Household sanitation access and risk for non-marital sexual violence among a nationally representative sample of women in India, 2015-16.

BACKGROUND: Lack of household sanitation, specifically toilet facilities, can adversely affect the safety of women and girls by requiring them to leave their households to defecate alone and at night, leaving them more vulnerable to non-marital sexual violence. This study analyzes the association between household sanitation access and past year victimization from non-marital sexual violence (NMSV) in India. METHODS: We analyzed 74,698 women age 15-49 from whom information on NMSV was collected in India's National Family Health Survey 2015-16 (NFHS-4). We used multivariable logistic regression to test the relationship between women's household sanitation access and recent NMSV experience, controlling for socioeconomics (SES;e.g., age, marital status, caste, wealth, employment), for the total sample and stratified by rural/urban, given lower access to sanitation and lower NMSV in rural contexts. RESULTS: We found that 46.2% of households in our sample lacked their own private sanitation facilities (58.0% rural; 24.5% urban) and were forced to openly defecate (37.3%) or walk to a shared sanitation facility (8.9%), and 0.45% of women report NMSV in the last 12 months (0.33% rural; 0.68% urban). Our multivariable model indicated no significant association between having private household sanitation facilities and NMSV for the total sample, but stratified analyses indicate a significant association for rural but not urban women. In rural India, those who lack private household sanitation, compared to those with a household toilet, have significantly greater odds of NMSV (AOR = 2.45; p < 0.05). These findings persist after accounting for demographics including age and marital status, socio-economic factors related to marginalization (e.g., caste, wealth), women's employment, and the overall climate of the state. CONCLUSION: Findings from this study support prior research suggesting that poor access to sanitation is associated with women's risk for NMSV in rural India. This may be via increased exposure, and/or as a marker for greater vulnerability to NMSV beyond what is explained by other SES indicators. Solutions can include increased access to private household sanitation and more targeted NMSV prevention in rural India.

Translating the human right to water and sanitation into public policy reform.

The development of a human right to water and sanitation under international law has created an imperative to implement human rights in water and sanitation policy. Through forty-three interviews with informants in international institutions, national governments, and non-governmental organizations, this research examines interpretations of this new human right in global governance, national policy, and local practice. Exploring obstacles to the implementation of rights-based water and sanitation policy, the authors analyze the limitations of translating international human rights into local water and sanitation practice, concluding that system operators, utilities, and management boards remain largely unaffected by the changing public policy landscape for human rights realization. To understand the relevance of human rights standards to water and sanitation practitioners, this article frames a research agenda to ensure that human rights aspirations lead to public policy reforms and public health outcomes.

Country clustering applied to the water and sanitation sector: a new tool with potential applications in research and policy.

The fields of global health and international development commonly cluster countries by geography and income to target resources and describe progress. For any given sector of interest, a range of relevant indicators can serve as a more appropriate basis for classification. We create a new typology of country clusters specific to the water and sanitation (WatSan) sector based on similarities across multiple WatSan-related indicators. After a literature review and consultation with experts in the WatSan sector, nine indicators were selected. Indicator selection was based on relevance to and suggested influence on national water and sanitation service delivery, and to maximize data availability across as many countries as possible. A hierarchical clustering method and a gap statistic analysis were used to group countries into a natural number of relevant clusters. Two stages of clustering resulted in five clusters, representing 156 countries or 6.75 billion people. The five clusters were not well explained by income or geography, and were distinct from existing country clusters used in international development. Analysis of these five clusters revealed that they were more compact and well separated than United Nations and World Bank country clusters. This analysis and resulting country typology suggest that previous geography- or income-based country groupings can be improved upon for applications in the WatSan sector by utilizing globally available WatSan-related indicators. Potential applications include guiding and discussing research, informing policy, improving resource targeting, describing sector progress, and identifying critical knowledge gaps in the WatSan sector.

Examining the Practice of Developing Human Rights Indicators to Facilitate Accountability for the Human Right to Water and Sanitation.

Flowing from the evolution of international legal obligations for water and sanitation, human rights practice has shifted to address state accountability for a human right to water and sanitation through the development of human rights indicators. This policy note focuses on efforts to develop indicators for state reporting to human rights treaty bodies, with human rights norms framing national reports and treaty bodies employing indicators to monitor the progressive realization of the human right to water and sanitation. In supporting evidence-based treaty monitoring through the United Nations (UN), both the UN High Commissioner for Human Rights and the UN Special Rapporteur on the human right to safe drinking water and sanitation have sought to develop indicators. This process of developing indicators for the human right to water and sanitation seeks to draw on previous indicator development practices, looking to these practices in framing, identifying and reviewing indicators. As part of a larger drive to facilitate rights-based accountability, there arises an imperative to study the political process of developing indicators, looking to past models in structuring future processes to assess the realization of the right to water and sanitation. Exploring the development of indicators for the human rights to health and education, this policy note analyses the indicator development process, proposing an indicator development process model as a basis for developing indicators that reflect the attributes of the right to water and sanitation, enlist key stakeholders in the policymaking process and have political relevance for state reporting to treaty bodies.

Implementing an evolving human right through water and sanitation policy.

With water and sanitation vital to the public's health, there have been growing calls to accept water and sanitation as a human right and establish a rights-based framework for water policy. Through the development of international law, policymakers have increasingly specified water and sanitation as independent human rights. In this political development of human rights for water and sanitation, the authors find that the evolution of rights-based water and sanitation policy reached a milestone in the United Nations (UN) General Assembly's 2010 Resolution on the Human Right to Water and Sanitation. By memorializing international political recognition of these interconnected rights and the corresponding obligations of national governments, states provided a normative framework for expanded efforts to realize human rights through water and sanitation policy. Examining the opportunities created by this UN Resolution, this article analyzes the implementation of the human right to water and sanitation through global water governance, national water policy and water and sanitation outcomes. While obstacles remain in the implementation of this right, the authors conclude that the UN Resolution could have lasting benefits for public health.