From sanitation to safety: Investigating the link between water, sanitation and hygiene and intimate partner violence in Nepal

Intimate Partner Violence (IPV) disproportionately affects women globally. While the link between Water, Sanitation, and Hygiene (WASH) and IPV is recognized, the underlying mechanisms require further exploration. This study investigates the mediating role of Menstrual Health and Hygiene (MHH) practices and the moderating role of Partner Controlling Behaviors in the WASH-IPV relationship in Nepal. Drawing on Sen's Capability Approach and Social Control Theory, we hypothesize that access to WASH facilities, by improving MHH practices, is negatively associated with IPV. We propose that this relationship is moderated by Partner Controlling Behaviors. Using Nepal Demographic Health Survey data of 5178 women and girls, we employed Structural Equation Modelling. Our findings reveal that access to WASH facilities was positively associated with better MHH outcomes, which were significantly negatively associated with IPV. The indirect effect of WASH on IPV via MHH was statistically significant, supporting MHH's mediating role. The interaction between Partner Controlling Behavior and MHH outcomes significantly predicts IPV, highlighting the moderating influence of gender norms. The protective effect of improved MHH practices is weakened where Partner Controlling Behavior are more prevalent. These findings underscore the importance of addressing both resource availability (enhancing capabilities) and harmful gender norms (enacted through controlling behaviors) to mitigate IPV. We advocate for a comprehensive approach that includes enhanced WASH access, improved MHH practices, and interventions targeting harmful gender norms and controlling behaviors within relationships.