Sanitation Insecurity: Definition, Measurement, and Associations with Women's Mental Health in Rural Orissa, India Open Access

Caruso, Bethany (2015)

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Water, sanitation, and hygiene (WASH) are critical for human health. Research on WASH and health to date has predominantly focused on infectious agents and resultant diseases, leaving other facets of health--such as mental health--underexplored. Qualitative investigations suggest that women experience assaults to their mental health due to poor sanitation conditions and the gendered sanitation behaviors they are expected to perform. No research has aimed to determine the association between women's sanitation-related experiences and their mental-health outcomes. The primary aims of this research were to (1) understand women's lived experiences of sanitation beyond access to a sanitation facility--their sanitation insecurity, (2) create a measure of sanitation insecurity, and (3) determine the association between sanitation insecurity and mental health among women at different life stages in rural Orissa, India. This mixed-methods investigation found that women have a myriad of concerns related to their urination, defecation, and menstrual management behaviors that vary by life stage; women face challenges performing sanitation-related behaviors despite access to a sanitation facility; and associations between women's sanitation insecurity and well-being, anxiety, depression, and distress exist.

Table of Contents

CHAPTER 1: Introduction 1

Dissertation Summary 1

Literature Review 3

1. Health and Gender Frameworks for Understanding WASH Impacts on Women 5

2. WASH, Gender, and Health 7

2a. Women face barriers to WASH resources and behaviors 7

2b. Women are WASH Duty-Bearers 10

2c. Women lack WASH Decision-Making Power 13

2d. Women-Specific WASH Needs Remain Under-explored 14

Research Gaps 16

References 18

CHAPTER 2: Understanding and Defining Sanitation Insecurity:

Women's Gendered Experiences of Urination, Defecation, and Menstrual Hygiene Management in Rural Odisha, India

Introduction 25

Methods 28

Results 32

Discussion 54

Tables and Figures 60

References 69

CHAPTER 3: Assessing Women's Experiences of Sanitation Insecurity:

The Development of a Novel Measure

Introduction 74

Methods 77

Results 88

Discussion 94

Tables and Figures 99

References 115

CHAPTER 4: The association between women's sanitation experiences and mental well being: A quantitative cross-sectional study in Rural, Odisha India

Introduction 121

Methods 123

Results 132

Discussion 136

Tables and Figures 145

References 155

CHAPTER 5: Conclusion 162

Summaries of three papers 163

Synthesis 169

Next Steps 171

Conclusion 175

References 177

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