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Abstract Safely managed waste reuse may be a sustainable way to protect human health and livelihoods in agrarian-based countries without adequate sewerage. The safe recovery and reuse of fecal sludge-derived fertilizer (FSF) has become an important policy discussion in low-income economies as a way to manage urban sanitation to benefit peri-urban agriculture. But what drives the user acceptance of composted fecal sludge? We develop a preference-ranking model to understand the attributes of FSF that contribute to its acceptance in Karnataka, India. We use this traditionally economic modeling method to uncover cultural practices and power disparities underlying the waste economy. We model farmowners and farmworkers separately, as the choice to use FSF as an employer versus as an employee is fundamentally different. We find that farmers who are willing to use FSF prefer to conceal its origins from their workers and from their own caste group. This is particularly the case for caste-adhering, vegetarian farmowners. We find that workers are open to using FSF if its attributes resemble cow manure, which they are comfortable handling. The waste economy in rural India remains shaped by caste hierarchies and practices, but these remain unacknowledged in policies promoting sustainable ‘business’ models for safe reuse. Current efforts under consideration toward formalizing the reuse sector should explicitly acknowledge caste practices in the waste economy, or they may perpetuate the size and scope of the caste-based informal sector. 

Sanitation research focuses primarily on containing human waste and preventing disease; thus, it has traditionally been dominated by the fields of environmental engineering and public health. Over the past 20 years, however, the field has grown broader in scope and deeper in complexity, spanning diverse disciplinary perspectives. In this article, we review the current literature in the range of disciplines engaged with sanitation research in low- and middle-income countries (LMICs). We find that perspectives on what sanitation is, and what sanitation policy should prioritize, vary widely. We show how these diverse perspectives augment the conventional sanitation service chain, a framework describing the flow of waste from capture to disposal. We review how these perspectives can inform progress toward equitable sanitation for all [i.e., Sustainable Development Goal (SDG) 6]. Our key message is that both material and nonmaterial flows—and both technological and social functions—make up a sanitation “system.” The components of the sanitation service chain are embedded within the flows of finance, decision making, and labor that make material flows of waste possible. The functions of capture, storage, transport, treatment, reuse, and disposal are interlinked with those of ensuring equity and affordability. We find that a multilayered understanding of sanitation, with contributions from multiple disciplines, is necessary to facilitate inclusive and robust research toward the goal of sanitation for all. Expected final online publication date for the Annual Review of Environment and Resources Volume 44 is October 17, 2019. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.