Exploring the experiences of the overburden of water collection responsibility of rural women in Ghana

Water inaccessibility, characterized by inadequate access to affordable, reliable, and safe water (Jepson et al. 2017), impacts over 30% of sub-Saharan Africans, with rural inhabitants disproportionately affected by chronic underservice and a lack of sustainable water infrastructure (UNICEF & WHO 2023). In 2020, only 41% of Ghanaian households had access to safely managed water, with significant disparities between rural and urban areas and across different regions (WHO & UNICEF 2021). Evidence underscores that access to safely managed water is below 50% for rural dwellers (Dongzagla et al. 2022; UNICEF & WHO 2023).

Studies have highlighted the consequences of water inaccessibility and the associated task of water collection beyond disease and mortality risks (Sorenson et al. 2011; Geere et al. 2018; McDonald et al. 2019; Asoba et al. 2020; Cole et al. 2024). Additional concerns include violence risks, animal attacks, nutritional deficiencies, psychological issues, musculoskeletal pain, and economic losses (Geere et al. 2018; McDonald et al. 2019; Choudhary et al. 2020; Venkataramanan et al. 2020; Miller et al. 2024). These findings emphasize the need for improved tools and programmes to ensure equitable water resource distribution and achieve Sustainable Development Goal 6 (Water and Sanitation) in support of other goals, such as gender equality (SDG 5).

Some studies have examined the gender consequences of water inaccessibility and long-distance water collection for (rural) women in Ghana (Archer 2005; Jeil et al. 2020; Achore & Bisung 2022; Nordström & Widman 2022; Ahiabli et al. 2023). However, further empirical research is required to provide a comprehensive understanding and additional insights into the disproportionate domestic water-supply burden consigned to rural women. In Ghana, like most patriarchal African cultures and societies, gendered division of labour and power imbalances are perpetuated (Alaci et al. 2013; Jeil et al. 2020). Women have a disproportionate responsibility for water and must collect it to maintain social acceptance, while men hold wage-earning responsibilities and (economic) power in households (Alaci et al. 2013; Jeil et al. 2020). These gendered divisions of labour and expectations drive women and men to engage in activities that align with their socially constructed identities and conform to prevailing gender norms (Cerrato & Cifre 2018; Owoo & Lambon-Quayefio 2021). As a result, women acquire and distribute water for household use, while men benefit from the advantages conferred by the patriarchal system (Graham et al. 2016; Van Houweling 2016; Jeil et al. 2020).

Compounded by patriarchal systems and structures, rural women face significant challenges in accessing and collecting water due to the lack of piped water systems in their homes, inadequate water facilities, and the persistent failure of rural water projects (Alaci et al. 2013; Jeil et al. 2020; Dongzagla et al. 2022). Most of these women endure difficult journeys, traversing long distances through challenging terrains and venturing to water sources at night to avoid lengthy queues (Alaci et al. 2013; Jeil et al. 2020). This precarity may further be aggravated and long-lasting considering the already vulnerable status these women hold as the poorest of the poor (Issahaku 2018; Aluko & Mbada 2020; Jerumeh 2024), which may hinder their ability to cope with and recover from water-related stress and shocks.

Addressing the need for improved water access and reducing vulnerabilities related to water inaccessibility, including gender-related threats, necessitates a comprehensive understanding of rural women's burden in water collection responsibilities, as captured in scholarly accounts (Geere et al. 2018; Choudhary et al. 2020; Venkataramanan et al. 2020; Miller et al. 2024). To this end, this research employed a community-based case study to explore factors influencing women's difficulties in accessing and collecting water off-premises as well as the ensuing health and economic consequences. The aim is to make valuable contributions towards the development of an integrated and cross-sectional intervention model focused on ensuring sustainable water security in rural areas in Ghana, while advancing knowledge on the gender dimensions of water access and collection. Ultimately, this will aid in empowering women and planning gender-sensitive interventions needed to achieve SDG 6 – universal and sustainable access to safely managed drinking water.

This study design is based on a coupled systems framework, designed to address water inaccessibility in rural sub-Saharan Africa, specifically focusing on gender and climate considerations (Apatinga et al. 2022). The framework highlights the interconnected nature of environmental, systemic, and individual elements that affect access to drinking water as well as the interplay between coping strategies in response to lack of access and the associated consequences. The study was conducted in Kologo in the arid Upper East Region in the savannah ecological zone of Ghana between August and October 2022. Kologo is an impoverished rural community in the Kassena-Nankana East Municipality, which is known for chronic water shortages. It is located approximately 25 min drive from the municipal capital – Navrongo. The Nankani-speaking people make up the majority of the community and have a diverse population of Christians, Muslims, and traditional worshippers. Kologo faces extreme water insecurity, with limited social amenities and infrastructure, including water facilities. Agriculture is the primary economic activity in the community, and literacy levels are generally low. Access to piped water is challenging due to poverty and high connection costs, leading households to rely on water sources such as boreholes, rainwater, and (un)protected dug wells. Water scarcity worsens during the long dry season.

The community consists of three sub-communities: Kolwingo, Nayiire, and Zuo (located in the savannah ecological zone). Kolwingo is the first area encountered when entering Kologo, known for its dispersed settlements and market square. Residents engage in subsistence and small-scale commercial farming. Kolwingo has one basic school and one dam, with social structures characterized by extended families and communal living. Water insecurity is a significant issue, with few boreholes and unprotected wells far from homes.

