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Cited by 24Gender Studies and Social IssuesChild Nutrition and Water AccessUrban and Rural Development Challenges

Women’s sanitation practices in informal settlements: A multi-level analysis of factors influencing utilisation in Nairobi, Kenya.

Winter, Samantha, Dreibelbis, Robert, Barchi, Francis·2019·Global Public Health
DOI 10.1080/17441692.2018.1534256
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Abstract

Samantha Wintera* http://orcid.org/0000-0001-6629-7642, Robert Dreibelbisb & Francis Barchiaa Edward J. Bloustein School of Planning & Public Policy, Rutgers, The State University of New Jersey, New Brunswick, USAb Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK CONTACT Samantha Winter winter.samantha@rutgers.edu Dorothy Byrne Postdoctoral Fellow in Global Health, Edward J. Bloustein School of Planning & Public Policy, Rutgers, The State University of New Jersey, 33 Livingston Avenue, New Brunswick, NJ 08901, United States ABSTRACTFor decades, countries throughout the world have failed to meet sanitation-related development goals. Access to safe sanitation is undeniably linked to improved health outcomes; yet, 2.4 billion people, globally, still lack access. The persistent failure to meet sanitation goals suggests that our understanding of the factors that influence sustainable sanitation access and utilisation is incomplete. Despite growing availability of toilets in informal settlements, there is evidence that women, in particular, may adopt other strategies for managing their sanitation needs. Empirical data documenting the motivations underlying such practices in sub-Saharan Africa are limited. This study uses cross-sectional data collected in 2016 from women in Mathare Valley Informal Settlement in Nairobi, Kenya. Boosted and logistic regressions were used to investigate which factors were associated with women’s common sanitation patterns. Lack of privacy and insecurity at toilets and neighbourhood disorganisation emerged as important factors – particularly for women who reported regularly using buckets or plastic bags for urination/defecation. These findings suggest that availability of toilets may not be enough to eliminate sanitation-related health risks in informal settlements. Future interventions may need to address other barriers to sanitation access if sustainable gains in this important public health area are to be achieved.

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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 [256]

  • Women in Nairobi, Kenya who rely on bags, buckets, or open defecation had lower odds of experiencing privacy; household or shared toilets do not always prevent women from being seen or heard while defecating.

    “Women in Nairobi, Kenya who rely on bags, buckets, or open defecation had lower odds of experiencing privacy [256].Household or shared toilets do not always prevent women from being seen or heard while defecating [123, 184, 186].”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [256]

  • A lack of privacy and security were related to women emptying bags and buckets at night, a behavior that can often increase the exposure of women to the threat of violence or sexual assault.

    “In particular, a lack of privacy and security were related to women emptying bags and buckets at night, a behavior that can often increase the exposure of women to the threat of violence or sexual assault (Winter et al., 2019).”

    From A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health (2020) · cites this paper as Winter et al., 2019

  • Stigma actively prevents women and girls from developing healthy habits, such as using soap and water or using latrines.

    “Stigma actively prevents women and girls from developing healthy habits (e.g., using soap and water or from using latrines (O'Reilly and Louis, 2014; Yeasmin et al., 2017;Winter et al., 2019).”

    From A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health (2020) · cites this paper as Winter et al., 2019

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Authors
Winter, S., Dreibelbis, R., & Barchi, F.
Affiliations
  • Rutgers, The State University of New Jersey (US)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Winter, Samantha
ORCID
Venue
Global Public Health
Publisher
Informa UK Limited
Published
2018-10-12
Volume
14
Issue
5
Pages
663-674
ISSN
  • 1744-1692 (ISSN-L)
  • 1744-1706
DOI
10.1080/17441692.2018.1534256
OpenAlex
W2897399631
Cited by
24
References
36
Citations by year
2026: 2 · 2025: 4 · 2024: 4 · 2023: 2 · 2022: 2 · 2021: 8 · 2020: 1 · 2019: 1
FWCI
4.67
Type
journal article
Language
en
Open access
closed
Locations
  • Global Public Health (publishedVersion)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Rutgers University Community Repository (Rutgers University) (submittedVersion)
  • eSpace (Curtin University) (submittedVersion)
Funders
  • Rutgers School of Graduate Studies
  • National Security Education Program
  • PEO International
Topics
  • Social Sciences › Gender Studies › Gender Studies and Social Issues
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Social Sciences › Urban Studies › Urban and Rural Development Challenges
Keywords
informal settlements, toilets, lack of privacy, Nairobi, sub-Saharan Africa, sanitation access, health risks
MeSH terms
Cross-Sectional Studies, Female, Humans, Kenya, Poverty Areas, Residence Characteristics, Sanitation

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