Abstract
Despite the heightened emphasis on the sanitation agenda of the country, driven by both international and national development goals, there is little scholarly work to base our understanding of infrastructural needs of users for effective implementation. This research was conceived as a part of an extended study to assess sanitation needs in the city of Warangal, Telangana, India. The aim of this study is, specifically, to understand the needs of women for public toilets (PTs) and sanitation facilities. This article presents the results from the analysis of interviews conducted among a cross section of women from various walks of life, and of different ages and qualifications. The interviews were subjectively parsed and interlinked by two independent women reviewers unacquainted with the project. The raw qualitative data was then text analysed, and networks were created to map the co-occurring concepts. This exercise led to the revelation that there is a need for (a) toilets with basic facilities exclusively for women; (b) caretakers who will collect user charges, keep the toilets clean and provide a semblance of security; (c) well-maintained sanitation facilities in places such as bus stops and railway stations and (d) easy accessibility of PTs on main roads and in busy commercial areas.
Introduction
The sanitation crisis is recognised as a critical global challenge of the 21st century, and sustainable development goals (SDGs) amplify the provision of safe sanitation as an international priority. The lack of sanitation has a negative impact on health, education and livelihoods. The WaterAid, Water Supply and Sanitation Collaborative Council (WSSCC) and Unilever (2013) report entitled, We Can’t Wait: A Report on Sanitation and Hygiene for Women and Girls, reiterates the importance of sanitation for women and girls and highlights the following important aspects:
One in three women worldwide (1.2 billion) risk shame, disease, harassment and even attack because they have no safe toilets. Women spend approximately 97 billion hours per annum looking for a safe place to relieve themselves. When they do find a secluded and private place to relieve themselves, they expose themselves to the dangers of rape and violation. Of the 1.2 billion, 526 million women have no choice but to use open spaces. Every day, around 2,000 mothers lose a child due to diarrhoea caused by a lack of access to safe toilets and clean water. Adequate and appropriate sanitation and hygienic facilities can provide a comfortable space for women to manage their menstrual cycles with privacy and dignity. One school study in Ethiopia reported that over 50 per cent of girls missed between day 1 and day 4 of school per month during their menstruation. Where toilets exist, they are unclean and unhygienic, without facilities to manage menstruation needs. The UNICEF estimates indicate that 1 in 10 girl child in Africa drops out of school for this reason.
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This number increases to 30 per cent in Nepal and Afghanistan and to 20 per cent in India.
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This is the case in most developing countries. A factory case study in Bangladesh showed that 60 per cent of female workers used rags from the factory floor as menstrual cloths. This resulted in infections that caused 73 per cent of absenteeism among the female workforce at an average rate of 6 days a month. An intervention to change this resulted in absenteeism dropping to 3 per cent, leading to significant economic gains for workers and the factory owner.
As per the latest JMP data (2017), 40 per cent of the population in India practices open defecation. The Swachh Bharat Mission management information system (MIS) reports that 421 (out of 720) districts and 19 states are open-defecation free as on 6 August 2018. Much progress has been made; yet the task before us now is to ensure that everyone has access to safe and functional toilets, and this includes those girls and women from marginalised communities in urban and rural areas.
While the lack of proper sanitation facilities may appear to be a problem of the poor or for rural areas, the lack of clean and safe public toilets (PTs) plague well-off people in urban areas too. As pointed out by Rithu Chatterjee in her post on PTs for women:
It’s a big issue even for women like me, who grew up in urban, educated, middle class households with toilets at home. As soon as you leave the security of your house, there’s no place for you to go. And even when there are toilets, like in my school [when I was] growing up, they’re filthy. Most of my girlfriends and I would hardly ever use our school toilet.
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In addition to the lack of clean sanitation facilities in public spaces, it is also very hard for women to find functional and safe toilets when they travel. Mr N. V. Vasudeva Sharma, who works in the field of child rights, started a petition in 2016 that has now been signed by over a million people. He stated:
I am extremely disturbed at seeing how women suffer when they travel by bus because they don’t have decent toilet options available. It is sheer torture for women to travel more than 12 hours in a bus on any route in India and not be able to go to the toilet.
