tag:theconversation.com,2011:/uk/topics/world-toilet-day-22681/articlesWorld Toilet Day – The Conversation2023-11-16T14:46:31Ztag:theconversation.com,2011:article/2173052023-11-16T14:46:31Z2023-11-16T14:46:31ZThere are too few toilets in Africa and it’s a public health hazard – how to fix the problem<p>Imagine you are miles from the nearest restroom, and nature’s call is urgent – a situation that might raise a mild panic during a hike or at a music festival. Now, picture that same scenario, not as a one-off inconvenience, but as a daily reality. This is the case for about <a href="https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-022-00416-5">half a billion</a> people globally. </p>
<p>In African countries, the issue of open defecation often goes unaddressed by society and policymakers despite its negative impact on health, economic development, dignity and the environment. </p>
<p>Led from Queen’s University Belfast, a team of multidisciplinary researchers aimed to evaluate how prevalent the practice is in African countries and which social factors are driving it. We also aimed to establish which communities were in most urgent need of interventions. </p>
<p>We used demographic and health surveys, alongside World Bank data. In a <a href="https://link.springer.com/article/10.1007/s10668-023-03992-6">recent paper</a> we set out our findings. </p>
<p>Our main ones were that in Nigeria, Ethiopia, Niger, the Democratic Republic of Congo, Burkina Faso and Chad, a large number of people engaged in open defecation. </p>
<p>We found that as few as ten countries could account for 247 million Africans defecating in the open by 2030 if critical and emergency actions are not taken.</p>
<p>The biggest driver is lack of access to proper sanitation facilities. The poorest individuals, particularly in rural areas, are more likely to resort to open defecation than people in urban areas. In regions with the most critical need, the poorest are 43 times more likely than the wealthy to resort to open toileting. </p>
<p>We recommend tackling poverty, and intervening in regions and communities that urgently need improved sanitation infrastructure and programmes. West Africa needs special attention since many of its communities are in the critical category.</p>
<h2>A systematic approach</h2>
<p>Sanitation has far-reaching implications for food safety. Contaminated water sources and unsanitary conditions can spread waterborne diseases, which can contaminate food and put millions at risk. Addressing open defecation is a step in ensuring the safety and hygiene of the food chain.</p>
<p>The link between poor sanitation and health is well <a href="https://www.who.int/news-room/fact-sheets/detail/sanitation">documented</a>. But our study casts this relationship in a new, alarming light: the likely role of open defecation in antimicrobial resistance. </p>
<p><a href="https://www.who.int/health-topics/antimicrobial-resistance">Antimicrobial resistance</a> is the ability of microbes, such as bacteria, viruses and fungi, to resist the effects of medications that were once used effectively against them. It is a looming crisis, threatening to make antibiotics ineffective. Common infections could once again become deadly. </p>
<p>Our research suggests a probable link between open defecation and antimicrobial resistance. When people defecate outdoors, resistant bacteria from human waste can contaminate water and food. This <a href="https://doi.org/10.1093/jtm/taad069">often leads</a> to faecal-oral diseases and urinary tract infections.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gutter-to-gut-how-antimicrobial-resistant-microbes-journey-from-environment-to-humans-189446">Gutter to gut: How antimicrobial-resistant microbes journey from environment to humans</a>
</strong>
</em>
</p>
<hr>
<p>However, there is a need for more research to clarify the relationship, its implications and prevention. A clear recommendation from our research is that data about antimicrobial resistance should be integrated into health surveys.</p>
<p>While the full breadth of the study’s findings is huge, its conclusions are clear: open defecation is a challenge in Africa that requires actions. Our research doesn’t just ring the alarm bell; it provides a blueprint for change, identifying specific regions where the practice is most prevalent and where interventions could have the greatest impact.</p>
<h2>What needs to be done</h2>
<p>Addressing open defecation across a continent as vast and diverse as Africa is no small feat. We made a number of recommendations in the study.</p>
<p><strong>A pragmatic three-tier priority system</strong> </p>
<p>This will categorise regions based on the urgency of need for intervention: critical, high, and medium. Regions marked as critical are those with the highest prevalence of open defecation (more than 80% of the population) and the least access to sanitation facilities. These areas need immediate attention with the deployment of resources and sanitation infrastructure. The high priority regions have some access to sanitation. Here, the strategy is a combination of infrastructure development and community education. For medium priority areas (40%-59%), where some sanitation infrastructure may exist, the focus should be on sustainable practices, behavioural change and maintenance of existing facilities.</p>
<p>The system above is just to cut the high rates and inequalities among communities in a country. There is also a lot to do in communities with an open defecation rate of less than 40%. The goal is to reinforce positive behaviour and ensure facilities are maintained and improved. </p>
<p>Policy support, such as incentives for building private toilets or community sanitation blocks, may also help. This tiered strategy hinges on continuous assessment and reallocation of resources. Interventions should respond to the changing landscape as regions improve or decline. </p>
<p><strong>Support sanitation projects and policies</strong></p>
<p>Advocacy is important to increase awareness and donations to organisations that build toilets and provide sanitation programmes in affected areas. </p>
<p><strong>Educate and spread awareness</strong></p>
<p>Learning about the cultural and socio-economic factors that contribute to this practice must be encouraged and the knowledge shared with others. Campaigns that focus on the importance of sanitation for health and the environment are key.</p>
<p><strong>Encourage sustainable sanitation practices</strong></p>
<p>This includes using toilets properly, not littering, and understanding local challenges. The use of compostable toilets and other sustainable waste management practices where traditional toilets are not feasible must be encouraged.</p>
<p><strong>Foster global partnerships for sanitation</strong></p>
<p>Global partnerships can amplify efforts to end open defecation. Collaborations between governments, NGOs, private sector stakeholders and international organisations must be encouraged. Pooling resources and sharing knowledge can lead to more effective and sustainable solutions.</p><img src="https://counter.theconversation.com/content/217305/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The struggle with open defecation is a silent emergency, undermining the continent’s efforts towards sustainable development goals.Omololu Fagunwa, Research Fellow, Queen's University BelfastHelen Onyeaka, Associate Professor, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1505512020-11-24T15:02:14Z2020-11-24T15:02:14ZRiver of bacteria: a South African study pinpoints what’s polluting the water<figure><img src="https://images.theconversation.com/files/371020/original/file-20201124-23-9049u7.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Apies river downstream of the informal settlement and the village of Hammanskraal.</span> <span class="attribution"><span class="source">Author supplied</span></span></figcaption></figure><p>In 2010, the United Nations recognised access to clean water and sanitation as a fundamental human right. However, over <a href="https://www.worldtoiletday.info/">4.1 billion</a> people around the world, particularly in low- and middle-income countries, still do not have access to this human right.</p>
<p>Clean and safe water is necessary for basic life functions — for drinking, for cooking, for bathing, and more. When it is not available, people resort to alternative sources, which are often polluted with pathogenic bacteria arising from human waste. Using such water exposes people to waterborne diseases such as diarrhoea.</p>
<p>In cities, most households have access to treated water and good sanitation services. However, over <a href="https://www.unicef.org/esa/sanitation-and-hygiene">340 million</a> people in sub-Saharan Africa, mostly in rural communities and informal settlements, do not. They may rely on rivers, lakes, and streams for their. In addition, over <a href="https://www.unicef.org/esa/sanitation-and-hygiene">270 million</a> practise open defecation or have poorly constructed toilets. Most have no choice but to defecate outdoors, often disposing of their faeces directly into rivers — the same ones they use as sources of water.</p>
<p>We, a group of researchers in South Africa, wanted to know more about how different human activities around rivers in the country affected the microbial quality of the water. We wanted to understand the extent to which <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664689/">informal settlements</a>, where access to basic sanitation and hygiene is limited or absent, affected the presence of waterborne bacteria.</p>
<p>We set out to explore how different human activities, such as sewage treatment plants, informal settlements and agriculture, affected the microbial quality of river water. We also used a mathematical model to show whether people could get sick from drinking untreated water from the river. We looked at <em>E. coli</em> as the indicator organism and <em>Vibrio</em>, <em>Salmonella</em> and <em>Shigella</em> as pathogenic organisms. Indicator organisms indicate the possible presence of pathogens, which are microorganisms that can cause disease. </p>
<p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/26318680/#:%7E:text=Seasonal%20variations%20had%20an%20impact,coli%20concentrations">research</a> found that in <a href="https://pubmed.ncbi.nlm.nih.gov/26318680/#:%7E:text=Seasonal%20variations%20had%20an%20impact,coli%20concentrations.">informal settlements</a> where sanitation and waste management facilities were absent, a high number of bacteria were often present in the water of the river we studied. Some of these bacteria were pathogenic forms of <em>E. coli</em>, which, when consumed, could make people sick. We also observed that the people living there frequently used the river water, without any treatment, for personal hygiene such as bathing and brushing their teeth. The river was also often used for rituals, which involved immersing oneself several times into the water as a form of spiritual cleansing.</p>
<h2>Samples from before and after activities</h2>
<p>The <a href="https://www.sahistory.org.za/place/apiesrivier-river-which-flows-through-pretoria">Apies river</a> takes its source from the south of the city of Pretoria (one of South Africa’s three capital cities) and flows towards the north of the city, before joining the Pienaars River. Samples were collected at ten different sites along the river. These sites were situated upstream and downstream from the different human activities we looked at. We tested the water in the laboratory for the presence of microorganisms.</p>
<p>There are numerous sewage treatment facilities that <a href="https://rekordeast.co.za/315344/north-residents-protest-sewage-spill-into-apies-river/">discharge wastewater directly into the river</a>. At times the discharged water is <a href="https://ewn.co.za/2011/10/12/Untreated-sewage-flows-into-Apies-River_">not treated</a> due to system failure, or poorly treated when overloaded. The river also receives waste from informal settlements situated along the riverbanks, either directly through dumping or indirectly from surface runoff during heavy rainfall. These <a href="http://www.statssa.gov.za/census/census_2001/urban_rural/urbanrural.pdf">informal settlements</a> are unplanned and the houses are sometimes built on illegally owned land, usually not built according to regulations. So they do not have waste management services.</p>
<p>This river is also used for irrigation. Villagers in <a href="http://www.statssa.gov.za/census/census_2001/urban_rural/urbanrural.pdf">the rural communities</a> – areas that are subdivided into “tribal” areas and commercial farms and usually have few houses – use the river water for their cattle too. The informal and rural settlements use the river directly to dump their waste – including faeces – and for personal and household hygiene.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cattle and water" src="https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/371022/original/file-20201124-13-1rbwiyu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cows using the water from the rural community of Potwane in the North.</span>
<span class="attribution"><span class="source">Author supplied</span></span>
</figcaption>
</figure>
<p>We isolated all the tested organisms in the water and sediment samples collected from this river. We found that the number of bacteria isolated before the water passed through informal settlements was lower compared to the number when the river had passed through the settlement. This was because of the lack of toilets in the settlement, forcing the communities to use the river as a toilet. We also found higher numbers of bacteria when the river received wastewater from the sewage treatment facilities. This shows that the treatment plant was discharging poorly treated water containing faeces in the river.</p>
<h2>Getting sick is almost guaranteed</h2>
<p>The World Health Organisation (WHO) recommends that there should be <a href="https://www.who.int/water_sanitation_health/dwq/2edvol3a.pdf">zero</a> <em>E. coli</em> in water meant for drinking. But we found up to 1 million <em>E. coli</em> cells in 100ml of water collected downstream for the informal settlement and sewage treatment facility sites. According to the mathematical model, someone who ingested as little as 1ml of untreated water had almost a 100% chance of getting sick during the rainy season – leading to school absences and missed days of work. </p>
<p>People living in informal settlements and rural areas need to be made aware of the negative impact of open defecation, especially directly into rivers. Where there is no alternative water source, they should be advised to treat the water, for example by boiling it before use.</p>
<p>Governments need to ensure that people living in rural communities and informal settlements have access to toilets and clean water. This can be done by building community toilets or providing them with <a href="https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/waterless-portable-private-toilet-an-innovative-sanitation-solution-in-disaster-zones/365904320A86CB239EDB3DEDA44D89C6">mobile toilets</a>, where construction may not be possible. Governments also need to ensure that sewage treatment facilities, where available, are functioning correctly to avoid the discharge of poorly treated water containing harmful bacteria and faeces into rivers.</p>
<p>The Department of Water and Sanitation of South Africa must also ensure that wastewater treatment plants adhere strictly to Section 39 of the National Water Act, 1998, <a href="https://www.wqms.co.za/infopages/236">which provides guidance</a> for quality and management of wastewater.</p><img src="https://counter.theconversation.com/content/150551/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Akebe Luther King Abia is affiliated to the Aspen Institute through the Aspen New Voices Fellowship. He is also a member of the Antimicrobial Research Unit, University of KwaZulu-Natal. This work was funded by the Water Research Commission of South Africa, and was part of a larger project on the dynamics and health implications of microbial pathogens in South African water resource sediments under changing climates</span></em></p>Water at informal settlements, where sanitation and waste management facilities were absent, had high bacteria levels.Akebe Luther King Abia, Research Scientist, University of KwaZulu-NatalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1505402020-11-24T05:36:57Z2020-11-24T05:36:57ZWe should talk more about toilets<figure><img src="https://images.theconversation.com/files/370951/original/file-20201124-17-j4xabd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We need a toilet design solution that suits local people's needs.</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/gender-88808/">Hafidz Alifuddin/Pexels.com</a></span></figcaption></figure><p>The United Nations (UN) designated 19 November as <a href="https://www.un.org/en/observances/toilet-day">World Toilet Day</a> to raise awareness that <a href="https://www.who.int/water_sanitation_health/publications/jmp-report-2019/en/">4.2 billion</a> people live without access to safe sanitation, including in Indonesia.</p>
<p>In Indonesia, around <a href="https://www.unicef.org/indonesia/water-sanitation-and-hygiene">25 million people</a> do not use the toilet when defecating. <a href="https://www.usaid.gov/actingonthecall/stories/indonesia-wash">One in three people</a> does not have access to flush toilets, latrines, or septic systems. Instead, they defecate in fields, bushes, forests, ditches, roads, canals, or other open spaces.</p>
<p>Research shows that poor sanitation <a href="https://www.ajtmh.org/content/journals/10.4269/ajtmh.18-0063">threatens children’s health, causing diarrhoea in Bandung, Indonesia</a> and <a href="https://doi.org/10.1016/j.ijpara.2016.07.005">infection with giardiasis</a> (digestive disorders due to parasitic infections in the small intestine) in Timor Leste.</p>
