Women's Health and Empowerment for Sustainable Development: Linking Sanitation Burden and Agency in Asia and Africa

ABSTRACT This paper aims to explore a research gap at the intersection of public health and empowerment literatures concerned with women's health‐related sanitation experiences and their sanitation‐specific agency. We shift focus from prevalent scholarly engagement with women's wellbeing as an outcome of their agency by asking an unexplored question in the opposite direction: what is the association between women's physical and mental health‐related sanitation burden and their household‐level and community‐level agency outcomes? Data for this study come from a comprehensive socio‐demographic and sanitation‐specific empowerment survey of 5744 women across eight cities in Asia and Africa. Health‐related sanitation burden is operationalized using a validated health scale that measures women's perceived and actual physical and mental wellbeing as affected by sanitation options and conditions at or outside their homes. Household‐level agency outcomes are assessed by women's sanitation‐specific decision‐making and freedom of movement. Community‐level agency outcomes are assessed by decision‐making and collective action related to community sanitation. Data are analyzed using a novel hierarchical regression model that accommodates multi‐level fixed effects and clustered standard errors. We find that lower sanitation burden is significantly associated with higher household‐level decision‐making but lower freedom of movement, community‐level decision‐making, and collective action. Findings matter for public health because they systematically assess the sanitation burden borne by women in their everyday lives and the extent to which it can demobilize them from living a full life. Findings inform policy recommendations that can reduce women's sanitation burden toward achieving Sustainable Development Goals 5 (gender equality) and 6 (safe sanitation).