Assessing women’s negative sanitation experiences and concerns: the development of a novel sanitation insecurity measure
Open accessAbstract
Lack of access to acceptable sanitation facilities can expose individuals, particularly women, to physical, social, and mental health risks. While some of the challenges have been documented, standard metrics are needed to determine the extent to which women have urination- and defecation-related concerns and negative experiences. Such metrics also are needed to assess the effectiveness of interventions to mitigate them. We developed a sanitation insecurity measure to capture the range and frequency of women's sanitation-related concerns and negative experiences. Research was conducted in rural Odisha, India with women across various life course stages to reflect a range of perspectives. This paper documents the mixed data collection methods and the exploratory and confirmatory factor analyses we employed to arrive at a final measure. The final sanitation insecurity measure includes 50 items across seven factors that reflect the physical environment, the social environment, and individual-level constraints. Most factor scores were significantly higher for unmarried women and for women who lacked access to functional latrines, indicating social and environmental influence on experiences. This measure will enable researchers to evaluate how sanitation insecurity affects health and to determine if and how sanitation interventions ameliorate women's concerns and negative experiences associated with sanitation.
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Fear of sexual assault was reported to be greatest at night, leading some women to use bags and buckets for sanitation needs; in India, urban settings reported greater fear than rural settings.
“Fear of sexual assault was reported to be greatest at night, [123, 186, 238, 239, 255] leading some women to use bags and buckets for sanitation needs [175, 255, 270].In India, those in urban settings reported greater fear of sexual assault when accessing sanitation than those in rural settings [181,189].”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [238]
Women reported myriad sanitation-related stressors, including fear of being attacked by men or ghosts, being shamed for using open defecation sites, suppressing urination or defecation, withholding food and water, needing help to meet sanitation needs, being hurried while using shared facilities, sanitation-related costs, and lacking privacy or being seen by others, especially men, while openly
“Women reported myriad sanitation-related stressors, including fear of being attacked by men or ghosts, [177, 181, 184, 189, 229, 238] being shamed for using open defecation sites, [172] suppressing urination or defecation, [184] withholding food and water, [184] needing help to meet sanitation needs, [184] being hurried while using shared facilities, [168, 185, 188] sanitation-related costs, [170,”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [238]
Women with children in India were scolded for abandoning children to meet sanitation needs.
“women with children were scolded for abandoning children to meet sanitation needs; and women across life stages worried about upsetting others if they asked for assistance meeting sanitation needs [238].”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [238]
Women across life stages in India worried about upsetting others if they asked for assistance meeting sanitation needs.
“women with children were scolded for abandoning children to meet sanitation needs; and women across life stages worried about upsetting others if they asked for assistance meeting sanitation needs [238].”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [238]
Studies in India, and Odisha specifically, have explored women's MHM challenges beyond adolescence, but have focused primarily on issues related to WASH conditions.
“Studies in India, and Odisha specifically, have explored women’s MHM challenges beyond adolescence, but have focused primarily on issues related to water, sanitation, and hygiene (WASH) conditions, including sanitation insecurity, experiences with sanitation-related psychosocial stress, and reproductive tract infections [19, 28, 44–46].”
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 [46]
Menstruation concerns extend beyond adolescence and WASH.
“Yet, menstruation concerns extend beyond adolescence and WASH.”