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Despite the large-scale prevalence of the problem and a general awareness of its consequences, little time and effort have been allocated to a systematic study on women related sanitation issues. Given the extent of the sanitation problem, most of the energy and effort are expended in firefighting rather than on carrying out adequate research to understand needs. A development of scholarly work that can provide a framework and direction for proper implementation of plans for better sanitation is lacking. The following section provides some gleanings from existing literature about toilet needs of women.
Background Literature
In most scholarly as well as journalistic literature on sanitation, designing PTs is seen as part of making the city more liveable in terms of quality. A great deal of attention is given to building PTs as a core element of environment design (Greed, 2004). However, the aspect of inclusive development of sanitation facilities for all groups such as women, children, the aged and the handicapped is often overlooked, hampering their larger participation in public life (Knight & Bichard, 2011). Although a good body of work is available through mass media such as in journalistic writings and in legal sources, there is very little scholarly work done on toilet needs for women in India. With a few exceptions, such as Kira (1976) and Wright (1967), there appears to be a dearth of scholarly literature on this topic. As Anthony and Dufresne point out:
[R]elatively little scholarly research has been written on social and psychological issues in restroom design. In the planning, architectural, interior design, or environment-behavior literature, people’s needs in restrooms have been paid short shrift. (Anthony & Dufresne, 2007, p. 268)
Even the recent work of Diane Coffey and Dean Spears (2017) on the Swachh Bharat Mission talks about the larger issues in sanitation such as open defecation but not about inclusive solutions to the problem. Their take on the subject deals with reasons why some of the approaches suggested for solving sanitation problems are not working. Perhaps the solution lies in focusing on users of sanitation facilities.
In an interesting paper that advocates ‘potty parity’ and the construction of planned toilets appropriate for different user groups, Anthony and Dufresne point out:
Historically, architects, contractors, engineers, and building code officials rarely contacted women to learn about their special restroom needs, and, until recently, women were rarely employed in these male-dominated professions or in a position to affect change. (Anthony & Dufresne, 2007, p. 268)
Sarah Moore, a legal scholar, opines that the lack of adequate toilets for women is a form of subtle discrimination aimed at keeping the status of women lower than men’s. She notes: ‘It often goes unnoticed and is considered normal, natural, or acceptable’ (Moore, 2002, p. 600). In her paper titled, ‘Facility hostility? Sex discrimination and women’s restrooms in the workplace’, she identifies four types of restroom inequality. These are as follows:
Unequal restrooms (fewer in number, smaller and farther than male restrooms) Inadequate restrooms (lack of soap and running water making it unhygienic for women) Missing women’s restrooms (women have to share with men) No restrooms at all (which implies that women have to hold it or use any outdoor private spaces)
One issue related to why women have to wait longer for toilet access has been that women take more time in using toilet, and hence even when there is an equal number of men’s and women’s toilets, women have to wait longer. Edwards and McKie (1996) use biological and social reasons to explain why it might take women longer in the toilet than men. According to Rawls (1988, p. 9), men spend an average of 86 seconds per visit while women take about 3 minutes per visit. Given this context, discussions on women’s usage needs and patterns become imperative to understand the issues better. Women urinate sitting down in small enclosed spaces and have to use water or toilet paper to clean themselves. Women also wear more cumbersome clothes and have purses and sometimes children to manage within the small enclosed spaces. These usage requirements make it harder and more time-consuming for women using PTs. Changing menstrual absorbents during menstruation takes even more time since it entails going through several steps involved in finding, using and disposing sanitary pads/tampons. Assuming similar timelines and usage patterns for men and women leads to poor planning and implementation.
John Banzhaf (2002), often known as ‘the father of potty parity’, points out that there are more health hazards for women compared to men when using toilets in public spaces. He points out that women who are menstruating or pregnant cannot wait for too long without relieving themselves as their discomfort level especially during pregnancy is higher, often causing health hazards due to infections. Edwards and McKie (1996) point out that women have greater contact with restroom fixtures, like toilet seats, and hence are at a greater risk of contracting infections. To avoid infections, women often hover over the seat while urinating to reduce contact which in turn leads to incomplete or partial emptying of the bladder.
