The impact of a sanitation intervention on women’s psychosocial health: a quasi-experimental, mixed methods study in Bihar, India

Publication Details

Robert Dreibelbis, Oliver Cumming, Seema Kulkarni, Kathleen O'Reilly, Belen Torondel
Institutional affiliations
None specified
Grant-holding institution
None specified
South Asia
Water and Sanitation
Rural Water and Sanitation
Gender analysis
Rural Water and Sanitation
Gender analysis
Equity Focus
Evaluation design
Difference-in Difference (DID), Propensity Score Matching (PSM)
Ongoing 3ie Funded Studies
3ie Funding Window
Sanitation and Hygiene Thematic Window


This impact evaluation assesses whether the Global Sanitation Fund’s (GSF) sanitation programme has an impact on the reduction of psychosocial stress, and the improvement of safety and quality of life among women and girls.


According to the National Sample Survey Organisation (2015), the open defecation rate in Bihar is 70 per cent. To address this issue, the Government of India, through its Swachh Bharat Mission (Clean India Mission), has been constructing toilets. GSF in India has been working in close partnership with the Government of India to raise community demand for toilet use as well as improve the supply of toilets.

3ie’s Evidence Gap Map on Water, Sanitation and Hygiene shows that not a single rigorous impact evaluation has so far attempted to measure impacts of water and sanitation improvements on women and girls’ safety and very few have examined the drudgery involved in water collection and transportation.

Research questions

The impact evaluation addresses the following question: Does the GSF programme reduce women and girls’ psychosocial stress and improve their safety and quality of life?


Intervention design

GSF’s programme includes four primary activities:

1)         Demand generation through community mobilisation and interpersonal communication activities;
2)         Supply-side improvements through training and mobilisation of masons and technicians for latrine construction;
3)         Support for institutional strengthening and capacity building; and
4)         Promotion of multi-stakeholder engagement and learning through support for research and advocacy.

The programme is aimed at helping villages attain the open defecation-free status, and for ensuring households have and use a sanitation facility.

Theory of change

The underlying theory of change is that demand generation through community mobilisation, as well as institutional strengthening through partnerships with state, district and community actors, would lead to more people using improved toilets and hand-washing facilities.

Evaluation design

The study uses the difference-in-difference method with matching to estimate the impact of the GSF’s programme on women’s psychosocial stress.

The impact evaluation also includes an ethnographic study to assess the participants’ experience of the GSF programme. The study will examine if and how specific intervention activities contribute directly or indirectly to psychosocial and behavioural outcomes such as stress and anxiety related to financing latrine construction.

Main findings

  1. What are the findings for the primary research questions proposed to 3ie? 
  2. What estimates (related to the key outcomes of interest?) are presented in the study and are they statistically significant?
  3. Are there any key heterogeneities of impact, including across gender lines?

Cost efficiency analysis

Costing, cost-effectiveness/benefit to achieve key impacts.

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