One of the most pervasive and common forms of gender discrimination experienced daily by girls and women around the world is their inadequate access to private toilets, according to a new paper by researchers at Columbia Mailman School of Public Health and colleagues at the International Rescue Committee. Despite the rise of advocacy and research efforts, they write, far too little has been done globally to improve the actual design, guidelines, and placement of toilets for girls and women. The paper is published online in a special issue on Water, Sanitation, and Hygiene in Humanitarian Contexts in the open-access journal Water.

Girls and women have unique sanitation needs as compared to men. About one-quarter of all adult women globally are menstruating at any given time. Finding private safe locations for menstrual hygiene management is often challenging, especially in urban slums and displacement camps.

"At the most basic level, adolescent girls and women around the world have increased and distinct water and sanitation-related needs, the product of their physiology, reproductive health processes linked to menstruation, and pregnancy, and safety concerns," said senior author Marni Sommer, DrPH, MSN, associate professor of Sociomedical Sciences at Columbia Public Health. "This can be especially challenging for girls and women living in low-resource or over-crowded contexts, such as urban slums, displacement camps and informal settlements."

Constrained access to an adequate toilet with doors and locks and trash bins for menstrual waste disposal often results in stress, embarrassment, physical discomfort and gender-based violence, noted Maggie Schmitt, MPH, a co-author and project director within Sociomedical Sciences.

In earlier research, Sommer reported actual consultation with girls and women regarding their sanitation needs is relatively rare. This is particularly the case in humanitarian contexts. Consultation with girls and women is often further hindered by taboos around menstruation, general discomfort discussing female sanitation, and societal expectations around female modesty. Also of importance, girls and women frequently assume greater caretaker roles within their families, requiring them to bring children into toilets or to accompany children, elderly and family members with disabilities into toilets to support their management of sanitation needs, multiplying the discrimination and stress levels to even greater degrees.

Anxiety finding a toilet outside of the home can also result in girls and women refraining from conducting daily activities like attending school, visiting the market, or standing in long lines for their family's daily supply of water. Poor access to toilets in workplace contexts may impact their productivity, wellbeing and attendance, especially during menstruation, noted Sommer, who also leads GATE (the Gender, Adolescent Transitions and Environmental Program) at Columbia Mailman School. .

Mainstreaming the provision of female friendly toilets, would have significant implications for meeting the United Nations' Sustainable Development Goals around health, education, sanitation, economic empowerment and gender, according to the researchers.

"One recommendation around how to mainstream the concept of female friendly toilets into water and sanitation efforts is incorporating core components of female friendly toilets into existing guidelines developed by key water, sanitation and hygiene actors, governments, international agencies—like UNICEF—and non-governmental organizations," according to Schmitt.

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