Improved quality of life and mental health

Research with the cohort of households used in the MapSan trial identified four main causes of sanitation- related psychosocial stress among men and women: stress related to safety and security; stress related to feelings of inadequate privacy; stress related to feelings of disgust; and stress related to interpersonal conflicts around community management of the toilet. 

 PERCEPTIONS OF SAFETY

There are real risks for women and girls leaving their homes to use the loo, particularly in the dark. Safety concerns related to toilet use were mentioned by approximately two-thirds of women questioned. This was driven, in part, by the perceived high levels of crime in these communities.

“I fear that because of the way the bathroom is designed, when you think about going out to use it, there could be someone hiding who might beat, kill, or even rape you, so many dangerous things happen around here,” reported one user.

Research into the stress felt by women in relation to safety and security following the sanitation intervention by WSUP suggested that users of improved sanitation blocks shared with just a few households felt considerably safer than they had previously. The proportion of women respondents reporting stress related to safety and security among shared toilet users (48%) was markedly lower than among women using traditional latrines (80%). Improvement in feelings of security was related to factors such as better construction, the presence of doors with locks, and – in some cases – new latrines being within compound walls.

“Before this bathroom, we had a precarious one made of tyres and stones. When this new bathroom was built, we gained many benefits, we can now clean it easily, we have lighting, and we feel safe because it has a door. Now we can use it even at night, and we can lock the latrine both inside and outside,” one shared toilet user reported.

However, while feelings of safety and security improved among shared toilet users, there was no overall improvement in women’s reported sense of security among users of the larger communal sanitation blocks. This supports the widely held view that user-group size is a useful, simple “minimum standards” criterion for shared toilets. The research suggests that shared sanitation interventions should pay careful attention to design features that can enhance women’s security, including solid construction with lockable metal doors, adequate outside and inside lighting, placement in a relatively secure location within the compound, and small user groups. In some situations, additional measures may be required, for example, improved fencing of the compound and broader interventions may be needed to reduce crime and enhance women’s security in the community.