Sanitation insecurity and Women's mental health of a coastal Upazila in Bangladesh: a community-based cross-sectional study

ABSTRACT Graphical abstract illustrating the relationship between sanitation insecurity and women’s mental health in climate-vulnerable coastal Bangladesh. The study assessed seven sanitation insecurity domains among 225 women and found high levels of moderate-to-severe anxiety, depression, and stress. Unsafe defecation places were strongly associated with anxiety and stress, while lack of social support was associated with depression. The graphic highlights the need for gender-sensitive WASH interventions that improve safety, privacy, and social support in coastal communities. Sanitation insecurity significantly impacts women's mental health in climate-vulnerable regions, yet this connection remains understudied. The study investigated the association between sanitation insecurity and mental health among women in climate-vulnerable coastal Bangladesh. A community-based cross-sectional survey of 225 women (15–80 years) in Shyamnagar, Satkhira, Bangladesh, used the DASS-21 and WHO-5 to assess anxiety, depression, stress, and well-being. Sanitation insecurity was measured across seven domains. Elevated symptoms were prevalent: 66.2% for anxiety, 78.3% for depression, and 73.4% for stress. Multivariable logistic regression revealed that insecurity in the defecation place domain was strongly associated with anxiety (AOR = 6.92, 95% CI 2.55–18.78) and stress (AOR = 5.66, 95% CI 2.13–15.05), while absence of social support was linked to depression (AOR = 1.81, 95% CI 1.02–3.17). Findings demonstrate that sanitation insecurity is a significant predictor of women's psychological distress. This study underscores an urgent need for gender-sensitive WASH interventions that address safety, privacy, and social support, integrating mental health into climate-resilient programming for coastal communities of Bangladesh.