Assessing women’s negative sanitation experiences and concerns: The development of a novel sanitation insecurity measure

• Type of Material: Article
• Authors: Bethany A. Caruso, Emory University; Thomas Clasen, Emory University; Kathryn Yount, Emory University; Hannah Cooper, Emory University; Craig Hadley, Emory University; Regine Haardoerfer, Emory University
• Language: English
• Date: 2017-07-11
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2017 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/ijerph14070755
• Title of Journal or Parent Work: International Journal of Environmental Research and Public Health
• ISSN: 1661-7827
• Volume: 14
• Issue: 7
• Grant/Funding Information: Bethany A. Caruso was funded in part by the NIH/NIGMS Institutional Research and Academic Career Development Award (IRACDA), 5K12-GM000680-17.; This research was possible with funding from the Bill & Melinda Gates Foundation (BMGF). BMGF provides funding for open access publication.
• Keywords: water; urination; sanitation; security; defecation; differential item functioning; factor analysis; gender
• Research Categories: Health Sciences, Public Health

Abstract

Lack of access to acceptable sanitation facilities can expose individuals, particularly women, to physical, social, and mental health risks. While some of the challenges have been documented, standard metrics are needed to determine the extent to which women have urinationand defecation-related concerns and negative experiences. Such metrics also are needed to assess the effectiveness of interventions to mitigate them. We developed a sanitation insecurity measure to capture the range and frequency of women’s sanitation-related concerns and negative experiences. Research was conducted in rural Odisha, India with women across various life course stages to reflect a range of perspectives. This paper documents the mixed data collection methods and the exploratory and confirmatory factor analyses we employed to arrive at a final measure. The final sanitation insecurity measure includes 50 items across seven factors that reflect the physical environment, the social environment, and individual-level constraints. Most factor scores were significantly higher for unmarried women and for women who lacked access to functional latrines, indicating social and environmental influence on experiences. This measure will enable researchers to evaluate how sanitation insecurity affects health and to determine if and how sanitation interventions ameliorate women’s concerns and negative experiences associated with sanitation.