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

Recent research has identified linkages between women's sanitation experiences, like safety and privacy, and their mental health. Our 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 = 2285). 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 WHO-5 scores and negative binomial regressions of PHQ-2 and GAD-2 scores on the four sanitation-related empowerment resources were conducted. Mean scores for the outcomes were: well-being = 17.2 (SD = 5.9), depression = 1.1 (SD = 1.4), and anxiety = 1.0 (SD = 1.4). Mean scores for primary exposures were: Bodily Integrity = 3.7 (SD = 0.4), Safety and Security = 3.5 (SD = 0.4), Privacy = 3.8 (SD = 0.5), and Time = 3.1 (SD = 0.5). Higher Privacy was associated with higher well-being scores in both regional samples with higher Time additionally associated with higher well-being scores in Bangladesh and India. In Bangladesh and India, higher Bodily Integrity and Time were associated with lower depression scores, and higher Bodily Integrity, Safety and Security, and Time were associated with lower anxiety scores. In Senegal and Uganda, higher Bodily Integrity, Safety and Security, and Privacy were associated with lower depression scores, and higher Privacy was associated with lower anxiety scores. Our findings provide evidence of associations between women's sanitation-related resources of Bodily Integrity, Safety and Security, Privacy, and Time and mental health. Sanitation initiatives should aim to enhance and evaluate women's experiences of these resources given their potential to benefit women's mental health and well-being. • Depression and anxiety scores indicated lower frequency of experiencing symptoms. • Higher Privacy was associated with higher well-being in both regional samples. • Higher Bodily Integrity was associated with lower depression in both regional samples. • Higher Time was associated with all three mental health outcomes in Bangladesh/India sample. • Higher Privacy was associated with all three mental health outcomes in Senegal/Uganda sample.