Gendered inequalities in water sanitation and hygiene access increase time poverty health risks and socioeconomic exclusion in Odisha India

Water, sanitation, and hygiene (WASH) are essential for public health, gender equality, and sustainable development. Despite substantial infrastructure expansion in India, gendered disparities in WASH access and outcomes persist in rural areas. Women bear disproportionate time, health, and dignity burdens due to social norms and limited governance participation. This study investigates the determinants of gendered WASH inequities in rural Odisha. A convergent parallel mixed-methods design was conducted between January and June 2023 across four districts of Odisha: Mayurbhanj, Ganjam, Keonjhar, and Gajapati. Quantitative data were collected from 400 rural households and complemented by 16 focus-group discussions and 32 key informant interviews. Analyses included Ordinary Least Squares, logistic regression, multilevel modelling, structural equation modelling, and propensity score matching to estimate the causal effects of women’s participation in Village Water and Sanitation Committees (VWSCs). A multidimensional Gender–WASH Inequality Index (GWII) was developed using the Alkire–Foster methodology. Women spent 1.4–2.7 h daily collecting water, with distance to the source emerging as the strongest predictor of time burden (β = 0.62, p < 0.001). Only 46% of household toilets were fully functional, and non-functional sanitation significantly increased the odds of water-borne illness. Women’s meaningful participation in VWSCs improved toilet functionality by 24.8%, reduced water collection time by 31.4 min, and lowered illness incidence by 12.7%. The GWII score (0.357) revealed substantial multidimensional deprivation, driven primarily by time poverty and limited decision-making. Sustainable WASH improvements require gender-transformative governance that strengthens women’s agency and institutional accountability alongside infrastructure expansion.