Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India

Emerging evidence demonstrates how inadequate access to water and sanitation is linked to psychosocial stress, especially among women, forcing them to navigate social and physical barriers during their daily sanitation routines. We examine sanitation-related psychosocial stress (SRPS) across women’s reproductive lives in three distinct geographic sites (urban slums, rural villages, and rural tribal villages) in Odisha, India. We explored daily sanitation practices of adolescent, newly married, pregnant, and established adult women (n = 60) and identified stressors encountered during sanitation. Responding to structured data collection methods, women ranked seven sanitation activities (defecation, urination, menstruation, bathing, post-defecation cleaning, carrying water, and changing clothes) based on stress (high to low) and level of freedom (associated with greatest freedom to having the most restrictions). Women then identified common stressors they encountered when practicing sanitation and sorted stressors in constrained piles based on frequency and severity of each issue. The constellation of factors influencing SRPS varies by life stage and location. Overall, sanitation behaviors that were most restricted (i.e., menstruation) were the most stressful. Women in different sites encountered different stressors, and the level of perceived severity varied based on site and life stage. Understanding the influence of place and life stage on SRPS provides a nuanced understanding of sanitation, and may help identify areas for intervention

Probability that each activity would be ranked as having the most stress or freedom associated with it according to rank ordered logistic regression.

<p>No stars indicates p≥0.05</p><p>one star (*) indicates p<0.05</p><p>two stars (**) indicates p<0.01</p><p>three stars (***) indicates p<0.001.</p><p>Probabilities are presented overall and by geographic area, and by life course group. Stars are used to represent where p-values fell when comparing each item’s probability of being ranked first when compared to a reference item (marked as “(ref)”).)”.</p

Participant Characteristics.

<p>Participant Characteristics.</p

Percentage of women who reported engaging in activities overall and by geographic area.

<p>Percentage of women who reported engaging in activities overall and by geographic area.</p

Applicability, stress, and freedom associated with sanitation activities.

<p>The diameter of each circle is proportional to the percentage of women who indicated the activity was applicable to them; the location of the center of the circle relative to the horizontal and vertical axes indicates the probability that the activity was rated most stressful and most free, respectively.</p

Visualizing Frequency and Severity of Common Stressors Based on Life Stage and Geographic Site.

<p>Each circle represents a sanitation stressor. The diameter of the circle is proportional to the percentage of women who reported that the stressor was applicable to them. The location of the midpoint of the circle on the horizontal and vertical axes reflects the proportion of those women who indicated that the item was a high severity stressor and high frequency stressor, respectively. Only stressors that were highly applicable, severe, or frequent are included in each graph.</p

Probability that each stressor be ranked occurring most frequently or being ranked as high severity.

<p>Bolded values indicate stressors that have 50% or greater consequence in the category.</p

Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India

Emerging evidence demonstrates how inadequate access to water and sanitation is linked to psychosocial stress, especially among women, forcing them to navigate social and physical barriers during their daily sanitation routines. We examine sanitation-related psychosocial stress (SRPS) across women's reproductive lives in three distinct geographic sites (urban slums, rural villages, and rural tribal villages) in Odisha, India. We explored daily sanitation practices of adolescent, newly married, pregnant, and established adult women (n = 60) and identified stressors encountered during sanitation. Responding to structured data collection methods, women ranked seven sanitation activities (defecation, urination, menstruation, bathing, post-defecation cleaning, carrying water, and changing clothes) based on stress (high to low) and level of freedom (associated with greatest freedom to having the most restrictions). Women then identified common stressors they encountered when practicing sanitation and sorted stressors in constrained piles based on frequency and severity of each issue. The constellation of factors influencing SRPS varies by life stage and location. Overall, sanitation behaviors that were most restricted (i.e., menstruation) were the most stressful. Women in different sites encountered different stressors, and the level of perceived severity varied based on site and life stage. Understanding the influence of place and life stage on SRPS provides a nuanced understanding of sanitation, and may help identify areas for intervention