WSSCC’s first 2017 Webinar session : Inadequate Sanitation and Stress


The hour-long discussion centred around a presentation on the sanitation-related stress experienced by women in the state of Odisha in India.

Globally, about 2.4 billion people have inadequate access to sanitation facilities and one billion people practice open defecation. In India, about 300 million women and girls have no choice but to defecate in the open.

According to the World Health Organization (WHO) and the United Nations Children’s Emergency Fund (UNICEF), the biomedical impacts of poor sanitation access have received considerable attention. However, there remains limited understanding of the psychological and social impacts of inadequate sanitation for women and girls.

In March, WSSCC kicked off its 2017 webinar series, with a session dedicated to exploring the psycho social stress related to poor sanitation that adversely affect the lives of women and girls. The discussion was based on a WSSCC study,  Sanitation-related psychosocial stressors during routine sanitation practices among women, which looks into  the practices of adolescent, newly married, pregnant and adult women in urban and rural settings, and in indigenous communities, in the state of Odisha in India.

Dr. Kathleen O’Reilly, Associate Professor at Texas A&M University presented the findings with the study’s researcher Dr. Krushna Chandra Sahoo from the Asian Institute of Public Health. The session was moderated by Archana Patkar, Head of Policy at WSSCC.

“All women experience one of several stressors related to the physical environment, social restrictions or the threat of gender-based violence,” said O’Reilly.

She noted that sanitation routines not only include defecation or urination but also anal cleansing after defecation, bathing and menstrual management.

Social, Sexual and Environmental Stress

Dr. Sahoo identified the various stressors and how they vary in different geographical settings.

Privacy is a main concern in the three geographic areas of the study. Being watched was reported in all sites, particularly when women are alone or isolated.

“All women in urban slums have experience sexual assault/rape stressors mainly due to overcrowding, encounters with strangers and a lack of social support and privacy,” said Sahoo.

The overall findings showed that urban women experienced more sexual and physical environment stressors than rural and indigenous women.

When looking through the life-stage approach, physical stressors are very high among pregnant women, social stressors for newly married women and sexual stressors for adolescent girls.

The research revealed the ways women coped with these stressors, by  seeking social support, changing behaviour and routines or even adopting maladaptive behaviour such as eating or drinking less to regulate bodily functions.

Moderator Archana Patkar asked participants how they would integrate personal safety, dignity, and security into WASH services, and many fed into the conversation with examples from women in their communities that align with the same result of stress.

“This deeply-rooted gender inequality plays itself most significantly in water and sanitation because of the nature of its daily need. We must defecate, wash ourselves and that’s why it is absolutely unacceptable that half the world’s population may have to think twice before they can answer this call,” said Patkar.

Dr. Sahoo concluded that policy will not work if there is no support from the community. Dr. Reilly concurred. “I would like to see women’s concerns placed at the forefront of sanitation interventions. There is a large sector of people going through daily stress. Latrine building is fantastic, we want to see more of that -  but the question of women’s ability to use these facilities safely and regularly is a key concern at the leading edge of sanitation programming,” she said.

The debate continues  on WSSCC’s Community of Practice (CoP) for Sanitation and Hygiene in Developing Countries.