Absorbent Hygiene Products Disposal Behaviour in Informal Settlements: Identifying Determinants and Underlying Mechanisms in Durban, South Africa

Abstract

Abstract Background: Within South Africa, many low-income communities lack reliable waste management services. Within these contexts, absorbent hygiene waste (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, in South Africa, and in low-income contexts. The purpose of this study is to determine the psycho-social factors driving AHP disposal behaviour for mothers and 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 purposively selected low-income communities (Johanna Road, Blackburn, and Mzinyathi), located within eThekwini Municipality (Durban), South Africa. The study included a qualitative pre-study (N=30) and a quantitative survey of 452 mothers and caregivers, utilise 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). 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. Moreover, 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 psychosocial 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 AHP’s 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 should inform an intervention strategy to implement a future collection system for these communities, and similar low-income or informal contexts within South Africa.