At the 77th World Health Assembly, our message for health leaders was clear: water, sanitation and hygiene must be at the heart of solutions and decisions to tackle antimicrobial resistance. 

Antimicrobial resistance (AMR) is a global killer – and mothers and babies are easy targets.  

But we cannot fight AMR without preventing infections in the first place.

And we cannot prevent these infections when 2.2 billion people around the world still don’t have safe water.

Clean water, decent sanitation and good hygiene are needed now to protect vulnerable people, such as mothers and their babies, and the healthcare workers who treat them.  

Half of all healthcare facilities don’t have basic hygiene services.

Every two seconds, a woman gives birth in a health centre without adequate water, sanitation and hygiene

in the world’s least developed countries.

A third of newborn deaths related to sepsis are linked to drug-resistant pathogens.

A silent pandemic

Antibiotics play an essential role in treating people who develop infections and sepsis, which happens when the immune system overreacts to an infection and starts to damage the body's own tissues and organs.  

However, antibiotics have been overused and misused as a quick fix in places without clean water and good hygiene. This has helped to create a deadly crisis – antimicrobial resistance.

Now, many healthcare staff are helpless in the face of infections, and mothers and their newborn babies are at high risk of drug-resistant infections and life-threatening sepsis.

Dhanpata Gudiya with her newborn baby at the maternity unit of Bardiya Hospital, Bardiya, Nepal, May 2019.
Dhanpata Gudiya with her newborn baby at the maternity unit of Bardiya Hospital, Bardiya, Nepal, May 2019.
Image: WaterAid/ Shruti Shrestha

Antimicrobial resistance occurs when germs, such as bacteria or fungi, are no longer affected by the drugs designed to kill them. This makes it difficult, and at times impossible, for doctors to prevent and control infections among patients.   

Resistance to antibiotics is a large part of this problem, which is already a major cause of death worldwide, contributing to around five million deaths every year.


With clean water, decent toilets and good hygiene, we can save mothers and their babies, and protect people’s health worldwide.  

Frequent handwashing by mothers and their healthcare workers, using clean equipment, and cleaning healthcare wards can all help to break the chain of infection, slow the spread of drug-resistant germs, and reduce the need for antibiotics.  

In fact, AMR can be reduced by 85% through improved hand hygiene, along with stewardship programmes and better environmental hygiene in health centres.  

Water, sanitation and hygiene is what women want.  

When asked about their top demands for maternal healthcare, 1.2 million women from 114 countries responded with a clear message: water, sanitation and hygiene (WASH) is the second highest priority (PDF), after respectful and dignified care.    

Only when we take on board the knowledge and experiences of communities, and actively listen to those  on the frontline of healthcare, will we be able to collectively fight global threats like AMR.

Elizabeth Nyanga, 63, whose daughter-in-law, Constance, gave birth at Sikachapa Rural Health Center in Kazungula District, Zambia. May 2022 at Sikachapa in Kazungula District, Zambia May 2022.
Elizabeth Nyanga, 63, whose daughter-in-law, Constance, gave birth at Sikachapa Rural Health Center in Kazungula District, Zambia. May 2022 at Sikachapa in Kazungula District, Zambia May 2022.
Image: WaterAid/ Cynthia Matonhodze
If I met our president, I would tell him about the trouble we have of lack of water at a healthcare facility. I will tell him of how much women are suffering, how they walk a distance to access water and how they sleep on the cold floor. I will ask him to immediately do something about it.
Elizabeth Nyanga

WaterAid at the 77th World Health Assembly

Water, sanitation and hygiene services are essential to protect vulnerable groups such as new mothers and their babies, and the healthcare workers treating them.

They are a non-negotiable in slowing the global spread of superbugs. And a non-negotiable for countries fighting this silent pandemic.

At the 77th World Health Assembly (WHA), our message was clear:  

Clean water, sanitation and hygiene must be at the heart of solutions proposed to tackle AMR. We called on:  

  • WHA member states, development banks and international financial institutions to work together and make sure WASH is adequately financed for the 66 countries that have already prioritised it in their AMR national action plans.  
  • WHA member states to make sure WASH is integrated as a non-negotiable solution in new global, regional and national AMR plans, including the WHO’s global strategy on AMR. 
  • Civil society organisations and WaterAid supporters everywhere to lead the fight against AMR by calling on their health ministers and governments to prioritise WASH as a non-negotiable in our fight against this global killer.  

Top image: Elisa Ravaoarisoa, 28, and her newborn baby at their home in Manjakandriana commune, Analamanga region, Madagascar, November 2020.