Abstract
The perception of social sanitation norms (PSSNs) around unacceptability of open defecation has been a key aspect of recent sanitation interventions. However, underlying mechanisms through which “reconstructed” PSSNs affect sanitation outcomes have been a black box. This explorative cross-sectional study examines direct and indirect links between PSSNs and sanitation safety using data from structured interviews and observations in 368 households in rural South Ethiopia. In addition to a positive association between PSSNs and sanitation safety, we propose and examine the following two mechanisms: First, we confirm a potentially adverse feedback of PSSNs on future sanitation safety by enhancing the emotional satisfaction with current sanitation practice (satisfaction independent of the functionality of sanitation facilities). Second, inspired by the social amplification/attenuation of risk framework, we demonstrate that PSSNs work as a “social filter” that can amplify or attenuate the effects of other variables targeted in sanitation interventions such as perceived health-related and non-health risks and benefits associated with open defecation and private latrine ownership, respectively, and factual hygiene and sanitation knowledge. These findings imply that PSSNs are not only important per se, but they are also important instrumentally because sanitation outcomes depend upon the capacity of social influences to shape the perception of sanitation risks and benefits and sanitation-related awareness in desirable ways. The mechanisms outlined in this paper as well as the sustainability of sanitation outcomes depend on whether and how social sanitation norms are internalized.
Highlights
Asone’s the second hypothesis, we propose thatthe an current indirect effect may sanitation lead through effectother of perceived social sanitation norms (PSSNs) emotional satisfaction within sanitation may lead through the effect of PSSNs on one’s emotional satisfaction within the current sanitation situation
The results obtained in this study are consistent with all three hypotheses outlined in the introduction (Figure 2) and they generally show that the relationship between PSSNs and sanitation
Constructing new PSSNs around the unacceptability of open defecation (OD) has been considered as a key element in improving sanitation outcomes at community level
Summary
Improving sanitation safety by eliminating open defecation (OD) and increasing the access and utilization of toilets that hygienically separate human excreta from human contact can bring important health benefits [1,2,3,4] and is known to generate notable socio-environmental transformation [5,6,7,8,9].Yet, it is estimated that in 2015 2.4 billion people lacked access to a safe sanitation facility and that nearly one billion people still defecate in the open with the majority living in the countries of Sub-SaharanAfrica and South Asia, often in environments characterized as infrastructure-restricted [10]. Improving sanitation safety by eliminating open defecation (OD) and increasing the access and utilization of toilets that hygienically separate human excreta from human contact can bring important health benefits [1,2,3,4] and is known to generate notable socio-environmental transformation [5,6,7,8,9]. Different paths from predominant OD to a sanitation-safe environment exist (Figure 1). Interventions focused predominantly on providing or subsidizing latrine construction, but neglecting issues related to various social, cultural and environmental constraints of their consistent usage are known to pose a risk of the “A”→“B” path, signified by the disuse of new sanitation facilities or recurrence of OD practice [11,12,13]. Interventions focused predominantly on providing or subsidizing latrine construction, but neglecting issues related to various social, cultural and environmental constraints of their consistent usage are known to pose a risk of the “A”→“B” path in Figure 1, signified by the disuse of new sanitation facilities or recurrence of OD practice [11,12,13].
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