Low water access as a gendered physiological stressor: Blood pressure evidence from Nepal
Abstract
OBJECTIVES: The study aims to test novel proposed biocultural pathways linking the stressful lived experience of water insecurity to elevated blood pressure, a risk factor for chronic disease. Using the case of Nepal, where women have primary responsibility for managing household water, allows testing for potentially gendered mechanisms that exacerbate negative physiological consequences of water insecurity for women relative to men. METHODS: Data are from the nationally representative 2016 Nepal Demographic and Health Survey (DHS), N = 8633 women and 6209 men. Multiple regression models tested effects of low household water access on systolic and diastolic blood pressure, as stress biomarkers, comparing women to men. Key covariates included HFIAS food insecurity scores, household wealth class (high, medium, low), and body mass index. RESULTS: In this cross-sectional study, low water access was consistently associated with higher women's systolic and diastolic blood pressure across all wealth levels. The strongest results were for the lowest wealth households, where low water access is concentrated. Higher food insecurity was also associated with higher systolic blood pressure values in women in these households. Men showed no such effects. CONCLUSIONS: This is the first study, to our knowledge, to demonstrate a consistent and direct association between living with water insecurity and elevated blood pressure measures. Findings support the proposition that the stress of living with water insecurity could manifest as chronic disease risk. In the Nepali case, the proposed mechanism appears highly gendered, reflecting the culturally prescribed responsibilities women particularly face for managing household water. Living with food insecurity compounds further the apparent effects.
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In Nepal, having intermediate and low water access was associated with higher systolic and diastolic blood pressure levels in women, while men's blood pressure was not statistically different; elevated levels of blood pressure were highest for women with the least water access.
“In Nepal, having intermediate and low water access was associated with higher systolic and diastolic blood pressure levels in women, while men's blood pressure was not statistically different; elevated levels of blood pressure were highest for women with the least water access [272].”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [272]
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“Aihara Y, Shrestha S, Kazama F, Nishida K. Validation of household water insecurity scale in urban Nepal.”
BackgroundInfluentialWater, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis
Caruso, B. A., Conrad, A., Patrick, M., Owens, A., Kviten, K., Zarella, O., Rogers, H., & Sinharoy, S. S. (2022) · PLOS Water · doi:10.1371/journal.pwat.0000026 · Cited by 94 · see citing works
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- Authors
- Brewis, A., Choudhary, N., & Wutich, A.
- Affiliations
- Arizona State University (US)
- Corresponding author
- Brewis, Alexandra
- Venue
- American Journal of Human Biology
- Publisher
- Wiley
- Published
- 2019-03-22
- Volume
- 31
- Issue
- 3
- Pages
- e23234-e23234
- ISSN
- 1042-0533 (ISSN-L)
- 1520-6300
- OpenAlex
- W2925023866
- Cited by
- 69
- References
- 70
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 6 · 2023: 10 · 2022: 16 · 2021: 8 · 2020: 8 · 2019: 10
- FWCI
- 14.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Human Biology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Social Sciences › Political Science and International Relations › Water Governance and Infrastructure
- Keywords
- water insecurity, household water access, blood pressure, physiological stress, gender differences, food insecurity, household wealth, chronic disease risk, Nepal
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Blood Pressure, Cross-Sectional Studies, Female, Food Supply, Humans, Male, Middle Aged, Nepal, Sex Factors, Socioeconomic Factors, Stress, Physiological, Water Supply, Young Adult
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