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 behaviours is limited. This secondary analysis of data generated as part of the Measuring Urban Sanitation and Empowerment 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, 1,308; 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. The results suggest that sanitation-related privacy, safety and health conditions should be addressed programmatically to improve women’s sanitation-related circumstances and behaviours. As a result of unsupportive sanitation environments, women may cope by suppressing urges to urinate and defecate or by not eating food and/or drinking water. Among urban women in Uganda and India, nearly all women surveyed reported suppressing urination and defecation urges. Withholding food and water was less common. Perceived privacy, safety and health influenced these coping behaviours.