Nayiire, the second subdivision, is the residence of the chief, hence its name meaning ‘chief's area.’ It shares similarities with Kolwingo and Zuo in terms of agrarian economy, dispersed settlements, traditional practices, and communal living. Nayiire has a basic school, a health centre serving all of Kologo, and a dam used for dry-season farming. However, this dam depletes during the dry season and is prone to breaches. Water facilities are limited, with a difficult-to-access community water tank and few boreholes.

Zuo is about a 20- to 25-min walk from Nayiire, sharing characteristics with Kolwingo and Nayiire such as agricultural economy, extended families, scattered settlements, and communal living. Zuo has one basic school but no dam, relying on dams in Kolwingo and Nayiire for dry-season farming. It preserves the cultural heritage of Kologo through its practices and traditions, with few strategically placed boreholes for water access.

Water insecurity in Kologo is an issue of significant concern, making it a suitable location for documenting the consequences of water scarcity and distant water collection on women. A community meeting was conducted with the Chief and elders to explain the study's purpose, address questions, and seek permission. After gaining approval, the research team spent time establishing relationships within the community prior to conducting the research.

This study adopted a mixed-methods approach, blending quantitative and qualitative methods in a convergent parallel design. Ethics approval was secured from the University of Saskatchewan Behavioural Research Ethics Board (Beh-REB#2711), McMaster Research Ethics Board (MREB#5809), and the University of Ghana Ethics Committee for the Humanities (ECH355/21-22). Participants had to meet specific criteria: being adults aged 18 or above, residing in the community for at least 1 year, and providing consent. Consent was obtained via signature, thumbprint, or verbal agreement.

The study involved community members from the three sub-communities in Kologo. Equal numbers of men and women across each sub-community were recruited through posters and announcements in the local dialect (Nankani). Fifty individuals, including both men and women, were randomly selected from each community using cluster sampling. This resulted in a sample size of three hundred. The sample size was determined based on the population of the Kologo community, which is slightly over 2,000, with the goal of achieving representativeness of the population under study, while also considering factors such as time and resources. Trained research assistants (one man and one woman) conducted the survey in the local dialect. The survey design was grounded in the conceptual framework and questions covered participants' backgrounds, water sources, gender roles, health implications, and household responses to water scarcity.

The survey contained detailed information on demographic and socioeconomic variables, health variables, and water access. Explanatory variables representing environmental, systemic, and individual-level factors were categorized according to the conceptual framework, ensuring alignment with the research objective and relevance to the phenomenon under study (Table 1). Difficulty accessing and collecting water was used as the main outcome or dependent variable (difficult or very difficult as none of the respondents identified other categories on the five-point Likert scale).

The selected independent and dependent variables were analysed using SPSS version 21. Initially, a multicollinearity test was conducted using tolerance and variance inflation factor (VIF) to assess potential correlations among the independent variables (Chatterjee & Simonoff 2013). This step was crucial to confirm that the variables were independent of each other, which is essential for accurate regression analysis outcomes. According to the tolerance (tolerance value less than 10% indicates severe multicollinearity) and VIF (VIF > 10 indicates severe multicollinearity) standards (Chatterjee & Simonoff 2013), all variables demonstrated sufficient independence (Table 1).

Regression analyses were then conducted to explore and highlight potential relationships between the predictors and categorical response variables. Binary logistic regression models, reporting odds ratios and 95% confidence intervals, were employed to identify significant predictors of women's relative difficulty in accessing and collecting water. This approach was chosen because of the binary nature of the dependent variable. Statistical significance was set at a 5% level. Using the enter method in binary logistic regression, two multivariable logistic regression models were created to understand: (1) women's water collection experiences; and (2) men's perceptions regarding women's water collection experiences. The enter method effectively includes all key independent variables in the model to evaluate their joint influence on the dependent variable. It examines each predictor beyond what other variables in the model have already predicted, reducing biases by incorporating all variables, irrespective of their statistical significance. This method is particularly useful in logistic regression when researchers seek a straightforward and comprehensive method for examining the relationship between multiple predictor variables and a binary outcome (Halinski & Feldt 1970; Thompson 1989, 1995; Stevens 2002; Gary 2018). The modelling process followed a hierarchical strategy, starting with environmental factors, then systemic variables, and finally addressing individual variables. This method allows for a comprehensive examination of various levels of influence on the dependent variable. By aligning with the adapted conceptual framework, this structured approach enhances interpretability and robustness, offering a well-defined path for the analysis of variables (Gary 2018).

Additive scale analysis (De Mutsert et al. 2011) provided insights into cumulative water-related issues among women. To calculate the composite score in SPSS for identifying cumulative water-related challenges, the variables representing health challenges (e.g., physical injuries, psychological health issues), safety issues (e.g., animal attacks, spousal violence, quarrels at water sources), and nutritional and hygiene challenges (e.g., not cooking enough food, uncompleted household tasks) were summed together using a binary scale (yes and no). These variables were assigned values of 0 for ‘no’ and 1 for ‘yes.’ For example, health challenges were calculated as the sum of physical health challenges and psychological health challenges related to water collection from alternative sources. Similar calculations were performed for the other categories. Descriptive statistics, including frequencies, were then computed to provide summary statistics. Additionally, cross-tabulations were conducted to understand how socioeconomic backgrounds influence water-related challenges.

Participants were recruited using similar techniques as for the surveys. Focus group discussions (FGDs) were held in each of the three sub-communities for young men or women (≤30), adult men or women (31–50), and older men or women (≥51). Led by a research assistant of the same gender, discussions focused on water access challenges and strategies, and were audio-recorded after securing participants' consent.

