Absorbent hygiene products disposal behaviour in informal settlements: identifying determinants and underlying mechanisms in Durban, South Africa.

BACKGROUND: Within South Africa, many low-income communities lack reliable waste management services. Within these contexts, absorbent hygiene product (AHP) waste, including nappies (diapers), are not recycled, and are often dumped, ending up in watercourses and polluting the local environment. The structural barriers to collection which have been well explored, however the behavioural determinants of safe disposal for AHPs remains poorly understood. The purpose of this study is to determine the psycho-social factors driving AHP disposal behaviour for caregivers, while identifying potential underlying mechanisms (such as mental health), which may be influencing disposal behaviour, with the intention of informing a future, contextually appropriate and sustainable, collection system. METHODS: The cross-sectional study was conducted within three low-income communities located within eThekwini Municipality (Durban), South Africa. The study included a pre-study and a quantitative survey of 452 caregivers, utilising the RANAS approach of behaviour change. The quantitative questionnaire was based on the RANAS model to measure psycho-social factors underlying sanitary disposal of AHPs. Mental health was assessed using the Self-Reporting Questionnaire (SRQ-20). Statistical analysis involved regressing psycho-social factors onto disposal behaviour and exploring their interaction with mental health through a moderation model. RESULTS: Our findings suggest that one third of caregivers do not dispose of nappies sanitarily, despite intent (86.9%). Regression analysis revealed ten psycho-social factors which significantly predict the desired behavioural outcome, the sanitary disposal of AHPs. Caregivers with poor mental health were less likely to dispose of AHP sanitarily, which reflects previous research linking poor mental health and the impairment of health-related daily activities, particularly within vulnerable groups. Specifically, several psycho-social factors underlying were moderated by poor mental health, the prevalence of sanitary disposal of AHPs depended on mental condition of caregiver. CONCLUSIONS: Our findings confirmed the link between poor mental health and unsanitary AHPs disposal. This is especially relevant because poor mental health is common within South Africa. Addressing mental health problems within these communities is an essential step to providing sustainable waste management services. The findings informed an intervention strategy to implement a future collection system for these communities, and similar low-income or informal contexts within South Africa.

The shrinking world of girls at puberty: violence and gender-divergent access to the public sphere among adolescents in South Africa.

Participatory mapping was undertaken with single-sex groups of grade 5 and grade 8-9 children in KwaZulu-Natal. Relative to grade 5 students, wide gender divergence in access to the public sphere was found at grade 8-9. With puberty, girls' worlds shrink, while boys' expand. At grade 5, female-defined community areas were equal or larger in size than those of males. Community area mapped by urban grade 8-9 girls, however, was only one-third that of male classmates and two-fifths that of grade 5 girls. Conversely, community area mapped by grade 8-9 boys was twice that of grade 5 boys. Similar differences emerged in the rural site. No female group rated a single community space as more than 'somewhat safe'. Although curtailed spatial access is intended to protect girls, grade 8-9 girls reported most places in their small navigable areas as very unsafe. Expanded geographies of grade 8-9 boys contained a mix of safe and unsafe places. Reducing girls' access to the public sphere does not increase their perceived safety, but may instead limit their access to opportunities for human development. The findings emphasise the need for better violence prevention programming for very young adolescents.