Access to sanitation services has been recognized as a human right by the UN since 2015: sanitary facilities are essential for men’s and women’s health alike. But despite a direct link between women’s rights and dependable access to toilets, the issue remains less visible than it should be.
In 2018, 60% of the total number of people who had to resort to open-air defecation were women, and in sub-Saharan Africa one girl in ten missed school during her period. Though women are at higher risk of lacking access to dependable sanitary facilities, and such access is key to empowering them, data on this basic right are limited.
No toilets: putting girls’ and women’s health and security at risk
According to the most recent available data, from 2017, over 500 million women lacked access to sanitation facilities. That means that 13% of the world’s female population was unable to use a toilet to go to the bathroom or manage menstrual hygiene. For these women, the risk of sexual assault is 40% higher than for women with access to sanitation facilities, according to a 2018 study conducted in the shanty towns of Kenya’s Mathare Valley. In India, this risk is as high as 50%.
What’s more, a lack of access to toilets poses higher health risks for women than for men. In addition to health risks shared by both sexes—including diarrhea, dehydration, dysentery, typhoid fever, hepatitis A and even polio—problems like toxic shock syndrome, vaginal or urinary infections, and pregnancy complications affect women alone. Illnesses due to a lack of personal and menstrual hygiene compound problems arising from contact with fecal matter, which tend to receive more attention.
Hygiene, health and security: when girls and women have to choose
As a 2016 study observes, attending to menstrual and personal hygiene while avoiding many of these illnesses necessitates four elements: privacy, water, soap and a trash disposal system. Unfortunately, even when sanitation infrastructure exists, it’s often ill-adapted to the needs of girls and women, according to the NGO WaterAid.
In Kenya, the sanitation facilities installed in the Mathare region are mixed-gender, few in number (with 1 toilet for every 70 to 100 people), fee-based, and often lack a door. Together with paid access, the lack of cleanliness, privacy and security drives many women to avoid using these toilets : “A third of women use a bucket or plastic bags or defecate outdoors at least once per day, and two-thirds of them do the same at night,” says researcher Samantha Winter.
When toilets contribute to female empowerment
In addition to being essential to girls’ health and security, access to dependable, well-designed sanitation facilities exerts a direct influence on girls’ education rates. In 2019 a third of the world’s schools lacked toilets, according to the UN. The direct result has been an increase in girls’ drop out and school absence rates when they reach puberty, owing to the lack of a place where they can change when they have their period. According to UNESCO, in sub-Saharan Africa one girl in ten misses 20% of the school year for the same reason.
For all these reasons, UNICEF is leading a program in Jharkhand, India to train women as masons. Girls who have dropped out of school because of the lack of facilities for dealing with their periods are becoming rani mistri, toilet-builders, in their communities.
For its part, WaterAid has drawn up a best-practices guide in partnership with UNICEF and Water & Sanitation for the Urban Poor (WSUP), designed for all actors involved in providing sanitation access. These initiatives have the same goal: promoting the inclusion of women in the planning and governance of sanitation infrastructure to ensure that their needs are taken into account.