‘We didn’t have anywhere to defecate as there is nowhere private. When we went outside, the boys used to follow us and we felt shy and afraid. We used to end up going inside our houses, on the floor, just like children, and then cleaning it up.’ It took guts for 15-year-old Baby from the Indian city of Gwalior to describe how she dealt with having no toilet in her home. The personal and sensitive nature of excretion renders it taboo, a topic that many grown women in developing countries, let alone adolescent girls, are uncomfortable discussing in public.
Women want and need toilets, but are profoundly inhibited from saying so. Access to a toilet is essential for female dignity, especially in cultures that demand high standards of modesty. But lack of discussion means that their provision is given very low priority, especially by those with the financial and political power to correct the situation – predominantly men. This paradox results in women living in a state of constant discomfort and anxiety. While men and boys can be seen squatting by Indian roadsides in broad daylight, similar behaviour for women and girls is unthinkable.
The sense of degradation is almost universal among the millions of women without facilities. ‘During the day we must walk far into the bush if we do not want to be seen. At night there is a danger from snakes and scorpions. Sometimes men follow us and that also makes us afraid,’ says Januta Buniya, a 30-year-old Nigerian mother. Women ‘prisoners of daylight’ – those obliged by custom to wait until nightfall to venture outside to relieve themselves – often face increased chances of urinary tract infection and chronic constipation. The stress and pain can be acute, especially for pregnant, elderly or disabled women.
Sexual exposure – and possible harassment – forms part of the embarrassment. Discussing the benefits of a WaterAid toilet-building programme in the city of Tamale in Ghana, 40-year-old Fatimata liked the idea of less disease and filth and fewer encounters with snakes and pigs in the forest, but top of her list was privacy. ‘This will save me from exposing myself to the public. It is a serious worry when men other than my husband see me naked. Now we will have a room where we can go and do whatever we want.’ Her neighbour Ashetu concurs: ‘In the forest men, women and children clash. Sometimes when I am squatting there a man comes and squats behind me. I can’t tell him to go away because it’s a public place, but people see things they shouldn’t see.’
Women also have to deal with their children’s bodily expulsions. In Tamale, this means extra trips to the forest to dispose of excreta, as Ashetu described: ‘Younger children defecate in chamber pots and we empty them in the forest. Older children who can cross the road come with us. But if they need to go in the night we take them outside, and then in the morning we dig a hole and bury it.’
In dense urban slums, high population density often means there is nowhere secluded outside or in. Women and girls often resort to ‘flying toilets’ – plastic bags that are thrown on to a dump – or, as in Baby’s case, the floor. People also resort to buckets, which are poured into open drains at night, creating serious public nuisance and adding to the risks of diarrhoeal infection.
Lack of sanitation can destroy girls’ education. As they hit puberty, many parents withdraw daughters from school out of concern for their modesty. Or the girls themselves choose to stay away when menstruating or suffering from diarrhoea. ‘Before the school had toilets we used to hide under the bamboo when we had to go,’ recounted Sabina Roka from Simle, Nepal. ‘During menstruation it was really difficult, and we used to stay at home instead.’ For millions of girls, lack of attention to their adolescent needs leads to their leaving school altogether – and thus, very often, to early marriage. Providing separate toilet blocks for girls – and inculcating a culture of respect towards all students and for personal and school cleanliness – helps retain them.
Women and girls also miss work and school due to their responsibility to care for relatives who are sick – often with diseases exacerbated by poor sanitation, indicating the compounding nature of the problem. In many children under five, diarrhoeal diseases prove fatal. Honufa, a 20-year-old mother from Dhaka, Bangladesh, laments: ‘Life is very hard here. The sanitation conditions everywhere are foul. Every day there is disease in this slum. I lost a two-year-old son to diarrhoea.’ Thus where health risks are understood, the impulse to adopt sanitary practices and hygiene can be strong. The difficulties are the crowded nature of the living space, lack of community organization, and expense. But where the will is there, these difficulties can be overcome.
Toilets aren’t the only sanitary improvement that women need. Private showers or washrooms are another female concern. A study by WaterAid in Tanzania cited how women from the village of Songambele who were able to bathe regularly during menstruation reported improved personal hygiene and with this, increased confidence. Mdala Rhoda Senduwu recalled the previous embarrassing situation where: ‘Women who had problems with their menstrual hygiene were taken to the elders for consultation so that they could improve their cleanliness.’ Some sanitation programmes offer a closet with toilet and bathroom tap or simple shower combined, with waste water used for flushing.
Waste-water disposal is also a problem – stagnant pools attract mosquitoes, and rotting garbage brings vermin and flies. In Ouakam, a poor urban community on the outskirts of arid and drainless Dakar, Senegal, women without their own soakpits have to pay other women 50 cents a time to carry their bowlfuls of dirty water away. This makes household laundry, washing-up and personal hygiene an extremely expensive affair.
Sanitation: what women need
The following are female sanitation priorities – mostly connected to dignity and convenience rather than health.
Privacy: no-one witnessing you going to the toilet or bathing.
Security: separate M and F facilities, in public and school toilets.
Soap and water: to wash hands, bodies, clothes, utensils, nappies/diapers and pads.
Disposal facilities: for sanitary cloths, wastewater and garbage.
Potties: to help deal with infants’ excreta.
Proximity to home: so that visiting the toilet doesn’t mean leaving children unaccompanied and there is easier access for the sick, elderly and disabled (all cared for by women).
Easily cleanable designs: women are invariably responsible for toilet maintenance.
Plenty of women customers
Better understanding of the misery and indignity that women endure is gradually emerging as genuine discussion and exchange become the basis of sanitation programmes – instead of the ‘build and lecture’ model too often deployed by public health engineers in the past. Most women without toilets and water taps live in serious poverty and have barely been to school. Even if they could summon the courage to talk frankly about their personal needs, they lack the time, skills, connections and knowledge to petition their governments, community leaders or even husbands for change. But now that more of them are being asked sensitively to identify their personal needs, and are being offered facilities they can afford, the myth that there are few customers for sanitation in poor communities is gradually being dispelled.
Consultations with women have led to various innovations. For example, children may fear a dark hole, and need to be reassured into using the toilet by special open-plan child-friendly design. In Mali, one programme adapted designs to make it easier for people blind from trachoma to use the toilet without the assistance of a caregiver – usually a woman. Teenage girls have been taught how to make reusable sanitary napkins. In a recent revamp of government-approved school toilet designs in India, a UNICEF sanitation officer managed to ensure that incinerators for menstrual cloths would automatically be included in the girls’ blocks.
All the evidence suggests that women are effective leaders of sanitary change, in both rural and urban settings, where they are given encouragement. But they need to be given the chance to express themselves without fear of ridicule and humiliation. Until the subject of human waste is removed from the closet and the silence surrounding it broken, poor sanitation will remain one of the most pressing concerns for women around the world; and by far the most politically neglected.
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