From menarche to menopause: A population-based assessment of water, sanitation, and hygiene risk factors for reproductive tract infection symptoms over life stages in rural girls and women in India
Open accessAbstract
Women face greater challenges than men in accessing water, sanitation, and hygiene (WASH) resources to address their daily needs, and may respond to these challenges by adopting unsafe practices that increase the risk of reproductive tract infections (RTIs). WASH practices may change as women transition through socially-defined life stage experiences, like marriage and pregnancy. Thus, the relationship between WASH practices and RTIs might vary across female reproductive life stages. This cross-sectional study assessed the relationship between WASH exposures and self-reported RTI symptoms in 3,952 girls and women from two rural districts in India, and tested whether social exposures represented by reproductive life stage was an effect modifier of associations. In fully adjusted models, RTI symptoms were less common in women using a latrine without water for defecation versus open defecation (Odds Ratio (OR) = 0.69; Confidence Interval (CI) = 0.48, 0.98) and those walking shorter distances to a bathing location (OR = 0.79, CI = 0.63, 0.99), but there was no association between using a latrine with a water source and RTIs versus open defecation (OR = 1.09; CI = 0.69, 1.72). Unexpectedly, RTI symptoms were more common for women bathing daily with soap (OR = 6.55, CI = 3.60, 11.94) and for women washing their hands after defecation with soap (OR = 10.27; CI = 5.53, 19.08) or ash/soil/mud (OR = 6.02; CI = 3.07, 11.77) versus water only or no hand washing. WASH practices of girls and women varied across reproductive life stages, but the associations between WASH practices and RTI symptoms were not moderated by or confounded by life stage status. This study provides new evidence that WASH access and practices are associated with self-reported reproductive tract infection symptoms in rural Indian girls and women from different reproductive life stages. However, the counterintuitive directions of effect for soap use highlights that causality and mechanisms of effect cannot be inferred from this study design. Future research is needed to understand whether improvements in water and sanitation access could improve the practice of safe hygiene behaviors and reduce the global burden of RTIs in women.
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Improper cleaning and drying of reusable menstrual materials may potentially lead to infection, although more research is needed to substantiate this connection.
“the improper cleaning and drying of these materials for reuse may potentially lead to infection, although more research is needed to substantiate this connection [27–29].”
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 [27]
Improvising sanitary materials can place women and girls at risk for leaks and discomfort depending on the quantity and quality of materials accessible.
“Improvising sanitary materials can place women and girls at risk for leaks and discomfort depending on the quantity and quality of materials accessible”
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 [27]
The relationship between the type and condition of materials and urogenital infections has not been substantiated.
“and while this relationship has not been substantiated”
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 [27]
Studies have explored the connection between the type and condition of materials with urogenital infections.
“Studies have explored the connection between the type and condition of materials with urogenital infections”
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 [27]
The effects of the concern about infection from drying cloth were felt among participants.
“the effects of this concern were felt among participants and warrant further exploration [6, 27–29].”
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 [27]
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Self-citationWater, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis
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- Authors
- Baker, K. K., Padhi, B., Torondel, B., Das, P., Dutta, A., Sahoo, K. C., Das, B., Dreibelbis, R., Caruso, B., Freeman, M. C., Sager, L., & Panigrahi, P.
- Affiliations
- University of Iowa (US)
- Asian Institute of Public Health (IN)
- University of Oklahoma (US)
- Emory University (US)
- University of Nebraska Medical Center (US)
- Corresponding author
- Baker, Kelly K.
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-12-05
- Volume
- 12
- Issue
- 12
- Pages
- e0188234
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5716553
- OpenAlex
- W2771610818
- Cited by
- 61
- References
- 81
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 8 · 2023: 5 · 2022: 9 · 2021: 10 · 2020: 8 · 2019: 5 · 2018: 2
- FWCI
- 3.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (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)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Department for International Development (6981)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Social Sciences › Gender Studies › Gender Studies and Social Issues
- Keywords
- water, sanitation and hygiene, reproductive tract infections, reproductive life stages, open defecation, latrine use, hand washing, soap use, bathing habits, rural women, girls, effect modification, India, reproductive health, unprotected sex, life stage transitions, life course epidemiology, causal inference limitations
- MeSH terms
- Adolescent, Adult, Cross-Sectional Studies, Female, Humans, Hygiene, India, Menarche, Menopause, Middle Aged, Pregnancy, Risk Factors, Rural Population, Sanitation, Social Class, Water Supply, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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