Silent Expressions: Water, Sanitation, and Hygiene Realities of Incarcerated Women in a South African Correctional Facility ^†

Introduction: Water, sanitation, and hygiene (WASH) are internationally recognized as essential human rights. United Nations Sustainable Development Goal 6 advocate for availability and sustainable management of clean water and sanitation for all by 2030 and beyond. Nelson Mandela Rules emphasis on promotion of prison health and dignity, require that adequate water and sanitation be available for personal care, including menstruation. Bangkok Rules calls for gender-responsive standards for incarcerated women. However, incarcerated women, especially those in low- and middle-income countries, frequently experience challenges in these areas, leaving their essential hygiene needs unmet. Visual methods, such as naïve sketching, offer a novel approach to uncover silent yet powerful expressions of incarcerated women’s lived realities. Aim: To explore the lived experiences of incarcerated women regarding water, sanitation, and hygiene within a correctional facility in Limpopo province, South Africa. Methods: The study was conducted in a female-only correctional facility located in Limpopo Province. A qualitative phenomenology and visual participatory study was employed, using naïve sketching supported by short narrative descriptions. Incarcerated adult women aged 18 and above, serving long-term sentences and living in the facility for at least six months, were purposively sampled. Data were collected through naïve sketches and follow-up narrative discussions. A descriptive phenomenological approach was applied to uncover the essence of participants’ lived experiences. Visual and textual data were integrated using interpretive analysis of the sketches and corresponding narratives, guided by meaning-making processes aligned with phenomenology, and clustered into thematic units of meaning guided by the availability, accessibility, acceptability, and quality framework. Results: Four major themes emerged, reflecting the lived realities of incarcerated women regarding water, sanitation, and hygiene: limited water access; compromised quality and accessibility of sanitation facilities; unacceptable menstrual health conditions; and internalized coping in silence. The visual narratives produced through naïve sketching revealed powerful symbolic portrayals of shame, psychological trauma, adaptation, and inner resistance, illuminating the emotional dimensions of inadequate water, sanitation, and hygiene services. Phenomenological interpretation further evidenced that water, sanitation, and hygiene neglect was not solely a matter of physical deprivation but was deeply embedded in emotional and spiritual suffering. Conclusions: This study explored the lived experiences of incarcerated women regarding water, sanitation, and hygiene (WASH) through naïve sketching and phenomenological interpretation. The findings revealed four key experiential themes. The findings carry significant implications for correctional health policy, gender equity, and rights-based approaches to incarceration. They highlight the urgent need for gender-responsive prison health reforms that address the specific hygiene and menstrual needs of women. Correctional institutions should prioritize the consistent availability of clean water, the maintenance of safe and private sanitation facilities, and the regular supply of adequate menstrual hygiene materials and disposal systems.