<p>Also, previous research in <a href="https://magdalene.co/story/poor-sanitary-and-hygiene-condition-at-schools-affect-female-students">Jakarta, East Nusa Tenggara and West Nusa Tenggara</a> shows that <a href="https://www.smeru.or.id/en/content/menstrual-hygiene-management-mhm-case-study-primary-and-junior-high-school-students">inadequate toilet facilities</a> and school infrastructure cause female students to change sanitary pads during menstruation rarely. Consequently, they are at risk of experiencing reproductive health problems. Some do not continue their studies.</p>
<h2>Health communication for toilet campaign</h2>
<p>Clean water and sanitation for all, which includes access to sanitary toilets, are part of the <a href="https://www.un.org/sustainabledevelopment/water-and-sanitation/">Sustainable Development Goals</a>.</p>
<p>Communication plays a vital role in changing the views and behaviour of individuals and communities who do not have or use toilets. But, campaigns on the importance of healthy toilets are lacking in Indonesia. </p>
<p>UNICEF provides a communication program campaign guide on sanitation using <a href="https://www.unicef.org/wash/%20files%20/%20com_e.pdf">the (ACADA: Assessment, Communication Analysis, Design, and Action)</a> model. Governments and non-governmental organisations can combine this model with the principle of health and risk communication involving <a href="https://www.who.int/risk-communication/training/Module-B5.pdf">community engagement</a>.</p>
<p>Governments and non-governmental organisations that hope to succeed in implementing sanitation programs need to understand the role of customs, beliefs, and community participation in constructing toilet facilities.</p>
<p>There is a myth developed in some areas, for example, <a href="https://ejournal.undip.ac.id/index.php/presapor/article/view/20782/14083">there should be no holes in the village</a>, so there are no toilets or WC in the village.</p>
<p>Therefore, program managers need to involve the community in creating a communication strategy before carrying out a campaign. Toilet health and sanitation promotion programs must avoid <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dech.12075">shaming</a> local culture.</p>
<p>Communication between program managers and local communities can provide good opportunities in the toilet prototyping process from the beginning of the design process. Involving the local community in visualising toilet design has been successful in <a href="https://doi.org/10.1177/095624780301500202">public toilets in Pune and Mumbai, India</a>.</p>
<p>About 600 million people in India do not use toilets. To solve this problem, <a href="https://www.sparkarchitects.com/world-toilet-day-spark-is-working-with-an-indian-university-to-deliver-an-easily-transportable-3d-printed-toilet/">India</a> built <a href="https://www.dezeen.com/2018/11/21/big-arse-toilet-spark-architects-3d-printed-generates-electricity/">3D printed toilets</a> for local people.</p>
<p>For Indonesia, we need a toilet design solution that suits local people’s needs.</p>
<h2>Overcome obstacles</h2>
<p>To involve communities to create communication channels sensitive to local cultures and languages, program managers can use the <a href="https://pubmed.ncbi.nlm.nih.gov/9112096/">Health Belief Model</a> (HBM) theory.</p>
<p>Based on HBM, two main things influence whether a person will adopt certain behaviours to protect his/her health.</p>
<p>First, they must personally feel vulnerable to the disease, so they should perceive that they are at risk. Second, the person must believe that the recommended measures will be effective in reducing the risks and the benefits outweigh the <a href="https://pubmed.ncbi.nlm.nih.gov/9112096/">costs of contracting the disease</a>.</p>
<p>This model also identifies psychological, structural, or financial barriers that influence health behaviour. For example, HBM will help program managers identify <a href="https://www.tandfonline.com/doi/abs/10.1080/108107398127157">what attitudes, lack of access or resources</a> that stop a family from building a toilet at home.</p>
<p>In <a href="https://www.unicef.org/wash/files/Soap_Stories_and_Toilet_Tales.pdf">Slaeng, Cambodia</a>, a village leader used these strategies and tactics to change the community’s behaviours using toilets. </p>
<h2>Toilet can protect our health</h2>
<p>Every day <a href="https://www.cnnindonesia.com/gaya-hidup/20181119120953-255-347634/krisis-toilet-yang-mengganggu-kehidup-manusia">14 thousand tons</a> of faeces pollute water bodies in Indonesia.</p>
<p>This is caused by overflows and leaks from pipes and septic systems, improper disposal and handling cause untreated human waste to contaminate the environment as well as inadequate toilets and the behaviour of people who practice open defecation.</p>
<p>Increasing access to sanitation facilities and toilets can reduce infection and death rates, especially in <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0106738">maternal and child health</a>.</p>
<p>Also, hygienic bathrooms and toilets with clean running water, sinks, and soap can help women and <a href="https://www.hindawi.com/journals/jeph/2018/1730964/">girls through menstruation</a> safely and healthily.</p>
<h2>Toilet and sustainable sanitation</h2>
<p>The effects of climate change also threaten water infrastructure, sanitation, and hygiene. When floodwater <a href="https://www.weforum.org/agenda/2018/11/what-do-toilets-have-to-do-with-climate-%20change%20/">contaminate wells used for drinking water or damage toilets</a>, human waste can spread to the community and food plants.</p>
<p>We need <a href="https://orsociety.tandfonline.com/doi/abs/10.1057/s41275-017-0062-x">sustainable sanitation</a> that’s resistant to external shocks such as flooding, water shortages, and sea-level rise.</p>
<p>Approximately <a href="https://www.sciencedirect.com/science/article/abs/pii/S0378377413002163?via%3Dihub">80% of the community’s waste-water</a> flows back into the ecosystem without being treated or reused. Sustainable sanitation systems capture, transport, treat, dispose, and safely reuse human waste.</p>
<p>Managing human waste through safe and environmentally friendly toilets is the key to reducing the impact of untreated waste-water.</p><img src="https://counter.theconversation.com/content/150540/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Juhri Selamet tidak bekerja, menjadi konsultan, memiliki saham, atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi selain yang telah disebut di atas.</span></em></p>Communication between programmers and local communities can provide good opportunities in the toilet prototyping process from the beginning of the design process.Juhri Selamet, Lecturer, Universitas Multimedia NusantaraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1065422018-11-20T13:19:54Z2018-11-20T13:19:54ZWhy, even with more access to toilets, women in a Kenyan slum avoid them<figure><img src="https://images.theconversation.com/files/246168/original/file-20181119-76134-1ovaugb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New toilet blocks in Mathare Valley informal settlement in Nairobi.</span> <span class="attribution"><span class="source">Samantha Winter</span></span></figcaption></figure><p>About <a href="https://washdata.org/sites/default/files/documents/reports/2018-01/JMP-2017-report-final.pdf">2.3 billion</a> people around the world lack access to basic toilets. This leads to poor sanitation and about <a href="http://www.who.int/en/news-room/fact-sheets/detail/sanitation">280,000 people</a> per year die as a result. But the global sanitation crisis isn’t equally distributed. Women in developing countries are <a href="http://journals.sagepub.com/doi/10.1177/0956247814564528">disproportionately burdened</a> by the <a href="http://eprints.uwe.ac.uk/25927/2/geelongtoiletmar2.pdf">persistent</a> lack of access to sanitation in their homes, communities, schools and public spaces. </p>
<p>Women and girls who rely on shared toilets, at schools or in densely populated urban settlements, <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2014.302525">lack</a> privacy, safety and hygiene to comfortably manage their daily toilet and menstruation needs. </p>
<p>This threatens their health. <a href="http://eprints.uwe.ac.uk/25927/2/geelongtoiletmar2.pdf">Exposure</a> to harmful bacteria in unsanitary environments puts women at risk of urinary tract infections, toxic shock syndrome and vaginal infections. Holding in their urine and faeces also puts them at <a href="https://www.tandfonline.com/doi/abs/10.1080/17441692.2015.1062905?journalCode=rgph20">risk of</a> dehydration and haemorrhoids. </p>
<p>We carried out <a href="https://www.tandfonline.com/doi/abs/10.1080/17441692.2018.1534256?journalCode=rgph20">a study</a> in Mathare Valley informal settlement in Nairobi, Kenya to better understand women’s daily sanitation practices and what influences their decision to use facilities in the settlement. </p>
<p><a href="https://mappingnobigdeal.wordpress.com/2011/04/29/second-phase-of-water-and-sanitation-mapping-%E2%80%93-intermediary-analysis/">Seven</a> years ago there were about 144 public toilet facilities in Mathare. <a href="https://academic.oup.com/heapro/article/31/2/258/1749406">Anywhere from</a> 17 to 232 people relied on a single toilet and over 70% of residents had to walk more that 50 meters to reach a toilet. </p>
<p>Since then, there’ve been concerted efforts by non-governmental organisations and the government to increase the number of toilets in Mathare. For instance Sanergy, a social venture, <a href="http://www.saner.gy/archives/5907">has launched</a> more than 140 toilets in Mathare. But many of the existing toilets still require payment to use, between KES 3 and KES 10 per use (USD$0.03 - USD$0.10). </p>
<p>Despite the growing availability, many women still don’t always use them. </p>
<p>In <a href="https://doi.org/10.1080/09603123.2018.1497778">our study</a> we found that about one-third of women relied on a bucket, plastic bags or open defecation at least once during the day and over two-thirds rely on those methods at night. </p>
<p>This means that its not just access that’s the issue. Many women aren’t using the new facilities because of concerns over their safety, privacy, health and ability to pay to use them.</p>
<p>Future interventions must address these problems – and not just supply toilets – if sustainable gains in this important public health area are to be achieved. </p>
<h2>Informal settlements</h2>
<p><a href="http://projects.worldbank.org/P113542/kenya-informal-settlements-improvement-project-kisip?lang=en">About</a> 6.5 million of Kenya’s 45.5 million people live in urban informal settlements. The population living in these settlements increased <a href="https://unhabitat.org/wp-content/uploads/2016/02-old/Slum%20Almanac%202015-2016_EN.pdf">by more</a> than three times, from 1.5 million to more than 6.4 million between 1990 and 2014 and is still expected to keep growing. This will exacerbate the challenges women face when it comes to sanitation. </p>
<p>We collected data in two phases between 2015 and 2017. During the first phase we partnered with representatives from the University of Nairobi and female residents from Mathare to conduct in-depth case studies with 55 women living in Mathare. In the second phase we worked with female residents in Mathare to carry out 550 household-level surveys with women.</p>
<p>We found that, about 40% of women relied on public toilets for some of their sanitation needs during the day, but are unable to rely solely on these toilets. Within 24 hours, 75% of women relied on plastic bags or buckets at least once for their ablutions. They then dispose of these in open drains or rivers near their homes. </p>
<p>This is surprising. Over the last few years there have been efforts to increase access to toilets in Mathare. Notable among them are Sanergy’s <a href="http://www.saner.gy/">fresh life toilets</a>, Grand Challenge Canada’s funded <a href="https://www.grandchallenges.ca/grantee-stars/0298-01/">Banza toilets</a> and a government effort under the National Youth Service’s <a href="https://journals.sagepub.com/doi/full/10.1177/0956247816689218">slum improvement project</a>. Each of these projects focused on some aspect of increasing access to sanitation, from provision of innovative toilets to household rubbish collection, drainage cleanup, and toilet construction and management. </p>
<p>A number of factors prevent women from regularly using the facilities. </p>
<p>Women fear victimisation – like sexual assault, rape, or theft – poor cleanliness and a lack of privacy. On average, toilets in Mathare <a href="https://academic.oup.com/heapro/article/31/2/258/1749406">are shared</a> by 70 people, with many being used by hundreds of people. This makes it very difficult to maintain them.</p>
<p>We found that <a href="https://doi.org/10.1080/09603123.2018.1497778">one or more</a> of the stalls at public toilets have missing doors or locks, are flooded or blocked, or aren’t cleaned well. Several of the public toilets, which have separate sections for men and women, aren’t always open or have closed one of the gender sections. Having to share facilities is a factor that makes women feel insecure, particularly at night. </p>
<p>The women didn’t see the toilets as safe spaces. They also don’t feel safe in the settlement. Participants said they felt unsafe leaving their homes at night, even if the toilets were located within a short walking distance.</p>
<p>Another reason women wouldn’t use the facilities is because most charge them, and they can’t afford to pay. Most toilets in Mathare charge a pay-per-use fee between KES 3 and KES 10 per use (USD$0.03 - USD$0.10). If they can afford the “family fee” (a bulk payment), then they can pay KES 100 to KES 150 per month (US$1 - US$1.50). The average household income in Mathare is about KES 8500 (USD$85), and estimated monthly expenditures <a href="http://healthycities.berkeley.edu/uploads/1/2/6/1/12619988/matharevalley_report_ucb_2_25_2012_final.pdf">often exceed</a> this amount. This leaves little or no money for spending on sanitation. </p>
<p>On top of this, we found that some women don’t have the decision making power or control over household spending to allocate additional funds to sanitation. </p>
<p>Interestingly, many of the community toilets in Mathare have separate urinals for men that are free to use but there’s no setup like this for women. </p>
<h2>Solutions</h2>
<p>When we asked the participants what would work for them, some <a href="https://www.tandfonline.com/doi/full/10.1080/09614524.2018.1519013">suggested</a> they needed more access to free urinals – one or two stalls in a public toilet facility – that they could use for urination and to change menstrual pads.</p>
<p>We also suggest that policymakers need to start accounting for other challenges to sanitation access, like strategies that increase women’s safety and privacy, especially at night. For example, <a href="https://challenges.openideo.com/challenge/womens-safety/shortlist/prakasa-lighting-tomorrow-with-today">better lighting</a> in and around public toilets or community or technological innovations to help women <a href="https://www.theguardian.com/world/2016/dec/12/india-sexual-assault-women-safety-apps">feel safer</a> when accessing public toilets.</p><img src="https://counter.theconversation.com/content/106542/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samantha Winter received funding for this project from the National Security Education Program in the United States as a Boren Fellow, PEO International, and the Rutgers Global Health Institute. </span></em></p>Women in developing countries are burdened by the lack of access to proper toilets in their homes, communities, schools and public spaces.Samantha Winter, Postdoctoral fellow, Rutgers UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1067562018-11-18T08:52:33Z2018-11-18T08:52:33ZSome smart ideas to make toilets fit for purpose in Africa’s cities<figure><img src="https://images.theconversation.com/files/245922/original/file-20181116-194513-1ya5wj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Every flush by a typical toilet sends about 6 to 16 litres of fresh water to wastewater treatment centres. </span> <span class="attribution"><span class="source">lchumpitaz/Shutterstock</span></span></figcaption></figure><p>About 23% of people living in Sub-Saharan Africa <a href="https://data.unicef.org/topic/water-and-sanitation/drinking-water/">don’t have access to toilets</a> while 31% with toilets use one’s that aren’t connected to a formal sanitation system. This means that more than half the people in sub-Saharan Africa live without proper sanitation – that’s about 570 million people. </p>
<p>One of the problems is that existing toilets aren’t a good fit for parts of sub-Saharan Africa because many areas lack water and there are often no proper plumbing or facilities to treat wastewater. </p>
<p>But there are solutions – toilets that are <a href="https://www.researchgate.net/publication/288827548_Innovative_Toilet_Technologies_for_Smart_and_Green_Cities">designed differently</a>. We have come up <a href="https://www.researchgate.net/publication/288827548_Innovative_Toilet_Technologies_for_Smart_and_Green_Cities">with some innovative designs</a> overcome the two biggest challenges – excessive use of water, and the fact that urine and faeces aren’t considered as resources.</p>
<p>The designs we suggest have a number of key features. Primarily, they use no water and store and treat urine and faeces separately. They include innovative technologies that reduce water and energy consumption – both vital steps if we’re going to start building smarter, greener cities. </p>
<h2>Problems with current designs</h2>
<p>Every flush by a typical toilet sends about six to 16 litres of fresh water to wastewater treatment centres. That’s a lot of water. The average <a href="https://water-for-africa.org/en/water-consumption.html">total water consumption</a> per person in Africa is about 20 litres a day. </p>
<p>On top of this, the treatment of waste uses up a huge amount of energy – about three to 15 kWh/m3. This energy is being used to provide fresh water from different sources – like dams – for the flushing process and <a href="https://www.iwapublishing.com/news/physico-chemical-water-treatment-processes">to treat</a> the produced wastewater. It’s a huge amount of energy given the fact that we need only about 2kWh <a href="https://www.forbes.com/sites/christopherhelman/2013/09/07/how-much-energy-does-your-iphone-and-other-devices-use-and-what-to-do-about-it/#66c9ee722f70">to charge</a> a smart phone over a whole year. </p>