Thematic analysis was employed to analyse the transcribed FGDs, using NVivo 12. The coding process involved deductive coding based on the adopted conceptual framework and interview questions and inductive coding to capture additional emerging themes. Codes were organized into categories and sub-categories aligned with the study's objective. Themes were derived by synthesizing related categories and sub-categories, capturing patterns in the data. The themes underwent thorough review and refinement to ensure accuracy, coherence, and relevance to the study's objective. Findings were presented using these refined themes, supported by de-identified verbatim quotes from participants.

Women (50 from Kolwingo, 50 from Nayiire, and 50 from Zuo) and men (50 from Kolwingo, 50 from Nayiire, and 50 from Zuo) were equally represented in the sampled population across communities (Table 2). Family sizes were generally consistent across communities, with an average of at least five members per household. Education attainment beyond the secondary level was higher among men than women and among men in Kolwingo (10%) than in Nayiire and Zuo (4%). Zuo had the highest percentage of individuals, both men (34%) and women (40%), without formal education.

At least half of respondents reported that their income was average compared to others in their sub-communities, with Nayiire women (72%) most likely to report average income, followed by Kolwingo (64%) and Zuo (60%). More men reported average income than women (Nayiire men – 86%, Zuo men – 78%, Kolwingo men – 69%). Farming was the predominant occupation among respondents indicating its dominance as the primary livelihood source in Kologo. For example, the majority of Zuo men (96%), and women (70%) engaged with farming. Across genders, responses indicated that men reported better health than women. Further, across sub-communities, a larger percentage of Kolwingo women (86%) and men (90%) reported being healthy as compared to those in Nayiire (women 68%, men 88%) and Zuo (women 66%, men 84%). The socioeconomic disparities between genders in Kologo underscore the patriarchal structure of the community, favouring men while marginalizing women.

Data reveal the prevalent use of government-provided, free-of-charge communal borehole water facilities throughout the year, reported by 66% of Zuo women, 60% of Nayiire, and 60% of Kolwingo (Table 2). Men perceived borehole usage to be higher: 86% in Nayiire, 86% in Zuo, and 82% in Kolwingo. Notably, 98% of women in Zuo, 90% in Kolwingo, and 82% in Nayiire reported obtaining water without payment. FGDs supported survey findings, emphasizing the significance of boreholes, as expressed by respondents from all three sub-communities: ‘We fetch from a borehole’ (Young Women, FGD, Kolwingo). This aligns with previous studies highlighting the prevalent use of boreholes or handpumps in rural areas (Fisher et al. 2015; Foster et al. 2018). However, women and men also reported scarcity of boreholes: ‘We do not have boreholes’ (Adult Women, FGD, Kolwingo); ‘One borehole serves about two or three sub-communities’ (Yong Men, FGD, Kolwingo); and ‘The number of boreholes is limited’ (Adult Men, FGD, Nayiire).

Rainwater harvesting was also widely used according to survey responses, with 42% in Kolwingo, 74% in Nayiire, and 54% in Zuo reporting its use in the wet season. Nayiire women mentioned: ‘Women harvest rainwater for use in the rainy season’ (Adult Women FGD, Nayiire), resonated by Nayiire men: ‘Women also harvest rainwater for use’ (Young Men, FGD, Nayiire). The semi-arid climate prevalent in the area, characterized by unpredictable rainfall patterns and a scarcity of government-provided water infrastructure, emphasizes the importance of rainwater harvesting as a sustainable method of water supply. However, other improved sources such as piped/tap water, protected dug wells, and springs were not commonly identified as water sources. For example, only 9% of Nayiire, 8% of Kolwingo, and 2% of Zuo women reported piped or tap water use, with only men in Kolwingo (8%) recognizing that their households depend on piped or tap water. Chronic poverty within the communities worsens the restricted use of piped water, as it is only accessible to a small minority who can afford it.

As a result of chronic poverty and poor access to improved water facilities within the communities, respondents indicated the use of unimproved sources, particularly dug wells (Table 2). In Kolwingo, 60% of women reported using unprotected wells, followed by Zuo (44%) and Nayiire (30%). Men's responses corresponded with these patterns but underreported usage, notably in Kolwingo (12%). Discussions within focus groups confirmed this reliance on unprotected wells across men and women and all sub-communities: ‘We go to the wells sometimes’ (Young Women, FGD, Zuo) and ‘In my household, we get water from a well’ (Adult Men, FGD, Zuo). Limited use of other unimproved sources like unprotected springs and surface water was also reported (Kolwingo and Nayiire-8%). The dispersed settlements underscore the challenges in accessing distant water facilities, exacerbating reliance on unimproved water sources. Other research highlights the simultaneous use of improved and unimproved water sources in rural areas due to inadequate infrastructure and frequent breakdowns (Foster 2013; Foster et al. 2018; Chew et al. 2019).

There is extensive evidence showcasing the unequal gender roles in domestic and community activities in patriarchal African cultures (Jeil et al. 2020; Owoo & Lambon-Quayefio 2021), extending to water rights, use, and control (Van Houweling 2016; Jeil et al. 2020). Nearly all men (>90%) across all three sub-communities acknowledged gender disparities in household chores, corroborated by over 80% of women, reflecting societal recognition of these dynamics (Table 2). Decision-making aligns with this division, with men predominantly influencing financial matters while women report more control in household chores and childcare decisions. Although over 70% of both men and women advocate for gender equality in decision-making, women's primary responsibility for water collection persists due to entrenched gender roles, as expressed in all men's focus groups: ‘Traditionally, a woman is born to fetch water’ (Young Men, FGD, Kolwingo).

