Community-driven and water quality indicators of sanitation system failures in a rural U.S. community

Safe sanitation access is commonly believed to be ubiquitous in high-income countries; however, researchers and community advocates have exposed a glaring lack of access for many low-income communities and communities of color across the U.S. While this disparity has been identified and quantified at a high level, local and household-level implications of sanitation failures remain ill-defined. We develop a set of user-based and environmental measures to assess the performance of centralized wastewater systems, septic systems, and straight-piped systems in Lowndes County, Alabama. We combine qualitative, survey, and environmental sampled data to holistically compare user experiences across infrastructure types. This integrated approach reveals new routes of exposure to wastewater through informal household maintenance and system backups and provides evidence for the spread of wastewater-like contamination throughout the community. This work elucidates the severity of sanitation failures in one rural U.S. community and provides a framework to assess sanitation quality in other contexts with limited sanitation access in high-income countries.