A recent study has shed light on the psycho-social stress faced by women due to limited or no access to safe toilets.
Durba Biswas, Fellow, Centre for Environment and Development at Ashoka Trust for Research in Ecology and Environment, and Shweta Joshi of Azim Premji University studied the situation at a slum in Nelamangala where residents "walk up to half a kilometre" to reach the open defecation site.
Of the 40 respondents who took part in the survey, only 17 had access to toilets and one of them, a woman, reported that she used the pay-and-use toilet facility regularly. The toilets were of poor quality with inadequate water supply and no cleanliness.
Lack of access to information meant women did not know about schemes like funding of toilets under the Swachh Bharat Abhiyan.
Conducted in 2017, the study called for a realistic understanding of problems faced by the poor in accessing sanitation services, especially in peri-urban areas. "...one of the women refrained from using her shared common toilet during her menses as she felt uncomfortable sharing it with men and reverted to open defecation", it said.
Women felt psychosocial stress due to the way open defecation compromised their safety and dignity, besides affecting their adherence to cultural or social norms. Open defecation also made the family anxious due to the threat of sexual violence.
Citing a 2017 report by WHO and UNICEF, which said 57.6 crore Indians continue to defecate in the open, the study notes that the poor in peri-urban areas are pushed to the margins due to inconsistent water and sanitation services, which complex institutional and administrative systems struggle to deliver.
Durba told DH that the study stressed the need to expand the definition of wellbeing, which is limited to physical health (diarrhoea and other illness at present).
"The current model of infrastructure planning fails to look at lived realities,” Durba said. “Unless we consider the psycho-social impact made by lack of basic amenities, we will be underestimating or overestimating what these interventions are doing."
She also said more research is needed to understand the long-term issues.