Kayser Georgia Lyn, Chokhandre Praveen, Rao Namratha, Singh Abhishek, McDougal Lotus, Raj Anita
Division of Global Health, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego (UCSD), La Jolla, CA, USA.
Center on Gender Equity and Health, Department of Medicine, School of Medicine, UCSD, La Jolla, CA, USA.
SSM Popul Health. 2021 Jan 23;13:100738. doi: 10.1016/j.ssmph.2021.100738. eCollection 2021 Mar.
Lack of household sanitation, specifically toilet facilities, can adversely affect the safety of women and girls by requiring them to leave their households to defecate alone and at night, leaving them more vulnerable to non-marital sexual violence. This study analyzes the association between household sanitation access and past year victimization from non-marital sexual violence (NMSV) in India.
We analyzed 74,698 women age 15-49 from whom information on NMSV was collected in India's National Family Health Survey 2015-16 (NFHS-4). We used multivariable logistic regression to test the relationship between women's household sanitation access and recent NMSV experience, controlling for socioeconomics (SES;e.g., age, marital status, caste, wealth, employment), for the total sample and stratified by rural/urban, given lower access to sanitation and lower NMSV in rural contexts.
We found that 46.2% of households in our sample lacked their own private sanitation facilities (58.0% rural; 24.5% urban) and were forced to openly defecate (37.3%) or walk to a shared sanitation facility (8.9%), and 0.45% of women report NMSV in the last 12 months (0.33% rural; 0.68% urban). Our multivariable model indicated no significant association between having private household sanitation facilities and NMSV for the total sample, but stratified analyses indicate a significant association for rural but not urban women. In rural India, those who lack private household sanitation, compared to those with a household toilet, have significantly greater odds of NMSV (AOR = 2.45; p < 0.05). These findings persist after accounting for demographics including age and marital status, socio-economic factors related to marginalization (e.g., caste, wealth), women's employment, and the overall climate of the state.
Findings from this study support prior research suggesting that poor access to sanitation is associated with women's risk for NMSV in rural India. This may be via increased exposure, and/or as a marker for greater vulnerability to NMSV beyond what is explained by other SES indicators. Solutions can include increased access to private household sanitation and more targeted NMSV prevention in rural India.
家庭卫生设施的匮乏，尤其是厕所设施的缺失，可能会对妇女和女孩的安全产生不利影响，因为这会迫使她们离开家独自在夜间排便，使她们更容易遭受非婚姻性暴力。本研究分析了印度家庭卫生设施的可及性与过去一年非婚姻性暴力（NMSV）受害情况之间的关联。
我们分析了印度2015 - 2016年全国家庭健康调查（NFHS - 4）中收集的74698名15 - 49岁女性的非婚姻性暴力信息。我们使用多变量逻辑回归来检验女性家庭卫生设施的可及性与近期非婚姻性暴力经历之间的关系，针对总样本并按农村/城市分层进行分析，因为农村地区卫生设施可及性较低且非婚姻性暴力发生率也较低，同时控制社会经济因素（SES；如年龄、婚姻状况、种姓、财富、就业情况）。
我们发现，样本中的46.2%的家庭缺乏自己的私人卫生设施（农村地区为58.0%；城市地区为24.5%），被迫露天排便（37.3%）或步行到共用卫生设施（8.9%），0.45%的女性报告在过去12个月遭受过非婚姻性暴力（农村地区为0.33%；城市地区为0.68%）。我们的多变量模型表明，对于总样本而言，拥有私人家庭卫生设施与非婚姻性暴力之间没有显著关联，但分层分析表明，农村女性存在显著关联，而城市女性则不然。在印度农村，与拥有家庭厕所的女性相比，缺乏私人家庭卫生设施的女性遭受非婚姻性暴力的几率显著更高（调整后的比值比[AOR]=2.45；p<0.05）。在考虑了包括年龄和婚姻状况在内的人口统计学因素、与边缘化相关的社会经济因素（如种姓、财富）、女性就业情况以及该邦的整体环境后，这些发现依然成立。
本研究结果支持了先前的研究，表明卫生设施可及性差与印度农村地区女性遭受非婚姻性暴力的风险相关。这可能是由于暴露增加，和/或作为一个标志，表明女性除了其他社会经济指标所解释的因素外，更容易遭受非婚姻性暴力。解决方案可以包括增加私人家庭卫生设施的可及性，以及在印度农村地区开展更有针对性的非婚姻性暴力预防工作。
