% to 19%). However, El Salvador and Honduras, which are benefiting from long-term political and financial stability presented an opposite trend. Although food security decreased in Chile and Uruguay, they still had the two highest prevalences of food security in 2017 (67% and 62%, respectively). As seen in other regions, food insecurity was strongly associated with poverty, low education, having three or more children in the household, lack of social support and poor wellbeing. Women were more likely to report food insecurity, but the elderly (60+) were less likely. Findings highlight that economic and social policies are needed to tackle this progressive deterioration of food security and guarantee the right to food if LA is to achieve 2030 targets.

In March 2020, the World Health Organization (WHO) issued a set of public guidelines for Coronavirus Disease 2019 (COVID-19) prevention measures that highlighted handwashing, physical distancing, and household cleaning. These health behaviors are severely compromised in parts of the world that lack secure water supplies, particularly in low- and middle-income countries (LMICs). We used empirical data gathered in 2017-2018 from 8,297 households in 29 sites across 23 LMICs to address the potential implications of water insecurity for COVID-19 prevention and response. These data demonstrate how household water insecurity presents many pathways for limiting personal and environmental hygiene, impeding physical distancing and exacerbating existing social and health vulnerabilities that can lead to more severe COVID-19 outcomes. In the four weeks prior to survey implementation, 45.9% of households in our sample either were unable to wash their hands or reported borrowing water from others, which may undermine hygiene and physical distancing. Further, 70.9% of households experienced one or more water-related problems that potentially undermine COVID-19 control strategies or disease treatment, including insufficient water for bathing, laundering, or taking medication; drinking unsafe water; going to sleep thirsty; or having little-to-no drinking water. These findings help identify where water provision is most relevant to managing COVID-19 spread and outcomes.

Billions of people globally, living with various degrees of water insecurity, obtain their household and drinking water from diverse sources that can absorb a disproportionate amount of a household's income. In theory, there are income and expenditure thresholds associated with effective mitigation of household water insecurity, but there is little empirical research about these mechanisms and thresholds in low- and middle-income settings. This study used data from 3655 households from 23 water-insecure sites in 20 countries to explore the relationship between cash water expenditures (measured as a Z-score, percent of income, and Z-score of percent of income) and a household water insecurity score, and whether income moderated that relationship. We also assessed whether water expenditures moderated the relationships between water insecurity and both food insecurity and perceived stress. Using tobit mixed effects regression models, we observed a positive association between multiple measures of water expenditures and a household water insecurity score, controlling for demographic characteristics and accounting for clustering within neighborhoods and study sites. The positive relationships between water expenditures and water insecurity persisted even when adjusted for income, while income was independently negatively associated with water insecurity. Water expenditures were also positively associated with food insecurity and perceived stress. These results underscore the complex relationships between water insecurity, food insecurity, and perceived stress and suggest that water infrastructure interventions that increase water costs to households without anti-poverty and income generation interventions will likely exacerbate experiences of household water insecurity, especially for the lowest-income households.

Background Global recognition of the need for food security and gender equality is highlighted by the Sustainable Development Goal (SDG) numbers two and five respectively, but there is a lack of data on how these issues are associated in the Global South to inform policy. Objective To assess the changes in perceptions of gender inequality (GI) and its association with food insecurity (FI) in Latin America (LA) Study Design, Settings, Participants This cross-sectional study uses Gallup World Poll data from 18 LA countries (n = 64,390) from 2014 to 2017. Food security status was measured by the Food Insecurity Experience Scale (FIES). Perception of gender inequality was assessed by a proxy question: “Are women in this country treated with respect and dignity? (yes or no).” Measurable Outcome/Analysis Descriptive and logistic regression analyzes were conducted to assess changes in the perception of GI and its association FI. Results Gradual increases in the perception that women are not treated with respect and dignity were found in LA from 2014 to 2017 (61% to 65%). Results from cross-tabulation analysis showed that food-insecure people reported higher perception that “women are not treated with respect and dignity” (65%) in comparison to those who are food-secure (59%). Food insecurity, gender, lack of social support and low level of education showed the strongest association with GI. Respondents who were food insecure, regardless of their gender, were 30 to 50% more likely to perceive that women are not treated with respected and dignity. Women were 43% more likely to perceive GI. Women are at higher risk of food insecurity, which has been attributed to gender disparities in access to education, employment, productive resources and income. Conclusion Results showed a strong association between food insecurity and perception of gender inequality, suggesting that food-insecure people are more exposed to an environment where women face greater disrespect. Understanding the association between food insecurity and gender inequality is important for the development of public policies towards achieving the second and fifth SDGs. Funding None.