A growing body of evidence

It’s no surprise, then, that recent evidence from India suggests that the significant challenge of finding safe, clean and private places to urinate, defecate and manage their menstruation near the household greatly increases women’s levels of stress. This becomes an even greater challenge when someone has an upset stomach, is experiencing incontinence or is pregnant and needs to urinate more frequently.

Overall, the impact of poor sanitation on women’s and girls' health remains underinvestigated. While there is recent research linking poor sanitation to preterm birth in India, women’s health hasn’t historically been the focus of sanitation-related research.

Research about sanitation in schools is more established. UNICEF (United Nations Children’s Fund) estimates that almost 50% of primary schools in the least- and less-developed countries do not have adequate sanitation (or water) on school grounds.

However, the true number of schools and children affected globally is unknown because many countries do not have robust systems for monitoring school water and sanitation facilities. Even if governments do know that schools lack facilities, constructing them may not be prioritized when budgets are tight.

Moreover, schools that do have facilities struggle to maintain them due to recurrent costs for soap or the need to make repairs.

A growing body of evidence indicates that many girls and female teachers are uncomfortable in school environments during their monthly menstruation. If toilets do exist, they might not have locks or be separate from the boys' toilets. They might not be clean, or have means for disposal of used sanitary materials. Water, if available on school grounds, may be located at some distance from the toilets, making it difficult to discreetly wash blood off hands or clothing.