Despite socioeconomic shifts challenging traditional roles, the prevailing societal norms still unevenly allocate domestic tasks. Water collection primarily falls on women, often involving girls collectively or on a rotating basis (Table 2). Zuo women predominantly (56%) receive support from girls in water collection, reiterated in FGDs: ‘My daughter…helps me fetch water’ (Adult Women, FGD, Zuo). Men mainly collect water circumstantially, reinforced by statements like: ‘When the woman is sick, the man has to go and fetch water’ (Adult Men, FGD, Kolwingo). Such sporadic men's involvement, often stigmatized culturally, aims to maintain social approval, reinforcing men's dominance within household dynamics (Asaba 2013; Van Houweling 2016).

The traditional duty of water collection, combined with decentralized water systems, burdens women, consuming significant time – often over 30 min daily (>80%) (Table 2), aligning with global rural water access challenges (WHO & UNICEF 2021). This difficulty is echoed in women's and men's discussions in all sub-communities, highlighting the strenuous efforts to access clean water: ‘It is not easy to fetch water because you have to suffer before you get water to fetch’ (Young Women, FGD, Nayiire); ‘Women fetch water as their duty, so they have to endure a lot of pain’ (Adult Men, FGD, Zuo). Consistent with prior research (Van Houweling 2016; Yillia et al. 2021; Apatinga et al. 2022), these findings underline the gender-based inequalities and burdens placed on women in water collection and access.

Multivariable analysis identified certain factors as statistically significant in explaining women's experiences with poor water access (Table 3). However, none of these variables were statistically significant when exploring men's perceptions of women's water access experiences. This demonstrates the disconnect between men as primary decision-makers and women as water purveyors in these communities.

Evidence underlines the significance of environmental factors in water availability and access (Apatinga et al. forthcoming; Foster 2013; Abu et al. 2021; Yillia et al. 2021). However, variables like community and time collecting water daily in a week in the wet and dry seasons lacked statistical significance in women's experiences (model 1) and men's perceptions (model 2). Despite this, earlier research highlights how these factors affect women's water access. Seasonal changes influence water availability and travel patterns (Kelly et al. 2018; Yillia et al. 2021). Rainfall can help, but also creates challenging muddy paths, as expressed in women's and men's focus groups in all sub-communities: ‘In the wet season, paths are muddy and make carrying water difficult’ (Young Women, FGD, Kolwingo); ‘A woman can slip and fall carrying water in the wet season’ (Young Men, FGD, Zuo). Conversely, dry seasons exacerbate scarcity: ‘We get water from the wells in the rainy season, but they dry up in the dry season’ (Older Men, FGD, Kolwingo). The depletion of these wells is expected due to Kologo's climate, which features only a single, brief rainy season, coupled with a limited groundwater recharge rate. These challenges align with earlier findings in Africa (Wilbur & Danquah 2015; Wrisdale et al. 2017).

In addition, responses indicated that women often spend significant time in water retrieval (Table 2). Over 50% of women across communities spend more than 30 min collecting water in wet (Kolwingo-111.90 ± 63.53, Nayiire-130.70 ± 56.78, Zuo-139.80 ± 51.52) and dry (Kolwingo-171.30 ± 84.71, Nayiire- 172.50 ± 60.47, Zuo-169.0 ± 52.77) seasons, a sentiment echoed in women's and men's discussions: ‘Time spent fetching water could help with work and money’ (Adult Women, FGD, Kolwingo); ‘Women spend a lot of time fetching water’ (Adult Men, FGD, Kolwingo); and ‘You can queue at the borehole for hours’ (Adult Women, FGD, Nayiire). As emphasized in both genders and across communities, this enduring commitment is often reflected in the distance to water sources, a widely voiced concern that significantly affects access and collection: ‘We walk to far places to fetch water’ (Young Women, FGD, Kolwingo); ‘Distance to water points is very far for women’ (Older Men, FGD, Nayiire). These findings corroborate studies addressing rural water access (Prokurat 2015; Graham et al. 2016), demonstrating the impact on per capita consumption (see Prokurat 2015).

These challenges impact different vulnerable groups uniquely. In Zuo, a visually impaired woman highlighted her struggle that: ‘I am blind and can't help myself, so if I could get support with closer water point’ (Adult Women, FGD, Zuo), aligning with Geere & Cortobius’ (2017) conclusion regarding the obstacles disabilities pose to accessing water. Women's and men's discussions revealed a reliance on unprotected sources due to distance: ‘We fetch from the dam because some boreholes are far’ (Adult Women, FGD, Nayiire); Men: ‘Some fetch water from wells and the dam because of distance to boreholes’ (Adult Men, FGD, Zuo). The dispersed nature of settlements in the Kologo community, combined with decentralized water systems and women's limited access to transportation, compels them to spend time and energy travelling long distances to collect water. The distance deters the use of improved sources (Chew et al. 2019), leading to a preference for accessible but unsafe water sources.

Scholars emphasize addressing poverty and enhancing water infrastructure to alleviate disparities (Schuster-Wallace et al. 2019; Apatinga et al. 2022; UNICEF & WHO 2023). This study supports these with occupation and water payment statistically significantly associated with difficulty collecting water for women (model 1). From an occupational perspective, women who were traders/business owners experienced less difficulty accessing water [OR 0.196; 95% CI (0.067, 0.569)] than those who were farmers. Also, women paying for water experienced fewer difficulties [OR 0.071; 95% (0.015, 0.340)] than those who did not. These findings underscore that higher-income occupations and the ability to pay improve water access (Wrisdale et al. 2017; Debela et al. 2020; Hailu et al. 2021).

