“No peace in my heart”: Exploring psychosocial problems experienced by women in relation to water insecurity and inadequate sanitation in an informal settlement, Kenya

Abstract

Background

Social determinants of mental health are recognized as significant contributors to the disproportionate burden of depression and anxiety experienced by women worldwide.

This study aimed to explore psychosocial problems experienced by women in relation to water insecurity and inadequate sanitation in an informal settlement in Kenya.

Methods

We conducted a qualitative study employing a phenomenological approach. The study setting was Kaptembwo, an informal settlement in Kenya. Data collection was conducted from March 28, 2023 to April 24, 2023. Twenty-one in-depth interviews were carried out in Swahili with women of reproductive age (18–49 years) selected through purposive sampling and snowballing. Women were approached as they accessed the common water point and sanitation facility at their households and invited to participate. Marrianne Hennik's thematic analysis approach was used to examine patterns, themes, and meanings of data.

Results

The key themes that emerged were stresses and social tension; bodily concerns and relational impacts; emotional consequences; and coping strategies. Unreliable and inadequate water and sanitation brought myriad stresses, led to stigma, and threatened social harmony as women struggled to maintain the health and dignity of their families. Women experienced infections and expressed bodily concerns including backpain, urinary problems and vaginal discharge, that fueled discord within their intimate relationships. Emotional consequences included stress, anxiety, shame, discomfort, frustration, embarrassment, and depression. Coping strategies reported by women included attempts to restore social relationships or seek social solutions to gender-based violence, with limited uptake of formal psychosocial care. Women's accounts supported conceptualization of psychosocial problems as a syndemic arising from interconnections between infections, gender disadvantage and environment.

Conclusion

Future research should focus on longitudinal and ethnographic observational studies to track evolving experiences of women and investigate the hypothesis that psychosocial problems in women in this informal settlement are the best conceptualized as a syndemic.