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A study on sanitation-related psychosocial stress among Indian women in Odisha finds that:

  • Sanitation-behaviors are more expansive than urination and defecation.
  • Three types of stressors are defined: environmental, social, and sexual violence.
  • Women regulate behaviours in response to stressors in ways that create health risks.
  • Life stage and geographic setting modify the intensity of stressors
TitleSanitation-related psychosocial stress : a grounded theory study of women across the life-course in Odisha, India
Publication TypeJournal Article
Year of Publication2015
AuthorsSahoo, KC, Hulland, KRS, Caruso, BA, Swain, R, Freeman, MC, Panigrahi, P, Dreibelbis, R
Secondary TitleSocial science & medicine
Date Published08/2015
Publication LanguageEnglish

While sanitation interventions have focused primarily on child health, women's unique health risks from inadequate sanitation are gaining recognition as a priority issue. This study examines the range of sanitation-related psychosocial stressors during routine sanitation practices in Odisha, India. Between August 2013 and March 2014, we conducted in-depth interviews with 56 women in four life stages: adolescent, newly married, pregnant and established adult women in three settings: urban slums, rural villages and indigenous villages. Using a grounded theory approach, the study team transcribed, translated, coded and discussed interviews using detailed analytic memos to identify and characterize stressors at each life stage and study site. We found that sanitation practices encompassed more than defecation and urination and included carrying water, washing, bathing, menstrual management, and changing clothes. During the course of these activities, women encountered three broad types of stressors—environmental, social, and sexual—the intensity of which were modified by the woman's life stage, living environment, and access to sanitation facilities. Environmental barriers, social factors and fears of sexual violence all contributed to sanitation-related psychosocial stress. Though women responded with small changes to sanitation practices, they were unable to significantly modify their circumstances, notably by achieving adequate privacy for sanitation-related behaviors. A better understanding of the range of causes of stress and adaptive behaviors is needed to inform context-specific, gender-sensitive sanitation interventions.


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