Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India

Kristyna R S Hulland,Pinaki Panigrahi,Bismita Biswal,Krushna Chandra Sahoo,Bethany A Caruso,Robert Dreibelbis,Rachel P Chase,Rojalin Swain,Alexandra Kavushansky

doi:10.1371/journal.pone.0141883

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.

Highlights

Despite efforts to improve access to basic resources, 768 million people rely on unimproved drinking-water for daily consumption, and an estimated 2.5 billion people lack access to PLOS ONE | DOI:10.1371/journal.pone.0141883 November 9, 2015Sanitation, Stress, and Life Stage
The current study aims to examine and compare stress as it relates to the specific sanitationrelated behaviors as well as explore the relative frequency and severity of individual stressors that contribute to sanitation-related psychosocial stress (SRPS) among a sample of women in Odisha
India’s Total Sanitation Campaign (TSC, 1999–2012) aimed to incentivize user- and community-driven demand for sanitation, but the focus on infrastructure development has been criticized as a top-down, government-led approach [30]

Summary

Methods

Study SitesAccess to sanitation in much of India remains scarce, and an estimated 44% of the population practices open defecation [1]. We interviewed women in two slums in Bhubaneswar, the capital of Odisha (population density of 2,134 people per square kilometer). Rural women were selected from Khurda district, an agricultural region outside of Bhubaneswar (population density of approximately 800 people per square kilometer). “tribal” is used to describe both the geographically isolated regions and ethnic minority populations, and we use the term “tribal” when referring to women from this site. Both sanitation practices and access to infrastructure vary here compared to rural areas in Odisha, and tribal women were expected to face unique sanitation challenges

Results

Discussion

Conclusion