From a qualitative perspective, women and men consistently highlighted financial constraints hindering water access in FGDs across communities: ‘Poverty makes it difficult to access water because we can't get pipes into our homes’ (Older Women, FGD, Zuo); ‘Poverty is the reason; we cannot afford to connect government tap water system in the community’ (Young Men, FGD, Nayiire). Consequently, FGDs reveal that some women resort to unsafe water sources: ‘We fetch from the dams because of no money’ (Adult Women, FGD, Nayiire). Poverty and low literacy levels are widespread in the communities of Kologo, posing challenges for women in accessing piped water into their homes, despite the presence of a centralized water tank in Nayiire serving the entire community. Poverty may encourage reliance on unsafe sources (Chew et al. 2019) and intertwine with insufficient water infrastructure, creating a critical link between economic limitations and inadequate water systems in rural areas (Kelly et al. 2018). Inadequate facilities compound water access challenges (Kelly et al. 2018), emphasizing that addressing water infrastructure gaps is crucial for equitable water access (Schuster-Wallace et al. 2019).

Research highlights the significance of individual factors like education, health, age, and family size in determining water access (Geere & Cortobius 2017; Wrisdale et al. 2017; Apatinga et al. 2022). This study confirmed the significance of all of these factors in women's water access challenges with the exception of family size. Women with secondary education had lower odds [OR 0.173; 95% CI (0.037, 0.819)] of facing difficulty compared to those with no education, likely due to better opportunities for employment and improved resources (Armah et al. 2018; Simelane et al. 2020). Age was influential, with women aged 31–50 having higher odds [OR 5.097; 95% CI (1.184, 21.938)] of encountering difficulty compared to older women. This is counterintuitive, as it was expected that older women will experience more difficulty in collecting water than adult women as evidenced in prior research (Geere & Cortobius 2017). Possibly because of the cultural significance of respecting elders in the Kologo community, older women are often revered, as is customary in many African cultures, making them receive more familial assistance, particularly in physically demanding tasks like water collection, compared to adult women. Research by Geere & Cortobius (2017) indicates that roughly 60% of children help retrieve water. This support network could ease older women's challenges in collecting water. Although family size did not show statistical significance, larger families typically face more challenges accessing water due to financial constraints, as more members increase water demand and expenses (Apatinga et al. forthcoming; Armah et al. 2018; Simelane et al. 2020). Good health correlated with less difficulty in water collection [OR 0.246; 95% CI (0.062, 0.973)] compared to health-challenged women, with women's and men's FGDs across communities confirming this link: ‘Distance to water sources becomes difficult because I am sick’ (Adult Women, FGD, Nayiire); ‘Women who are not well may find it difficult to carry water’ (Young Men, FGD, Zuo). Given the challenging circumstances of dispersed settlements in Kologo and decentralized water systems, physically strong women might manage better when collecting water from decentralized systems over long distances compared to those who are in poor health, heightening the vulnerability of the latter to water insecurity (Geere & Cortobius 2017; Wrisdale et al. 2017).

Most women and men acknowledge the physical health issues associated with water collection (Table 4). In Kolwingo, 86% of women and 96% of men acknowledged women's challenges during water collection, echoing similar patterns in Nayiire and Zuo. This highlights men's awareness of the physical challenges despite not directly participating in collecting water. Surprisingly, some men across communities underreported women experiences (Kolwingo – 2%; Nayiire – 4%; Zuo – 6%), suggesting that they do not understand the health toll that water collection has on their spouses. Pain and injury were the most commonly reported issues by women in Kolwingo (88%) and Nayiire (70%). Men's perspectives again corroborated these trends in higher numbers than the women themselves, notably in Zuo (95%). Fatigue was less frequently reported by women (44 of 150), with the majority from Nayiire (51%), followed by Zuo (30%) and Kolwingo (11%).

FGDs among women and men across communities echoed these challenges, sharing a spectrum of physical strains women experience with water collection: ‘We experience rib, chest, neck, and back pains after water fetching’ (Adult Women, FGD, Kolwingo); ‘I have chest, waist, and leg pain after fetching; sometimes, I can't walk properly’ (Adult Women, FGD, Zuo); and ‘Carrying water is tiring and gives women neck, chest, and body pains’ (Adult Men, FGD, Nayiire). Dispersed settlements and limited water facilities within the communities of Kologo mean women must travel longer distances to collect water, increasing physical strain and injury risks. Additionally, Kologo's socioeconomic context, marked by poverty and limited infrastructure, adds to the burden on women. The lack of medical facilities and support systems further compounds physical health issues, with only one health centre serving the entire community. These findings add to the scant research linking musculoskeletal pain and injuries to distant water collection and heavy containers used for water carriage (Sorenson et al. 2011; Geere et al. 2018; Geere & Hunter 2020; Venkataramanan et al. 2020).

In addition, over 90% of women across communities expressed worry about water collection and shortages and similar numbers of men also perceived this stress in women (Table 4). Long distances leading to pain and injuries (≥20%), fatigue (≤20%), and time loss (6–22%) were commonly reported reasons across genders and communities, highlighting the psychological burden stemming from water-related challenges. As a result, women shared deep frustrations across communities in FGDs: ‘We [women] suffer a lot because of water issues; my slippers got broken and all that disturbs us; sometimes, we contemplate suicide because of the anger’ (Young Women, FGD, Zuo). Men concurred, linking women's mental well-being with water challenges, noting that: ‘Women age very rapidly due to carrying water’ (Young Men, FGDs, Kolwingo). The community dynamics of Kologo, marked by communal living and extended family setups in all subdivisions impose additional responsibilities on women to fulfil the water requirements of large households, thus amplifying their psychological strain. Additionally, Kologo's economic backdrop, characterized by poverty and insufficient infrastructure, further compounds this psychological burden. The need to meet gendered obligations and social expectations combined with long walks and queueing at water sources are physically and emotionally demanding, leading to worry, frustration, and anxiety (Geere et al. 2018; Collins et al. 2019; Achore & Bisung 2022).