<p>The process of treating wastewater, so that it can be recycled and reused, is expensive because urine and faeces are mixed at the source. This makes treatment lengthy, expensive and power intensive. It’s also bad because there are valuable elements in human waste – like nitrogen and phosphorous – that aren’t being extracted and reused. </p>
<p>The cost of a more innovative toilet system can be higher than others – like pit latrines – but it really depends on the raw construction materials like concrete and wood. Tanks and other parts can also be made through locally available materials – like jerrycans. But once it’s built, the operation and maintenance process is easy and can be done by local labours. </p>
<h2>New ideas</h2>
<p><strong>Separate waste:</strong> Our main idea, when it comes to improving toilets, is to view urine and faeces as a resource instead of waste. Nutrients from human waste – which can be used as a <a href="https://www.sciencedirect.com/science/article/pii/S0959652614000948">fertiliser</a> to grow crops – can be removed during the treatment process through better management and technology.</p>
<p>To take advantage of this, the urine must be separated from the faeces. There are many toilets <a href="https://doi.org/10.2166/9781780404851">around the world</a> that already do this. In some Asian countries, like Korea, Japan and Vietnam, it’s a traditional mechanism. </p>
<p>These toilets look similar to normal ones but there are two different inlets that store the waste in different tanks. Here they can be treated to remove smell and increase their fertility.</p>
<p>It’s a highly efficient process which doesn’t need complicated infrastructure and reduces the time needed for the treatment of waste. The system saves a huge amount of water and energy, which is beneficial to many local governments that are already <a href="https://water-for-africa.org/en/water-consumption.html">under pressure</a>.</p>
<p><strong>Waterless</strong>: For most existing toilets, water is essential for flushing and draining. But it’s possible to have a waterless toilet. Again, the toilet must collect the urine separately from the faeces. Instead of flushing, the faeces and urine are separated from the source using <a href="http://www.wecf.eu/download/2009/08-09-25WECF_ConstructionUDDT.pdf">urine-diverting dry toilets</a>. These toilets are available in both sitting or squatting models and take advantage of the anatomy of the human body, which excretes urine and faeces separately. The urine is kept separate and drained via a basin with a small hole near the front of the toilet bowl or squatting pan, while faeces fall through a larger drop-hole at the rear.</p>
<p><strong>Enhance waste</strong>: When waste is separated and collected into tanks, microbes can be added to them which ‘nitrify’ the waste – making it a better fertiliser – and control any bad smells from the toilet. </p>
<p><strong>Community support:</strong> If these toilets are used communally they can bring huge social and economic benefits for communities. While common toilet systems are expensive to maintain, and pit latrines can be public health hazards, these systems are safe and can provide an <a href="https://doi.org/10.1016/j.scitotenv.2018.09.009">excellent source</a> of fertiliser for groups that grow their own food, or produce food for markets. </p>
<p>As African cities grow and develop, and pressure on natural resources and infrastructure – like sewerage – increase, these systems offer a sustainable and more hygienic way forward.</p><img src="https://counter.theconversation.com/content/106756/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mooyoung Han receives funding from Korea Research Foundation. He is affiliated with Water and Sanitation Appropriate Technology(WASAT) center at Seoul National University.</span></em></p><p class="fine-print"><em><span>Shervin Hashemi is affiliated with Department of Civil and Environmental Engineering, Seoul National University. </span></em></p>Existing toilets aren’t a good fit for parts of sub-Saharan Africa because many areas lack water and there’s often no proper plumbing.Mooyoung Han, Professor , Seoul National UniversityShervin Hashemi, Research fellow, Seoul National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/917242018-02-20T14:37:28Z2018-02-20T14:37:28ZWhy your tourist toilet habits are bad for locals – and the environment<figure><img src="https://images.theconversation.com/files/206809/original/file-20180216-50550-1yppnws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>While many prospective holidaymakers actively seek a change in cuisine or climate when choosing their destination, standardised sanitation usually remains a must.</p>
<p>You might think that the preference for a porcelain pew is harmless, but in reality it can put a serious strain on both the local population and the environment. In fact, many of the most pervasive problems associated with tourism can be seen through the toilet bowl.</p>
<p>Research suggests that in some locations <a href="https://www.sciencedirect.com/science/article/pii/S0261517711000793">up to 40% of water is consumed by tourists</a>. Tourists tend to splash out <a href="https://www.tourismconcern.org.uk/wp-content/uploads/2014/09/Unit2-Resource-A-1.pdf">far more per day on average</a> than local residents, who are often <a href="https://www.sciencedirect.com/science/article/pii/S0160738312000047">outcompeted</a> by industry for water access. Using limited freshwater supplies to flush tourists’ toilets means less for residents’ drinking, cleaning and cooking needs.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Don’t be scared.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-style-japan-toilet-415484425?src=dQP67N10AKsBsw_E8TjrIg-1-3">Heemsuhree/Shutterstock</a></span>
</figcaption>
</figure>
<p>Environmentally, the sheer volume of incoming tourists can come at a high price. Local sewage facilities often struggle to cope with the influx of human waste. Many small islands with limited infrastructure, <a href="https://www.researchgate.net/profile/Michelle_Mycoo/publication/249023794_Sustainable_Tourism_Using_Regulations_Market_Mechanisms_and_Green_Certification_A_Case_Study_of_Barbados/links/5591255108aed6ec4bf69627.pdf">such as Barbados</a>, have no choice but to pump raw sewage straight into the sea, putting vast swathes of the Caribbean’s coral reefs at risk.</p>
<p>This defecatory deluge also depletes limited water reserves. In Cape Town, hotels are having to <a href="http://www.independent.co.uk/travel/news-and-advice/cape-town-drought-water-shortage-luxury-five-star-hotels-day-zero-laundry-showers-toilet-flush-pool-a8191966.html">abruptly limit guests’ water usage</a> as the city suffers drought. In Bali, fast-growing tourism demand is linked to <a href="http://www.idepfoundation.org/en/bwp/summary">rapid depletion of the island’s water resources</a>.</p>
<h2>Sanitation solutions</h2>
<p>These economic and environmental harms often stem from a misplaced sense of cultural superiority that accompanies us to the bathroom. The internet is awash with travellers’ <a href="https://thetravelmanuel.com/why-malaysia-has-the-worst-toilets-in-the-world/">toilet horror stories</a>, written with apparently little social sensitivity or willingness to compromise.</p>
<p>Those fortunate enough to be able to travel might want to remind themselves of UN estimates for 2017, which suggest that <a href="http://www.unwater.org/new-publication-whounicef-joint-monitoring-programme-2017-report/">61% of the global population</a> – roughly 4.5 billion people – lack access to a toilet or latrine that disposes of waste safely. Westerners tend to judge other cultures harshly, when really they should be judging global inequality, poverty and politics.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/xtn21JwhPiE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Perhaps some judgement should be reserved for people in rich countries themselves, where bathroom norms aren’t exactly perfect. For example, <a href="https://www.theguardian.com/lifeandstyle/2015/may/18/truth-about-poo-doing-it-wrong-giulia-enders-squatting">squatting</a> rather than sitting is better for the colon. Rather than a sight to be avoided, a glance at one’s waste before flushing can in fact be a <a href="https://www.cnwl.nhs.uk/wp-content/uploads/Healthy_Bowel-_Patient_Information_leaflet.pdf">quick and easy health check</a>. Embarrassment about bodily functions is inhibiting when holidays are meant to be liberating.</p>
<p>Different sanitation solutions suit different situations. The <a href="http://www.worldbank.org/en/news/feature/2017/11/17/world-toilet-day-2017">World Bank</a> and the <a href="https://www.worldwildlife.org/magazine/issues/fall-2016/articles/sustainable-toilets-and-their-role-in-freshwater-conservation">WWF</a> have both worked to celebrate toilet innovations across the world that challenge preconceptions and improve sustainability. For instance, <a href="http://www.worldbank.org/en/news/feature/2017/11/17/world-toilet-day-2017">urine-diverting privies in Bolivia</a> are an integral link in a chain that converts waste into fertiliser for growing crops. Cranfield University is developing the <a href="http://www.nanomembranetoilet.org/">Nano Membrane Toilet</a>, which converts waste into clean water and energy, without the need for external power or water.</p>
<p>Some Western tourist locations are already rethinking their taste in toilets. Composting toilets introduced in various Scottish nature reserves have proved <a href="https://www.fvl.org.uk/files/2314/5933/7417/Eco-loo_Case_Studies.pdf">highly popular with visitors</a>. Melbourne Zoo and other attractions have implemented <a href="https://www.zoo.org.au/about-us/vision-and-mission/environmental-sustainability/saving-water">water conservation and recycling measures</a> in restrooms, including waterless urinals. The increasing use of such practices by authorities and businesses will only help to challenge harmful expectations when people travel further afield.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/jGPpXF7y9Rg?wmode=transparent&start=37" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>Potty training</h2>
<p>There are also simple changes that tourists can make when going to the bathroom that will have a positive impact on the environment and local communities, and possibly even lead to more interesting holiday experiences.</p>
<p>Remember that different ecological settings require different bathroom styles. Always avoid flushing wipes and other non-biodegradables. In water stressed areas, be conscious of your water usage. Don’t demand what local people don’t have. The threat of extreme drought has forced Cape Town luxury hotels to ask guests to limit the length of showers, turn off the tap while brushing their teeth, and <a href="http://www.independent.co.uk/travel/news-and-advice/cape-town-drought-water-shortage-luxury-five-star-hotels-day-zero-laundry-showers-toilet-flush-pool-a8191966.html">let it mellow if its yellow</a>, but actions like these could benefit locals in tourist destinations across the developing world.</p>
<p>Support small businesses. Their toilets may not always be gleaming, but the experience might be more memorable. While luxury tourism in developing countries <a href="https://theconversation.com/is-it-ethical-to-take-a-luxury-holiday-in-a-developing-country-80984">rarely benefits those in need</a>, going local is one way to contribute. </p>
<p>Lastly, nurture your sense of adventure. If you want to live like a local, you should defecate like one. Pack your hand sanitiser and spare toilet roll, and immerse yourself in local culture. Get ready to try out new facilities, not just whatever commode is à la mode. There are <a href="http://www.traveller.com.au/traveller-10-the-worlds-top-toilets-gzs1l0">toilet attractions</a> dotted all over the globe that are well worth a visit. For example, why not try the <a href="https://www.theguardian.com/world/2012/nov/09/south-korea-toilet-theme-park">Haewoojae Museum</a> in South Korea, solely dedicated to celebrating the lavatory.</p>
<p>We shouldn’t expect all toilets to look the same. Tourism is about challenging expectations, exploring alternatives and expanding horizons. For the sake of the environment and the vulnerable, it is high time that we became more open-minded and adventurous with our toilette when travelling. After all, when in Rome, wipe as the Romans wiped (using a <a href="https://www.theatlantic.com/health/archive/2016/01/ancient-roman-toilets-gross/423072/">wet sponge on a stick</a>, apparently).</p><img src="https://counter.theconversation.com/content/91724/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brendan Canavan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you want to live like a local when on holiday, you should defecate like one.Brendan Canavan, Senior Lecturer in Marketing, University of HuddersfieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/690152016-11-18T16:59:23Z2016-11-18T16:59:23ZWhy it’s easier for India to get to Mars than to tackle its toilet challenge<figure><img src="https://images.theconversation.com/files/146550/original/image-20161118-19356-1ska9lw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Public toilets in the city of Varanasi in India.</span> <span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/9/90/India_-_Varanasi_public_toilet_-_2118.jpg">Jorge Royan</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>In 2013, India became the fourth country in the world (after Russia, the United States and the European Union) and the only emerging nation to launch <a href="http://www.dnaindia.com/india/commentary-as-it-happened-isro-s-mars-orbiter-mission-spacecraft-separates-from-pslv-c25-successfully-enters-earth-s-orbit-1913946">a Mars probe</a> into space. But it remains part of the group of 45 developing countries with less <a href="http://www.thehindu.com/data/what-numbers-tell-us-about-open-defecation-in-india/article9176392.ece">than 50% sanitation coverage</a>, with many citizens practising open defecation, either due to lack of access to a toilet or because of personal preference. </p>
<p>According to the <a href="http://censusindia.gov.in/2011census/hlo/Data_sheet/India/Latrine.pdf">Indian census of 2011</a>, only 46.9% of the 246.6 million households in India had their own toilet facilities, while 3.2% had access to public toilets. In this context, the remaining 49.8% households had no option but to defecate in the open. As a point of comparison, in 2011 53.2% of households had <a href="http://www.bbc.com/news/world-asia-india-17362837">a mobile phone</a>. In rural areas, where nearly 69% of India’s population lives, 69.3% of households lack toilets; in urban areas that number falls to 18.6%. </p>
<p>At first glance, such statistics and technological capabilities alongside large-scale open defecation is a puzzle. On the supply side, it does not seem difficult for a country that can construct sophisticated and complex <a href="https://theconversation.com/smartphones-in-india-how-to-get-1-25-billion-people-online-65137">cell phone</a> technology to develop the capacity to build simple low-cost toilets. And for users, a toilet evidently offers more social benefits in terms of health and human dignity than a telephone. </p>
<p>Yet the citizenry has not enthusiastically adopted low-cost toilets, especially rural households. Why? Let us explore the reasons for this paradoxical outcome. </p>
<p>At a systemic level, <a href="https://www.econometricsociety.org/publications/econometrica/1957/10/01/hybrid-corn-exploration-economics-technological-change">economists have pointed out</a> that technical and commercial availability and consumer acceptability of an <a href="http://www.jstor.org/stable/3502005?seq=1#page_scan_tab_contents">innovation</a> are the two main drivers of its diffusion. Evidently both are a problem in India. </p>
<p>For firms, it makes business sense to provide mobile phones in a variety of quality-price ranges as the network infrastructure is well developed and demand for this communication tool is assured. However, they are not interested in selling low-cost toilets to the poor, as the need for that product is not supported by a willingness or capacity to pay for it. </p>
<h2>State programmes for sanitation coverage</h2>
<p>Because companies are disinclined to market a product that requires investment in awareness and demand creation, the state must step in. </p>
<p>From the mid-1980s till the late 1990s, when India adopted economic reform, toilets were distributed free via the top-down state-funded Central Rural Sanitation Programme. But the programme, which assumed that availability would automatically lead to usage, failed because most beneficiaries did not see the need or have the desire for sanitation. </p>
<p>Consequently, in the new millennium, the Indian government switched to demand-focused interventions. Today, the state is a financier for <a href="http://www.sciencedirect.com/science/article/pii/S0040162511001314">public-private partnerships</a> involving NGOs, micro-finance companies and <a href="http://www.sulabhinternational.org/wp-content/uploads/2015/07/SISSO-Case-Study-IIM-Ahmedabad.pdf">other social enterprises</a> that <a href="http://www.sciencedirect.com/science/article/pii/S0040162516304735">interact closely</a> with the targeted beneficiaries to provide accompaniment and education for sanitation literacy and use. </p>
<p><a href="http://www.mdws.gov.in/sites/default/files/Total%20Sanitation%20Campaign%20Sanitation%20for%20All%20-%202012.pdf">The Total Sanitation Campaign</a> launched in April 1999, emphasised that “Information, Education and Communication” should precede sanitation construction to ensure sustained demand and behavioural change.</p>
