Mental health at the intersections of marginalization: A conceptual model to explore the mental health concerns of women sanitation workers in India

In India, sanitation work is predominantly undertaken by persons from oppressed castes whose customary roles relegate them to stigmatized occupations. Women sanitation workers, comprising nearly half of the urban workforce, grapple with multiply marginalized identities and social positions. Marginalized at the intersections of caste, gender, and occupation, they contend with violence and socio-economic discrimination. The literature on the occupational and psychosocial risks of sanitation workers indicates that the mental health concerns of women sanitation workers remain largely unaddressed in research and public policy. This paper draws on an analytical review of research on women sanitation workers’ occupational and psychosocial risks with the objective of conceptualizing the relationship between marginalization and mental health. Utilizing intersectionality and social systems theories to present women sanitation workers as a critical case, their experiences of marginalization at the intersections of caste, gender, and occupation are analyzed. Consequently, a conceptual model of mental health outcomes at the intersections of multiply marginalized identities and social positions is developed to analyze the implications of marginalization for mental health. Guidelines for action to inform public policy and social work practice are suggested, emphasizing the need for intersectional interventions and a social justice framework in mental health care for marginalized groups.