Community hygiene norm violators are consistently stigmatized: Evidence from four global sites and implications for sanitation interventions

Alexandra Slade, Amber Wutich, Margaret V. du Bray, Jonathan Maupin, Roseanne C. Schuster, Matthew M. Gervais

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Community sanitation interventions increasingly leverage presumed innate human disgust emotions and desire for social acceptance to change hygiene norms. While often effective at reducing open defecation and encouraging handwashing, there are growing indications from ethnographic studies that this strategy might create collateral damage, such as reinforcing stigmatized identities in ways that can drive social or economic marginalization. To test fundamental ethnographic propositions regarding the connections between hygiene norm violations and stigmatized social identities, we conducted 267 interviews in four distinct global sites (in Guatemala, Fiji, New Zealand, USA) between May 2015 and March 2016. Based on 148 initial codes applied to 23,278 interview segments, text-based analyses show that stigmatizing labels and other indices of contempt readily and immediately attach to imagined hygiene violators in these diverse social settings. Moral concerns are much more salient at all sites than disease/contagion ones, and hygiene violators are extended little empathy. Contrary to statistical predictions, however, non-empathetic moral reactions to women hygiene violators are no harsher than those of male violators. This improved evidentiary base illuminates why disgust- and shame-based sanitation interventions can so easily create unintended social damage: hygiene norm violations and stigmatizing social devaluations are consistently cognitively connected.

Original languageEnglish (US)
Pages (from-to)12-21
Number of pages10
JournalSocial Science and Medicine
StatePublished - Jan 2019


  • Behavior change
  • Community-Led Total Sanitation
  • Culture
  • Hygiene
  • Intervention
  • Norms
  • Sanitation
  • Stigma

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science


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