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 [46]
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Cites
Costello, A. B., & Osborne, J. (2005) · University of Massachusetts Amherst · doi:10.7275/jyj1-4868 · Cited by 10,297 · see citing works
KANDIYOTI, D. (1988) · Gender & Society · doi:10.1177/089124388002003004 · Cited by 3,081 · see citing works
Global burden of childhood pneumonia and diarrhoea
Walker, C. L. F., Rudan, I., Liu, L., Nair, H., Theodoratou, E., Bhutta, Z. A., O'Brien, K. L., Campbell, H., & Black, R. E. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60222-6 · Cited by 2,356 · see citing works
Measurement in Medicine: A Practical Guide
de Vet, H. C. W., Terwee, C. B., Mokkink, L. B., & Knol, D. L. (2011) · doi:10.1017/cbo9780511996214 · Cited by 2,321 · see citing works
Multilevel Analysis in Public Health Research
Roux, A. V. D. (2000) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.21.1.171 · Cited by 1,224 · see citing works
Holgado–Tello, F. P., Chacón–Moscoso, S., Barbero–García, I., & Vila–Abad, E. (2010) · Quality & Quantity · doi:10.1007/s11135-008-9190-y · Cited by 1,200 · see citing works
Berkman, D. S., Lescano, A. G., Gilman, R. H., López, S., & Black, M. M. (2002) · The Lancet · doi:10.1016/s0140-6736(02)07744-9 · Cited by 807 · see citing works
The impoverished gut—a triple burden of diarrhoea, stunting and chronic disease
Guerrant, R. L., DeBoer, M. D., Moore, S. R., Scharf, R. J., & Lima, A. A. M. (2013) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2012.239 · Cited by 604 · see citing works
Effect of Sanitation on Soil-Transmitted Helminth Infection: Systematic Review and Meta-Analysis
Ziegelbauer, K., Speich, B., Mäusezahl, D., Bos, R., Keiser, J., & Utzinger, J. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001162 · Cited by 570 · see citing works
Clasen, T., Boisson, S., Routray, P., Torondel, B., Bell, M., Cumming, O., Ensink, J., Freeman, M., Jenkins, M., Odagiri, M., et al. (2014) · The Lancet Global Health · doi:10.1016/s2214-109x(14)70307-9 · Cited by 537 · see citing works
Self-citationWolf, J., Prüss‐Ustün, A., Cumming, O., Bartram, J., Bonjour, S., Cairncross, S., Clasen, T., Colford, J. M., Curtis, V., De France, J., et al. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12331 · Cited by 461 · see citing works
Self-citationCharacterization of household food insecurity in Québec: food and feelings
Hamelin, A.-M., Beaudry, M., & Habicht, J. (2002) · Social Science & Medicine · doi:10.1016/s0277-9536(01)00013-2 · Cited by 426 · see citing works
Factor Analysis: Exploratory and Confirmatory
Hancock, G. R., Hancock, G. R., Mueller, R. O., Stapleton, L. M., & Mueller, R. O. (2010) · Routledge eBooks · doi:10.4324/9780203861554-15 · Cited by 395 · see citing works
Wutich, A., & Ragsdale, K. (2008) · Social Science & Medicine · doi:10.1016/j.socscimed.2008.09.042 · Cited by 357 · see citing works
Improving Your Exploratory Factor Analysis for Ordinal Data: A Demonstration Using FACTOR
Baglin, J. (2020) · ScholarWorks@UMassAmherst (University of Massachusetts Amherst) · doi:10.7275/dsep-4220 · Cited by 336 · see citing works
Osterlind, S. J., & Everson, H. T. (2009) · Sage eBooks · doi:10.4135/9781412993913 · Cited by 304 · see citing works
Sahoo, K. C., Hulland, K. R. S., Caruso, B. A., Swain, R., Freeman, M. C., Panigrahi, P., & Dreibelbis, R. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.06.031 · Cited by 300 · see citing works
Self-citationGrimes, J. E. T., Croll, D., Harrison, W. E., Utzinger, J., Freeman, M. C., & Templeton, M. R. (2014) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0003296 · Cited by 296 · see citing works
Gender bias in the food insecurity experience of Ethiopian adolescents
Hadley, C., Lindstrom, D., Tessema, F., & Belachew, T. (2007) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.08.025 · Cited by 281 · see citing works
