Sanitation-related empowerment resources are associated with womens well-being, anxiety, and depression: findings from Bangladesh, India, Senegal, and Uganda

Nascent public health research has identified linkages between sanitation experiences and mental health. The present study examined associations between sanitation-related empowerment resources (Bodily Integrity, Safety and Security, Privacy, and Time) and mental health outcomes (well-being, depression, and anxiety). We conducted a secondary analysis of cross-sectional data collected in 2021-2022 from household surveys of women in Bangladesh, India, Senegal, and Uganda (n = 2,122). The primary exposures were sanitation-related empowerment resources measured using the Agency, Resources, and Institutional Structures for Sanitation-related Empowerment (ARISE) Scales. Three outcomes were assessed: subjective well-being (World Health Organization Well-being Index, WHO-5), anxiety (General Anxiety Disorder measure, GAD-2), and depression (Patient Health Questionnaire, PHQ-2). Linear regressions of the WHO-5, PHQ-2, and GAD-2 scores on the four sanitation-related empowerment resources were conducted. Overall mean scores for well-being were moderate, and overall mean scores for anxiety and depression indicated normal prevalence (well-being mean = 17.2, SD = 5.8, depression mean = 1.1, SD = 1.4; anxiety mean = 1.0, SD = 1.4). In the adjusted well-being model, there was a positive association between Privacy and well-being ({beta} = 2.0, p<.001). In the adjusted depression model, there were negative associations between Bodily Integrity and depression ({beta} = -0.3, p=.002) and between Privacy and depression ({beta} = -0.4, p<.001). In the adjusted anxiety model, there were negative associations between all four resources and anxiety (Bodily Integrity {beta} = -0.7, p<.001; Safety and Security {beta} = -0.3, p=.025; Privacy {beta} = - 0.3, p=.037; Time {beta} = -0.2, p=.009). Our findings provide evidence of associations between womens sanitation-related resources of Bodily Integrity, Safety and Security, Privacy, and Time and mental health. Sanitation initiatives should aim to enhance and evaluate womens experiences of these resources given their potential to benefit womens mental health and well-being.