Mumbai: For Telangana based 37-year-old Vidya Panicker, having access to a brand-new toilet with handwashing and bathing arrangements didn’t stop her from defecating in the open. Her hope of finally using a toilet built under Swachh Bharat Abhiyan was dashed after the public toilet, newly built by the Greater Warangal Municipal Corporation (GWMC) in March 2017 was at an inappropriate location and had a male caretaker. Like Vidya, 21 other women from the same vicinity were uncomfortable to use these public toilets. When the civic corporation conducted a study involving 197 women they found several reasons for this, ranging from uncleanliness, presence of men near the location of the toilets, restricting women from using these toilets. Based on the suggestions of participants, the corporation designed exclusive toilets for women in October 2017 integrating features like female caretakers, choice of squatting and raised seats and means for disposing used sanitary napkins. Within days of its launch, the number of open defecation instances involving women have come down significantly.
Most of the toilets built across India are designed in a way that tend to force women to compromise on their personal hygiene. For instance, a 2017 study by ActionAid India showed that 35 per cent of 229 surveyed public toilets in Delhi did not have a separate section for women. Further, 53 per cent of women’s toilets did not have running water and 45 per cent toilets did not have a mechanism to lock the door from inside.
To help tackle this issue, WaterAid, United Nations International Children’s Fund (UNICEF) and Water and Sanitation for the Urban Poor (WSUP) have jointly launched a guide for government and toilet-building agencies to develop toilets that cater to the needs of women and girls.
What Are Female-Friendly Toilets?
In a recently launched guidebook titled ‘Female-friendly Public and Community Toilets’, these organisations have listed factors that make a toilet female-friendly:
- Safety and privacy: One of the main reasons pointed out by Vidya was the common entrance and a shared wall between the female and male toilets, second being the fear of being harassed as the toilet was located in a narrow lane. As per the guidebook, toilet blocks must have separate entrances to the male and female sections and there should be sufficient distance between the sections with separate walls. The toilets should be well lit, and caretakers must be present during all hours of operation.
- Accessibility: Many people experience difficulties using water and sanitation facilities, such as older people, people with disabilities, pregnant women, small children and people who are injured or sick. Ensuring toilets are accessible to all users contributes to inclusion, health, poverty reduction and economic empowerment objectives, as well as meeting the human right to sanitation for ensuring all citizens.
- Affordability and availability: If there are fees, it needs to be affordable so as not to prevent anyone from using the toilets. Opening times of toilets should be adapted to the community needs and displayed clearly. For instance, community toilets and public toilets near a busy station might have to operate 24 hours.
- Menstrual hygiene management: According the United Nations, an average woman menstruates for 3,500 days of her life, yet little attention is given to her menstrual hygiene requirements. Access to menstrual hygiene products like pads must be kept in a visible place that users can take (or buy at an affordable price) from the caretaker. Sanitary napkin incinerators or bins should also be there inside the female toilet block. The toilets must also have options for washing reusable menstrual products.
- Good maintenance and management: Even the most carefully designed and constructed toilet is useless if not kept clean and functional. A frequent cleaning schedule should be in place. Toilet caretakers must be given the means and resources – including salary and working conditions – to perform this task.
- Meeting the additional requirements of caregivers/parents: A clean and safe place for parents or caregivers to clean and change baby diapers should be provided. Additional suggestions include clothes-washing facilities and breast-feeding stations.
Why Are Female-Friendly Toilets Essential?
Sanitation is a cornerstone of public health. Improved sanitation contributes enormously to human health and well-being, especially for girls and women. We know that simple, achievable interventions can reduce the risk of contracting diarrhoeal disease by a third, said WHO Director-General Dr Margaret Chan.
Lack of female-friendly toilets can put women and girls at greater risk of damaging their health. Unlike men, women cannot openly urinate and so restrict themselves from eating or drinking to delay the toilet use. This may lead to several health problems like Urinary Tract Infections (UTIs), kidney stones and weaker bladder muscles.
