title: Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India.
abstract: Emerging evidence demonstrates how inadequate access to water and sanitation is linked to psychosocial stress, especially among women, forcing them to navigate social and physical barriers during their daily sanitation routines. We examine sanitation-related psychosocial stress (SRPS) across women's reproductive lives in three distinct geographic sites (urban slums, rural villages, and rural tribal villages) in Odisha, India. We explored daily sanitation practices of adolescent, newly married, pregnant, and established adult women (n = 60) and identified stressors encountered during sanitation. Responding to structured data collection methods, women ranked seven sanitation activities (defecation, urination, menstruation, bathing, post-defecation cleaning, carrying water, and changing clothes) based on stress (high to low) and level of freedom (associated with greatest freedom to having the most restrictions). Women then identified common stressors they encountered when practicing sanitation and sorted stressors in constrained piles based on frequency and severity of each issue. The constellation of factors influencing SRPS varies by life stage and location. Overall, sanitation behaviors that were most restricted (i.e., menstruation) were the most stressful. Women in different sites encountered different stressors, and the level of perceived severity varied based on site and life stage. Understanding the influence of place and life stage on SRPS provides a nuanced understanding of sanitation, and may help identify areas for intervention.
authors.affiliation: Center for Global Health, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Kristyna R S
authors.initials: KR
authors.lastname: Hulland
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Chase
authors.affiliation: Department of Behavioral Science and Health Education, Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
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: Asian Institute of Public Health, Bhubaneswar, India.
authors.forename: Bismita
authors.initials: B
authors.lastname: Biswal
authors.affiliation: Asian Institute of Public Health, Bhubaneswar, India.
authors.forename: Krushna Chandra
authors.initials: KC
authors.lastname: Sahoo
authors.affiliation: Epidemiology and Pediatrics and Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America.
authors.forename: Pinaki
authors.initials: P
authors.lastname: Panigrahi
authors.affiliation: Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma, United States of America.
authors.forename: Robert
authors.initials: R
authors.lastname: Dreibelbis
mesh_terms: D000293:Adolescent; D000328:Adult; D060766:Drinking Water; D005260:Female; D006801:Humans; D006920:Hygiene; D007194:India; D011204:Poverty Areas; D011247:Pregnancy; D012424:Rural Population; D012499:Sanitation / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D014038:Toilet Facilities / Q000706:statistics & numerical data*; D014505:Urban Population; D055815:Young Adult
chemical_list: D060766:Drinking Water