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Cited by 87Child Nutrition and Water AccessGender Studies and Social IssuesMental Health Treatment and Access

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

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Caruso, Bethany A., Cooper, Hannah L.F., Haardörfer, Regine, Yount, Kathryn M., Routray, Parimita, Torondel, Belen, Clasen, Thomas·2018·SSM - Population Health
DOI 10.1016/j.ssmph.2018.06.005PMC PMC6077264
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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.

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  • Women reported different health concerns, mostly negative, based on life stage and circumstance, including pregnant women's fears related to sanitation-related superstitions, stress about accessing sanitation sites for women with trouble controlling urination or defecation, lower odds of good health for women reliant on bags, buckets, or open defecation, and difficulty/pain defecating and urin

    “Women reported different health concerns, mostly negative, based on life stage and circumstance.Notably, pregnant women expressed health fears related to sanitationrelated superstitions (India [184, 189]), women with trouble controlling urination or defecation stressed about accessing sanitation sites (India [2]), women reliant on bags, buckets, or open defecation had substantially lower odds of”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [2]

  • Access to sanitation facilities was associated with mental well-being; ownership of functional household latrines and enclosed bathing spaces were significantly associated with well-being among women in rural India; toilet access in Kenya was associated with better mental health and well-being; women who received latrines in Mozambique reported decreased stress; and women in India reported private

    “Access to sanitation facilities was associated with mental well-being.Ownership of functional household latrines and enclosed bathing spaces were significantly associated with well-being among women in rural India [2].Toilet access in Kenya was associated with better mental health and well-being among women [289].Women who received latrines in Mozambique reported that they decreased their stress,”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [2]

  • Compromised water and sanitation environments have contributed to compromised mental well-being.

    “compromised mental well-being; [2, 76, 90, 96, 100, 108, 123, 139, 163, 165, 168, 170, 172, 173, 175, 177, 178, 185, 188, 189,192,198,201,202,205,209,229,271,274,275,280,283,289]”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [2]

  • Compromised water and sanitation environments have led to suppression of urination, defecation and menstrual hygiene needs.

    “and suppression of urination, defecation and menstrual hygiene needs, [2,62,181,184,188,190,191,214,217,224,229,235,236,238,240,241,247,248,250,270] among other impacts.”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [2]

  • Bathing areas that are separate from latrines have been associated with well-being among this population.

    “Bathing areas that are separate from latrines have been associated with well-being among this population”

    From ’It’s like a burden on the head’: Redefining adequate menstrual hygiene management throughout women’s varied life stages in Odisha, India. (2019) · cites this paper as [48]

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Research works printed but not linked: 1

  1. WHO (1946). (1946, 19 June - 22 July). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York.

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Authors
Caruso, B. A., Cooper, H. L. F., Haardörfer, R., Yount, K. M., Routray, P., Torondel, B., & Clasen, T.
Affiliations
  • Emory University (US)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Caruso, Bethany A.
ORCID
Venue
SSM - Population Health
Publisher
Elsevier BV
Published
2018-08
Volume
5
Pages
257-266
ISSN
2352-8273 (ISSN-L)
DOI
10.1016/j.ssmph.2018.06.005
PMC
PMC6077264
OpenAlex
W2809192395
Cited by
87
References
67
Citations by year
2026: 11 · 2025: 17 · 2024: 11 · 2023: 6 · 2022: 17 · 2021: 11 · 2020: 7 · 2019: 5 · 2018: 2
FWCI
5.17
Type
journal article
Language
en
Open access
Licence
Locations
  • SSM - Population Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Funders
Bill and Melinda Gates Foundation
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Social Sciences › Gender Studies › Gender Studies and Social Issues
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
mental health, anxiety, depression, psychological distress, psychological well-being, rural women, Odisha, life stages, sanitation interventions

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