Talking to NDTV about the health risks that pose women in India, VR Raman, Head of Policy at WaterAid India says,
While using dirty and unhygienic toilets lead to several infections, absence of adequate and hygienic toilet facilities most often also makes women to postpone or hold back their physiological needs. It is critical to go to the toilet at the right moment and to avoid prolonging peeing or pooing, since such retaining can cause many health issues. Holding back urine for long can cause infections and can lead to issues with bladder muscles as well as kidneys. Similarly, if faeces are not expelled in time, the small intestine tends to collapse, stopping assimilation of nutrients, leading to worsening of the already deficient nutrition of the poorest women in India, who suffer high rates of anaemia and immunosuppression. It also makes gases to accumulate in the intestine, leading to damage of intestinal systems and vulnerabilities to infection. Women from poor economic backgrounds and from working class has added burden of poor-quality water and food, which leads to chronic illnesses and related risks.
Menstruating women need a private and accessible toilet. Being unable to manage menstruation hygienically affects women’s health, mobility and dignity. Using the same sanitary product for too long can increase the risk of infection, while not washing hands after changing menstrual products can help spread infections such as Hepatitis B. Pregnant women using toilets need to be protected from various infections and illnesses too.
Thus, using proper toilets and hand washing – preferably with soap – prevents the transfer of bacteria, viruses and parasites found in human excreta which otherwise contaminate water resources, soil and food.
In addition to the requirements around health and hygiene, pregnant women, mothers with children, women with disabilities and age-old women have specific other requirements around toilets, which are important to be met as well.
The fact that we had to come up with this guide in itself indicates the unfortunate situation prevailing around addressing the needs of women and their health, which should have been addressed long ago. Though we have initiatives like female-friendly toilets in Hyderabad, Delhi and Pune, initiatives in Delhi and Bengaluru giving free or paid access to toilets in restaurants and the SBM (U) Toilet Locator android app by the Ministry of Housing and Urban Affairs, we still have to understand and address sanitation needs of women at scale. In most places, the concept of having adequate toilet facilities for women is missing, says Mr Raman.
He further says,
Adding to this, the concept of maintaining the available toilets hygienically is also not well established. The guide, in this context, has taken into account the needs of a range of female population from small girls, menstruating women, pregnant women, women with small kids, women with disabilities, to elderly women and to make it as inclusive as possible. The success of this initiative will depend on the realization and implementation of these recommendations in scale, by local bodies.
Further talking about challenges that pose the female-friendly toilets in India, he says,
Maintaining hygiene and cleanliness in public toilets is a challenge that is going to remain, especially in crowded places like railway stations, bus stops, markets and so on. Unlike in elite places like malls, where the maintenance staff has been hired and deployed for routine cleaning, the public toilets in such crowded places do not have sufficient number of caretakers to ensure cleaning between frequent uses. Community toilets for the urban poor are missing many of the critical elements that women would require too.
WaterAid, together with UNICEF, has prepared a shorter version of this guide that consists of key takeaways from the global guide and necessary additions for the Indian scenario, and submitted it to the Swachh Bharat Mission (Urban) (SBM-U). WaterAid expects this to be further taken up by the SBM-U soon, preferably on World Toilet Day (November 19), as a priority with the urban local bodies across the country.
NDTV – Dettol Banega Swachh India campaign lends support to the Government of India’s Swachh Bharat Mission (SBM). Helmed by Campaign Ambassador Amitabh Bachchan, the campaign aims to spread awareness about hygiene and sanitation, the importance of building toilets and making India open defecation free (ODF) by October 2019, a target set by Prime Minister Narendra Modi, when he launched Swachh Bharat Abhiyan in 2014. Over the years, the campaign has widened its scope to cover issues like air pollution, waste management, plastic ban, manual scavenging and menstrual hygiene. The campaign has also focused extensively on marine pollution, clean Ganga Project and rejuvenation of Yamuna, two of India’s major river bodies.