Self-citationWeaver, L. J., & Hadley, C. (2009) · Ecology of Food and Nutrition · doi:10.1080/03670240903001167 · Cited by 275 · see citing works
Self-citationStevenson, E. G. J., Greene, L. E., Maes, K. C., Ambelu, A., Tesfaye, Y. A., Rheingans, R., & Hadley, C. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.03.022 · Cited by 270 · see citing works
Stocks, M. E., Ogden, S., Haddad, D., Addiss, D. G., McGuire, C., & Freeman, M. C. (2014) · PLoS Medicine · doi:10.1371/journal.pmed.1001605 · Cited by 269 · see citing works
Routray, P., Schmidt, W.-P., Boisson, S., Clasen, T., & Jenkins, M. W. (2015) · BMC Public Health · doi:10.1186/s12889-015-2206-3 · Cited by 253 · see citing works
Self-citationBarnard, S., Routray, P., Majorin, F., Peletz, R., Boisson, S., Sinha, A., & Clasen, T. (2013) · PLoS ONE · doi:10.1371/journal.pone.0071438 · Cited by 237 · see citing works
Self-citationElicitation techniques for cultural domain analysis
Borgatti, S. (1999) · UKnowledge (University of Kentucky) · Cited by 220 · see citing works
Frongillo, E. A., & Nanama, S. (2006) · Journal of Nutrition · doi:10.1093/jn/136.5.1409s · Cited by 218 · see citing works
Interventions to improve disposal of human excreta for preventing diarrhoea
Clasen, T. F., Bostoen, K., Schmidt, W.-P., Boisson, S., Fung, I. C.-H., Jenkins, M. W., Scott, B., Sugden, S., & Cairncross, S. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007180.pub2 · Cited by 190 · see citing works
Self-citationBisung, E., & Elliott, S. J. (2017) · Journal of Water and Health · doi:10.2166/wh.2016.158 · Cited by 171 · see citing works
Bapat, M., & Agarwal, I. (2003) · Environment and Urbanization · doi:10.1177/095624780301500221 · Cited by 166 · see citing works
Caruso, B. A., Clasen, T. F., Hadley, C., Yount, K. M., Haardörfer, R., Rout, M., Dasmohapatra, M., & Cooper, H. L. (2017) · BMJ Global Health · doi:10.1136/bmjgh-2017-000414 · Cited by 165 · see citing works
Self-citationSanitation, stress, and life stage: A systematic data collection study among women in Odisha, India.
Hulland, K. R. S., Chase, R. P., Caruso, B. A., Swain, R., Biswal, B., Sahoo, K. C., Panigrahi, P., & Dreibelbis, R. (2015) · PLoS ONE · doi:10.1371/journal.pone.0141883 · Cited by 152 · see citing works
Self-citationHousehold sanitation facilities and women's risk of non-partner sexual violence in India
Jadhav, A., Weitzman, A., & Smith-Greenaway, E. (2016) · BMC Public Health · doi:10.1186/s12889-016-3797-z · Cited by 148 · see citing works
Building Household Food-security Measurement Tools from the Ground Up
Wolfe, W. S., & Frongillo, E. A. (2001) · Food and Nutrition Bulletin · doi:10.1177/156482650102200102 · Cited by 140 · see citing works
Padhi, B. K., Baker, K. K., Dutta, A., Cumming, O., Freeman, M. C., Satpathy, R., Das, B. S., & Panigrahi, P. (2015) · PLoS Medicine · doi:10.1371/journal.pmed.1001851 · Cited by 138 · see citing works
Health, hygiene and appropriate sanitation: experiences and perceptions of the urban poor
Joshi, D., Fawcett, B., & Mannan, F. (2011) · Environment and Urbanization · doi:10.1177/0956247811398602 · Cited by 130 · see citing works
Hadley, C., & Wutich, A. (2009) · Human Organization · doi:10.17730/humo.68.4.932w421317680w5x · Cited by 128 · see citing works
Self-citationWhy gender matters in the solution towards safe sanitation? Reflections from rural India.
Khanna, T., & Das, M. (2016) · Global Public Health · doi:10.1080/17441692.2015.1062905 · Cited by 120 · see citing works
Stevenson, E. G. J., Ambelu, A., Caruso, B. A., Tesfaye, Y., & Freeman, M. C. (2016) · PLoS ONE · doi:10.1371/journal.pone.0153432 · Cited by 120 · see citing works
Self-citationWinter, S. C., & Barchi, F. (2016) · International Journal of Environmental Health Research · doi:10.1080/09603123.2015.1111309 · Cited by 110 · see citing works
Women’s role in sanitation decision making in rural coastal Odisha, India.
