Not Just a Toilet: Access to Sanitation and Its Associations with Non-Partner and Intimate-Partner Violence in Informal Settlements in Nairobi, Kenya

Background and Purpose: Violence against women (VAW) is a major source of physical, sexual, and psychological harm to many. Scholars have identified myriad risk factors for VAW in different contexts around the world, but the majority of these are individual- and household-level factors. Few notable studies have started to recognize a link between VAW and women’s environmental and living conditions, particularly in informal settlements. Recent theory posits, for example, that VAW may be associated with limitations and omissions in urban infrastructure such as lack of secure and/or adequate sanitation. A growing number of studies suggest that women living in urban informal settlements where access to sanitation is limited, risk violence and harassment when having to go outside to urinate/defecate in the open or use shared public toilets. To date this literature has largely focused on non-partner violence (NPV). Research in informal settlements in Nairobi, Kenya suggests, however, that up to 75% of female residents rely on plastic bags or buckets in the home to manage urine/feces—potentially complicating already strained familial dynamics and increasing risk of intimate partner violence (IPV). The purpose of this study was to explore the link between women’s access to sanitation and their experiences of NPV and IPV in informal settlements in Nairobi.

Methods: Data were collected in 2018 as part of a survey focused on women’s physical and mental health in a large informal settlement in Nairobi. The study included 552 randomly selected participants. A key measure in this study was recent (in the last year) IPV; thus, the analysis sample included only women with partners or boyfriends (n=361). Logistic regressions were used to analyze associations between women’s access to sanitation and their experiences of recent sexual and physical NPV and sexual, physical, and psychological IPV.

Results: Using a private or private-shared toilet in one’s home or building was associated with lower odds of any (sexual and/or physical) recent NPV and lower odds of recent psychological IPV compared to using bags/buckets/open defecation. Using a public toilet was associated with lower odds of recent sexual, physical or psychological IPV compared to using bags/buckets/open defecation.

Conclusions and Implications: The finding that suggests women with access to private or private-shared toilets have lower odds of experiencing recent NPV is consistent with existent literature. However, results also that suggest women who rely on public toilets have lower odds of sexual, physical, and psychological IPV compared to women relying on bags/buckets/open defecation. Most literature, to date, suggests that women risk violence/harassment when using public toilets; yet, because these toilets cost money and are located outside the home, perhaps they also serve as a proxy for socio-economic status or freedom of movement for some women. More research is needed to explore these associations. Regardless, results from this study suggest there is a link between women’s access to sanitation and their experiences of NPV and IPV in informal settlements in Nairobi—findings that have important implications for theory and interventions focused on preventing and eliminating VAW in these rapidly expanding communities.