The case of Lynch and Freeman recounted in Anthony and Dufresne (2007, p. 275) illustrates the nature of problems that women face even in workspaces. Eileen Lynch was hired as an apprentice in a construction site which only had two portable toilets for women. It was maintained so badly that she started to hold her urine, which eventually led to pains in her abdomen. Her doctors diagnosed her with cystitis, a urinary tract infection. After this incident, she started using a cleaner restroom in the powerhouse, which was normally closed to construction workers. She was fired for using this facility, which led to litigation. The court in this case proclaimed, ‘all females were placed at a higher risk of urinary tract infections by using unsanitary portable toilets or by avoiding the use of such toilets and holding their urine.’
Banzhaf (2002) points out that even if the toilets were sparkling clean, holding urine for too long can lead to urinary tract infections which in turn lead to renal damage if left unattended. Naeye (1979) indicates that the low birthweight of babies is caused by urinary tract infections, and the National Institutes of Health (1995) indicates that delayed defecation can lead to constipation, abdominal pain, diverticula and haemorrhoids.
Danish Khan, a reporter in Mumbai who studied PTs in railway stations in Mumbai found that most toilets were not usable owing to clogged drains, and most stations did not have toilets for women. Khan (2004, p. 274) states, ‘[m]ost women in the city would prefer a bursting bladder to using public toilets at railway stations. But those willing to brave it will just have to grimace and bear it like the rest of us.’
According to the findings of an inspection of PTs mandated by the Delhi High Court in 2007, out of the 3,192 urinals in the city, only 132 were toilets for women. Ashok Agarwal, the advocate who filed the suit, wrote:
It is submitted that failure on the part of the MCD (Municipal Corporation of Delhi) to provide adequate number of well-maintained urinals for women in every zone is a violation of fundamental and human rights of the women as guaranteed to them under Articles 14 and 21 of the Constitution of India. (cited in Sheikh [2008])
In her study for the Center for Civil Society, Shahana Sheikh points out:
Only 4 per cent of the public urinals in Delhi have facilities for women. Women face a constant risk of being sexual[ly] harassed while going to relieve themselves outside. It is essential that this percentage is enhanced, so that women, even from the lower economic strata, have access to a proper enclosed cubicle as a toilet. (Sheikh, 2008, p. 69)
Despite a fair understanding of the negative consequences of the lack of proper sanitation facilities for women, little work exists in understanding the nature of women’s needs in sanitation. This is further accentuated in the Indian context where the focus continues to be on the fulfilment of basic requirements in general, without adequate attention to the special needs of women. One such rare ‘need-assessment’ study is the 3-year study by Hanson et al. (2007) among 548 people in London which points to the social, physical and political dimensions of toilet provision in public life. Another observation study undertaken in Turkey at 14 different points by Afacan and Gurel (2015) indicates physical and social barriers in toilet use. Physical problems including accessibility, usability, ease of manipulation and way of finding were some of the issues identified by Afacan and Gurel (2015).
This study captures the experiences, usage patterns and needs of women in the city of Warangal, the second largest city in the newly formed state of Telangana. It forms a part of the sanitation improvement programme being initiated by the municipality of the city of Warangal. The research included qualitative and quantitative approaches to the problem. This article describes the qualitative study carried out subsequent to a dipstick quantitative study and provides an analytical insight into the experience and perception of women using PTs in the Warangal area.
Site of the Study
Warangal, the second largest city of the newly formed state of Telangana, has a population of 610,000 as per the 2011 census, and the estimated population in 2017 was about 1,000,000. Located at a distance of 145 km from Hyderabad, it has an area of 472 sq km. It has 0.19 million households, and 30 per cent of the population lives in its 183 slums. It is a developing city and a tourist destination. The Greater Warangal Municipal Corporation (GWMC), with a technical support from the Administrative Staff College of India and the Bill and Melinda Gates Foundation, has been implementing several initiatives in mission mode to achieve comprehensive sanitation improvements in the city through the provision of household toilets, public and community toilets, public urinals, sludge and septage management, school sanitation and an awareness creation about sanitation, hygiene and health.
