Psychosocial impacts of the lack of access to water and sanitation in low- and middle-income countries: a scoping review

Abstract

The lack of access to safe water and adequate sanitation has implications for the psychosocial well-being of individuals and households. To review the literature on psychosocial impacts, we completed a scoping review of the published literature using Medline, Embase, and Scopus. Fifteen studies met the inclusion criteria and were reviewed in detail. Of the included studies, six were conducted in India, one in Nepal, one in Mexico, one in Bolivia, two in Ethiopia, one in Zimbabwe, one in South Africa, and two in Kenya. Four interrelated groups of stressors emerged from the review: physical stressors, financial stressors, social stressors, and stressors related to (perceived) inequities. Further, gender differences were observed, with women carrying a disproportionate psychosocial burden. We argue that failure to incorporate psychosocial stressors when estimating the burden or benefits of safe water and sanitation may mask an important driver of health and well-being for many households in low- and middle-income countries. We propose further research on water-related stressors with particular attention to unique cultural norms around water and sanitation, short and long term psychosocial outcomes, and individual and collective coping strategies. These may help practitioners better understand cumulative impacts and mechanisms for addressing water and sanitation challenges.

“It makes us really look inferior to outsiders”: Coping with psychosocial experiences associated with the lack of access to safe water and sanitation

“…The literature on psychosocial concerns also indicates that these impacts are likely to be more pronounced among women than men. 10,15,18,22 Thus, in circumstances where water and facilities are limited, interventions should target at-risk and vulnerable groups (e.g., women and children), as they stand to be greatly affected in terms of deteriorating physical and mental health.…”

“…Thus, themes and subthemes were allowed to emerge from participants' perspectives, together with others that were deductively coded by thoroughly matching constructs in the data with coping resources identified in the PSYCHOSOCIAL STRESS AND COPING WITH LACK OF WATER literature. 11,[15][16][17] Data abstraction was done by combining subthemes based on convergence on identical constructs and concepts into major conceptual themes. 25 These major themes (coping resources) were reviewed against the initial subthemes to identify any discrepancies and make inferences.…”

“…Further, diverting limited household resources into coping (e.g., buying water from vendors) may result in opportunity costs in terms of reduced savings or resources for other household needs, such as food. 14 In addition, a scoping review conducted by Bisung and Elliott (2016) 15 identified (perceived) inequities in access to safe water and adequate sanitation as a major source of stress. For example, individuals without access often feel neglected and marginalized, particularly where geographical and social disparities in access exist.…”

“…Such feelings can translate into distrust and annoyance towards officials responsible for water delivery. 15 While the literature on psychosocial stress related to safe water and sanitation is expanding, there is limited understanding of the kinds of coping resources individuals and households draw upon to reduce, cope with, or adapt to such stress, particularly in the context of complex socio-ecological settings in Africa. However, the few studies that exist have identified financial and social capital, as well as migration, water reuse and economization, as important coping resources and strategies.…”

Water Access, Women’s Empowerment, Sanitation and Children’s Anthropometric Status: A Study of Ethiopian Mothers With Children Under Five

“…The consequences of poor water access are far reaching. In Ethiopia, poor access to water has economic, social, health, and food security effects, especially among women [5]- [8]. For individuals lacking water sources in or near home, obtaining water often involves a great expense of time and energy [9].…”