Poor sanitation causes psychosocial stress among women

Sanitation in India is at a critical juncture. The Indian government has been contemplating new strategies to deal with the country's sanitation crisis by making massive investments under the Swachh Bharat Mission. Introducing sanitation programmes that reflect user needs and preferences will be critical to the program's success and impact, especially understanding women's sanitation needs can prove to be an important factor influencing the success of sanitation programmes in the country.

Health risks of inadequate sanitation among women

The paper titled 'Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India' published in the journal Social Science and Medicine, informs that many of the sanitation interventions until recently have focused on the impacts of poor sanitation on the health of children. However, there has been a growing awareness in recent years on the unique health risks that women face because of inadequate sanitation.

For example, inadequate sanitation is linked to increased maternal mortality due to risk from unhygienic birthing practices and poor infection control, urinary and genital tract infections, urinary incontinence and chronic constipation as well as increasing the probability of sexual violence among women.

Poor sanitation and psychosocial stress

A combination of physical, social and environmental factors play a role in influencing poor health outcomes among women. A number of studies in low income countries have found the link between insufficient access to basic water and sanitation facilities and psychosocial stress among women.

Current discussions around sanitation-related psychosocial stress focus primarily on the experience of adolescent girls, particularly in the context of managing menstruation. However, experience shows that these stressors extend beyond adolescence and are significant throughout the life of women, occur across the range of sanitation behaviors and are not limited to the menstrual period.

What is the situation in India?

The paper presents the findings of a study that examines the range of sanitation-related psychosocial stressors experienced by women during routine sanitation practices in Odisha. For the study, indepth interviews with 56 women from four life stages namely adolescence, newly married, pregnant and adulthood from three settings such as urban slums, rural villages and indigenous villages were conducted.

Findings of the study

• Sanitation practices extended beyond defecation and urination and included carrying water, washing, bathing, menstrual management, and changing clothes.
• During the course of these activities, women encountered three kinds of stressors namely, environmental, social, and sexual, the intensity of which was modified by the woman's life stage, living environment, and access to sanitation facilities.
• Environmental barriers, social factors and fears of sexual violence all contributed to sanitation-related psychosocial stress.
• Newly married women were particularly vulnerable to sanitation related stress as they lived highly regulated lives with strict rules, which made it difficult for them to manage sanitation with privacy and dignity.
• The fear of sexual violence was the most important stressor that women living in marginalised urban slums faced.
• Although women tried to cope with their circumstances by making small changes in their sanitation practices, they were unable to bring about a significant change in their circumstances by achieving adequate privacy for sanitation related behaviors.

The paper argues that this study has implications for how sanitation is defined and improvement activities are designed. It reveals that:

• Sanitation provision does not merely include provision of toilets. It includes redressal of all the factors that extend beyond defecation and urination and contribute to better access and better availability of resources to fulfill other sanitation practices such as easy access to water, washing facilities and privacy and dignity for bathing, menstrual management, and changing clothes.
• Intervention strategies for urban and rural areas need further articulation and differentiation according to type of settings.
• The study questions the extent to which shared sanitation facilities present a viable solution for improving sanitation access in India.

The paper ends by arguing for the urgent need to strengthen gender sensitive policies and work with women to address barriers to sanitation as well as to reduce sanitation related psychosocial stressors .

Please download a copy of the paper below.