The interview data for this study conducted in March 2016 was collected from women across multiple public spaces such as bus stops, schools, open marketplaces and office spaces to examine the need for PTs in places where women spend time outside of their homes.
Methodology
Study Design, Selection of Subjects and Data Collection
This study represents one part of a longitudinal study undertaken to assess and understand the PT needs in Warangal. A pre-assessment structured questionnaire was used for a quantitative dipstick study to assess the PT usage habits of 197 women from all strata of society and different occupations, including street vendors, government officials, business women and students. This variety was required to ensure a cross section of responses to an effective interview schedule used for in-depth interviews with women selected for the purpose.
This pilot investigation revealed the following:
Older women had a higher awareness of sanitation hygiene issues while occupational differences did not make a difference to awareness levels. While a majority of the women were aware of general hygiene issues, they were unable to point out or name specific consequences of poor hygiene, such as diarrhoea and urinary tract infections.
A large number of respondents said that they washed their hands after visiting the toilet; however, in several cases they could not since there was no soap and running water in the public facilities they visited.
Women who stayed over 10 minutes away from their homes used PTs, and hence distance from home was a critical reason for using PTs.
Less educated women used PTs more often than better educated women. This is perhaps because women who worked in outdoor public spaces, for example, street vendors, were often less educated than those who had access to offices and workplaces housed in buildings.
All women (100%) said there was a PT nearby, but almost 50 per cent of them chose not to use it. Some reasons for not using PTs were lack of cleanliness, bad location, absence of locker facilities and of a caretaker for maintenance of the toilet.
About half of the interviewed women (52.8%) used PTs, and a quarter of them stated that they had no complaints. Their experience was determined by cleanliness, odour and accessibility.
Most women in the sample indicated that they did not wash their hands with soap (74/104), and about 66 per cent said they used the PT once during the day. All of them paid over ₹5 for its use.
The absence of a trained caretaker, unacceptable behaviour of the caretaker and Western type commodes seem to discourage the use of PTs.
Appealing colours of the walls and the décor in the toilet encourage toilet usage by providing a sense of space and showing that the toilets are cared for.
The presence of a caretaker and reasonable fees increase the usage frequency.
The quick quantitative assessment helped narrow down the scope of the study and develop an open-ended interview guide (see Appendix A). Detailed interviews were carried out in the local language among 21 women who live in the city. The sample of women selected for the second set of interviews represented various income groups, had varying educational qualifications and belonged to different strata of society (see Table A1 for the list of interviewees and their occupations). They were selected keeping in mind the need for perspectives from women of various income and professional strata and the time they spent outside their home for work or leisure.
Ethical Considerations
The data was recorded and transcribed first in Telugu, the local language, and then was translated into English. The women were informed that the interviews were being conducted for a study on women’s use of PTs and that their names would be kept confidential.
Limitations
Since the qualitative study was carried out in Warangal city/district, the data culled from the interviews may be specific to the region and its geographic, socio-economic and cultural conditions. However, the method could be applied anywhere.
Data Analysis
The transcripts were made in English and then subjected to text analysis where the word count and frequency analysis was carried out. The phrase count analysis was also carried out since several of the words were two-word phrases that lost meaning on being counted individually. Hence the analysis was further carried out on the two-word concepts. The frequency data was subjected to a non-metric multidimensional scaling (NMDS) 5 based co-occurrence and similarity analysis, leading to an interesting set of clusters. This data was further analysed using network analysis, 6 which revealed strong relationships among some of the concepts.
Validity and Reliability
Two independent reviewers read the transcripts to develop their own themes. The themes revealed from the text analysis were compared with those developed by the researchers, and five broad themes are reported in a narrative format in this article.
