Individual, Family, and Neighborhood Characteristics and Children\u27s Food Insecurity

A growing body of work documents the influence of neighborhood environments on child health and well-being. Food insecurity is likely linked to neighborhood characteristics via mechanisms of social disadvantage, including access to and availability of healthy foods and the social cohesion of neighbors. In this paper, we utilize restricted, geo-coded data from the Early Childhood Longitudinal Study, which allows us to link individual children with their neighborhood\u27s census characteristics, to assess how the neighborhoods of food secure and food insecure children differ at both the kindergarten level and in third grade. The average food insecure child lives in a neighborhood with a higher proportion of black and Hispanic residents, a higher proportion of residents living in poverty, and a higher proportion of foreign-born and linguistically isolated residents. After accounting for individual and household-level characteristics, children living in neighborhoods with a high proportion of Hispanic and foreign-born residents have a significantly increased risk of food insecurity compared to children living in neighborhoods which are predominantly white and have high socioeconomic status. We argue that interventions which take neighborhood context into account may be most efficacious for curbing child food insecurity

Sundaas Story: A Mixed-Methods Study of Household Sanitation Provisioning in Urban Informal Housing in India

The aims of this research were to examine sanitation insecurity in urban informal housing through the lens of the built environment, social disparities, and health implications. While the Millennium Development Goals for halving the global proportion of people without access to safe drinking water were met ahead of schedule, progress fell short for sanitation, creating new objectives for the Sustainable Development Goals to be met in 2030. Much research in the Global South is dedicated to community-level sanitation promotion, but often presumes a rural rather than urban setting. Urban informal housing settings constitute a unique challenge due to the range of population sizes, tenure uncertainty, and location on potentially hazardous landscapes. In addition, while social scientific work theorizes the relationship between urban planning priorities and infrastructure inequalities, less work focuses on the social and environmental dynamics that shape sanitation within poor communities. Using quantitative, qualitative, and spatial data analyses, I examine: 1) whether demand for a household toilet is associated with the built environment; 2) socio-spatial processes that are enmeshed in daily sanitation decision-making among women householders; and 3) whether women’s defecation and urination avoidance strategies (“holding it”) correspond to the availability of a household toilet as opposed to shared facilities. The research occurred through a partnership with an NGO that has been engaged in sanitation and housing in urban slums in Maharashtra, India for more than two decades. In synthesizing results, I argue that sanitation demand must be understood through daily sanitation journeys, which are enmeshed within social inequalities, ambiguity over shared infrastructure, and housing insecurity. These themes are shaped by the social and built environment. First, household size, home ownership, individual household water sources, and open defecation avoidance are significantly associated with sanitation demand. Second, intra-community tensions play a major role in the lack of clarity over management of shared water and sanitation infrastructure. This, alongside gender imbalances and fear of violence, shape how women seek out daily sanitation, particularly around where and when to go to the bathroom. Toilets also present the potential for formalization and upward mobility for residents, but housing insecurity and the threat of eviction complicate the decision to build a toilet. Finally, the provision of a household toilet corresponds to a major reduction in avoidance behaviors among female primary respondents. Respondents who report community toilets as unsafe are much more likely to engage in bathroom avoidance behavior, especially if their household is water-insecure. These findings have bearings for research and policy regarding sanitation and poor urban populations. First, I shed new light on sanitation and gender inequity, especially the issue of women routinely avoiding defecation, a practice whose health implications have not been studied. Secondly, my findings suggest that sanitation promotion activities that approach the community as a single unit that will work together to solve open defecation and to manage shared facilities whose management is unclear may not be successful. Thirdly, housing insecurity constitutes a major site of tension for residents of informal settlements, and planning priorities must engage with housing insecurity alongside the provision of sanitation infrastructure overall

Women ‘holding it’ in urban India: Toilet avoidance as an under-recognized health outcome of sanitation insecurity

Emerging research on sanitation challenges in the Global South increasingly uncovers health and social impacts by gender, particularly lack of sanitation safety. Women may employ strategies to avoid urination or defecation (‘holding it’) in the absence of safe sanitation, but the practice is not well understood. We quantitatively analyze survey data on women from urban slums across three cities in Maharashtra, India whose households constructed a toilet through an intervention programme. We assess relationships between household versus shared sanitation, perceptions of safety, and women’s toilet avoidance behaviours, including diet restriction. At baseline, women have more than three times the odds of reporting avoidance behaviours if they perceive a community toilet to be unsafe, even after controlling for other factors. Household water insecurity is also instrumental in the relationship between avoidance and lack of safety. Finally, avoidance exhibits a significant and major drop upon provision of a household toilet. This study provides substantial support for the prevalence of habitual toilet avoidance among vulnerable urban women without access to safe sanitation. We conclude with recommendations for policy approaches and call for more attention to the health repercussions of habitual toilet avoidance among women as a consequence of sanitation insecurity