Identifying factors associated with women’s sanitation practices in informal settlements in sub-Saharan Africa: a case study of Mathare Valley in Nairobi, Kenya

Background: Approximately 2.4 billion people around the world lack access to basic sanitation. Sanitation access has proven to be a particularly persistent obstacle to meeting international, national, and local poverty alleviation and sustainability initiatives, especially in sub-Saharan Africa. Literature has shown that women living in informal settlements in these “developing” contexts are disproportionately burdened by lack of access to sanitation. These women, who are often socially and economically disadvantaged, are not only more likely to be excluded from accessing basic services, such as water and sanitation, but are likely to suffer a broader range of consequences from lacking access. While there have been a number of studies over the last decade recognizing women’s unique relationship to sanitation and the disproportionate disadvantages women face as a result of lacking access to sanitation, there have been very few studies focused exclusively on the multi-level factors associated with women’s ability to access and utilize sanitation in informal settlements in East Africa. The purpose of the dissertation was to explore these factors in a large informal settlement in Nairobi, Kenya using a multiphase, mixed methods approach. Methods: The study design for the project was approved in May 2015. Data collection for the project was carried out independently in Mathare Valley informal settlement. Case studies of 55 women in Mathare were carried out between September 2015 and February 2016. Between April 2016 and June 2016, 550 household-level surveys were collected. The project concluded with a period of preliminary analysis and member checking carried out in Mathare between June and August 2016. The goals of this dissertation were to investigate: (1) women’s sanitation utilization practices in Mathare; (2) the factors that women identify as influencing their utilization practices; (3) the role that women's fear of victimization/perceived sense of safety plays in women’s utilization practices; (4) the role that the proximal social context plays in women's utilization practices; and (5) women’s solutions to current sanitation challenges in informal settlements of Nairobi, Kenya. Key Findings: The first aim of the dissertation was to document and empirically analyze the complexity of women’s sanitation practices in informal settlements in Nairobi and to generalize about these sanitation practices without losing all the complexity. Findings from the study revealed that women’s sanitation profiles are heterogeneous not just in terms of how they manage urine and feces, but also in terms of when. Qualitative findings from the first phase of the study revealed that women in these environments often have up to four different strategies for dealing with their basic sanitation needs in any given 24-hour period. Findings also suggested that even these daily sanitation routines may be interrupted or changed based on a number of factors. Results from a latent class analysis of quantitative data suggested that there are 5 common patterns (sanitation profiles) representing women’s typical sanitation practices in Mathare. Qualitative findings were used to confirm these generalized sanitation profiles. In order to address the second, third, and fourth research aims several analyses were conducted. The first part of the process involved a thorough literature review to identify potential factors influencing women’s sanitation utilization and behaviors in general. Subsequently, qualitative analyses (cross-case, thematic) and quantitative analyses (boosted logistic and logistic regressions) were carried out to determine which and to what extent the multi-level factors were associated with women’s sanitation profiles in Mathare. Results revealed a number of factors at the social/macro-, community/ neighborhood-, family/household-, individual-, and habitual-levels influence women’s sanitation utilization in informal settlements in Nairobi including issues of insecurity, fear of sanitation-related victimization, privacy and social disorganization. Even though most development policies call for the involvement of women in sanitation-related interventions and projects, women’s voices and needs are still often unintentionally left out or ignored in the planning, implementation, and management of sanitation-related development. The final aim of the dissertation was to encourage women to think about solutions to sanitation issues in informal settlements in Nairobi and to document their thoughts to help better inform future sanitation policy and interventions. Data for this portion of the dissertation were qualitative in nature. Cross-case and thematic analyses were carried out on responses from 55 qualitative interviews and on verbatim responses to qualitative questions from the 550 household surveys. Women identified a number of gender-specific solutions to sanitation. These findings mimic several scholars’ sentiments about redefining sanitation-related policies and interventions to not just “include” women in projects, but to integrate gender into the very structure of these policies and interventions. Conclusions: The most critical limitations of the study were that the data were cross-sectional, the sample size was relatively small for the complexity of the analyses, and many of the measures were exploratory. However, the findings from the study had a number of implications for sanitation-related policy, development, intervention, and education. The most prominent implication was that gender needs to be more than an after-thought in sanitation policies and interventions. It needs to be at the center. The disproportionate sanitation-related burden born by women stems not only from their disadvantaged position in society and access to services like sanitation, but in the way sanitation decisions are made, in the interventions that are carried out, and in the policies that govern sanitation development. Even more so, findings from this study confirmed a number of results and anecdotal claims from previous studies and provided new insights about the gendered-disadvantages women face when trying to deal with their sanitation needs on a daily basis. The methods, analysis strategies, and interpretation of results in this study were guided by principles that cut across a plethora of disciplines. The interdisciplinary approach used to carry out this research and analyze the findings highlighted a critical need to expand our perspectives and approaches to researching and teaching about issues like sanitation coverage if we have any hope of trying achieve lofty sanitation development goals.Ph.D.Includes bibliographical referencesby Samantha Winte