Some broad themes of concern culled out from an independent review of the interviews include:
Usage of PTs in public spaces Usage of PTs when travelling outside and during long hours of work outside the home Cleanliness and hygiene Facilities—water, washing facilities (soap and running water) and commodes (toilet faucets) Security and safety—adequate lighting and women caretakers Visibility—easy to access from main roads, having signboards and so on
The concepts developed by researchers were plotted into a relational diagram as provided in Figure A.1 as the themes were not entirely independent of one another. However, the analysis was subjective, and further analysis was undertaken for more objective assessment of the themes.
Results
In this second phase, QDA Miner and Wordstat 7.1 were used to analyse the free-flowing transcript in a frequency analysis 7 (Table A2—word frequency). It may be noted from the table that single words did not make sense by themselves (e.g., ‘public’/‘toilet’ versus ‘public toilet’ and ‘waiting’/‘area’ versus ‘waiting area’) and hence phrases with two words that occurred more than four times in the transcript were chosen for frequency analysis (Figure A.2). It may also be noted that all words are relevant to the analysis of themes from the transcript.
This frequency data was then tested for co-occurrence within paragraphs. Since each question in the interview was answered in smaller paragraphs, the co-occurrence of themes was assessed in each paragraph of the transcript. The co-occurrence was tested in Sorensen’s coefficient of similarity 8 . The dendogram 9 given in Figure A.2 provides an overview of the number of clusters using the similarity index.
Figure 1 provides a visual graphic of the clusters based on NMDS* of the list of phrases.
This multidimensional scaling based graph (see Figure 1) generated from non-metric frequency and co-occurrence data is projected at a stress level = 0.342 and R2 = 0.5. Although this might be considered inadequate by some reviewers, given the number of data points and number of dimensions generated, increasing dimensions would not provide further clarity on the clusters. From the data visualisation image given in Figure 1, it is clear that there is an adequate degree of divergence among concepts. This was hence used for visualisation rather than for analysis. Based on this dimensionality, five broad themes were identified.
As we may note from Table 1, ‘basic toilet facilities exclusively for women’ is the most important variable in enabling usage of toilets. The respondents have indicated that they require certain exclusive facilities and that the presence of female caretakers would make them feel more secure. Access from main roads and in locations such as petrol pumps, bus stops or railway stations where they stop during travel appear to be important locations for such toilets. Based on the NMDS results, links among these concepts within the clusters were further analysed using network analysis to examine the most closely linked ties among concepts. The clusters were anchored by one or two concepts denoted by the larger circle in figures and in bold in the table. The network analysis results and narratives from interviews are provided in Figure 2.
Basic and Exclusive Sanitation Facilities for Women
From Figure 2, it may be noted that the basic infrastructure is most closely linked to water supply (0.6) and hand wash (0.42). The link among ‘proper maintenance’, petrol pump and water facility’ (all over 2.0) is quite strong, indicating that women felt that water facilities in toilets at petrol pumps was important and that water is important for proper maintenance since water facilities in this network is linked only to these two phrases. Overall, basic facilities are linked to most of the nodes with a strong connection to exclusive women’s facilities (0.3). Clearly, there is a very important need for clean, hygienic and well-maintained facilities in general. Based on the keywords analysis, the interviewed women indicated the need for basic facilities.
Sujata, 10 a programme manager by profession, pointed out the need for basic facilities ‘like sufficient water, hand wash facility, dustbins, spotless commode, mug and bucket…’ Srilata, a street vendor added: ‘…hand wash with soap, dustbins, proper doors and latches, mirror, sanitary ware. Separate entrance/ exclusive women’s toilets are recommended. Public toilets need not be luxurious, basic facilities with proper maintenance are more advisable.’ And Binita, a sanitation worker, suggested: ‘Basic facilities like dustbins, taps with 24x7 water supply, mug and bucket, liquid for hand wash facility, soap for face wash and a mirror are enough and there should be a small space as a waiting area.’ She further added, ‘We are not demanding luxury facilities. Basic facilities with a basic fee like ₹2 for using public toilets is far better for all groups of people in society especially for low income[people].’
