For Many Indian Women, Lack of Toilet Access Poses Health Risks

For Many Indian Women, Lack of Toilet Access Poses Health Risks

ON A HUMID AFTERNOON in May, a handful of local residents gathered at a one-room home in an unplanned housing settlement in Mumbai. The women greeted each other and then sat down on the small porch and on the tiled floor inside, swapping stories about the day’s events through the doorframe. Their conversation was lighthearted until someone mentioned hydration and the mood changed. “We won’t be consuming any more liquids today,” said 31-year-old Kalawati Yadav. “If we do, we might have the urge to urinate by later in the evening.” By then, the public toilets would be filthy from the day’s use, and without lighting, they would also be dark. “It’s not a safe time to go,” Yadav said.

Daytime is not much better, though, because the facilities are rarely truly clean. According to the women, the public toilets are usually dirty, unlit, and lacking in water. They are also in short supply. Two facilities, each with a dozen toilets — six for women and six for men — service the entire settlement, Subhash Nagar, which covers about one tenth of a square mile and as of 2020 housed more than 9,000 people. The municipal government is supposed to be responsible for sanitation, but there is very little oversight. (City officials did not respond to multiple requests for comment.)

As a result, for residents of Subhash Nagar, and for millions of low-income residents across India, bathroom schedules are often dictated not by biological need, but by inadequate toilet infrastructure. Several women told Undark that they routinely hold their urine and avoid drinking liquids in an effort to reduce trips to the facilities. These behaviors lead to stomach aches and constipation, but the women said they don’t have better options. Their neighborhood was unplanned — starting as a collection of tin plank homes, which were later replaced with concrete structures — so the houses are not connected to septic tanks. There are no private toilets, and the owners cannot afford to regularly use the fee-based facilities in other parts of the city.

This predicament is part of a larger story of India’s efforts to bring affordable and sanitary toilets to its population of 1.4 billion people. According to The Hindu, an Indian daily newspaper, nearly half of all Indians practiced open defecation as recently as 2013, with people going outside in fields, bodies of water, or other open spaces. Without public sanitation — septic tanks in particular, but also water and cleaning products — pathogens spread readily, causing serious health problems. The U.N. Deputy Secretary-General has called for the elimination of open defecation, and in 2014, Prime Minister Narendra Modi launched Swachh Bharat Abhiyan, or Clean India Mission, an effort that led to the construction of over 100 million toilets. Today, according to the World Bank, just 15 percent of the population practices open defecation.

Having new public toilets “is a step forward,” wrote Sarita Vijay Panchang, a public health researcher who did her 2019 dissertation on India’s urban sanitation, in an email to Undark. But many of India’s public toilets are overcrowded, she noted. This leads to long lines, sewage overflows, and concerns about personal safety — all of which constitute their own set of public health problems.

Surveys show that the situation is especially acute in urban areas like Mumbai. Safety concerns, as well as cultural norms, deter women from practicing open defecation as a fallback. (Men are more likely than women to practice open defecation even when public toilets are available.) Physicians and activists say the continued practice of caste- and class-based discrimination compounds the harms, as some women are forbidden from using the toilets in their workplaces.

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