Routray, P., Torondel, B., Clasen, T., & Schmidt, W.-P. (2017) · PLoS ONE · doi:10.1371/journal.pone.0178042 · Cited by 105 · see citing works
Self-citationHirve, S., Lele, P., Sundaram, N., Chavan, U., Weiss, M., Steinmann, P., & Juvekar, S. (2015) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2014.110 · Cited by 99 · see citing works
Rangarajan Committee Report on Poverty Measurement Another Lost Opportunity
Ray, R., & Sinha, K. (2014) · Cited by 94 · see citing works
From toilet insecurity to toilet security: creating safe sanitation for women and girls
O’Reilly, K. (2015) · Wiley Interdisciplinary Reviews Water · doi:10.1002/wat2.1122 · Cited by 90 · see citing works
Illustration of MIMIC-Model DIF Testing with the Schedule for Nonadaptive and Adaptive Personality
Woods, C. M., Oltmanns, T. F., & Turkheimer, E. N. (2008) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-008-9118-9 · Cited by 88 · see citing works
Domestic water and sanitation as water security: monitoring, concepts and strategy
Bradley, D. J., & Bartram, J. (2013) · Philosophical Transactions of the Royal Society A Mathematical Physical and Engineering Sciences · doi:10.1098/rsta.2012.0420 · Cited by 80 · see citing works
Childhood stunting: measuring and stemming the staggering costs of inadequate water and sanitation
Dillingham, R. A., & Guerrant, R. L. (2004) · The Lancet · doi:10.1016/s0140-6736(03)15307-x · Cited by 75 · see citing works
Clasen, T., Boisson, S., Routray, P., Cumming, O., Jenkins, M. W., Ensink, J. H. J., Bell, M. J., Freeman, M. C., Peppin, S., & Schmidt, W. (2012) · Emerging Themes in Epidemiology · doi:10.1186/1742-7622-9-7 · Cited by 73 · see citing works
Self-citationBisung, E., & Elliott, S. J. (2016) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2016.122 · Cited by 72 · see citing works
Gender disparities in water, sanitation, and global health
Caruso, B. A., Sevilimedu, V., Fung, I. C.-H., Patkar, A., & Baker, K. K. (2015) · The Lancet · doi:10.1016/s0140-6736(15)61497-0 · Cited by 70 · see citing works
Self-citationBoisson, S., Sosai, P., Ray, S., Routray, P., Torondel, B., Schmidt, W., Bhanja, B., & Clasen, T. (2014) · BMC Research Notes · doi:10.1186/1756-0500-7-486 · Cited by 68 · see citing works
Self-citationPutting menstrual hygiene management on to the school water and sanitation agenda
Marni Sommer, M. S. (2010) · Waterlines · doi:10.3362/1756-3488.2010.030 · Cited by 63 · see citing works
Routray, P., Torondel, B., Jenkins, M. W., Clasen, T., & Schmidt, W. (2017) · BMC Public Health · doi:10.1186/s12889-017-4382-9 · Cited by 33 · see citing works
Self-citationHadley, C., & Freeman, M. C. (2016) · Food Security · doi:10.1007/s12571-016-0599-1 · Cited by 29 · see citing works
Self-citationErhard, L., Degabriele, J., Naughton, D., & Freeman, M. C. (2013) · Global Public Health · doi:10.1080/17441692.2013.838284 · Cited by 24 · see citing works
Measuring Attitudes About Women’s Recourse After Exposure to Intimate Partner Violence
Yount, K. M., VanderEnde, K. E., Zureick‐Brown, S., Minh, T., Schuler, S. R., & Anh, H. T. (2013) · Journal of Interpersonal Violence · doi:10.1177/0886260513511536 · Cited by 19 · see citing works
Self-citationTaking Stock: Incompetent at incontinence – why are we ignoring the needs of incontinence sufferers?