<p>State investment in sanitation thereafter received another fillip under Prime Minister Narendra Modi. He is the first politician since <a href="http://blogs.wsj.com/briefly/2015/10/01/5-things-mahatma-gandhi-said-about-sanitation/">Mahatma Gandhi</a> to emphatically underscore, through major media campaigns, that a “clean India” is necessary for the well-being of its citizens. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/146539/original/image-20161118-19345-1qs927d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/146539/original/image-20161118-19345-1qs927d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=902&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146539/original/image-20161118-19345-1qs927d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=902&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146539/original/image-20161118-19345-1qs927d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=902&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146539/original/image-20161118-19345-1qs927d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1133&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146539/original/image-20161118-19345-1qs927d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1133&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146539/original/image-20161118-19345-1qs927d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1133&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Modi during a cleanliness drive in Assi Ghat Varanasi.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/narendramodiofficial/15515129203/in/photostream/">Narendra Modi Official/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>On October 2 2014, to commemorate Mahatma Gandhi’s birth anniversary, Modi inaugurated the <a href="http://www.pmindia.gov.in/en/government_tr_rec/swachh-bharat-abhiyan-2/">Swachh Bharath Mission</a>, or the Clean India Mission. Unlike the earlier state programmes, it recognises that “availability” does not guarantee “acceptability”. The central objective of the mission is to eliminate open defecation in India by 2019, not just to ensure universal sanitation coverage. </p>
<p>The target is to transform villages and cities into “open defecation-free” communities, meaning they demonstrate: toilet access, toilet use and toilet technology that keeps both people and the environment safe. The programme <a href="https://www.theguardian.com/global-development-professionals-network/2016/nov/18/open-defecation-india-solution-world-toilet-day">invests</a> in capacity building in the form of trained personnel, financial incentives and systems for planning and monitoring to ensure behavioural change. States are given flexibility in terms of implementation. Today, a variety of experiments, from the national to village level, are underway to achieve Modi’s Clean India mission. </p>
<h2>It’s not just about building toilets</h2>
<p>But for India, providing access to some form of a toilet is the easy part. <a href="http://www.epw.in/journal/2014/38/special-articles/revealed-preference-open-defecation.html">What’s harder is getting people to use them</a>. In rural areas, toilet-rejection varies by gender. </p>
<p>An ongoing <a href="http://www.mnemerge.com">study</a> based on 300 focus groups with men across the country revealed that they prefer open defecation to a toilet because it: saves water; provides access to fresh water and a breezy environment; lowers the wear and tear of the toilet; protects women from getting embarrassed by the sight of men; and offers a handy excuse to escape importunate wives and mothers.</p>
<p>Public agencies try to persuade families to invest in toilets for the <a href="http://www.pri.org/stories/2016-05-12/india-access-toilets-remains-huge-problem-worst-all-women-and-girls">safety of their young girls</a>. But in Tamil Nadu villages, another focus group-based study – this one with female teachers and girls – revealed that a central advantage of open defecation is that it offers opportunities for same-sex social interactions for females. </p>
<p>Girls and women in many regions are not allowed to gather in <a href="https://www.icrw.org/not-just-an-urban-problem-how-icrw-is-working-to-expand-public-safety-to-women-and-girls-in-rural-areas-3/">public places</a> to debate issues, exchange ideas or simply relax together. Adolescents face even greater restrictions, because older women often sanction free discussion among youngsters. In this regard, open defecation rendezvous offer an excuse to talk and spend time together free, from other constraints. </p>
<p>In the isolated villages we visited with largely Dalit and fisherfolk populations in Tamil Nadu, the risk of <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3797-z">sexual harassment</a> is not perceived to be high enough to make toilets a safe haven. Thus, to eliminate open defecation in such villages, alternative safe gendered spaces for social interactions are needed first. </p>
<h2>Cooperation between the players</h2>
<p>India’s additional <a href="http://www.merit.unu.edu/publications/books/book-abstract/?id=5487">challenge</a> is to <a href="http://www.sciencedirect.com/science/article/pii/S1353829214000768">diffuse not just any toilet but a high-quality</a>, long-lasting, non-contaminating product that minimises water and soil pollution and promotes sustained use. This will require that the sanitation subsystem (i.e. the part under the toilet seat/slab), and its <a href="http://www.sciencedirect.com/science/article/pii/S0040162511001314">waste-processing technology design</a> to be adapted to the <a href="http://phg.sagepub.com/content/35/5/608">geo-physical features</a> of the targeted zone, taking into account soil type, rainfall, water table, water availability, wind velocity and slope.</p>
<p>Thousands of toilets lie abandoned in India either never used or abandoned after short use, due to poor construction quality or inappropriate technology design. </p>
<p>When a toilet’s superstructure begins to deteriorate or the toilets stop working well, problems can emerge. For example, if the family can’t afford or doesn’t want to invest in repairs, or if there isn’t a local agency to repair toilets (which is often the case), foul odours and leaks may begin. This, in turn, creates negative perceptions about toilets, which may trigger a bandwagon effect such that whole the community ultimately <a href="http://www.epw.in/journal/2014/49/notes/open-defecation-india.html">returns to open defecation</a>. </p>
<p>Thus, it is imperative to ensure quality construction in sanitation drives and trained rural masons for individual construction initiatives. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/146543/original/image-20161118-19348-1lfmhpt.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/146543/original/image-20161118-19348-1lfmhpt.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146543/original/image-20161118-19348-1lfmhpt.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146543/original/image-20161118-19348-1lfmhpt.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146543/original/image-20161118-19348-1lfmhpt.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146543/original/image-20161118-19348-1lfmhpt.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146543/original/image-20161118-19348-1lfmhpt.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Tamil woman and her mother-in-law in front of their toilet whose roof caved in - hence the thatch.</span>
<span class="attribution"><a class="license" href="http://artlibre.org/licence/lal/en">FAL</a></span>
</figcaption>
</figure>
<p>To address this need, <a href="http://epaperbeta.timesofindia.com/Article.aspx?eid=31818&articlexml=Masons-to-Get-Skill-Training-for-Future-Housing-25122015015026">various institutions</a> are teaching masonry to youth with little formal education. But there is no common standardised programme that focuses on sanitation systems. Moreover, illiterate rural masons may be intimidated by formal courses and thus fail to attend. </p>
<p>At the same time, since masons learn their craft by doing, or through apprenticeships, their learning is <a href="http://friend-in-need.org/wordpress/wp-content/uploads/2013/12/5a.-mason-innovation-contest-report2009.pdf">slow, shaky and tacit</a> – meaning that two people with the same skill set may execute a project differently. There is a need to address these issues while promoting skills building. </p>
<p>For an emerging country like India, it is easier to take part <a href="http://indianexpress.com/article/technology/science/nasa-invites-india-to-jointly-explore-mars-send-astronauts/">in exploratory missions to Mars</a> than to tackle its sanitation challenge. The former can be addressed through a linear process spearheaded by the advanced, well-resourced Indian Space Research Organisation, while the latter calls for systemic change encompassing thousands of towns and villages. </p>
<p>For India to meet its goal of eliminating open defecation, it will need cooperation and coordination between a diverse variety of systemic actors, generation of knowledge products in the form of accessible curriculum for masons, and community engagement to build only safe toilets – and to use them well.</p><img src="https://counter.theconversation.com/content/69015/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shyama V. Ramani has received research grants from ICSSR (India), Department of Science and Technology (India), NWO (The Netherlands) and the European Commission. She is also the founder-director of Friend In Need India. </span></em></p>For an emerging country like India, it is easier to take part in exploratory missions to Mars than to tackle its sanitation challenge.Shyama V. Ramani, Professorial Fellow, Maastricht Economic and Social Research Institute on Innovation and Technology (UNU-MERIT), United Nations UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/507002015-11-19T11:18:51Z2015-11-19T11:18:51ZGender equality comes one toilet at a time<figure><img src="https://images.theconversation.com/files/102404/original/image-20151118-14191-kxt2hv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Newly built toilets at Harper transit site in Liberia.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/oxfam/5621438439/in/photolist-9yKkNp-2dstet-hgFCnM-cGmus5-7tKRr1-7wcRns-7w94wR-8SivKf-5s6iBM-kY2M6X-kY2Me2-kY3iwK-kY4aEb-kY2Lwv-kY4b1G-kY4aNC-kY49jW-kY49Yw-kY4bbG-kY2LiV-kY4aij-kY3j3K-kY3ieF-kY3jQr-kY3jkP-cAkpq1-pSh5nU-oVmrGw-e9EwNc-5G6dYH-bmCVYQ-cqNXLC-9eAkXo-hiZScc-21f82Q-dWadw7-hye3Ww-7kpFo3-7kkMur-dQxiUB-7S4jdR-e2Cd7w-dW4BHF-dW4BGc-dWaduy-dWadwS-dW4BHP-9Y2De9-hydRok-e2wBg8">Oxfam International/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Across the world, <a href="http://www.unicef.org/publications/files/Progress_on_Sanitation_and_Drinking_Water_2015_Update_.pdf">2.4 billion people</a> do not have access to proper sanitation, including toilets and latrines, with nearly <a href="http://www.unicef.org/publications/files/Progress_on_Sanitation_and_Drinking_Water_2015_Update_.pdf">one billion people</a> left to defecate in the open. </p>
<p>It’s remarkable that today so many people still do not have access to a simple, private place to go to manage their bodily functions in dignity and comfort, putting them at increased risk of disease. And while everyone needs access to proper sanitation to be healthy, for girls and women this is also an issue of safety and equal participation in society. </p>
<p>In fact, one of the United Nations’ new <a href="https://sustainabledevelopment.un.org/?menu=1300">Sustainable Development Goals</a> focuses on ensuring availability and sustainable management of water and sanitation for all “paying special attention to the needs of women and girls.” </p>
<p>Yet research highlighting the effect poor sanitation has on women’s health, safety and equality is nascent, and some issues, including sanitation in workplaces, remain uninvestigated. Here is what we know so far.</p>
<h2>Sanitation and safety</h2>
<p>In countries across Africa, Asia and other low-income regions of the world (and even among the homeless or <a href="https://www.researchgate.net/profile/Joe_Brown7/publication/257781005_Limited_Access_to_Safe_Drinking_Water_and_Sanitation_in_Alabamas_Black_Belt_A_Cross-Sectional_Case_Study/links/54763ff00cf29afed6142001.pdf">rural poor</a> here in the United States), many people don’t have easy access to toilets or latrines.</p>
<p>Even for those who do have access to a toilet, there is no guarantee that it’s clean, private, easy to get to or even safe. A household’s latrine may be located a significant distance from the house, <a href="http://washinschoolsmapping.com/projects/mongolia.html">making access challenging</a> during the nighttime hours or in harsh weather such as monsoon rains or heavy snowfall. This makes girls and women more vulnerable to harm. </p>
<p>Seeking privacy, women might opt to go the toilet in the early morning hours or after dark. If women are forced to manage their needs in the open, such as by the roadside after dark or in a field at dawn, they are at <a href="http://www.susana.org/en/resources/library/details/2098">high risk</a> of <a href="http://eau.sagepub.com/content/27/1/105.full.pdf">violence</a>, including <a href="http://www.bbc.com/news/world-asia-india-22460871">rape</a>. </p>
<p>It’s no surprise, then, that recent evidence from India <a href="http://www.sciencedirect.com/science/article/pii/S0277953615300010">suggests</a> that the significant challenge of finding safe, clean and private places to urinate, defecate and manage their menstruation near the household greatly increases women’s levels of stress. This becomes an even greater challenge when someone has an upset stomach, is experiencing incontinence or is pregnant and needs to urinate more frequently.</p>
<p>Overall, the impact of poor sanitation on women’s and girls’ health remains underinvestigated. While there is recent research linking <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001851">poor sanitation to preterm birth in India</a>, women’s health hasn’t historically been the focus of sanitation-related research.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/102417/original/image-20151118-14183-13ft0cc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/102417/original/image-20151118-14183-13ft0cc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102417/original/image-20151118-14183-13ft0cc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102417/original/image-20151118-14183-13ft0cc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102417/original/image-20151118-14183-13ft0cc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102417/original/image-20151118-14183-13ft0cc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102417/original/image-20151118-14183-13ft0cc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Girls need adequate sanitation facilities to manage menstruation.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/gtzecosan/5570897330/in/photolist-9u1Fzj-9tZ6qh-bW7gFE-b9HuSt-9uhiFY-7iiPYP-7Df4TU-6a77Mm-9tYEs9-9oDGD4-9tYAPt-8ADJcS-ba9P94-9QRzRG-7Df53E-9ugNrW-a9UA3v-9udMaR-cersU1-8PP7j6-cerhpb-9tVF4k-8vLWiR-9ugNxb-9tVF1K-baanB2-8AADMH-8JJNb3-7ALh5H-8ADHJQ-9u3g1C-7DbgVR-baardH-9RZ4M2-9QRxpN-8AADog-7o2eWd-7nXkiT-7nXkgk-7nXkhr-8wFioy-7inLyE-7nXkb2-7o2eGs-7nXk7K-7nXkrR-7nXk9B-7o2eV1-7o2eS5-8ADHyC/">SuSanA Secretariat/Peter Morgan</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Students around the world don’t have access to adequate sanitation</h2>
<p>Research about sanitation in schools is more established. UNICEF (United Nations Children’s Fund) estimates that <a href="http://www.unicef.org/wash/schools/washinschools_53108.html">almost 50% of primary schools</a> in the least- and less-developed countries do not have adequate sanitation (or water) on school grounds. </p>
<p>However, the true number of schools and children affected globally is unknown because many countries do not have robust systems for monitoring school water and sanitation facilities. Even if governments do know that schools lack facilities, constructing them may not be prioritized when budgets are tight. </p>
<p>Moreover, schools that do have facilities <a href="http://water.care2share.wikispaces.net/file/view/Sustaining+School+Hand+Washing+and+Water+Treatments+Programmes.pdf/501019752/Sustaining+School+Hand+Washing+and+Water+Treatments+Programmes.pdf">struggle to maintain</a> them due to recurrent costs for soap or the need to make repairs. </p>
<p>A growing body of evidence <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301374">indicates</a> that many girls and female teachers are uncomfortable in school environments during their monthly menstruation. If toilets do exist, they might not have locks or be separate from the boys’ toilets. They might not be clean, or have means for disposal of used sanitary materials. Water, if available on school grounds, may be located at some distance from the toilets, making it difficult to discreetly wash blood off hands or clothing. </p>
<p><a href="http://www.unicef.org/wash/schools/files/Bolivia_MHM_Booklet_DM_15_Nov_single_0940_Bolivia.pdf">Research has found</a> that girls may skip class, leave school early or be distracted while in the classroom due to fears of having a menstrual leak. Even if a student has affordable good cloth or sanitary pads for managing her menstruation, with the absence of adequate toilets in school, she has no place to privately and comfortably <a href="http://washdev.iwaponline.com/content/3/4/612">change these materials</a> during the school day.</p>
<h2>Participation in the workplace</h2>
<p>Given the growing role of women in informal and formal work environments, one can extrapolate the potential impacts of inadequate workplace sanitation on their productivity and overall health and well-being. But not much research has been done on how much the absence of proper sanitation can affect working women. </p>
<p>But we do know that inadequate sanitation comes at a price; the <a href="http://water.worldbank.org/news/inadequate-sanitation-costs-india-equivalent-64-percent-gdp">World Bank</a> calculates that poor sanitation costs India <a href="http://womensenews.org/story/reproductive-health/150415/world-bankers-please-study-menstruation-costs">US$53.8 billion per year</a> thanks to increased disease, as well as “losses in education, productivity, time and tourism.” </p>