In Kolwingo and Zuo, approximately 20% of both women and men acknowledged incidents that compromise women's personal safety during water collection, with slightly lower percentages in Nayiire (women – 16%, men – 12%) (Table 5). While relatively low frequency, more Nayiire women reported animal attacks (12%) compared to Kolwingo (8%) and Zuo (6%). In focus groups, women and men expressed concerns about women encountering snakes and insects during water retrieval: ‘Fetching water exposes us to dangers like snake bites’ (Young Women, FGD, Kolwingo); ‘Fetching water in the morning or evening can lead to snake bites’ (Young Men, FGD, Zuo) also documented in previous research (Berrian et al. 2016; Pommells et al. 2018). In Kologo, dense vegetation and trees, particularly during the rainy season, create habitats for snakes and insects, posing significant threats during water collection, especially in low visibility times like early mornings or late evenings. Cultural practices exacerbate these risks as women, primarily responsible for water collection, are frequently exposed to hazards. The prevalence of extended family structures means women collect water not only for immediate families but also for extended households, increasing their exposure. During the dry season, water scarcity forces women to travel farther, heightening the risk of encounters with dangerous animals. Kolwingo and Zuo experience slightly fewer safety issues, possibly due to closer water sources, reducing travel distances compared to Nayiire.

Interpersonal conflicts tend to arise at water sources due to overcrowding and misunderstandings resulting from insufficient facilities (Table 5). Notably, more women in Zuo (30%), followed by Kolwingo (26%) and Nayiire (20%) reported these conflicts. Women also described these scenarios during focus groups: ‘Fetching water often leads to fights at crowded boreholes’ (Young Women, FGD, Kolwingo). In these communities, the combination of limited water facilities and communal lifestyles transforms water sources into social hubs where tensions can quickly flare up. The scarcity of boreholes and wells, spread sparsely across the area, forces women to congregate at these few sources, increasing the likelihood of conflicts over water. Competition for water often leads to misunderstandings and disputes among women. Despite the presence of a community water tank, many residents still face accessibility issues, resulting in overcrowding at other sources and escalating conflicts. Furthermore, the reliance on agriculture and traditional practices means water collection may coincide with peak farming periods, further exacerbating overcrowding and tension at water points.

FGDs also identified sexual violence risks, particularly for pre-pubescent girls: ‘Young girls are at risk of assault while collecting water, especially during the rainy season’ (Adult Men, FGD, Nayiire). The risk of sexual violence, particularly affecting young girls, is intensified by the need to travel long distances to collect water, often traversing isolated and hazardous areas. Cultural norms and the extended family structure in Kologo commonly designate water collection tasks to young girls, heightening their susceptibility to assaults, especially during the rainy season when paths become more perilous and visibility decreases. This underscores the risk of gender-based violence linked to water inaccessibility authors have been calling for greater research and policy attention (Pommells et al. 2018; Fleifel et al. 2019). Such assaults not only cause physical harm but also expose women to enduring health risks like Human Immunodeficiency Virus (HIV) (Krumdieck et al. 2016; Fleifel et al. 2019).

The gender-based violence risk extends to the domestic arena (Pommells et al. 2018; Collins et al. 2019; Tallman et al. 2023; Cole et al. 2024), as evidenced by the number of women reporting spousal violence across communities (48% of Kolwingo women, 42% of Nayiire women, and 44% of Zuo women), often triggered by delays in water-related tasks like cooking (≤20) and bathing (6–26%) due to water scarcity and collection (Table 5). FGDs provided additional context of conflicts arising from these shortages, as a woman from Nayiire articulated: ‘We fight when there is no water to cook after coming back late from the farm’ (Older Women, FGD, Nayiire). A Zuo man concurred, stating that: ‘Sometimes, we get [into] conflicts with our wives due to water shortages; in fact, fetching water is a serious challenge’ (Adult Men, FGD, Zuo). The long journeys to water sources and dependence on communal water points lead to delays and extended waiting times, causing tensions to rise within households. With communal living arrangements, any delay in water-related tasks affects the entire extended family, placing added pressure on women and frequently sparking domestic conflicts. Balancing agricultural work with household duties due to the agrarian economy further fuels conflicts when water tasks are postponed. The cultural significance in these communities amplifies social expectations, where any deviation from these norms, such as delays in cooking or bathing, can result in spousal abuse. Entrenched gender roles often unfairly attribute these delays to women, despite underlying structural issues. This blend of physical and emotional strain, coupled with high expectations placed on women, heightens stress levels and the likelihood of domestic violence.

