Despite evidence suggesting women are disproportionately affected by the lack of adequate and safe sanitation facilities around the world, there is limited information about the factors that influence women's ability to access and utilize sanitation, especially in sub-Saharan Africa. The purpose of this study was to explore factors influencing women's sanitation practices in informal settlements in Nairobi, Kenya. Information from 55 in-depth interviews conducted in 2016 with 55 women in Mathare Valley Informal Settlement in Nairobi was used to carry out cross-case, thematic analysis of women's common sanitation routines. Women identified neighborhood disorganization, fear of victimization, lack of privacy, and cleanliness/dirtiness of facilities as important factors in the choices they make about their sanitation practices. This suggests that future sanitation-related interventions and policies may need to consider strategies that focus not only on toilet provision or adoption but also on issues of space and community dynamics.

BackgroundDiarrheal disease kills over half a million people each year in sub-Saharan Africa; the majority are children under 5 years. About 58% of diarrhea cases are associated with poor water, sanitation, and hygiene—a critical issue for people living in informal settlements. In Kenya, 60% of Nairobi’s population lives in informal settlements; yet, there is a paucity of research exploring the relationship between water, sanitation and hygiene (WASH) conditions in these settlements and associated health outcomes.MethodsThe study examines characteristics of women’s WASH behaviors and environments as potential factors associated with household diarrhea in Mathare Valley Informal Settlement in Nairobi using cross-sectional survey data collected from 550 women.ResultsApproximately 17% of participants reported that at least one member of the household suffered from diarrhea in the previous 2 weeks—48% of the cases were children under five. Results from a logistic regression exploring factors associated with reports of household diarrhea suggest that women’s sanitation management strategies are associated with recent household diarrhea. Women who use toilets for defecation during the day, but rely on bags, buckets, or open defecation (OD) for urination during the day and for urination and defecation at night have over five time the odds of recent household diarrhea than women who use a toilet for all their sanitation needs. The odds of diarrhea were also higher for participants who walk up to 2 min to reach their toilets/sites for defecation and those who rely on water from taps inside buildings and plots. Odds were 62% lower for participants with clean toilets.ConclusionsFindings suggest that health targets to reduce the prevalence of diarrheal diseases in informal settlements may not be met unless particular attention is paid to the needs of women living in these environments.

While access to safe sanitation is a global issue, there are large disparities in access. Women living in informal settlements, in particular, are disproportionately affected by lack of access to sanitation. Without adequate sanitation, these women may resort to unsafe strategies to manage their sanitation needs, but limited research has focused specifically on this issue. Qualitative and quantitative data were collected from women in the Mathare informal settlement in Nairobi, Kenya in 2016. A latent class analysis (LCA) using the quantitative data yielded five distinct sanitation profiles (SP) among women in Mathare. In-depth interviews and sanitation walks with women added further detail about the characteristics of and motivations underlying each profile. Women’s sanitation profiles in these settlements are complex. A majority of women in this study utilized an unsafe method of disposal at least once in a 24-hour period that increased their risk of direct exposure to waste and harmful pathogens.

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Approximately, 2.4 billion people, globally, lack access to safe toilets. The burden of this deficiency falls disproportionately on women living in informal settlements in developing countries. While there is a growing body of literature looking at the factors influencing women’s sanitation behavior, little is known about the role of the neighborhood environment. This study sought to explore this issue using data from a 2016 mixed-methods study focused on women in Mathare Valley informal settlement in Nairobi, Kenya. Qualitative and quantitative data were used to analyze the role of neighborhood disorganization in the relationship between women’s sanitation-related stressors and their sanitation behaviors (utilization). Findings suggest that neighborhood disorganization is inextricably linked to women’s daily sanitation behaviors and the stressors that are associated with those behaviors. These results suggest that the health and safety of neighborhood environments may be critical factors in the future success of sanitation-related interventions and policies.