Inadequate access to a private, comfortable, and well-located toilet remains a critical challenge for many girls and women around the world. This issue is especially acute for girls and women living in densely populated urban slums, displacement camps, and informal settlements, often resulting in anxiety, embarrassment, discomfort, and gender-based violence. The unique sanitation needs of girls and women are rarely accounted for during the design and construction of toilet facilities, including needs related to their physiology, reproductive health processes, prevalent social norms, and their heightened vulnerability to violence. It is critical that a new norm be developed regarding the design of female-friendly toilets which better enables girls and women to feel confident, safe, and dignified while managing their daily sanitation needs. This includes adopting specific design measures which account for their menstrual hygiene, personal safety, and dignity-related needs. Ultimately, an enhanced dialogue must take place among designers, policy makers, water, sanitation, and hygiene (WASH) practitioners, and other relevant actors, in addition to the target female users themselves, about how to adapt toilets in a range of development and emergency contexts and operations to better address these critical needs of girls and women.

Introduction

One of the most pervasive yet common forms of gender discrimination experienced daily by girls and women around the world is their inadequate access to a private, comfortable, and convenient toilet. Although men and women both share the critical need for adequate access to toilets, a range of social, cultural, and biological realities often impact and differentiate their sanitation experiences, including their ability to advocate and address these sanitation needs. Girls and women living in low-resource rural and urban areas within development and humanitarian contexts, especially those dwelling in densely populated urban slums, displacement camps, and informal settlements, suffer even more from constrained access to an adequate toilet, resulting in experiences of stress [1,2,3,4], embarrassment [5,6,7], physical discomfort, and gender-based violence [8,9,10].

More recently, topics of “potty parity,” “period equity”, and “toilet insecurity” have gained traction within global-level gender and development dialogues [11,12,13,14,15]. Such concepts have been linked to advocacy efforts promoting sanitation and gender issues around the world through platforms like “World Toilet Day” and “Menstrual Hygiene Day.” The “period equity” movement largely focuses on advocating for menstrual health needs, primarily access to menstrual products [12,15,16,17] in high-income countries, while the discourse concerning “toilet insecurity” is focused on generating better evidence about the negative health and psychosocial impact of poor toilet access for girls and women in low- and middle-income country contexts [1,3,14].

Despite the rise of these critical advocacy and research efforts, far too little has been done globally with respect to improving the design, guidelines, and placement (within a given location) of toilets that specifically support girls and women. This includes the testing of new ideas and systems regarding the concept of a female-friendly toilet. For example, most toilets accessed by girls and women in low-resource and emergency contexts continue to lack integral design measures for managing their menstruation and other sanitation needs comfortably and with dignity, including easy access to water and soap, safety measures (locks, doors, gender segregation, and lights) and a mechanism for discreetly handling menstrual waste (Box 1). The lack of consideration for a female’s distinct sanitation needs may be related to the predominance of males in the water and sanitation engineering fields who are responsible for toilet design [18]. As non-menstruators and with differing bodily needs, their perspectives on toilet design may be limited. However, even female water and sanitation engineers, despite their own experiences with menstruation, may not always appreciate the specific needs that girls and women have in relation to toilet design, given longstanding established norms and standards related to current toilet design [19].

In addition, actual consultation with girls and women regarding their sanitation needs is relatively rare [1,20,21]. This is particularly the case in humanitarian contexts where emergency responders’ baseline knowledge about the cultural sanitation practices and needs of displaced females may be low [5,22,23]. Consultation with girls and women is often further hindered by strong taboos linked to menstruation and general discomfort discussing female sanitation. Furthermore, societal expectations regarding female modesty and sanctions against inadvertently exposing their bodies [21,23], particularly in low- and some middle-income countries which may have more limited sanitation options in place, lead girls and women to seek out alternative options for managing their menstruation and other sanitation needs. For example, girls and women may seek out locations under cover of darkness, such as near railroad tracks or in fields, with few options provided in societies that do not prioritize their gendered sanitation needs [24]. Consulting girls and women directly in order to understand why, for example, some may prefer to change menstrual materials in bathing shelters is essential, with cultural reasons being the rationale for some [5], and limited latrine design aspects, including the insufficient availability of privacy or water in bathing stalls [14,20] or long waiting queues, being the rationale for others.

At the most basic level, girls and women around the world have distinct sanitation needs as compared to men, which is the product of their physiology, reproductive health processes, existing social norms, and vulnerability to violence. Girls and women generally use toilets more frequently and for a longer period of time than boys and men [18,25], especially while managing their monthly menstruation, when pregnant, or during other periods of extended vaginal bleeding [11,26]. This may have design implications, such as a need for a larger stall space to adequately move around inside the cubicle more comfortably, additional stalls within a latrine block given the stigma or vulnerability to harassment from standing in long lines in peri-urban slum environments, or better lighting for nighttime usage.

In addition, girls and women frequently assume greater caretaker roles within their families, requiring them to bring children into toilets or to accompany children, elderly individuals, and family members with disabilities into toilets to support their management of sanitation needs. In some urban contexts (e.g., in urban slum environments in Uganda and Kenya), girls and women rely on the use of pay-for-service communal toilets. In addition to covering their own costs, women sometimes must cover the cost of their children’s access to such toilets, adding an additional financial burden that may limit their own usage [6,9]. Furthermore, water, which is essential for cleaning both after defecating (as anal cleansing remains common in Asian contexts) and during menstruation, is also often inconveniently located from the placement of rural latrines (e.g., such as a water source being located a sizable distance from a toilet), resulting in additional stress for the procurement of water by girls and women prior to toilet usage [1,3,8,27,28].

Read the ‘Making the Case for a Female-Friendly Toilet‘