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      What motivates open defecation? A qualitative study from a rural setting in Nepal

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          Abstract

          Introduction

          Open defecation is ongoing in Nepal despite the rise in efforts for increasing latrine coverage and its use. Understanding the reasons for open defecation would complement the ongoing efforts to achieve the ‘open defecation free’ status in Nepal. This study aimed at exploring different motivations of people who practice open defecation in a village in Nepal.

          Methods

          This study was conducted among the people from the Hattimudha village in Morang district of eastern Nepal, who practiced open defecation. Maximum variation sampling method was used to recruit participants for 20 in-depth interviews and 2 focus group discussions. We adopted a content analysis approach to analyze the data.

          Results

          We categorized different reasons for open defecation as motivation by choice and motivation by compulsion. Open defecation by choice as is expressed as a medium for socializing, a habit and an enjoyable outdoor activity that complies with spiritual and religious norms. Open defecation by compulsion include reasons such as not having a latrine at home or having an alternative use for the latrine structures. Despite having a private latrine at home or access to a public latrine, people were compelled to practice open defecation due to constraints of norms restricting latrine use and hygiene issues in general. For women the issues with privacy and issues refraining women to use the same latrine as men compelled women to look for open defecation places.

          Conclusion

          Open defecation is either a voluntary choice or a compulsion. This choice is closely linked with personal preferences, cultural and traditional norms with special concerns for privacy for women and girls in different communities. The ongoing campaigns to promote latrine construction and its use needs to carefully consider these factors in order to reduce the open defecation practices and increase the use of sanitary latrines.

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          Most cited references19

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          Sanitation and Health

          As one article in a four-part PLoS Medicine series on water and sanitation, David Trouba and colleagues discuss the importance of improved sanitation to health and the role that the health sector can play in its advocacy.
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            Sanitation-related psychosocial stress: A grounded theory study of women across the life-course in Odisha, India.

            While sanitation interventions have focused primarily on child health, women's unique health risks from inadequate sanitation are gaining recognition as a priority issue. This study examines the range of sanitation-related psychosocial stressors during routine sanitation practices in Odisha, India. Between August 2013 and March 2014, we conducted in-depth interviews with 56 women in four life stages: adolescent, newly married, pregnant and established adult women in three settings: urban slums, rural villages and indigenous villages. Using a grounded theory approach, the study team transcribed, translated, coded and discussed interviews using detailed analytic memos to identify and characterize stressors at each life stage and study site. We found that sanitation practices encompassed more than defecation and urination and included carrying water, washing, bathing, menstrual management, and changing clothes. During the course of these activities, women encountered three broad types of stressors-environmental, social, and sexual-the intensity of which were modified by the woman's life stage, living environment, and access to sanitation facilities. Environmental barriers, social factors and fears of sexual violence all contributed to sanitation-related psychosocial stress. Though women responded with small changes to sanitation practices, they were unable to significantly modify their circumstances, notably by achieving adequate privacy for sanitation-related behaviors. A better understanding of the range of causes of stress and adaptive behaviors is needed to inform context-specific, gender-sensitive sanitation interventions.
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              Behavioral indicators of household decision-making and demand for sanitation and potential gains from social marketing in Ghana.

              Household demand for improved sanitation in developing countries is an important social and behavioral process with implications for public health, sanitation policy and planning, and sanitation design and technology development. This paper develops a behavioral approach to assess household demand for improved sanitation in Ghana. Adoption decision stages of preference, intention, and choice to install a toilet in Ghana are defined, measured in a survey, and used to estimate sanitation demand, identify factors affecting demand at each stage, and classify households by adoption stage to identify targeted demand-stimulation strategies. Results from a representative national sample of 536 households indicate that of 74% of households without any home sanitation, 31% have some likelihood of installing a toilet within the next year, but only 6% are very likely to do so; 62% had not considered the idea. Motivating and constraining factors are compared at each adoption stage and strategies likely to increase toilet installation in Ghana discussed. The approach is useful for assessing behavioral indicators of sanitation demand in developing countries and suggesting where marketing approaches can and cannot work to accelerate adoption of household sanitation improvements.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                1 July 2019
                2019
                : 14
                : 7
                : e0219246
                Affiliations
                [1 ] B. P. Koirala Institute of Health Sciences, Dharan, Nepal
                [2 ] London School of Hygiene and Tropical Medicine, London, United Kingdom
                [3 ] University of the Philippines Open University, Laguna, Philippines
                Tribhuvan University Institute of Medicine, NEPAL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                [¤a]

                Current address: Bayalpata Hospital (Nyaya Health Nepal / Possible), Achham, Nepal

                [¤b]

                Current address: Golden Community, Lalitpur, Nepal

                [¤c]

                Current address: B. P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal

                [¤d]

                Current address: Patan Academy of Health Sciences, Lalitpur, Nepal

                Author information
                http://orcid.org/0000-0002-8614-1087
                http://orcid.org/0000-0002-2179-6365
                http://orcid.org/0000-0002-9975-9804
                http://orcid.org/0000-0002-9965-181X
                Article
                PONE-D-19-09504
                10.1371/journal.pone.0219246
                6602253
                31260506
                976eae10-af8f-4880-8400-80f16b4b5d0d
                © 2019 Bhatt et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 April 2019
                : 20 June 2019
                Page count
                Figures: 0, Tables: 2, Pages: 15
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Defecation
                Medicine and Health Sciences
                Physiology
                Physiological Processes
                Defecation
                Medicine and Health Sciences
                Health Care
                Environmental Health
                Sanitation
                Medicine and Health Sciences
                Public and Occupational Health
                Environmental Health
                Sanitation
                Social Sciences
                Anthropology
                Cultural Anthropology
                Religion
                Social Sciences
                Sociology
                Religion
                Medicine and Health Sciences
                Public and Occupational Health
                Hygiene
                Social Sciences
                Sociology
                Culture
                People and Places
                Geographical Locations
                Asia
                Nepal
                Social Sciences
                Sociology
                Sexual and Gender Issues
                Biology and Life Sciences
                Psychology
                Behavior
                Habits
                Social Sciences
                Psychology
                Behavior
                Habits
                Custom metadata
                All relevant data are within the paper and its Supporting Information file.

                Uncategorized
                Uncategorized

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