Why gender matters in the solution towards safe sanitation? Reflections from rural India.

Family members (often husbands, fathers, and in-laws) restricted water fetching and sanitation-related movements, most intensely for unmarried daughters and recently married and pregnant women, less intensely for women of lower castes and widows.

“Research in India found that family members (often husbands, fathers, and in-laws) restricted water fetching and sanitation-related movements, most intensely for unmarried daughters [174,182,190] and recently married and pregnant women, [178, 182, 189] (less intensely for women of lower castes [135] and widows [174]).”

Movement restrictions influenced women and girls' access to water and defecation, urination, and menstrual management locations, and are most widely reported in India.

“Movement restrictions influenced women and girls' access to water [101, 110, 178] and defecation, urination, and menstrual management locations, and are most widely reported in India [62, 135, 174, 181, 182, 184, 187], [101,110,187,[189][190][191].”

Fear and experiences of sexual violence were reported by women and girls who had to leave home for water and sanitation needs; women openly defecating were particularly vulnerable to non-partner sexual violence compared to those using latrines.

“Fear and experiences of sexual violence were reported by women and girls who had to leave home for water and sanitation needs (_((((xxx))))_)[70, 76, 108, 123, 135, 143, 153, 171, 173-175, 177, 179, 181, 183, 184, 186-189, 191, 198, 214, 231, 233, 238-240, 255, 258, 259, 261, 265, 268-270] Research from India, [181, 268] Kenya, [269] and Nigeria [70] found women openly defecating were particularly”

All research describing fear or experience of non-partner physical violence focused on sanitation, while all articles focusing on intimate partner physical violence and most focusing on interpersonal conflict focused on water.

“All research describing fear or experience of non-partner physical violence focused on sanitation, while all articles focusing on intimate partner physical violence and most focusing on interpersonal conflict focused on water (_((((xxx))))_)[61, 62, 76, 86, 89, 101, 110, 111, 123, 135, 143, 144, 171, 173-175, 177, 179, 181, 182, 188, 189, 191, 198, 201, 243, 251, 255, 257, 258, 260, 262, 264, 266,”

Fears or experiences of harm from domestic and wild animals and insects were reported for both water collection and sanitation activities; women and girls reported fear and actual experiences of injury at and when accessing sanitation locations, regardless of sanitation type.

“Fears or experiences of harm from domestic and wild animals and insects were reported for both water collection and sanitation activities [62, 135, 143, 170, 172-174, 177-179, 184, 187, 189-191, 198, 201, 214, 226, 229, 257, 258, 296].Women and girls reported fear and actual experiences of injury at and when accessing sanitation locations, regardless of sanitation type [135, 168, 172, 174, 184, 18”

Women and girls feared, risked, or experienced varied harms related to their water and sanitation circumstances and activities, with water fetching related harms in particular resulting in serious and long-term consequences, including general and localized pain, headaches and head injury, and injury from falls, trucks, and/or car accidents.

“Women and girls feared, risked, or experienced, varied harms related to their water and sanitation circumstances and activities (_((((xxx))))_)[62, 63, 78, 90, 101, 135, 141, 143, 144, 158, 168-170, 172-174, 177-179, 181, 182, 184, 186, 187, 189-191, 197-199, 201, 214, 226, 231, 244, 257, 258, 261, 276, 277, 296].Many noted exacerbated”

Women who withheld food and water or suppressed urination and defecation when lacking access to safe, clean latrines reported experiencing urinary tract infections, headaches, stomach aches, constipation, diarrhea, and other illnesses.

“Women who withheld food and water or suppressed urination and defecation when lacking access to safe, clean latrines reported experiencing urinary tract infections, headaches, stomach aches, constipation, diarrhea, and other illnesses [135, 168, 172-174, 184, 190, 214, 248].”

Limited income and asset access and control, including over land, constrained women's access to sanitation and limited independent decision-making about latrine construction; women reported using public pay-per-use toilets and incurring higher costs than men due to more frequent need.

“Similarly, limited income and asset access and control, including over land, constrained women's access to sanitation [119, 124, 125, 135, 147, 168, 171, 174, 186, 187, 191, 217, 239, 240, 270] and limited independent decision-making about latrine construction [119, 124, 135].Women reported using public pay-per-use toilets [168, 171, 174, 227, 239, 270] and incurring higher costs than men due to”

Limited household income has forced women to prioritize needs like food over sanitation; women in Kenya and India adapted by using preferred pay-per-use locations less often or strategically, like for defecation only.

“Limited household income has forced women to prioritize needs like food over sanitation, whether investing in or paying to use toilets [135,147,186].Women in Kenya [240, 270] and India [187] adapted by using preferred pay-per-use locations less often or strategically, like for defecation only [187,240,270].”

Women have faced difficulties accessing government subsidies or loans large enough for latrine construction and reported willingness to make financial sacrifices, like paying higher rent or accepting a lower wage job, to gain toilet access; in India, even women with economic and decision-making power could not build latrines without land ownership.

“Women have faced difficulties accessing government subsidies [125, 135] or loans large enough for latrine construction [131] and reported willingness to make financial sacrifices, like paying higher rent [191] or accepting a lower wage job, [174,217] to gain toilet access.In India, even women with economic and decision-making power could not build latrines without land ownership [124,187,190].”

Women accessed social networks to address water and sanitation problems and take on roles, including lobbying officials, raising complaints with local authorities, leveraging village council connections to access latrine construction subsidies, and creating strategic alliances with male household members.

“Women accessed social networks to address water and sanitation problems and take on roles [65,79,90,95,135,149,158,193].They used social networks to lobby officials to solve water problems (Thailand [193]), raise complaints with local authorities about water issues (Ecuador [79] and Nigeria [158]), leverage village council connections to access latrine construction subsidies (India [135]), and”

Women expended great amounts of time meeting sanitation needs and fulfilling sanitation-related responsibilities, including long walks to sanitation sites when lacking private home toilets, waiting in long toilet queues, going for sanitation in early morning or late at night to avoid queues or ensure privacy, or open defecating rather than walking to and queuing at latrines.

“Women expended great amounts of time meeting sanitation needs and fulfilling sanitationrelated responsibilities [64, 66, 121, 122, 125, 127, 128, 132, 133, 135, 138, 141, 168, 173, 174, 182, 184, 185, 187, 189,190,195,219,226,228,236,239,240,248,250,256,265].Women in India, [125,195] Kenya, [256] and South Africa [265] reported long walks to sanitation sites when they lacked private home toilets,”

Rural Indian women were often responsible for assisting others, including children, adolescent girls, and elderly family members, with sanitation needs.

“and were often responsible for assisting others, including children, adolescent girls, and elderly family members, with sanitation needs [62,131,135,184,190].”

Women did so to avoid harassment from community members when going to latrines and open defecation sites after dark.

“and to avoid harassment from community members when going to latrines and open defecation sites after dark [135,143,168,182,190,228,238].”

Women frequently accompanied one another or asked men to accompany them for safety when open defecating.

“Regarding sanitation, women frequently accompanied one another or asked men to accompany them for safety when open defecating, [135, 173-175, 182, 187, 189, 251]”

Khanna and Das [34] reported that poorly designed and constructed WaSH facilities lacking safety were the reason women did not use sanitation facilities provided but engaged in open defecation.

“Similarly, Khanna and Das [34] in their study in India, reported that the poorly designed and constructed nature of WaSH facilities which lacked safety—e.g., lacking seats or slabs, poorly lit or without locks—were the reason women did not use the sanitation facilities provided but engaged in open defecation.”