<h2>Making World Toilet Day a thing of the past</h2>
<p>The first step to improving sanitation access is to overcoming taboos in countries struggling with the issue. For instance, in Nepal, taboos may restrict a girl’s participation in household life because menstruating girls and women are perceived as unclean or polluting. In response to these prohibitions, one Nepali girl wrote <a href="http://www.npr.org/sections/goatsandsoda/2015/10/17/449176709/horrible-things-happen-to-nepali-girls-when-they-menstruate-15girls">a novel</a> that describes a world where menstruation gives girls superpowers. </p>
<p>In India, Prime Minister Narendra Modi and other political leaders have called for the <a href="http://www.economist.com/news/asia/21607837-fixing-dreadful-sanitation-india-requires-not-just-building-lavatories-also-changing">construction of more toilets</a>, but local cultural beliefs and taboos around sanitation practices are hard to change. This may include beliefs encouraging defecation far away from home to avoid impurity, or relegating waste management to certain castes in society.</p>
<p>Solving this problem isn’t as simple as building more toilets and latrines. They must be culturally appropriate, environmentally sound, accessible at all times and attentive to <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61497-0/fulltext">gender</a>. To achieve this, local <a href="https://www.humanitarianresponse.info/en/system/files/documents/files/Sustainable%20sanitation%20alliance.pdf">community members</a>, including girls and women, <a href="https://www.humanitarianresponse.info/en/system/files/documents/files/Sustainable%20sanitation%20alliance.pdf">must be consulted</a> on the location and design of toilets and latrines, to make sure that they will actually be used. </p>
<p>This highlights another reason that women should be involved in discussions about sanitation. According to the United Nations, women play a key role in <a href="http://www.unwater.org/downloads/EGM_report.pdf">promoting sanitation</a>. Very often women have the primary responsibility for health, hygiene and sanitation for their family. Lack of access to sanitation (and water) impacts not only a woman’s health, but that of her whole family.</p>
<p>As low- and middle-income countries rapidly urbanize, the <a href="https://www.ucl.ac.uk/sustainable-cities/smallgrants/small-grants-2014-15/gcsc-2014-15/belur">need for privacy and safety</a> for toileting become ever more urgent.</p>
<p>If we were to assure that all girls and women (and boys and men) had access to toilets that were safe, accessible and comfortable, we expect that the world would see improvements in health, in educational outcomes and productivity. Not to mention we would achieve every human’s basic human right to sanitation.</p><img src="https://counter.theconversation.com/content/50700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While everyone needs access to proper sanitation to stay healthy, for girls and women it is also an issue of safety and equal participation in society.Marni Sommer, Associate Professor of Sociomedical Sciences, Columbia UniversityBethany Caruso, Assistant Professor, Hubert Department of Global Health, Rollins School of Public Health, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/506462015-11-19T11:18:41Z2015-11-19T11:18:41ZToilet talk: meeting one of the world’s grand challenges with innovation<figure><img src="https://images.theconversation.com/files/102411/original/image-20151118-14207-t5ixlm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children in Ethiopia wash their hands outside a school latrine.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/unicefethiopia/11304533103/in/photolist-idWFRa-czN2a5-pzErXq-czMZES-nq84ei-nGA5VQ-drRsN5-8D6JiG-e5xKQ3-7AFmhN-hEMo7H-bNU5gF-6iK9p4-91WTUq-bnEckg-onSssS-2FpSAx-cco4YE-bFG1gZ-ob7rqG-oKrKoF-6XdnMu-a2XUz4-drRsph-drRsxw-6iK9tk-8qgfgN-5J86Yp-jKDh6f-o9DXqb-dEV1PF-7ABRHz-e56KLW-fareS-97aezX-bDPf7P-6iKaDD-8iszR5-DDR3v-DDPWE-7ABAi8-4B817y-52RjH8-oqScYF-52R9Nr-dFKGsw-bmgmyE-upo3CC-bnD7Qi-5tBmDL/">Unicef Ethiopia</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>How is it possible that <a href="http://www.who.int/water_sanitation_health/monitoring/jmp-2015-update/en/">2.4 billion people</a> lack access to improved sanitation facilities in 2015? </p>
<p>While many westerners use their bathroom time as “me time,” 40% of the world’s population may be pooping outdoors, in an unsanitary latrine, or in a plastic bag and <a href="http://www.dw.com/en/world-toilet-day-kibera-slum-seeks-to-ground-flying-toilets/a-18072068">launching flying toilets</a> to dispose of their waste. </p>
<p>The environmental impact of the worldwide sanitation situation cannot be underestimated. Not only do the unsanitary conditions and noxious odors of many latrines pose a health hazard for fecal-transmitted diseases, but in many cases the fecal matter ends up in the environment, untreated. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/102401/original/image-20151118-14230-e7nu1i.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/102401/original/image-20151118-14230-e7nu1i.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/102401/original/image-20151118-14230-e7nu1i.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102401/original/image-20151118-14230-e7nu1i.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102401/original/image-20151118-14230-e7nu1i.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102401/original/image-20151118-14230-e7nu1i.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102401/original/image-20151118-14230-e7nu1i.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102401/original/image-20151118-14230-e7nu1i.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The SFD, or shit flow diagram, for Dhaka, Bangladesh shows that nearly all of waste is released into the environment untreated.</span>
<span class="attribution"><a class="source" href="http://programme.worldwaterweek.org/event/4748">World Water Week</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Recent <a href="http://www.susana.org/images/documents/SFD/sfd%20sda.jpg">analysis by the World Bank</a> reported that in a study of 12 cities, an average of 69% of the fecal sludge was released untreated into the environment – that is, only 31% was safely treated. In places like Dhaka, Bangladesh, only 2% of the fecal sludge is safely handled, while 98% is dangerously released into the environment. </p>
<p>The United Nations Millennium Development Goals (MDGs), a 25-year effort that wrapped up in 2015, aimed to “Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation.” While the goals for “access” to safe drinking water have been met, the UN revealed that <a href="http://www.un.org/sustainabledevelopment/water-and-sanitation/">1.8 billion people</a> still use drinking water that is fecally contaminated, connecting the dots between lack of adequate sanitation and contamination of drinking water. </p>
<p>Since the MDGs have ended, the world is now striving toward the Sustainable Development Goals (<a href="https://theconversation.com/us/topics/un-sustainable-development-goals">SDGs</a>), a 15-year effort to achieve universal and equitable access to safe drinking water and sanitation. </p>
<p>How can we achieve safe sanitation? One way is through innovation. </p>
<h2>Sustainable sanitation technologies</h2>
<p>Sanitation systems protect human health by providing facilities and services for the collection and disposal of human urine and feces, ensuring a clean environment and breaking the cycle of disease. In order to be sustainable, sanitation technologies must be economically viable, socially acceptable and environmentally sound. </p>
<p>Economic viability ensures that a sanitation system can be built, operated and maintained without outside subsidies. Social acceptability determines adoption and proper operation and maintenance. Environmental sustainability refers to the technology’s ability to reduce harmful pollution, use limited resources (water, land, energy) and recover resources contained in human waste. </p>
<p>Sanitation technologies include anything from pit latrines to flush toilets connected to septic or sewer systems. But in many cases, existing systems have technical or operational problems.</p>
<p>Pit latrines are socially unacceptable due to odors, and they are environmentally unsustainable since they only collect waste and do not treat it. Flush toilets connected to septic tanks or sewers must not only transmit the waste away but also treat it in centralized facilities. That requires major infrastructure, which uses precious water resources and is not possible in areas that need sanitation the most. Construction, operation and maintenance of sewer infrastructure and treatment plants represent prohibitive costs for many parts of the developing world. </p>
<p>What, then, is a better alternative? </p>
<p>The world needs sanitation systems that are socially acceptable, reduce water consumption, take advantage of renewable energy, operate off-grid with little maintenance and harvest useful products from human waste. The introduction of sustainable sanitation technology would result in greatly improved health, environment and energy conservation for both the developing and developed world.</p>
<h2>Turning waste into valuable product</h2>
<p>This need for better sanitation technologies has spawned a wave of innovations in toilet technologies, driven by the private sector, public sector and foundations. </p>
<p>Solutions making headway range from adapting and improving on the current paradigm of pit latrines to development of novel devices and approaches. </p>
<p>Businesses such as <a href="http://saner.gy/our-work/the-sanergy-model">Sanergy</a> profit from providing clean toilet services and the collection and recovery of fecal waste. They provide the toilets, keep them clean, haul the fecal waste, treat and then reclaim the waste resources for reuse in agriculture. Using a franchise approach, their waste haulers safely compost large volumes of fecal sludge to make and sell valuable fertilizer. The Sanergy model can reach deep into informal settlements by using human labor to access and haul waste, where mobile trucks cannot access.</p>
<p>Another social enterprise, <a href="http://www.sanivation.com/">Sanivation</a>, has a similar collection model to Sanergy but turns fecal waste into a fuel through a briquetting process. Their approach is to install low-infrastructure mobile toilets that can be deployed in urban communities and refugee camp settings. After collection, the waste is treated using solar energy. This solar-dried waste is then combined with a binder and made into fuel briquettes that can be sold as a replacement for wood, coal and other sources.</p>
<h2>Toilet tech</h2>
<p>In parallel with efforts to change the face of conventional latrines, there is a wide effort under way to completely rethink what a toilet is and how we can recover the value in waste. </p>
<p>The Bill & Melinda Gates Foundation (BMGF) in 2011 launched the <a href="http://www.gatesfoundation.org/What-We-Do/Global-Development/Reinvent-the-Toilet-Challenge">Reinvent the Toilet Challenge</a> and funded 16 teams around the world to dream big and re-create the toilet paradigm. (The BMGF is a funder of The Conversation Media Group.) Clearly, business as usual is not working, and given society’s experience in other sectors, why not develop “leapfrog” technologies that leave our 20th-century toilet behind? </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/102405/original/image-20151118-14183-1a5fw6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/102405/original/image-20151118-14183-1a5fw6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/102405/original/image-20151118-14183-1a5fw6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102405/original/image-20151118-14183-1a5fw6f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102405/original/image-20151118-14183-1a5fw6f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102405/original/image-20151118-14183-1a5fw6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102405/original/image-20151118-14183-1a5fw6f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102405/original/image-20151118-14183-1a5fw6f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Sol-Char Toilet concentrates sunlight to produce heat that converts fecal matter into biochar, which can be used as fuel or as a soil amendment.</span>
<span class="attribution"><a class="source" href="http://www.colorado.edu/solchar/">University of Colorado Boulder</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>While technology is not the single solution to the worldwide sanitation crisis, it does have the potential to reshape the landscape and create new ways to do your business. </p>
<p>The 21st-century toilet must provide a safe and hygienic environment, effectively treat the waste for safe handling, and recover resources embedded in the waste. It should also do all this while using no water resources or electrical energy. </p>
<p>To meet this challenge, our group at the University of Colorado Boulder developed the <a href="http://www.colorado.edu/solchar/">solchar toilet</a>, which uses concentrated solar energy to destroy the pathogens in fecal waste and transform the waste into biochar, similar to charcoal made from plants and other organic materials. Biochar is a valuable, safe-to-handle product that can serve as an agricultural amendment or be made into a char-fuel briquette with similar heating efficiency to commercial charcoal. This household toilet prototype is being redesigned into a system that can serve multiple houses in a community setting. </p>
<h2>Pieces of a puzzle</h2>
<p>There are a number of other techniques being explored and being tested. They include the use nanomaterials to separate usable water from fecal sludge and thicken the feces for further treatment; electrochemistry to break down fecal solids into fertilizer and <a href="http://www.digitaltrends.com/cool-tech/toilet-of-the-future/#ixzz3rt0DQedI">sanitize the water</a> to be reused for flushing or irrigation; and hydrothermal carbonization, which converts fecal sludge into an aqueous suspension of charlike material that is safe to handle and easily separated from the liquid phase.</p>
<p>Another BMGF-funded device is the <a href="http://janickibioenergy.com/">omni-processor</a>, a wastewater treatment plant device that treats a community’s waste to a safe end product at little to no energy cost and creates safe drinking water that’s good enough for <a href="https://www.youtube.com/watch?v=bVzppWSIFU0">Bill Gates to drink</a>.</p>
<p>While early-stage toilet technologies may eventually provide sustainable sanitation for many communities, the solution to the world’s toilet problem has no single solution. Approaches by the private sector and those promoted by universities and foundations around the world are all pieces to the puzzle. </p>
<p>Despite the basic facts of life that we all need to rid our bodies of waste, this is not an easy problem to solve, and we have not evolved quickly enough to keep up with our own poop. While demand must originate from local communities, innovations in technology will keep us imagining what the possibilities are, and if we can meet the UN’s SDGs, then maybe everyone can enjoy a little “me time” in the bathroom.</p><img src="https://counter.theconversation.com/content/50646/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karl Linden receives funding from US EPA, Bill and Melinda Gates Foundation and the National Science Foundation.</span></em></p>More than two billion people lack access to decent sanitation. Innovative sanitation technologies can bring toilets into the 21st century with benefits for the developing and developed world.Karl Linden, Professor of Environmental Engineering and the Mortenson Professor in Sustainable Development, University of Colorado BoulderLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/500452015-11-19T11:17:50Z2015-11-19T11:17:50ZTalking heads: what toilets and sewers tell us about ancient Roman sanitation<figure><img src="https://images.theconversation.com/files/102339/original/image-20151118-14191-5yzen5.jpg?ixlib=rb-1.1.0&rect=0%2C460%2C4073%2C2379&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ruin of a second-century public toilet in Roman Ostia.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/paullew/7870818466">Fr Lawrence Lew, OP</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>I’ve spent an awful lot of time in Roman sewers – enough to earn me the nickname “Queen of Latrines” from my friends. The Etruscans laid the first underground sewers in the city of Rome around 500 BC. These cavernous tunnels below the city’s streets were built of finely carved stones, and the Romans were happy to utilize them when they took over the city. Such structures then became the norm in many cities throughout the Roman world. </p>
<p>Focusing on life in ancient Rome, Pompeii, Herculaneum and Ostia, I’m deeply impressed by the brilliant engineers who designed these underground marvels and the magnificent architecture that masks their functional purpose. Sewer galleries didn’t run under every street, nor service every area. But in some cities, including Rome itself, the length and breadth of the main sewer, the Cloaca Maxima, rivals the extent of the main sewer lines in many of today’s cities. We shouldn’t assume, though, that Roman toilets, sewers and water systems were constructed with our same modern sanitary goals in mind.</p>
<p>The streets of a Roman city would have been cluttered with dung, vomit, pee, shit, garbage, filthy water, rotting vegetables, animal skins and guts, and other refuse from various shops that lined the sidewalks. We moderns think of urban sewers as the means to remove such filth from streets – and of course flush away human waste that goes down our toilets.</p>
