Informal settlements and a relational view of health in Nairobi, Kenya: Sanitation, gender and dignity.
Open accessAbstract
On an urban planet, slums or informal settlements present an increasing challenge for health promotion. The living conditions in complex informal settlements interact with how people navigate through their daily lives and political institutions to shape health inequities. In this article, we suggest that only a relational place-based characterization of informal settlements can accurately capture the forces contributing to existing urban health inequities and inform appropriate and effective health promotion interventions. We explore our relational framework using household survey, spatial mapping and qualitative focus group data gathered in partnership with residents and non-governmental organizations in the Mathare informal settlement in Nairobi, Kenya. All data interpretation included participation with local residents and organizations. We focus on the inter-relationships between inadequate sanitation and disease, social, economic and human rights for women and girls, who we show are most vulnerable from poor slum infrastructure. We suggest that this collaborative process results in co-produced insights about the meanings and relationships between infrastructure, security, resilience and health. We conclude that complex informal settlements require relational and context-specific data gathering and analyses to understand the multiple determinants of health and to inform appropriate and effective healthy city interventions.
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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].”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [240]
Political and social factors created household water and sanitation characteristics that are far worse in Nairobi's informal settlements compared to the city at an aggregated level.
“Political and social factors created household water and sanitation characteristics that are far worse in Nairobi’s informal settlements compared to the city at an aggregated level [31].”
From Physical, social, and political inequities constraining girls’ menstrual management at schools in informal settlements of Nairobi, Kenya. (2017) · cites this paper as [31]
Ninety-four percent of informal settlement residents have access to a toilet, but as many as 83% rely on paid public toilets, which forces many residents to use flying toilets or open defecation.
“Ninety four percent of informal settlement residents have access to a toilet, but as many as 83% rely on paid public toilets, which forces many residents to use flying toilets (when one defecates into a plastic bag and throws it away) or open defecation [28, 31, 32].”
From Physical, social, and political inequities constraining girls’ menstrual management at schools in informal settlements of Nairobi, Kenya. (2017) · cites this paper as [31]
Using public toilets costs 3-7% of a family's income, they tend to be over 50 m away from homes, and every time women walk to the toilet, they risk sexual violence by community members.
“Using these public toilets costs 3–7% of a family’s income, they tend to be over 50 m away from their homes, and every time they walk to the toilet, women risk sexual violence by community members [31].”
From Physical, social, and political inequities constraining girls’ menstrual management at schools in informal settlements of Nairobi, Kenya. (2017) · cites this paper as [31]
Participants in private schools reported that they sometimes missed school due to inadequate facilities and menstrual materials.
“participants in private school reported that they sometimes missed school due to inadequate facilities and menstrual materials.”
From Physical, social, and political inequities constraining girls’ menstrual management at schools in informal settlements of Nairobi, Kenya. (2017) · cites this paper as [31]
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- Authors
- Corburn, J., & Karanja, I.
- Affiliations
- University of California, Berkeley (US)
- Corresponding author
- Corburn, Jason
- Venue
- Health Promotion International
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-11-24
- Volume
- 31
- Issue
- 2
- Pages
- 258-269
- ISSN
- 0957-4824 (ISSN-L)
- 1460-2245
- OpenAlex
- W1991099681
- Cited by
- 93
- References
- 39
- Citations by year
- 2026: 11 · 2025: 8 · 2024: 10 · 2023: 14 · 2022: 12 · 2021: 8 · 2020: 7 · 2019: 8 · 2018: 8 · 2017: 5 · 2016: 1 · 2015: 1
- FWCI
- 10.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Promotion International (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Rockefeller Foundation
- Topics
- Social Sciences › Urban Studies › Urban and Rural Development Challenges
- Social Sciences › Health › Public Health and Social Inequalities
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Public Health and Environmental Issues
- Keywords
- informal settlements, slums, urban health disparities, relational framework, place-based health, sanitation, gender, women's dignity, human rights, health promotion, healthy cities, Nairobi, urban infrastructure, resilience
- MeSH terms
- Chronic Disease, Female, Health Status, Humans, Infections, Kenya, Male, Poverty Areas, Sanitation, Urbanization, Women, Personhood, Health Status Disparities, Social Determinants of Health
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