For the lack of Toilets : Menstrual Health and Gender-based violence

Mounting evidence suggests that lack of water, sanitation and health (WASH) facilities, such as toilets and sinks, disproportionality affect women’s health, education, safety and dignity (Fisher et al., 2017). The disproportionate effects on women were first recognised In 1990 with ‘gender mainstreaming’, and then in 2015, Sustainable development goal 6 called for special attention for girls concerning WASH (Fisher et al., 2017). This acknowledgement of gender as a vital concern due to menstrual health and gender-based violence is something I will further illustrate using case studies of Tanzania and Nairobi.

 

Menstruation in schools 

 

First, I want to look at menstrual hygiene management (MHM). The World Bank (2021p3) describes privacy, soap and water as vital elements of MHM that allow girls to manage menstruation with "dignity and without discomfort or fear". However, limited toilets, with no or infrequent water supply, pose a threat to MHM, this is seen in Tanzania, with a 114:11 ratio of schoolgirls to toilets (Sommer, 2013). Sommer's (2013) research on Tanzanian schools highlights that toilets with water are essential for managing menstruation, ensuring that girls can wash away blood that can cause shame and harassment by other pupils. Menstrual taboos and stigmatisation make menstruation challenging in schools, especially when there's no privacy to change or water to clean, this can result in girls staying at home during menstruation, evident in South Sudan, with 57% of girls saying they do this, or even dropping out altogether (Worldbank, 2021). As a result, the gender inequality gap is widened as girls fall behind in school, as seen in Kenya, with 50% of girls reporting this, limiting future economic opportunities for women (Worldbank, 2021).

 

Toilets in Nairobi 

 

The lack of toilets is prevalent, not just in schools but also in informal settlements like Nairobi, Kenya, where only 24% of residents have access to toilets at a household level (Ruhiu et al. 2019).  In some settlements such as Mathare, toilets are considered a luxury good, and in Kibera, on average, one pit latrine would be shared by up to 50 people (Thieme, 2018). Limited toilets result in women having to walk long distances or open defecate, leaving them vulnerable to gender-based violence such as rape (Sommer et al., 2014). Women in Kibera report to Amnesty International (2010) that there are high numbers of women and girls who have experienced rape or sexual assault whilst walking to a toilet, especially at night. Gender-based violence creates stress and physiological damage to women, which widens the gender inequality gap.

Distribution of toilets in Mathare and customers 

Overall, it is evident that access to toilets with water is paramount to women's development and well-being. Women's voices and experiences must be heard to empower them to become leaders in WASH and create gender equality in and out of schools (Fisher et al., 2017). Organisations need to use Women's ideas on how toilets should be to make them safe, as seen in Sommer's (2013) Tanzania study, where girls said that they preferred pit latrines over flush toilets as they remove signs of blood. This contradicts top-down modernisation approaches, which wouldn't consider women's needs in that context (Lawhon et al., 2022). On the other hand, this issue is deeper than infrastructure; to effectively tackle WASH, gender inequalities, cultural taboos, and gender-based violence needs to be addressed within boys and men to make women safe.

Figure 3 - "The perfect toilet" by girls in Tanzania