<p>Researching Roman urban infrastructure for my new book <a href="http://uncpress.unc.edu/books/T-5298.html">The Archaeology of Sanitation in Roman Italy</a> made me question whether the Romans shared the same vision. The archaeological evidence suggests that their finely constructed sewer systems were more about drainage of standing water than the removal of dirty debris. And Romans’ sense of cleanliness and privacy around bathroom matters was quite different from our tender modern sensibilities.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/102334/original/image-20151118-14183-1m8yeu7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/102334/original/image-20151118-14183-1m8yeu7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/102334/original/image-20151118-14183-1m8yeu7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102334/original/image-20151118-14183-1m8yeu7.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102334/original/image-20151118-14183-1m8yeu7.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102334/original/image-20151118-14183-1m8yeu7.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102334/original/image-20151118-14183-1m8yeu7.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102334/original/image-20151118-14183-1m8yeu7.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Inside a tunnel of Rome’s sewer, the Cloaca Maxima.</span>
<span class="attribution"><span class="source">Ann Olga Koloski-Ostrow</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Sewers managed excess water more than waste</h2>
<p>The Cloaca Maxima in Rome was not part of a <a href="https://yalepress.yale.edu/yupbooks/book.asp?isbn=9780300101867">master plan to sanitize the city</a>. Its purpose was removing water that pooled on the city’s uneven streets and draining water from low-lying areas when the adjacent Tiber River flooded, which happened quite frequently. Its main function was drainage – and what it drained ran right back into Rome’s major drinking supply before the aqueducts, the Tiber.</p>
<p>Roman sewers moved filthy water away from where it hindered cleanliness, economic growth, urban development and even industry. My work in the sewers of Herculaneum and Pompeii – both buried by the pyroclastic flow caused by Mount Vesuvius’ volcanic eruption in AD 79 – has brought me to the same conclusion.</p>
<p>At the bottom of one sewer under a street in Herculaneum, the first excavators found an <a href="http://www.quartoknows.com/books/9780711231429/Herculaneum.html">ancient deposit of hardened sludge</a> measuring about 1.35 meters high. No amount of water, however fast-flowing, would have been able to remove that. Several ancient sources state that Roman sewers needed manual cleaning from time to time, a job often done by city slaves or <a href="https://archive.org/stream/letterswithengli02plinuoft/letterswithengli02plinuoft_djvu.txt">prisoners</a>. I’d argue these urban sewer systems provided minimal sanitary benefits overall.</p>
<h2>Plenty of toilets, few sewer hookups</h2>
<p>Public and private toilets were sprinkled throughout the city of Pompeii. But despite the city’s sewer infrastructure, virtually none of these toilets had sewer connections. We have similar evidence for ancient Herculaneum.</p>
<p>In fact, almost every private house in these cities, and many apartment houses in Ostia, had private, usually one-seater, toilets not connected to the main sewer lines.</p>
<p>And these cesspit toilets were often situated in the kitchen, where food was prepared! The comforting smells from a hearty stew would have mingled with the gross odors from the nearby open cesspit. Collected waste was either sold to farmers for fertilizer or used in <a href="http://penelope.uchicago.edu/Thayer/E/Roman/Texts/Columella/de_Re_Rustica/1*.html">household gardens</a> – which must have made for some pretty stinky garden parties from time to time.</p>
<p>According to Ulpian’s Digest, written between AD 211 and 222, connections to the sewers from private dwellings certainly were legal. So why didn’t property owners hook up to the public sewer lines?</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/102332/original/image-20151118-14214-1pedy5t.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/102332/original/image-20151118-14214-1pedy5t.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/102332/original/image-20151118-14214-1pedy5t.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=895&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102332/original/image-20151118-14214-1pedy5t.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=895&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102332/original/image-20151118-14214-1pedy5t.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=895&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102332/original/image-20151118-14214-1pedy5t.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1125&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102332/original/image-20151118-14214-1pedy5t.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1125&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102332/original/image-20151118-14214-1pedy5t.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1125&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A private toilet under the stairs in Herculaneum’s Casa del Gran Portale.</span>
<span class="attribution"><span class="source">Ann Olga Koloski-Ostrow</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>One reason may be tied to that fact that Roman sewer openings had no traps. One never could be sure what might climb out of an open sewer pipe and into your house.</p>
<p>We have at least one dramatic ancient story that illustrates the danger of hooking your house up to a public sewer in the first or second century AD. The <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A2008.01.0590%3Abook%3D1%3Achapter%3D13">author Aelian tells us</a> about a wealthy Iberian merchant in the city of Puteoli; every night a giant octopus swam into the sewer from the sea and proceeded up through the house drain in the toilet to eat all the pickled fish stored in his well-stocked pantry.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/102408/original/image-20151118-14217-15dco8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/102408/original/image-20151118-14217-15dco8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/102408/original/image-20151118-14217-15dco8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102408/original/image-20151118-14217-15dco8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102408/original/image-20151118-14217-15dco8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102408/original/image-20151118-14217-15dco8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102408/original/image-20151118-14217-15dco8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102408/original/image-20151118-14217-15dco8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Broken connections in a Herculaneum house’s terracotta downspout within the wall would have caused stinky leaks.</span>
<span class="attribution"><span class="source">Ann Olga Koloski-Ostrow</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Adding to the stench of Roman life, my close examination of ancient plumbing found that many downpipes from house toilets on upper floors would have suffered serious leakage inside the walls as well as oozing onto the outside of the walls too. The fittings of these terracotta downpipes loosened over time, and their contents would have caused stink everywhere.</p>
<p>I was able to identify at least 15 upper-story toilets at Pompeii and others at Herculaneum and elsewhere. In some cases, I <a href="https://books.google.com/books/about/Roman_Toilets.html?id=bF1jXwAACAAJ">obtained proof through scientific testing</a> for urine and/or excrement that the spillage was indeed human waste from these pipes. </p>
<h2>Public toilets held their own hazards</h2>
<p>Even public latrines – multi-seater toilets that were almost always connected to the main sewer lines of a city – posed serious threats to users. Don’t be fooled by the clean white marble and open-air sunniness of the reconstructed ruins we can see today; most Roman public toilets were dark, dank and dirty, and often situated in small spaces. Those who could “hold it” long enough to return to their own houses with their own cesspit toilets certainly would have done so.</p>
<p>One public toilet at Ostia, with its revolving doors for access and fountain basin for cleaning up, could handle more than 20 clients at a time. I have found no evidence that Romans had to pay to use public toilets, and we really don’t know who managed or cleaned them, apart from the possibility of public slaves. To our modern eyes there was almost a complete lack of privacy in such facilities; but bear in mind that Roman men would have been wearing tunics or togas, which would have provided more screening than a modern man would enjoy with pants that have to be pulled down. Perhaps a bigger problem for today’s standards of cleanliness: the Roman version of toilet paper in many cases was a communal sponge on a stick.</p>
<p>Even worse, these public latrines were notorious for terrifying customers when flames exploded from their seat openings. These were caused by gas explosions of hydrogen sulphide (H2S) and methane (CH4) that were rank as well as frightening. Customers also had to worry about rats and other small vermin threatening to bite their bottoms. And then there was the perceived threat of demons that the Romans believed inhabited these black holes leading to the mysterious underbelly of the city.</p>
<p>One late Roman writer tells a particularly exciting story about such a demon. A certain Dexianos was sitting on the privy in the middle of the night, the text tells us, when a demon raised itself in front of him with savage ferocity. As soon as Dexianos saw the “hellish and insane” demon, he “became stunned, seized with fear and trembling, and covered with sweat.” Such superstition would provide another good reason for avoiding sewer connections in private house toilets.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/102328/original/image-20151118-14202-6gj6vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/102328/original/image-20151118-14202-6gj6vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/102328/original/image-20151118-14202-6gj6vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=566&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102328/original/image-20151118-14202-6gj6vv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=566&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102328/original/image-20151118-14202-6gj6vv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=566&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102328/original/image-20151118-14202-6gj6vv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=712&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102328/original/image-20151118-14202-6gj6vv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=712&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102328/original/image-20151118-14202-6gj6vv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=712&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Goddess Fortuna on the wall of a the Suburban Baths in Pompeii.</span>
<span class="attribution"><span class="source">Ann Olga Koloski-Ostrow</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Going to a public toilet was definitely a dangerous business, so it is no wonder that the Goddess Fortuna often appears as a kind of “guardian angel” on the walls of toilets. We don’t tend to put religious shrines in our toilets, but we find them again and again in both public and private toilets in the Roman world.</p>
<p>One graffito on a side street in Pompeii directs a warning at a toilet-user himself: “Crapper Beware the Evil”… of crapping on the street? Of putting your bare bottom on an open toilet hole for fear of biting demons? Of the ill health you will feel if you do not move your bowels well? We’ll never know for sure, but these are likely possibilities, I think.</p>
<p>When we look at the evidence for Roman sanitary practices, both textual and archaeological, it becomes obvious that their perspectives were quite different from ours. Gaining a better understanding of Roman life on their streets, in their public spaces, and in their private dwellings shows us that they were in the early stages of developing systems that we’ve adopted – with upgrades – for our own problems with sanitation and clean water today.</p><img src="https://counter.theconversation.com/content/50045/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ann Olga Koloski-Ostrow does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Archaeological and textual detective work is filling in some information about how ancient Romans used and thought about their sewers thousands of years ago.Ann Olga Koloski-Ostrow, Professor of Classical Studies, Brandeis UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/501072015-11-19T11:17:24Z2015-11-19T11:17:24ZWhy do public bathrooms make us so anxious, and why aren’t we doing anything about it?<figure><img src="https://images.theconversation.com/files/101881/original/image-20151113-10438-1pi0mqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The treacherous toilet. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/rebeccagrace/177928038/in/photolist-gHVNN-HsfaG-2byhY-h59DQM-ax7EJ1-pG2DP-iBRWR-5PRNA-eDVYk-eDVYm-eDVYn-eDVwJ-eDVwL-eDVwF-eDVwE-eDVwH-eDVYo-5uXKzj-5Q3k5K-iNiYx-7tHjX-kC48Bn-9213Li-8Er3GZ-75K5D4-ctxmp7-awmfP-eTkniD-eTwLJC-4gK2gp-CHrwt-b9YmrV-ax7FQS-cXmaVL-BCB2L-4ShhxW-3bU9uo-gywE1G-x9zYK-5PSw6u-5PNfwB-5PSwiA-8Af3Bj-954RBQ-2Gs2z-aybh5W-4tAeLu-7re8yE-8N4XWR-8Fxgfq">Rebecca Boyd/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>“Public” and “toilet” don’t go together, except when they must. And that “must” is the moment we’re not home – when we need to go and can’t hold it in any longer.</p>
<p>Only then do we face the predicament of having to perform a deeply private act in the presence of others.</p>
<p>Yet for one reason or another, American public bathrooms are often designed to make the experience exceedingly uncomfortable. Silence about the issue persists, largely because of cultural taboos that discourage any discussion about alleviating design flaws.</p>
<h2>No room for “rest”</h2>
<p>Our lives are ordinarily carried out through careful – indeed, exquisite – impression management. We adhere to a delicate etiquette of gesture, sound and scent, all so we can display ourselves as dignified, civilized human beings. </p>
<p>Enter: the toilet, which blunders in with sounds, smells and strangers. Hovering above it all is the deepest of pollutants, human waste – often in places where it’s not supposed to be. </p>
<p>From earliest childhood (<a href="https://thepsychologist.bps.org.uk/volume-25/edition-6/toilet-psychology">thank you, Professor Freud</a>) we participate in the game of excrement as taboo. Any talk is handled through binary code: “Number One,” “Number Two” or the likes of pee and poo. And as children we learn the shrieks of horror that can arise when things go awry.</p>
<p>We bear the burden of all this — and more — when we enter the so-called “restroom.” It’s no wonder we look for an escape. One solution is to just not go at all: we hold it in until we get home or at least to a more opportune setting. </p>
<p>Another strategy is to manipulate intake — eating and drinking — to align elimination with being home. For me, it’s akin to the Japanese art of bonsai: trimming a plant’s roots to shape what comes out the other end. It is a difficult skill to master, for which few of us have had proper instruction. </p>
<h2>Privacy discouraged, by design</h2>
<p><a href="http://www.csun.edu/%7Etph53095/Meanwhile%20Backstage%20Reading.pdf">According to one survey</a>, over 60% of respondents reported that they would delay using a public restroom if they felt like they didn’t have enough privacy. </p>
<p>The design of American public bathrooms can complicate the struggle for a modicum of privacy. In the US, stall enclosures typically have large bottom (and top) openings, along with peek-a-boo gaps at panel seams. The US is a distinctly open society; in virtually every country which has them, toilets have more solid enclosures, with stalls going closer to the ground and ceiling, </p>
<p>The US features probably arose from authorities’ concern, way back when, over what people might do if they had <em>more</em> privacy – specifically, drugs or sex (especially homosexual male sex). </p>
<p>Either way, it’s now expected that when we sit on a public toilet, we expose our feet to the occupant next door. Among other effects, this allows those who know us to make positive and precise identifications based on shoes: another blow to anonymity. Who hasn’t experienced the dread of a boss or colleague plopping down in an adjacent stall?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/101873/original/image-20151113-10393-1rx4cp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/101873/original/image-20151113-10393-1rx4cp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/101873/original/image-20151113-10393-1rx4cp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/101873/original/image-20151113-10393-1rx4cp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/101873/original/image-20151113-10393-1rx4cp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/101873/original/image-20151113-10393-1rx4cp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/101873/original/image-20151113-10393-1rx4cp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Anonymity, compromised.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-35828983/stock-photo-girl-in-bathroom-stall.html?src=6oiUFMFik1uG3SXpmjhZHQ-1-7">'Feet' via www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>There can be strategies. Some choose restrooms where a colleague or classmate will less likely be present. That might mean going to a different building, floor or division. Others try to time visits for when nobody else will be around (although if everyone selects the same time, there could be comedic bathroom jams instead of circumvention). Of course, openly coordinating among one another to prevent such an outcome would be out of the question: your self-consciousness would be exposed. </p>
<h2>Simple fixes met with silence</h2>
<p>Why haven’t industrial designers and architects stepped in to address some of these issues? </p>
