Health and social impacts of open defecation on women: a systematic review

Abstract

BackgroundThe significance of sanitation to safeguard human health is irrefutable and has important public health dimensions. Access to sanitation has been essential for human dignity, health and well-being. Despite 15 years of conjunctive efforts under the global action plans like Millennium Development Goals (MDGs), 2.3 billion people have no access to improved sanitation facilities (flush latrine or pit latrine) and nearly 892 million of the total world’s population is still practicing open defecation.MethodsThe study provides a systematic review of the published literature related to implications of open defecation that goes beyond the scope of addressing health outcomes by also investigating social outcomes associated with open defecation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was used to frame the review, empirical studies focusing upon open defecation in women aged 13–50 in low and middle income countries were included in the review. Research papers included in the review were assessed for quality using appropriate critical appraisal tools. In total 9 articles were included in the review; 5 of these related to health effects and 4 related to social effects of open defecation.ResultsThe review identified 4 overarching themes; Health Impacts of open defecation, Increased risk of sexual exploitation, Threat to women’s privacy and dignity and Psychosocial stressors linked to open defecation, which clearly present a serious situation of poor sanitation in rural communities of Lower-Middle Income Countries (LMICs). The findings of the review identified that open defecation promotes poor health in women with long-term negative effects on their psychosocial well-being, however it is a poorly researched topic.ConclusionThe health and social needs of women and girls remain largely unmet and often side-lined in circumstances where toilets in homes are not available. Further research is critically required to comprehend the generalizability of effects of open defecation on girls and women.Prospero registrationCRD42019119946. Registered 9 January 2019 .

Combating Open Defecation through Community-led Sanitation

“…Caruso et al [28] have investigated women's security issues in relation to sanitation and open defecation. Saleem et al [6] reported that there is an increased risk to women and girls due to the practice of open defecation. Access to safe toilets has a prominent role in defending women's safety and self-esteem.…”

“…Accessibility to basic sanitation and hygiene does have a major impact on public health, child mortality, education, economic development, and ecosystem quality [5]. Women and girls are not only susceptible to the health consequences of poor sanitation, but also to the danger of physical assaults and wild animal encounters [6].…”

“…Mara[22] mentioned a set of health problems related to open defecation: stunting and long-term cognitive impairment, intractable intestinal infections, persistent effects of soil-transmitted helminthiasis, environmental enteropathy, giardiasis, small intestinal bacterial overgrowth, and anemia. Saleem et al[6] have reported the social and health consequences of open defecation for women: such as threats to privacy and dignity, and psychosocial stress.…”

A study to assess the awareness and practice regarding utilization of sanitary toilet in the rural villages of Kalaburagi district

“…3 Open defecation is an issue that can affect everyone but women are often at more risk of experiencing violence and multiple health vulnerabilities and women with poor sanitation facilities are more susceptible to hookworm infestation resulting in maternal anemia, which in turn is directly associated to adverse pregnancy outcomes. 4 Further evidence by media analysis and reporting show that adolescent girls and young women going for open air defecation have to bear extreme hardships and vulnerabilities. They are subjected to eve teasing and other forms of sexual exploitation besides having to cope with the vagaries of weather and other hazards on a daily basis.…”

Combination Of Extension And Triggering Methods Of Changes In Family Head Attitudes About Stop Open Defecation Free (ODF)

“…The practice of open defecation has become one of the factors that drive citizens to be lazy to use public toilets (Chitra Dewi, 2019). ODF remains the leading cause of water pollution, the spread of infectious diseases that immediately have an impact on public health (Saleem, Burdett, & Heaslip, 2019).…”