title: Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India.
abstract: 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.
authors.affiliation: Asian Institute of Public Health, Bhubaneswar, India.
authors.forename: Krushna Chandra
authors.initials: KC
authors.lastname: Sahoo
authors.affiliation: Center for Global Health, University of Chicago, Chicago, IL, USA.
authors.forename: Kristyna R S
authors.initials: KR
authors.lastname: Hulland
authors.affiliation: Department of Behavioral Science and Health Education and Center for Global Safe Water/Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Bethany A
authors.initials: BA
authors.lastname: Caruso
authors.affiliation: Asian Institute of Public Health, Bhubaneswar, India.
authors.forename: Rojalin
authors.initials: R
authors.lastname: Swain
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Freeman
authors.affiliation: Epidemiology and Pediatrics and Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Pinaki
authors.initials: P
authors.lastname: Panigrahi
authors.affiliation: Center for Applied Social Research, Civil Engineering and Environmental Science, and Department of Anthropology, University of Oklahoma, Norman, OK, USA. Electronic address: rdreibe@ou.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Dreibelbis
mesh_terms: D000293:Adolescent; D000328:Adult; D004777:Environment; D005260:Female; D066296:Grounded Theory; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D007194:India; D011247:Pregnancy; D011584:Psychology; D015980:Public Health Practice; D012424:Rural Population / Q000639:trends; D012499:Sanitation / Q000331:legislation & jurisprudence / Q000592:standards*; D013315:Stress, Psychological; D014038:Toilet Facilities / Q000592:standards
keywords: Gender; India; Open defecation; Psychosocial stress; Sanitation; Sexual violence; Women