<p>From knowing many of them, I believe they’d be eager to facilitate change: many would gladly make stall walls more substantial, while acoustic specialists would delight in muffling unpleasant sounds with the white noise of running water or music (why not <a href="https://www.youtube.com/watch?v=movTSvVQxX0">opera</a>, a la the fountains of Las Vegas’ Bellagio Hotel?) </p>
<p>Sinks and toilets could be combined into a single unit (such models exist in both Japan and Spain) so that the water from the sink enters into the toilet tank, where it is stored for the next flush. This lowers water use and yields hands that are clean before they touch the hardware of the stall exit. (No more opening locks with scrunches of toilet paper!) </p>
<p>Insulin users need a shelf to rest their syringe. Indeed, so do all intravenous drug users. And they need good enough lighting to both see their veins and avoid bloodying things up. </p>
<p>People from Middle Eastern cultures are accustomed to cleansing after defecation with water, often with a spray hose fixed to a wall adjacent to the toilet. (For them, wiping with paper disgusts.) Such preferences should be accommodated; given a chance, it may catch on with the wider public. </p>
<p>Public toilets invite recycling of all waste. And larger facilities, especially, should invite on-site recycling, with user-friendly displays of the process (show the plumbing, digesters and fittings through transparent pipes and walls). Use the toilet to press a wider public agenda.</p>
<p>And that goes for gender too. Gender segregation continues to deliver injustice. Women need more opportunities to go, a fact increasingly being reflected in changing building codes in the US and other countries. Now starting to appear on public policy agendas are the difficulties of people who are transgender or gender-nonconforming. Some people are actually forced to use a bathroom designated for the opposite sex due to their situation: women caring for men (and vice versa), fathers for girls and other variations. </p>
<p>So why not open it up and let all genders share the same zone? It would yield a huge increase in space efficiency, while alleviating the long lines at the women’s rooms, which often occur as stalls remain empty in the men’s room. Integration might also enhance safety: more people would be on hand to act in case of emergency. Hanging a “women” sign over a door only keeps out men with good intentions. (After all, those with bad intentions won’t be impeded by a sign.)</p>
<p>Making change requires making talk. Unfortunately, “the talk” can be rather awkward – awkward for politicians to introduce change or for architects to convince clients to depart from custom. Having sat on many university building committees, I can report that not much time is devoted to the arrangements of restrooms; when it comes to the toilet and its surroundings, silence is business as usual. </p>
<p>Deprivations, some of them unspeakable, fill the void.</p><img src="https://counter.theconversation.com/content/50107/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harvey Molotch does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Public ‘restroom’ is a euphemism of the highest order. We don’t find it restful.Harvey Molotch, Professor of Sociology and Metropolitan Studies, New York UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/508312015-11-19T11:16:18Z2015-11-19T11:16:18ZExplainer: Why transgender students need ‘safe’ bathrooms<figure><img src="https://images.theconversation.com/files/116797/original/image-20160330-28483-1xb0cki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What's the fuss over gender-neutral bathrooms?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/denverjeffrey/6859753101">Jeffrey Beall</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The newest front line in the battle for LGBTQ safety and dignity involves bathroom access for the transgender community. The <a href="https://www.washingtonpost.com/local/education/gavin-grimm-just-wanted-to-use-the-bathroom-he-didnt-think-the-nation-would-debate-it/2016/08/30/23fc9892-6a26-11e6-ba32-5a4bf5aad4fa_story.html">national spotlight</a> has turned to transgender individuals who are finding their ability to use public bathrooms <a href="https://www.nytimes.com/2017/02/27/us/jackie-evancho-transgender-sister-bathroom.html">under investigation</a> – and sometimes attack – by school boards and state legislators.</p>
<p>But why has transgender bathroom use garnered such attention? And how will it impact transgender students?</p>
<p>My research shows how political and <a href="http://onlinelibrary.wiley.com/doi/10.1111/lsi.12233/abstract">legal battles</a> over LGBTQ rights can negatively impact the daily lives of LGBTQ individuals and families. Right now, transgender students are currently suffering significant setbacks at the local, state and federal level, limiting their access to public bathrooms and threatening their health and safety. </p>
<p>Here’s why.</p>
<h2>The current state of transgender bathroom rights</h2>
<p>On Feb. 22, President Donald Trump <a href="https://www.washingtonpost.com/local/education/trump-administration-rolls-back-protections-for-transgender-students/2017/02/22/550a83b4-f913-11e6-bf01-d47f8cf9b643_story.html?utm_term=.7f64fc4b5f0c">rescinded</a> a key protection issued by former President Barack Obama. Obama’s <a href="https://www2.ed.gov/about/offices/list/ocr/letters/colleague-201605-title-ix-transgender.pdf">2016 “dear colleague” letter</a> required schools that receive federal funding to accommodate a transgender student’s gender identity when granting access to bathrooms or other gender-specified facilities.</p>
<p>In her explanation of Trump’s directive, Secretary of Education Betsy DeVos argued that although “protecting all students, <a href="http://www.mediaite.com/online/betsy-devos-protecting-lgbtq-students-should-be-key-priority-for-all-schools/">including LGBTQ students</a>” is “a key priority for the department,” the issue of transgender bathroom access is “best solved at the state and local levels.” </p>
<p>However, as the past year indicates, there are problems with leaving this critical civil rights issue up to state legislatures.</p>
<p>For instance, at least <a href="http://www.ncsl.org/research/education/-bathroom-bill-legislative-tracking635951130.aspx">10 states</a> are considering bills that would require individuals to use multi-stall public bathrooms that match their biological gender – and at least two impose criminal sanctions on any violation. </p>
<p>State bills like these would take precedence over local efforts to enact anti-discrimination policies. North Carolina, for example, passed one such state law last year: the now infamous <a href="http://www.ncleg.net/Sessions/2015E2/Bills/House/PDF/H2v4.pdf">HB2 bathroom bill</a>. The bill was introduced in direct response to a <a href="http://charlottenc.gov/NonDiscrimination/Pages/default.aspx">Charlotte City Council ordinance</a> outlawing discrimination against members of the LGBTQ community.</p>
<p>Meanwhile, Arkansas legislators prevailed on Feb. 23 in a similar battle with local officials over transgender bathroom rights. The <a href="http://www.cbsnews.com/news/arkansas-supreme-court-strikes-lgbt-protections-fayetteville/">Arkansas Supreme Court overturned</a> a nondiscrimination ordinance <a href="http://www.arktimes.com/ArkansasBlog/archives/2015/09/08/early-vote-favors-fayetteville-civil-rights-ordinance-68-32">passed by the city of Fayetteville</a>, ruling that one city cannot expand the state’s anti-discrimination protection to include gender identity.</p>
<p>In both of these cases, the state laws and city ordinances are in direct conflict, but the state takes precedence, making it illegal for transgender individuals to use the bathrooms matching their gender identity.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/159220/original/image-20170302-14714-1q6ogv4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159220/original/image-20170302-14714-1q6ogv4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/159220/original/image-20170302-14714-1q6ogv4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159220/original/image-20170302-14714-1q6ogv4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159220/original/image-20170302-14714-1q6ogv4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159220/original/image-20170302-14714-1q6ogv4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159220/original/image-20170302-14714-1q6ogv4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159220/original/image-20170302-14714-1q6ogv4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Gavin Grimm’s case is scheduled to appear before the Supreme Court in March. It’s unclear whether Trump’s reversal on the Obama administration’s guidance on transgender bathrooms will stall the case.</span>
<span class="attribution"><span class="source">AP Photo/Steve Helber</span></span>
</figcaption>
</figure>
<p>As is true in <a href="https://www.oyez.org/cases/2014/14-556">many</a> <a href="https://www.oyez.org/cases/2012/12-307">cases</a> <a href="https://www.oyez.org/cases/2002/02-102">involving</a> <a href="https://www.oyez.org/cases/1995/94-1039">LGBTQ rights</a>, the Supreme Court may end up having the last word on the issue. The court is set to hear oral arguments in March for a case involving a <a href="http://www.scotusblog.com/case-files/cases/gloucester-county-school-board-v-g-g/">transgender boy’s fight for adequate access to restrooms in his high school</a>.</p>
<p>All told, only <a href="https://www.aclu.org/map/non-discrimination-laws-state-state-information-map">13 states (and the District of Columbia)</a> explicitly protect against gender identity discrimination in public schools. Without these statewide protections – and with local governments being overruled by state law – many transgender students living in the remaining 37 states cannot feel safe when using school bathrooms.</p>
<h2>Issues of physical, emotional safety</h2>
<p>So why do we need legal protection against bathroom restrictions?</p>
<p>The stakes are high for transgender students. </p>
<p>Studies show that transgender students could be harassed, sexually assaulted or subjected to other physical violence when required to use a gendered bathroom.</p>
<p>Recent studies suggest that over 50 percent of transgender individuals <a href="http://faculty.mu.edu.sa/public/uploads/1425310920.5389violence%20transgender.pdf">will experience sexual assault</a> in their lifetime (a rate that is far higher than for nontransgendered individuals), and that (absent protections) using bathrooms could pose a significant threat of physical harm or harassment. </p>
<p>One survey, commissioned by <a href="https://williamsinstitute.law.ucla.edu/">UCLA’s Williams Institute</a>, found that <a href="https://williamsinstitute.law.ucla.edu/wp-content/uploads/Herman-Gendered-Restrooms-and-Minority-Stress-June-2013.pdf#page=7">68 percent of participants</a> were subjected to homophobic slurs while trying to use the bathroom. <a href="https://williamsinstitute.law.ucla.edu/wp-content/uploads/Herman-Gendered-Restrooms-and-Minority-Stress-June-2013.pdf#page=7">Nine percent</a> confronted physical violence.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/116803/original/image-20160330-28451-kkodni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/116803/original/image-20160330-28451-kkodni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/116803/original/image-20160330-28451-kkodni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/116803/original/image-20160330-28451-kkodni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/116803/original/image-20160330-28451-kkodni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/116803/original/image-20160330-28451-kkodni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/116803/original/image-20160330-28451-kkodni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Studies have shown how use of bathroom results in assaults.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/zappowbang/466812968/in/photolist-Hfxes-eefZ2p-9kV8Zc-ehrBL8-ehxizq-7m27qQ-9h8L5F-mYXfHf-8xuFeH-9hnH2c-ehryFP-ehrzi4-ehrzCK-8xxGKu-9kYdKC-bM5Hq4-gndp7V-i77iJ6-i76zC3-9kYbaC-nzxgu8-biTybn-9kRX8i-i76Upd-9kYbso-i77kTX-eaviCn-7Haptx-8UsHwV-i76tgM-9kYbWu-9kV514-Hfx97-asDYat-9kYdx3-3onp1-7Haw9k-HfAdV-9kV2bu-esvjh-8xuFsx-9kYbKf-i76Qyq-HUqgR-HTXK2-8xxGAs-8xtRp2-9kV6xp-nYTMPE-7kXdV8">Justin Henry</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Another study that surveyed transgender individuals in Washington, D.C. found that <a href="https://williamsinstitute.law.ucla.edu/wp-content/uploads/Herman-Gendered-Restrooms-and-Minority-Stress-June-2013.pdf#page=7">70 percent</a> were either verbally threatened, physically assaulted or prevented in some way from using the bathroom of their choice. Some experienced more than one form of such behavior.</p>
<p>Yet another survey found that <a href="http://comptroller.nyc.gov/wp-content/uploads/documents/Gender_Neutral_Bathrooms.pdf#page=2">26 percent of transgender students</a> in New York were denied access to their preferred bathrooms altogether.</p>
<p>The result? Transgender students need to constantly weigh the trade-offs as they consider bathroom options.</p>
<p>As one University of Washington student <a href="http://www.king5.com/news/local/seattle/uw-students-call-for-more-gender-neutral-restrooms_20160418093106605/140291974">articulates</a>:</p>
<blockquote>
<p>Do I choose physical safety or emotional safety? Do I choose physical health or mental health?</p>
</blockquote>
<h2>Bathroom redesign</h2>
<p>In response to demands from transgender advocates, parents and transgender students, administrators from California to Texas, in elementary schools and colleges, have considered the costs and benefits of redesigning bathrooms to accommodate transgender students.</p>
<p>For example, students at the <a href="http://pittnews.com/62434/news/beds-and-bathrooms-pitt-goes-gender-neutral/">University of Pittsburgh</a> can now use bathrooms that conform to their own gender identity. Arizona State University, Ohio State and Wesleyan University, among several others, <a href="http://www.houstonpress.com/arts/gender-neutral-bathrooms-are-opening-their-doors-in-houston-and-elsewhere-6392063">have instituted policies requiring all new construction to include gender-neutral bathrooms</a>. They are assessing how to modify the existing bathrooms to become gender-neutral or single-stall facilities.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/102265/original/image-20151118-23204-bx0tjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/102265/original/image-20151118-23204-bx0tjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102265/original/image-20151118-23204-bx0tjt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102265/original/image-20151118-23204-bx0tjt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102265/original/image-20151118-23204-bx0tjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102265/original/image-20151118-23204-bx0tjt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102265/original/image-20151118-23204-bx0tjt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Universities are bringing in policies to have gender-neutral bathrooms.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/taedc/15799031740/in/photolist-q57aGY-jeZ6FB-7h4zDD-uDWfrH-e7hipR-mEwTCq-qLuCEj-qfxPeM-e7nVzj-NHLdq-dvcDVd-8q94PM-k6LNzB-e7nVXJ-ndU2MK-nb7xLz-k6CTQd-e7nWHU-uDWYbe-uDgBjy-un7BVA-un7YdY-upwMXE-5otHqH-gdKmK-4xfLxD-k6CBsd-k6CQY1-o4o72q-k6BfFz-63nebf-k6ATcT-77ZsTH-7mTVrd-nDmSCD-7cARDf-5ELJFo-5bWgco-8TNgHF-tGRLMK-icYznx-AxQW98-xv4Ymq-wEgLAS-uBi2JN-sTy3er-regVdu-qVBa4W-qgEiNw-rbhMhB">Ted Eytan</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>As increasing numbers of primary- and secondary-school-aged children are identifying as transgender, public schools have become “<a href="http://www.theatlantic.com/education/archive/2015/07/the-k-12-binary/398060/">ground zero</a>” for fights over bathroom safety.</p>
<p><a href="http://www.sfgate.com/bayarea/article/Bathrooms-at-Miraloma-Elementary-in-S-F-go-6481544.php">Miraloma Elementary School</a>, in San Francisco, for instance, removed gendered signs from many of their bathrooms.</p>
<p>About two years ago, Governor Jerry Brown signed into law the <a href="http://www.cde.ca.gov/re/di/eo/faqs.asp">School Success and Opportunity Act</a>, requiring that all students be able to access bathrooms or locker rooms that are consistent with their own gender identity in California’s K-12 settings.</p>
<h2>Need for safety</h2>
<p>But these school or district-level efforts have been either limited to states with existing gender identity protections (like California) or have been overturned by school board or state action. </p>
<p>This is why Obama’s directive was so important. Regardless of where a student lived or attended school, it provided students with legal protection.</p>
<p>Without the directive, and despite DeVos’ assurances, bathroom options will be limited for many transgender students.</p>
<p>Either they have to travel quite a distance to get to the nearest single-stall gender-neutral bathroom, or just “hold it in.” </p>
<p>Such options have clear drawbacks and health risks. <a href="http://www.nytimes.com/2015/07/27/opinion/for-transgender-americans-legal-battles-over-restrooms.html">Urinary tract infections</a>, <a href="http://thinkprogress.org/lgbt/2015/10/14/3712394/wisconsin-transgender-school-discrimination/">depression and even suicide</a> could be among them. </p>
<p>One <a href="http://www.tandfonline.com/10.1080/00918369.2016.1157998">study</a> of transgender individuals found that over 60 percent of participants who had experienced some form of bathroom exclusion had attempted suicide – a rate far higher than among respondents who had experienced no constraints on bathroom use.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/159223/original/image-20170302-14695-we9oh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159223/original/image-20170302-14695-we9oh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/159223/original/image-20170302-14695-we9oh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159223/original/image-20170302-14695-we9oh2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159223/original/image-20170302-14695-we9oh2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159223/original/image-20170302-14695-we9oh2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159223/original/image-20170302-14695-we9oh2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159223/original/image-20170302-14695-we9oh2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Signage outside a restroom at 21c Museum Hotel in Durham, North Carolina, May 12, 2016.</span>
