Beyond Gender: A Mixed-method Study of Intersectional Exclusion from WASH Services for Women and Persons with Disabilities in Rural Ethiopia

Abstract Background Access to safe water, sanitation, and hygiene is a fundamental human right, yet significant disparities persist in service delivery for vulnerable populations, particularly women and persons with disabilities (PWDs), in rural Ethiopia. Despite policy commitments to inclusive WASH, there is limited empirical evidence on the actual barriers these groups face at the household level. Objective This study assessed the accessibility, inclusiveness, and equity of services for women and persons with disabilities in Berebere woreda, Bale zone, Oromia Region, Ethiopia, with a focus on identifying structural, financial, socio-cultural, and institutional barriers to equitable service delivery. Methods A mixed-methods cross-sectional study was conducted using multiple data sources: (i) a structured household survey; (ii) focus group discussions and key informant interviews with community members, women, PWDs, and sector officials; (iii) structured observation checklists at households, schools, and health facilities; and (iv) a desk review of woreda- and zonal-level administrative records and policy documents. Quantitative data were analyzed using descriptive statistics, while qualitative data were thematically analyzed to identify patterns of exclusion. Results Only 9% of households had access to public taps, with the majority relying on rivers (38%) and springs (26%). Only 14% of respondents reported that WASH facilities were accessible to PWDs, and only 22% confirmed accessibility for women and girls. Water collection remained predominantly female responsibility (94%), with women spending 2–3 hours daily, and PWDs requiring several hours per trip. In WASH governance, while 43% of WASHCO members were women, representation was nominal, with women concentrated in cashier roles and holding no leadership positions; critically, not a single WASHCO member was a person with disability. No PWD-disaggregated indicators were present in the district water office's monitoring systems. Socio-cultural norms, including menstrual taboos, fears of violence during water collection, and stigma toward disability, further constrained equitable access. Schools and health facilities lacked accessible infrastructure, including ramps, handrails, adapted toilets, and menstrual hygiene management materials. Women and PWDs were absent from WASH-related enterprises, with barriers including limited capital, training, social stigma, and childcare responsibilities. Conclusions This study reveals systematic and compounding exclusion of women and persons with disabilities from WASH services in rural Ethiopia—a pattern driven by the convergence of infrastructural inaccessibility, financial barriers, socio-cultural norms, and institutional failures in governance, monitoring, and staffing. Despite formal policy commitments, the absence of accountability mechanisms, disaggregated data, and representation of vulnerable groups perpetuates inequity. Urgent policy action is needed to establish mandatory accessibility standards, fee waiver mechanisms, PWD-disaggregated indicators, and formal representation of women and PWDs in WASH governance structures to translate inclusive commitments into equitable service delivery.