Their education suffers, particularly for girls with nowhere to manage their periods, says Ada Oko-Williams
It may not be the most glamourous of inventions, but the humble toilet saves lives and creates futures. Yet one in four people do not have access to even a basic toilet and 620 million of the world’s schoolchildren—almost twice the population of the United States—do not have decent toilets at school. Living without a basic toilet threatens the health and safety of children and has a major impact on their chances of an education.
Tragically, many children don’t even make it to primary school, with diarrhoea caused by dirty water and poor sanitation killing around 310,000 children under the age of 5 every year.
Dirty water and diarrhoea
For those children who do survive repetitive bouts of diarrhoea, prolonged undernutrition can cause them to be malnourished and their growth stunted, which means they are likely to struggle with impaired emotional, social, and cognitive development. A quarter of all stunting is attributed to five or more episodes of diarrhoea in the first two years of life.
Having decent toilets at school means children don’t have to run home during lessons to use the toilet or relieve themselves outside in potentially unsafe situations.
It’s a particular problem for women and girls when they are on their period. If they have no toilets that lock properly, no adequate period products or bins to put them in, and no water to wash themselves clean it can be humiliating, limit their opportunities to learn and develop, and can also be unsafe. Embarrassment often forces them to stay at home, instead of working or going to school. Ultimately, it means millions of girls and women have fewer opportunities and are disadvantaged at every stage of their lives.
Rotten wooden floor
Where there are toilet facilities, many are not maintained and can pose risks to children’s physical safety. Recently, a South African 5 year old died after falling through the rotten wooden floor of her school latrine. The case caused such an outcry that the government pledged to install decent toilets in all state schools within two years.
The situation is particularly grave in Niger in West Africa, where three quarters of schools do not have adequate facilities and only 28% of children complete primary school. Ethiopia doesn’t fare much better: just 40% of primary schools have toilets, and more than nine in 10 people lack basic facilities at home as well. In Madagascar meanwhile, one of the poorest countries in the world, one in three schools don’t have a functioning toilet.
“We share the old toilet with the boys, and when the door was not working properly you can imagine how it felt,” explains 15 year old Melakie from Ethiopia. “I had a friend who missed school days every month because of her period.”
Despite Nigeria having the continent’s largest economy, the situation there is getting worse. The proportion of people with decent toilets is decreasing and a staggering 52% of schools lack toilets. In Chad, Africa’s fifth largest nation, nine in 10 people live without even basic sanitation.
Achieve their potential
Thankfully, there are success stories in countries where governments have made decent toilets in schools a priority, ensuring that children are able to attend their lessons and achieve their potential. Although Burkina Faso and Zambia are lagging in provision of household sanitation, 70% and 66% of their schools have basic toilet facilities, allowing children to complete their education.
At WaterAid we work with local communities and partners to build toilets in schools to keep children in lessons and to provide girls with a safe space to manage their periods. The charity also persuades governments and decision makers that building and maintaining toilets is a good investment that can drastically improve the health and lives of their people.
Safe toilets are a human right and a key component of the United Nations Sustainable Development Goals, which world leaders have promised to deliver to everyone everywhere by 2030. The rights to health, education, women’s rights and equality cannot be achieved without the basic provision of clean water, decent toilets and good hygiene.
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Ada Oko-Williams, senior WASH manager – Sanitation, WaterAid, London
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Provenance and peer review: Commissioned; not externally peer reviewed.
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.