Remote water retrieval hinders paid and unpaid activities (Geere & Cortobius 2017; Komarulzaman et al. 2019). Respondents reported several negative impacts of water retrieval on women's economic engagements (Table 6). At least half of the women surveyed across sub-communities reported that water collection off-premises impacts work- and non-work-related activities. However, men's perceptions differed significantly between communities; while men from Zuo reported similar levels of impact, this fell to less than 50% of men in Nayiire. Women reported significant impacts of water collection on trading/business (Nayiire – 26%, Kolwingo – 20%, and Zuo – 12%) and farming (Zuo – 34%, Nayiire – 18%, and Kolwingo – 12%) across communities. Men also recognized these impacts, citing reduced work time (Kolwingo – 60%, Nayiire – 32%, and Zuo – 20%) and lateness or absenteeism at work (Nayiire – 24%, Zuo – 20%, Kolwingo – 12%). Reported impacts were higher among women farmers (60%) than those who were traders (29%) or formal or skilled workers (10%). These differences could be attributed to the physically demanding nature of farming activities, amplifying women's challenges associated with water collection. In focus groups, women and men across sub-communities described the substantial time and opportunity losses: ‘Fetching water takes the time meant for working and earning money; it is like spending the entire day on just that task’ (Adult Women, FGD, Kolwingo); ‘The time spent fetching water could have been utilized more productively’ (Adult Men, FGD, Nayiire). The distant location of improved water facilities in these communities leads to longer travel times for water access, reducing available time for economic pursuits. In Kolwingo, where the market square acts as a central business hub, any time spent on water collection can significantly impact the incomes of women traders, especially those not residing locally. Reliance on communal water sources worsens the situation, with women often enduring long queues, further cutting into their productive hours. Balancing domestic duties with agricultural work, the time-consuming process of water collection affects both farming and trading activities. High societal expectations place pressure on women to efficiently manage multiple roles, resulting in decreased productivity and economic losses, as observed by men noting reduced work time and increased tardiness or absenteeism. Women in Zuo particularly highlight the substantial impact on farming activities, illustrating the heavy burden of water collection they bear.

In addition, FGDs across communities revealed out-of-pocket payments related to maintaining water facilities: ‘As for our borehole, we contributed and drilled it by ourselves, and we do same with the maintenance. A woman pays 10 cedis [$1.5], and a man 20 cedis [$2.5]’ (Young Women, FGD, Nayiire); ‘When a borehole breaks down, every household contributes for repairs’ (Older Men, FGD, Zuo). The collective use of water facilities implies that any malfunction necessitates joint efforts and financial contributions from all households. The expenses linked with borehole repairs compound economic pressures, especially in communities reliant on agriculture as the main economic activity, where income and literacy levels are generally low, thus restricting income-generating prospects. Additionally, women raised concerns about health expenses resulting from adverse health effects of water collection: ‘The distance to water sources makes our health bad, which you will need to buy medicines to be treated but there is no money’ (Young Women, FGD, Kolwingo). Relying on distant water sources exacerbates women's health challenges. Travelling long distances for water exposes them to physical strain and environmental hazards, increasing the risk of injuries and illnesses. Limited healthcare facilities within these communities worsen their health issues, leading residents to incur additional costs for treatment. In economically impoverished communities, the added expense of purchasing medications further strains household finances. Women are tasked with supporting water infrastructure while also covering healthcare expenses, highlighting the intertwining economic and health obstacles in the community. In addition to the usual health concerns, the scarcity of water and water collection from remote sources result in a multitude of unforeseen complications that extend to socioeconomic consequences (Ablo & Yekple 2018; Collins et al. 2019).

Poor water access and distant water collection disrupt essential household activities like washing, cooking, and bathing (Brewis et al. 2019), reducing the consumption of quality items and decreasing dietary diversity (Workman & Ureksoy 2017; Choudhary et al. 2020; Miller et al. 2024). Women reported that sometimes they are unable to cook desired meals and enough food because of water shortages and the time-consuming nature of water collection (Table 7).

More women in Zuo (54%) reported the inability to cook desired meals than Kolwingo (44%) and Nayiire (34%). Also, more women in Kolwingo (36%) and Zuo (36%) reported not being able to cook enough food than in Nayiire (26%). Women and men expressed their frustrations in FGDs: ‘When we come back late from the farm, you are not able to cook for your family, and everyone has to sleep on an empty stomach’ (Adult Women, FGD, Nayiire); ‘We sometimes have to eat less than three times a day because of water problems’ (Adult Men, FGD, Nayiire). These findings highlight the significant impact of water-related challenges on household food security and nutrition, influenced by the unique characteristics of each sub-community. Dependence on communal water sources exacerbates issues faced during meal preparation. Limited water availability affects cooking options, resulting in compromises in both the quality and quantity of meals. These difficulties are magnified by the seasonal nature of farming activities in these communities, which can exacerbate food insecurity during periods of reduced agricultural output. Inadequate nutrition compounded by a lack of quality diet can result in malnutrition and undernourishment (UNICEF et al. 2015), particularly impacting women who often prioritize the needs of men and children over their well-being.

Hygiene concerns were also reported, with 56% of Kolwingo women, 48% of Zuo women, and 46% of Nayiire women unable to complete household tasks due to water scarcity (Table 7). The inability to wash was reported most often by women from Kolwingo (16%) followed by Nayiire (12%) and Zuo (4%) and supported through focus group discussions: ‘If no water, I won't cook, talk less of anyone bathing, and when all this happens, I am always unhappy’ (Older Women, FGD, Kolwingo); ‘When there is not enough water, we use little to cook and bathe till the next day’ (Adult Women, FGD, Zuo). The persistent poverty and reliance on distant water sources in these communities exacerbate the challenges of maintaining hygiene standards. Water scarcity hinders the completion of essential household tasks like cooking and bathing, leading to increased frustration and dissatisfaction among residents. Women are forced to ration water, allocating minimal amounts for cooking and bathing, which may compromise personal hygiene and sanitation norms.