<span class="attribution"><span class="source">AP Photo/Gerry Broome, File</span></span>
</figcaption>
</figure>
<p>Importantly, the risks of physical and verbal assault – as well as the attendant risks of depression and suicidality – are present even when a transgender student uses the bathroom that matches his or her birth-assigned gender. </p>
<p>When students who, in every visible way, present as their identified gender are forced to use bathrooms that match their biological genders, reactions are strong. <a href="https://www.washingtonpost.com/posteverything/wp/2016/04/19/as-a-trans-man-i-never-felt-scared-or-unsafe-then-north-carolina-passed-its-discrimination-law/?utm_term=.c57e68dcdbc2">Payton McGarry</a>, a transgender male, describes being “screamed at, pushed, shoved or even slapped” when he used the women’s restroom after he began to develop male attributes.</p>
<p>This leaves transgender individuals with no real public bathroom option. As <a href="http://www.rollingstone.com/politics/news/what-its-like-to-use-a-public-bathroom-while-trans-20160331">Brynne Tannehill,</a> a transgender woman, describes, you could use “the women’s room and probably be OK and break the law.” Or “you walk into the men’s room… and you stay and that immediately marks you as transgender.” In this instance, argues Tannehill, following the law is far riskier. “Last year, we had 22 or 23 trans women murdered.”</p>
<p>As a result, sometimes transgender college students see their <a href="http://hub.jhu.edu/2014/11/25/homewood-bathroom-signs">best option</a> as renting a house near campus so they can go home to use the bathroom.</p>
<p><a href="http://www.nbcnews.com/feature/nbc-out/transgender-hotline-reports-flood-calls-after-trump-walks-back-federal-n725796">Recent transgender hotline activity</a> suggests that Trump’s actions have provoked fear among transgendered individuals and their allies. As news spread of his new directive, hotlines were flooded with calls. For instance, in January, Trans Lifeline received on average 139 calls per day. On Feb. 23, the lifeline fielded 379 calls. The crisis hotline has also seen a marked increase in “high severity calls” – those indicating “immediate crisis” – since Trump’s inauguration.</p>
<p>Legal groups like the American Civil Liberties Union (ACLU) are continuing their fight in court, <a href="http://www.cnn.com/2016/03/23/politics/north-carolina-gender-bathrooms-bill/">arguing</a> that these bathroom bills “push ugly and fundamentally untrue stereotypes that are based on fear and ignorance.”</p>
<p>For many, though, Trump’s decision to prioritize states’ rights means no bathroom options for trans students – especially in states that prohibit any local accommodation.</p>
<p>“Trans women are killed for using the men’s restroom, and they’re jailed for using the women’s restroom,” explains <a href="http://www.usatoday.com/story/news/nation/2016/04/28/transgender-bathroom-bills-discrimination/32594395/">Tyler Beebe</a>, a 27-year-old trans woman. “In the end, what choice do we have?”</p>
<p><em>Editor’s note: This is an updated version of an article first published on Nov. 19, 2016.</em></p><img src="https://counter.theconversation.com/content/50831/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Gash does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The bathroom has become a battleground for transgender rights — and rightfully so. Research shows that bathroom restrictions threaten the health and safety of the transgender community.Alison Gash, Assistant Professor of Political Science, University of OregonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/509172015-11-19T09:08:02Z2015-11-19T09:08:02ZAfrican cities aren’t keeping up with the demand for basic toilets<figure><img src="https://images.theconversation.com/files/102468/original/image-20151119-18436-calvmd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Poor sanitation leads to diseases like malnutrition and stunted growth in children. It also makes them sick and unable to attend school.</span> <span class="attribution"><span class="source">Finbarr O'Reilly/Reuters</span></span></figcaption></figure><p>Over the last 15 years, <a href="http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-Update-report-2015_English.pdf">68 million people</a> gained access to improved sanitation in urban areas in sub-Saharan Africa. This is a big achievement. But in the same period the urban population grew by an estimated <a href="http://www.wssinfo.org/data-estimates/tables/">167 million</a>. That leaves an additional 99 million urban dwellers without access to improved sanitation.</p>
<p>Since the beginning of this century there has been an increase in the number of people without access to improved sanitation in <a href="http://www.wssinfo.org/data-estimates/tables/">42 out of 51 African countries</a>. With the rapid rate of urbanisation on the continent, this number is going to increase.</p>
<p>This means there are 99 million - and rising - urban dwellers who are at increased risk of diarrhoea and other diseases spread by contact with faeces. The lack of sanitation in these areas is causing roughly <a href="http://onlinelibrary.wiley.com/doi/10.1111/tmi.12329/full">50,000 deaths</a> per year (assuming 40% urbanisation).</p>
<p>The health risks associated with poor sanitation include stunting in <a href="http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2013/02/05/000158349_20130205082533/Rendered/PDF/wps6351.pdf">children</a> as well as malnutrition. This, in turn, has an impact on cognitive development. On top of this, illness from poor sanitation prevents children from going to school and adults from going to work. The economic impact of the lack of sanitation has been estimated at up to <a href="https://www.wsp.org/sites/wsp.org/files/publications/WSP-Investment-in-Sanitation-to-Support-Growth-Africa.pdf">US$80 billion</a> annually for Africa.</p>
<h2>A new way needed</h2>
<p>Unfortunately, what should have been 15 years of investment in sanitation under the Millennium Development Goals or MDGs hasn’t materialised in Sub-Saharan Africa. Sanitation did not initially get the attention it deserved. As result there was lower investment and slower progress globally.</p>
<p>The new goals have tried to address this. The target in the Sustainable Development <a href="https://sustainabledevelopment.un.org/topics">Goals</a> is to achieve access to adequate and equitable sanitation for all by 2030. </p>
<p>But how will urban sub-Saharan Africa meet the goal of universal access to sanitation if progress is going backwards?</p>
<p>One way is to think about the pathways to universal access, rather than just focusing on a target of universal access. In the past 15 years, the focus has been on the target. And the target has been set by defining access to sanitation as “improved” or “unimproved”. These two measures have been determined by the kind of <a href="http://www.wssinfo.org/definitions-methods/watsan-ladder/">technology</a> used.</p>
<p>Improved sanitation systems included those that are considered to hygienically separate human excreta from human contact such as flush toilets and pit latrines with washable slabs. But only private latrines - that is where only one household has access - have been included as improved.</p>
<p>On the other hand, shared sanitation has been considered “unimproved” and not providing hygienic separation of human excreta. But it is one of the areas where there was the most progress over the MDG period. In urban areas in sub-Saharan Africa the population using shared sanitation doubled from <a href="http://www.wssinfo.org/data-estimates/tables/">64 million to 128 million</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/102469/original/image-20151119-18436-67vjtp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/102469/original/image-20151119-18436-67vjtp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/102469/original/image-20151119-18436-67vjtp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102469/original/image-20151119-18436-67vjtp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102469/original/image-20151119-18436-67vjtp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102469/original/image-20151119-18436-67vjtp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102469/original/image-20151119-18436-67vjtp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102469/original/image-20151119-18436-67vjtp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A ditch filled with sewage close to where people live.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Debunking myths about shared sanitation systems</h2>
<p>Shared sanitation systems are a practical option in informal settlements where space is limited and tenure for the household and the community is insecure. And there is a growing body of research that questions the assumption that shared sanitation is unhygienic compared to private latrines.</p>
<p>Research on shared toilets in urban areas in <a href="http://library.eawag.ch/eawag-publications/openaccess/Eawag_07279.pdf">Kampala</a> found that while households with private latrines thought their toilets were less dirty, in reality there was little difference between private toilets and shared toilets when there are fewer than four households sharing.</p>
<p>Research looking at the presence of bacteria had similar results. Recent <a href="http://pubs.acs.org/doi/pdf/10.1021/es503945x">research</a> from Tanzania demonstrated that shared sanitation systems had significantly less <a href="http://www.webmd.com/a-to-z-guides/e-coli-infection-topic-overview"><em>E. coli</em></a> bacteria at places where people touch the toilets with their hands than private sanitation. In fact, contrary to the concerns about hygiene in shared sanitation, in their regression model, sharing was considered protective against <em>E. coli</em> contamination.</p>
<p>Decisions will be made in the coming months about what indicators will be used to measure progress towards the SDGs. The Joint Monitoring Programme for Water Supply and Sanitation has <a href="http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-Green-Paper-15-Oct-2015.pdf">recommended</a> keeping shared sanitation as unimproved as they consider that the weight of evidence isn’t sufficient to change practices.</p>
<h2>A need for a shift in focus</h2>
<p>I believe we have to shift the focus from only looking at universal access to including realistic pathways that are addressing the growing demand adequately.</p>
<p>The hard fact is that shared sanitation will continue to be a reality in Africa’s cities. It should therefore be viewed as part of the transition to universal access and, as such, kept on the research and implementation agenda to support this transition.</p>
<p>I accept that there are good reasons why it should be considered as a transitional arrangement only. Most people who have experienced public toilets will attest to the shortcomings. </p>
<p>The two main barriers to shared sanitation being considered <a href="http://programme.worldwaterweek.org/sites/default/files/charles_katrinacharles_sanitation_swww_aug2015_v2.pdf">adequate</a> in informal urban settlements in East Africa were the lack of privacy and not having 24 hour a day access because caretakers lock the doors at night. But I believe that we can design better shared sanitation to meet the needs of the growing urban populations now, and help give Africa’s urban population a healthier environment.</p><img src="https://counter.theconversation.com/content/50917/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katrina Charles receives funding from DFID and has received funding from the SPLASH programme and the Swiss Agency for Development and Cooperation (SDC).</span></em></p>We know that Africa’s cities need better sanitation. But is the global focus on private rather than shared toilets really the best approach?Katrina Charles, Lecturer and course director in Water Science, Policy and Management, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/509162015-11-19T04:24:39Z2015-11-19T04:24:39ZLessons from three East African cities on why sanitation is such a challenge<figure><img src="https://images.theconversation.com/files/102349/original/image-20151118-14198-tb24f3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Residents of Kigali, the capital of Rwanda. Sanitation in the city is extremely poor.</span> <span class="attribution"><span class="source">Reuters/Tobias Schwarz</span></span></figcaption></figure><p>More than half of people living in informal settlements in East Africa live in insanitary and overcrowded conditions. The <a href="http://www.sidint.net/sites/www.sidint.net/files/docs/SoEAR2012_final.pdf">number of people</a> without adequate access to sanitation is around 55% in Kenya, 63% in Uganda and 68% in Rwanda.</p>
<p>Poor sanitation and unsanitary conditions pose a serious threat to <a href="http://www.who.int/mediacentre/news/releases/2008/pr08/en/">health</a>. Governments have failed to address the problem because they have not prioritised the provision of sanitation, particularly to poor people. </p>
<p>The question is: why has there been so little progress in delivering decent sanitation for millions on the continent?</p>
<p>In an attempt to answer this question, my colleagues and I conducted <a href="http://www.sciencedirect.com/science/article/pii/S0197397515000867">research</a> to understand how supply and demand have affected both the provision of toilets, as well as their use, in Rwanda’s capital Kigali, the Ugandan capital Kampala and Kisumu in Kenya.</p>
<p>Our <a href="http://www.sciencedirect.com/science/article/pii/S0197397515000867#bbib22">study</a> compared the similarities and strong differences of the sanitation markets in the three East African cities. </p>
<p>There is clearly no constraint on the demand side. But on the supply side we found a host of problems that are preventing the provision of decent toilets.</p>
<h2>What’s stopping toilets being built</h2>
<p>We identified a number of key problems. These included:</p>
<ul>
<li><p>Bricks and mortar: Materials needed for building toilets were very expensive because most building materials are imported. </p></li>
<li><p>Skilled labour: there is also a lack of skilled builders. Artisans are available in Rwanda, Uganda and Kenya to build latrines but they are general builders rather than specialists in sanitation.</p></li>
<li><p>Lack of training: Government’s and municipalities have not taken the initiative to train skilled builders.</p></li>
<li><p>Products and services: these are largely unavailable.</p></li>
<li><p>Cost: high cost was <a href="http://dx.doi.org/10.1016/j.pce.2012.08.010">identified</a> as the biggest factor preventing households from benefiting from improved sanitation.</p></li>
<li><p>Poor needs analysis: households are provided with sanitation products and services that they do not want. </p></li>
<li><p>Geography: the physical features of some informal settlements add to the struggle of <a href="http://www.sciencedirect.com/science/article/pii/S1474706510001312">sanitation</a>. Settlements are geographically rugged and are built on difficult terrain. Many people are forced to settle for shallow pits. And lack of vehicle access to settlements makes it impossible for service providers to use trucks to empty latrines.</p></li>
</ul>
<h2>Solutions</h2>
<p>Addressing a range of constraints, rather than single ones, is likely to be more effective. </p>
<ul>
<li><p>Awareness campaigns, communication and education programmes. Residents must be made aware of the availability of sanitation products and services and how they can access them. Changes to services must be accompanied by appropriate communication. And information centres can be used to teach people about what technologies are available, as well as financing programmes.</p></li>
<li><p>Long term national and local planning is necessary to overcome the constraints of limited infrastructure and lack of space. These also require a cross-sectoral approach.</p></li>
<li><p>Technologies need to be developed that take space and emptying difficulties into consideration. Examples of these are the <a href="http://akvopedia.org/wiki/Human-Powered_Emptying_and_Transport">MAPET and Gulper systems</a>. These are manually operated systems which limit the amount of contact humans have with waste when emptying. They’re also cheaper and less time consuming. </p></li>
<li><p>Emptying services and waste disposal goes hand-in-hand. Setting up waste transfer stations in settlements has been <a href="http://cdn.intechopen.com/pdfs-wm/40527.pdf">recommended</a>. They enhance resource recovery and the re-use of faecal <a href="http://www.ncbi.nlm.nih.gov/pubmed/18653932">sludge</a>.</p></li>
<li><p>Training: the construction of various latrine technologies could be improved through training. But there is a lack of understanding and skills among informal providers, such as manual emptiers, about the appropriate way of disposing waste. Training is one way of rectifying this.</p></li>
</ul>
<p>On their own the above solutions won’t ease the sanitation problems in East Africa. They need to be used together to achieve the required results.</p><img src="https://counter.theconversation.com/content/50916/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aime Tsinda receives funding from SPLASH EU Funded Research Project</span></em></p>Sanitation is a massive problem in East Africa. On the supply side there are a host of problems which are preventing people from accessing decent sanitation.Aime Tsinda, Lecturer in Environmental Geography and Urban Planning, University of RwandaLicensed as Creative Commons – attribution, no derivatives.