Although 2.7 billion people use household pit latrines daily, fecal sludge (FS) contained in pits is frequently managed in rural areas using unsafe practices that endanger public and environmental health, mitigating the benefits of improved sanitation. Rural households typically decide how to manage their FS; thus, safe fecal sludge management (FSM) relies on households choosing safe FSM practices. Despite its criticality to safe FSM globally, rural FSM decision-making has not been studied in detail, hindering the development of safe rural FSM practices and services. This dissertation uses two surveys and one discrete choice experiment to describe the FSM decision-making process of rural households in Cambodia. Based on survey responses from 3715 households across seven provinces, this research shows that four in ten households intend to manage their fecal sludge unsafely (41%), and desirable FSM intentions increase markedly after rice harvest and vary markedly across provinces. Predictors of desirable FSM intentions are also identified. Using a discrete choice experiment administered to 1461 households across five provinces, this research then investigates rural households’ valuation of four FSM service attributes and shows that rural households prefer services that prevent contact with FS most, followed by those that reduce foul odor and produce fertilizer from FS.

Preferences are also analyzed by region and demographics, which exhibit strong preference heterogeneities, and practical recommendations are provided. Lastly, using survey responses from 1472 households across five provinces, this research comprehensively describes the FSM decision-making processes of rural households in Cambodia using six behavioral determinants to evaluate where households are more or less accepting of safe FSM practices. Rural Cambodian households tend to prefer FSM practices that endanger public and environmental health due to a lack of access to knowledge about FSM and deeply rooted social norms that promote unsafe FSM practices. Acceptance of safe FSM practices is analyzed by region and demographics, and practical recommendations are also provided. The results and practical recommendations in this dissertation provide useful information for organizations and governments to improve the safety of rural FSM and help improve public and environmental health.