The association between women's sanitation experiences and mental health: A cross-sectional study in Rural, Odisha India

Abstract

Emerging qualitative research suggests women’s sanitation experiences may impact mental health. However, specific associations remain unclear. We aimed to determine if sanitation access and sanitation experiences were associated with mental health among women in rural Odisha, India. Using a cross-sectional design, we evaluated the association between sanitation access and sanitation experiences and selected mental health outcomes. Data were collected from 1347 randomly selected women across four life course stages in 60 rural communities (December 2014-February 2015). Our four primary outcomes included: mental well-being, and symptoms of anxiety, depression, and distress. The primary exposures were (1) access to a functional latrine within the household compound and (2) sanitation insecurity (SI), evaluated using a seven domain measure assessing women’s negative sanitation experiences and concerns. We used hierarchical linear modeling to determine associations between the exposures and mental health outcomes, adjusting for covariates (life stage, poverty, current health status, social support). Mean well-being scores were moderate and mean anxiety, depression, and distress scores were above a threshold indicating the potential presence of any of the three conditions. Access to a functional household latrine was associated with higher well-being scores, but not with anxiety, depression or distress. Women’s SI domains were associated with all four outcomes: four domains were significantly associated with lower well-being scores, two were significantly associated with higher anxiety scores, three were significantly associated with higher depression scores, and three were significantly associated with higher distress scores, all independent of functional household latrine access. Women in rural Odisha, India may suffer assaults to their well-being and have higher symptoms of anxiety, depression, and distress when urinating and defecating, even if they have an available facility. These findings suggest that sanitation-related interventions should consider how to accommodate women’s experiences beyond excreta management to comprehensively impact health.

Women are more likely to expect social sanctions for open defecation: Evidence from Tamil Nadu India

“…Third, our survey measures were developed and validated in similar peri-urban communities in Tamil Nadu, India, which could be context-specific. However, evidence from rural Odisha (India) that highlighted similar psychosocial stressors suggests these measurements and findings may be applicable in similar contexts [ 40 ].…”

“…Inadequate menstrual hygiene management is also tied to school absenteeism for girls, which highlights the disproportionate impact on women who do not have adequate access to sanitation [39]. These negative experiences, both external, such as shaming or gossip, as well as internal, such as guilt or shame, may have long-term impacts on mental health and well-being [40]. Therefore, understanding gender differences in the social beliefs related to sanitation behaviors and how these social beliefs relate to each other can inform gendered sanitation interventions.…”

Water and mental health

“…Moreover, because the burden of water fetching is typically borne by women and girls (Crow & McPike, 2009;Geere & Cortobius, 2017;Graham, Hirai, & Kim, 2016), these activities can be physically dangerous given the risk of falls or sexual assault (Bisung & Elliott, 2017a, 2017bCollins et al, 2017, Pommells, Schuster-Wallace, Watt, & Mulawa, 2018. For example, in a study of women in Pune, India, Hirve et al (2015) pointed to women's fears of attacks from people, animals, or insects when openly defecating (see also Caruso et al, 2017Caruso et al, , 2018Corburn & Hildebrand, 2015;O'Reilly, 2016;Sahoo et al, 2015;Sommer et al, 2015;Winter & Barchi, 2016). In another study in Zimbabwe, women reported worries around sexual assault while queuing at boreholes (Mukuhlani & Nyamupingidza, 2014).…”

Exploring the meanings of “Sanitation Well-being” in Tha khlong, Thailand.

“…This information indicated lack of freedom for decision making processes among the tenant group [11].…”