Sanitation-related withholding and suppression among women in urban Uganda and India

Despite sanitation facility availability, perceived privacy, safety and security, and health status and risks may prevent toilet use, particularly for women. Women may withhold food and water (withholding) or suppress urination and defecation urges (suppression) to cope, though evidence on the prevalence and drivers of these behaviors is limited. This secondary analysis of data generated as part of the Measuring Urban Sanitation and Empowerment (MUSE) project (n=2,173) assesses the prevalence of withholding and suppression among urban women in Kampala, Uganda and Tiruchirappalli, India and associations with perceived sanitation-related privacy, safety and security, and health status and risks (withholding analytic sample: 1308; suppression analytic sample: 862) Witholding was reported by 38% (265/697) of women in Kampala and 16% (100/611) in Tiruchirappalli ; more than 93% of women in both populations (Kampala: 415/440; Tiruchirappalli: 336/350) reported suppression. Privacy, safety and security, and health scores were all significantly associated with the odds of withholding in both cities. Fewer significant results were found from linear regression analyses assessing privacy, safety, and health scores and suppression, suggesting other unaccounted for influences. Results suggest that sanitation-related privacy, safety, and health conditions should be addressed programmatically to improve women’s sanitation-related circumstances and behaviors.

尽管卫生设施已配备到位，但女性可能因感知到的隐私、安全保障状况，以及自身健康状态与相关卫生风险而不愿使用厕所，这一问题在女性群体中尤为突出。女性可能会采取限制饮食饮水的克制行为（withholding），或是抑制排尿、排便冲动的排泄抑制行为（suppression）来应对这一困境，但目前针对这类行为的流行率与驱动因素的相关研究证据仍较为有限。本研究为城市卫生与赋权测量（Measuring Urban Sanitation and Empowerment，MUSE）项目所生成数据的二次分析，总样本量为2173例，旨在评估乌干达坎帕拉与印度蒂鲁吉拉伯利两座城市的女性群体中，克制行为与排泄抑制行为的流行率，及其与感知到的卫生相关隐私、安全保障、健康状态及风险间的关联（克制行为分析样本量为1308，排泄抑制行为分析样本量为862）。据报告，坎帕拉有38%（265/697）的女性存在克制行为，蒂鲁吉拉伯利的这一比例为16%（100/611）；两座城市中均有超过93%的女性报告存在排泄抑制行为（坎帕拉：415/440；蒂鲁吉拉伯利：336/350）。隐私、安全保障及健康评分均与两座城市中女性出现克制行为的发生比呈显著相关。而通过线性回归分析评估隐私、安全与健康评分与排泄抑制行为间的关联时，得到的显著结果更少，这提示可能存在其他未被纳入考量的影响因素。研究结果表明，应通过系统化项目干预优化与卫生相关的隐私、安全及健康状况，从而改善女性的卫生相关处境与行为表现。