Hafskjold, B. N., Pop-Stefanija, B., Giles-Hansen, C., et al. (2016) · Waterlines · doi:10.3362/1756-3488.2016.018 · Cited by 16 · see citing works
Women–water–sanitation: The case of Rimuka high-density suburb in Kadoma, Zimbabwe.
Remigios, M. V. (2011) · Agenda · doi:10.1080/10130950.2011.576004 · Cited by 10 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- [29]Frongillo E. Nanama S. Wolfe W. Technical Guide to Developing a Direct, Experience-Based Measurement Tool for Household Food Insecurity Ph.D. Thesis Food and Nutrition Technical Assistance Project, Academy for Educational Development Washington, DC, USA 2004 1 51
- [48]Creswell J.W. Clark V.L.P. Designing and Conducting Mixed Methods Research 2nd ed. SAGE Publications, Inc. Thousand Oaks, CA, USA 2011
- [52]De-Vet H. Terwee C.B. Mokkink L. Knol D. Measurement in Medicine Cambridge University Press Cambridge, UK 2011
Cited by
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Self-citationSclar, G. D., Penakalapati, G., Caruso, B. A., Rehfuess, E. A., Garn, J. V., Alexander, K. T., Freeman, M. C., Boisson, S., Medlicott, K., & Clasen, T. (2018) · Social Science & Medicine · doi:10.1016/j.socscimed.2018.09.016 · Cited by 113 · see citing works
Self-citationMacRae, E. R., Clasen, T., Dasmohapatra, M., & Caruso, B. A. (2019) · PLOS ONE · doi:10.1371/journal.pone.0220114 · Cited by 111 · see citing works
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Self-citationCaruso, B. A., Cooper, H. L. F., Haardörfer, R., Yount, K. M., Routray, P., Torondel, B., & Clasen, T. (2018) · SSM - Population Health · doi:10.1016/j.ssmph.2018.06.005 · Cited by 87 · see citing works
Self-citationNunbogu, A. M., & Elliott, S. J. (2022) · Water Security · doi:10.1016/j.wasec.2022.100113 · Cited by 59 · see citing works
Winter, S., Barchi, F., & Dzombo, M. N. (2018) · International Journal of Environmental Health Research · doi:10.1080/09603123.2018.1497778 · Cited by 37 · see citing works
Water and sanitation are not gender-neutral: Human rights in rural Brazilian communities.
Silva, B. B., Sales, B., Lanza, A. C., Heller, L., & Rezende, S. (2020) · Water Policy · doi:10.2166/wp.2020.126 · Cited by 32 · see citing works
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Winter, S. C., Dreibelbis, R., Dzombo, M. N., & Barchi, F. (2019) · PLoS ONE · doi:10.1371/journal.pone.0214114 · Cited by 29 · see citing works
Wodnik, B. K., Freeman, M. C., Ellis, A. S., Awino Ogutu, E., Webb Girard, A., & Caruso, B. A. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15091994 · Cited by 26 · see citing works
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Winter, S. C., Obara, L. M., & Barchi, F. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16203948 · Cited by 21 · see citing works
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- Authors
- Caruso, B., Clasen, T., Yount, K., Cooper, H., Hadley, C., & Haardörfer, R.
- Affiliations
- Emory University (US)
- Corresponding author
- Caruso, Bethany
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2017-07-11
- Volume
- 14
- Issue
- 7
- Pages
- 755
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC5551193
- OpenAlex
- W2736032609
- Cited by
- 79
- References
- 57
- Citations by year
- 2026: 14 · 2025: 10 · 2024: 4 · 2023: 9 · 2022: 10 · 2021: 9 · 2020: 8 · 2019: 7 · 2018: 6 · 2017: 1
- FWCI
- 12.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Bill and Melinda Gates Foundation
- National Institutes of Health
- National Institute of General Medical Sciences (GM000680, K12GM000680)
- Topics
- Social Sciences › Gender Studies › Gender Studies and Social Issues
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
- Keywords
- latrine access, social environment, physical environment, life stages, sanitation interventions, rural Odisha
- MeSH terms
- Adult, Data Collection, Female, Humans, India, Mental Health, Rural Population, Sanitation, Social Environment, Toilet Facilities
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