Sanitation: Toilet Talk


Imagine it’s 2 AM and you have to pee. You stumble out of bed, walk down the hall to the bathroom, lock the door, and use the restroom. Now imagine instead of walking down the hall, you had to walk down the street to a restroom you shared with other families. Would you make the trip at 2 AM? Would you hold it? 


Going to the bathroom becomes a lot more complicated when there’s not a toilet in your home, but this is the unfortunate reality for billions of people. According to the World Health Organization (WHO), in 2017, only 45% of the world's population had access to private hygienic sanitation facilities, and 2 billion people did not have access to a toilet at all. 

Definition of Sanitation

Sanitation is the promotion of hygiene and the prevention of disease by removing sewage and trash from human contact. The WHO defines different levels of sanitation. Open defecation into pits without slabs, hanging latrines, or buckets is defined as “unimproved sanitation.” Basic sanitation hygienically separates human feces from human contact; it is considered limited when multiple households share this facility. The highest level of sanitation is considered safely managed, and takes the waste from basic sanitation and properly treats it. 

How it Works

People who don't have access to a toilet may rely on bucket latrines, hanging latrines, pit latrines without slabs, or may practice open defecation. None of these methods hygienically separate users from waste or dispose of waste. Poor sanitation is often accompanied by poor hygiene practices and limited water access, meaning that people are unable to clean themselves properly after they use the bathroom. This inadequate hygiene can further the spread of human waste into farming land or drinking water. Contact with human excrement can lead to transmission of diseases such as cholera, dysentery, hepatitis A, typhoid, tropical diseases such as intestinal worms and schistosomiasis, and polio. Furthermore, lack of sanitation causes around 432,000 deaths related to diarrhea. Diarrhea is also a leading cause of malnutrition and stunted growth in children. 

A lack of safe, improved sanitation can also cause stress and anxiety, lowered school or work attendance, and reduced daily-life productivity. Additionally, these circumstances introduce the risk of physical and sexual violence, which only increase at night and with the distance needed to travel. Women, particularly those in refugee contexts and violent areas are especially vulnerable to these risks. 

Why Care?

Top physicians from the British Medical Journal consider the development of clean water and sewage facilities the most important medical milestone in the past 150 years, even more important than antibiotics! Yet, there is still an incredible gap in access to these sanitation services between high-income and low- and middle-income countries. 

In 2018, the WHO reported only 31% of people globally use private sanitation facilities connected to a sewer system that actually treats the wastewater. Sanitation coverage is even worse in rural areas and among the urban poor. UNICEF reports that 75% of open defecation occurs in India, Indonesia, Nigeria, Pakistan, and Ethiopia, where sanitation services are rare. Sanitation technology needs to not only be available to all, but also be regularly and safely accessible long-term. 

Investing in improved sanitation technologies only fixes half the problem: there must also be accompanying behavior interventions. Good hygiene education can help prevent diseases and is just as integral as securing hygiene and water improvements.

There is still a lot of work to do for everyone to have adequate and equitable sanitation and hygiene. Homeless shelters are always in need of basic hygiene supplies like soap, so consider donating to a local one. You can also get involved in and support organizations like Sulabh International, which promotes sanitation coverage in areas where poor sanitation facilities and practices are widespread. The United Nations has made efforts to promote both better sanitation access and education through Sustainable Development Goal 6, so you can also advocate by contacting your representatives about the importance of this goal. Everyone deserves safe access to improved sanitation; it’s a human right.

Think Further

  1. Why do you think improved sanitation is such a widespread problem?
  2. Which should be addressed first in a community: waste disposal or access to clean water and hygiene practices? Why?
  3. Can you think of any setbacks, besides funding, in increasing sanitation around the world? 


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Learn More

  1. De los Reyes, Francis. “Sanitation is a basic human right.” Ted, Ted, Aug. 2013, 
  2. Regan, Helen, and Manveena Suri. “Half of India couldn’t access a toilet five years ago. Modi built 110M latrines — but will people use them.” CNN, Cable News Network, 5 Oct. 2019, 
  3. Belton, Padraig. “Why do billions of people still lack basic sanitation?” BBC News, BBC, 
  4. Black, Maggie. “Last Taboo: Opening the Door on the Global Sanitation Crisis.” Earthscan, 2008.