Linking WASH with Mental Health: Evidence from the WSSCC Library


WSSCC evidence shows that the lack of sanitation and the taboos around routine practices are linked to psychosocial stress

Access to water, sanitation and hygiene (WASH) are essential to leading a healthy life. With 2.4 billion people denied this right, WSSCC and its partners have found strong evidence and links between the lack of sanitation and psychosocial stress.

Studies also highlight the multitude of risks faced by women and girls, who are the primary victims of this stress. The main stress points are revealed to be lack of information on sanitation issues, shame, stigma, taboo, lack of privacy and safety, and potential for violence.

The theme for World Health Day #2017, #LetsTalk encourages discussion about depression and mental health. We share with you our co-authored research on the many impacts of sanitation on mental health.

  • SCA’s Hygiene Matters 2016-2017 Report:

 WSSCC has partnered with SCA to raise awareness on menstruation and personal hygiene issues since 2014. In 2016, we released the Hygiene Matters Report, based on a survey in 12 countries exploring the economic perspective on the value of hygiene, the social perspective focused on taboos and stereotypes around hygiene, and the role hygiene will play in social and economic development in emerging and developed markets in the future.

Chapter 2, “Emotions in the way of progress” investigates the stigma caused by taboos surrounding natural bodily functions that lead to limited participation for women and girls in society.  More than half of the female population in the majority of the countries covered in the survey said they feel uncomfortable in social situations when they have their period- indicating the universal nature of stigma around menstruation.


The chapter also highlights some of the findings of the WSSCC/UN Women Joint Programme on Gender Sanitation and Hygiene in West and Central Africa, and the many restrictions faced by women as a result of menstruation practices.

Data from one of the studies in Senegal shows that a lack of information around sanitary practices results in psychosocial stress for women.

Another study shows that the majority of refugee women in Gado-Badzere, Ngam and Timangolo camps in Cameroon fear going to the bathroom at night.

  • The WSSCC/SHARE briefing notes on the “Impact of inadequate access to WASH facilities on women and girls in India and Bangladesh”

The Sanitation and Hygiene Applied Research for Equity (SHARE) Research Consortium and WSSCC formed a research partnership in 2013 to investigate the specific impact of inadequate access to water, sanitation and hygiene (WASH) facilities on women and girls in India and Bangladesh.

The briefing notes focus on the lack of safe sanitation choices for women and girls for. They provide links between unsafe sanitation and women and girls’ poor health in terms of stress and infections.

“Coping strategies to deal with inadequate WASH facilities and related health risks” documents stress levels linked to sanitation among adolescent and adult women particularly by the absence of sanitation infrastructure at home and in public areas.

Sanitation vulnerabilities: Women’s stresses and struggles for violence-free sanitation” details the findings of a research undertaken in India, Pune and Jaipur on poor urban women’s experiences of harassment and violence related to the lack of adequate sanitation facilities as well as the multitude of coping mechanisms that they have adopted to minimize risk and psycho-social stress.

Social and psychological impact of limited access to sanitation” discusses the social and psychological impact of limited sanitation access and the associated health risks particularly among women.

  • Studies on sanitation-related psychosocial stress in Odisha, India

Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India
Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India

These 2015 WSSCC-commissioned studies consider 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. They thoroughly analyzes the various stressors women face when they attend to their daily-sanitation routine.  The first study was discussed in WSSCC’s first 2017 Webinar session on sanitation related social stressors shared on World Health Day 2017.

The second research paper continues to explore the theme of stress related to sanitation routines going in depth and asking women to rank seven sanitation activities (defecation, urination, menstruation, bathing, post-defecation cleaning, carrying water, and changing clothes) based on stress (high to low) and on the level of freedom associated.

Understanding the influence of place and life stage on sanitation-related psychosocial stress (SRPS) provides a better understanding of sanitation, and can help identify areas for intervention.
This video was made to complement the study. Women from the Pune slums in India speak plainly about the sanitation challenges they experience - from lack of facilities to threats to their personal safety.