While analysis to this point has focused on the prevalence of impacts, none of these exist in isolation. Indeed, women experience compounded adverse effects across different areas, such as health, safety, and socioeconomics, due to water insecurity (Table 8). This interconnectedness is evident in how specific health issues, both physical and psychological, coincide among women. Notably, 87% of women in Kologo reported both sets of health issues together; more Nayiire (35%) and Zuo (35%) women reported both sets of issues together than Kolwingo (29%). These health issues are closely intertwined with safety concerns arising from water insecurity. Over half of Kologo women (58%) faced various safety problems due to water insecurity. This overlap is higher among Kolwingo women (71%), followed by Nayiire (28%), and none of the Zuo women reported experiencing all three safety issues together. These safety worries contribute significantly to mental and emotional stress (Workman & Ureksoy 2017; Wutich et al. 2020). Moreover, 20% of Kologo women simultaneously grappled with two or three nutritional and hygiene problems alongside these challenges. In contrast to Zuo (36%) and Nayiire (23%), more Kolwingo women (40%) confronted these compounded issues.

The convergence of these challenges amplifies their impact on women's health, reinforcing their vulnerability to overlapping problems. For example, fewer Kologo women faced only one problem (2.9%) or nine problems (1.6%), while 16% faced four issues concurrently, closely followed by 14% dealing with five problems, demonstrating the multifaceted impact of water-related problems on their lives, encompassing health, safety, socioeconomic, and nutritional/hygiene aspects. Socioeconomic backgrounds play a pivotal role; for instance, farmers (66%) faced disproportionate effects compared to those in trading (22%) or formal/skilled work (1%). Even over 50% of women who identified as healthy experienced all consequences, highlighting the severity and impact of water insecurity in these communities. These persistent issues perpetuate a cycle of water insecurity, exacerbating the challenges of collecting water for these women (Table 8). With 71% of women dealing with three to seven interconnected water-related consequences, their struggle to access and collect water intensifies, underscoring the complexity and distress of their experiences. The variations in the compounded adverse effects on women across the three sub-communities result from several contextual factors. The presence of dispersed settlements and limited water access magnifies challenges for women. Insufficient water infrastructure and safety measures increase their vulnerability to health and safety risks, contributing to the observed compounded adverse effects. Socioeconomic factors, such as reliance on traditional livelihoods and inadequate access to essential services, intersect with these adverse effects. Additionally, cultural norms and gender roles influence women's vulnerability to these challenges, further exacerbating the compounded adverse impacts.

This cross-sectional study employs a multifaceted approach to the challenges women face in accessing and collecting water. It acknowledges the intricate health and socioeconomic difficulties involved. By utilizing Apatinga et al.'s integrated framework, this research underscores the interplay between environmental, systemic, and individual factors at the community level. The comprehensive approach integrating surveys, FGDs, and coupled systems frameworks provides an in-depth understanding of these women's challenges while collecting water. This study not only identified individual challenges caused by water-related issues but also revealed how these challenges compound, leading to sustained water insecurity and exacerbating difficulties in water retrieval – a novel finding not previously evidenced in scholarship.

While this study holds significant research and policy implications, it is important to note that the findings might only apply to some rural women in Ghana. Sociocultural contexts, socioeconomic disparities, and geopolitical boundaries may influence how rural women experience water access and collection differently. However, while experiences may vary among specific groups, the ideas and responses hold transferable value. Additionally, it is crucial to consider the potential impact of social desirability bias on the study's outcomes, as participants may have underreported or overreported issues related to water access and collection. Nonetheless, taking into account Kologo's extended family arrangements, cultural norms, and communal living, delving into the unique yet interlinked experiences of its sub-communities offered valuable insights into the socioeconomic consequences and daily struggles arising from water insecurity. By linking women's water collection experiences and the drivers offers a plausible route to create more holistic and scalable interventions. Understanding multiple influences is crucial in designing integrated, cross-sectional approaches that can be applied to diverse settings (rural or urban) to improve access to water resources on a larger scale.

This study employed a community-based case study to explore factors influencing women's difficulties in accessing and collecting water off-premises as well as the ensuing health and economic consequences. The study moves beyond the identification of drivers and impacts of lack of water access to underscore the interplay between the significant challenges women face in obtaining and collecting water, stemming from multifaceted environmental, systemic, and individual factors. Women can find themselves trapped in a relentless cycle where water insecurity exacerbates existing health and socioeconomic challenges, creating a self-perpetuating process. Gender-based divisions of labour, power dynamics, and societal expectations disproportionately burden women regarding water access and insecurity. The intertwining influence of gender constructs, sociocultural identities, and persistent water insecurity significantly influences the diverse lived experiences of these women. In doing so, this study emphasizes the critical need for an intersectional, gender-focused approach to address remote water collection and water scarcity issues. It is imperative for governments and policymakers to acknowledge these complexities in integrated water resource management strategies.

Ensuring equitable access to water is a critical step to closing access gaps among different social groups. In all of these, geographical proximity to water sources is the underlying factor influencing the health, economic challenges, and security threats rural women face during water retrieval. If women do not undertake lengthy journeys to access water sources, they can avoid navigating uneven terrains and have more time for productive activities, thereby reducing risks and security threats. Minimizing the distance to water sources becomes imperative in reducing these challenges and underlines the necessity of in-house piped water systems or nearby water sources in rural communities. Overall, addressing gender norms, power structures, and socio-environmental and individual issues influencing women's water access challenges is crucial for paving a sustainable future aligned with the sustainable development agenda.

Data cannot be made publicly available; readers should contact the corresponding author for details.

The authors declare there is no conflict.