Life Stages. Sanitation-related stressors and experiences have varied across life stages that are attributed to their expected role, sanitation needs, and additional gendered social norms. Studies in rural Odisha by Xxxxxxx et al. and Xxxxxx et al. found a variation in sanitation concerns and experiences across life stages (Xxxxxxx et al., 2015; Xxxxxx et al., 2017). Newly married and unmarried women expressed more concerns about potential health risks or lack of privacy and resources for menstruation, urination, and sanitation-related activities than women married for more than three years or women older than 47 years of age. Unmarried women also discussed feeling worried about leaving behind socializing during open defecation if they were to get married (Xxxxxx et al., 2017). Xxxxxxx et al. emphasized how the sources of sanitation-related stress and the degree to which it impacted women varied based on their life stage (Xxxxxxx et al., 2015). For example, while defecation was ranked as the highest stress for adolescents, menstruation and carrying water were indicated as the highest stress for newly married and pregnant women (Xxxxxxx et al., 2015). According to Xxxxx et al., social regulations and norms highly tie into women’s agency and freedom of movement when it comes to sanitation (Sahoo et al., 2015). Younger girls and adolescents had more freedom and support with an increased familiarity with the community they live in and having family accompaniment during challenging times. However, they face challenges managing menstruation as certain communities separate girls during menstruation due to hygiene concerns or ‘impurity’ or available facilities lack adequate privacy or resources such as dustbins/water supply (Sahoo et al., 2015). When an adolescent transitions into the newly married period, she reportedly faces more social restrictions. Newly married women face new restrictions about when and where they can defecate and the people they can move around with. This is exacerbated by having to relocate to her in-law’s home which can bring challenges of an unfamiliar environment. Again, pregnant women face similar challenges with added restrictions placed by society to protect their children (Xxxxx et al., 2015).
Life Stages. Life Stages is a strategic programme of change that aims to transform how the CPP plans and delivers services to ensure more effective interventions, tackle inequalities and achieve positive outcomes for our communities. It is about embedding a new way of working and driving service redesign around three principles; use of evidence to target services to reduce inequalities, shifting resources upstream to deliver preventative services and ensuring that we obtain maximum impact for our expenditure. The programme used evidence and logic modelling3 to identify a set of short, medium and long term outcomes that everyone would want at each stage of life (Early Years, School Age, Young People in Transition, Adults of Working Age, Older 3 Logic modelling involves identifying the steps needed to ensure someone gets a better outcome, by working back from the outcome people need rather than forward from the services currently provided People), along with a target group within each life stage who are most in need of support to achieve better outcomes and avoid worsening inequalities. Life Stages focuses on redesigning services around the needs of target groups, looking at what works to improve outcomes and using a partnership approach to ensure coordinated multi-agency provisions. Partners also need to work in an intergenerational way to ensure the most effective package of interventions for families most in need. Work began in 2014/15 to track and assess how the Life Stages programme has informed the CPP’s approach to service delivery to date. It is intended that this programme will be revisited and refreshed from summer 2015 to ensure that it continues to positively influence the direction of travel for the CPP.