Kala, a homemaker, directed our attention to: ‘good water facility with taps. It will be good if mirror and dustbin facility are provided. Shower facilities may help visitors and tourists.’ Sowmya, a street vendor, also provided her wish list, ‘The commode should be spotless with 24x7 water supply, instead of soap, a liquid hand wash is better, good odour, good quality of mug and bucket, mirror, dustbins and availability of sanitary pads especially will be useful…’
Themes from the NMDS Categories
Srinidhi, a government school teacher, pointed out:
Public toilets should have more water facilities. This particularly requires attention as the public toilets built in the city are not well maintained, I have seen toilets inside public gardens which are in terrible condition with no water facility and no proper maintenance and in spite of this being reported several times no authority has responded.
Ishita, a business woman, narrated her experience, ‘I used toilets near the bus stops in Hyderabad but not public toilets. But it was a bad experience as there is no proper maintenance, no water facility, bad odour, mosquitoes and it was very unhygienic to use.’
From the foregoing statements of respondents, it is apparent that the most basic requirements and amenities for clean and hygienic maintenance of PTs is missing, including requisite supplies of buckets, mugs, mirrors, soap for hand washing, regular water supply and an odourless and clean environment. These are critical aspects of a user’s experience. Maintenance is also closely linked to appropriate disposal facilities for sanitary pads. Women’s ability to go out to work with confidence has to do with the sanitation infrastructure available to them outside the home. A clean and hygienic toilet provides a sense of security and safety for menstruating women who need to change and dispose their menstrual absorbent, clean themselves and sometimes even wash and dry used cloth. With 355 million or almost 30 per cent of the country’s population comprising menstruating women, it is critical that sanitation facilities respond to the biological needs of women and address gender disparities.
Caretakers, Security and Cleanliness
Figure 3 indicates that the presence of female caretakers in women’s toilets strongly influences the feeling of security (0.533), making women comfortable enough to relax in waiting areas/sitting spaces (0.571). Women tend to rest comfortably in sitting areas when they feel secure (0.667) and are willing to tip caretakers who will ensure cleanliness of toilets.
Sangita and Lalita, both homemakers, felt that, ‘wherever there is a toilet, try to have a caretaker instead of a machine as a machine may not work sometimes. It is much better to have a caretaker and provide a livelihood opportunity for a poor person…’.
Urmila, a government school teacher, pointed out, ‘A public toilet with a caretaker is a better option because, in case there is any problem like no water, we can inform her. It is also not safe for ladies to go to the toilet alone without a care taker [in charge].’
Sowmya, the street vendor said, ‘A public toilet should have a caretaker because men might enter the women’s toilet without notice and that would be dangerous, so a woman [sitting] outside [the toilet] make us feel safe.’ Binita, the sanitation worker felt that a PT with women caretakers is preferable as users feel secure and need not worry about their belongings when a woman is sitting outside the toilet seemingly in charge of safety.
However, caretakers were not totally trustworthy or praiseworthy. Manisha, a school employee, indicated, ‘A caretaker always shouts at women for using more water and also for using the toilet for long. I have never used a public toilet but have heard this from people who used public toilets’ Geeta, a member of a local club stated:
Public toilets with caretakers are dangerous for women who wear jewellery and we cannot trust even the caretaker outside … for this reason, some people avoid public toilets. Otherwise, we can have some [electronic] type of security. We can have an alarm. If anyone enters [the toilet] by force, then the alarm should ring….
Shilpa, a cook, said: ‘[E]ven the presence of a caretaker is not enough, there have been incidents of people running away with jewelry and bags ….’
Yet, on the whole, the weight of opinion seemed to be on the side of having a caretaker in charge of PTs for women. Kirti, an employee with Balavikas, pointed out that ‘caretakers are not responsible for cleaning and maintaining the toilet. They are there only for the sake of collecting money (tips or fee).’ Cleaning could be automated, but users would prefer to see real people to whom they can pay the user fee. Automated or e-toilets that clean themselves automatically by dropping a coin in a slot were also discussed. Many women, challenged by technology, felt unsafe in such toilets fearing that they might get locked up inside.
Ishita, the business woman, felt that since everyone may not use the toilet in a hygienic way, ‘an e-toilet is much better than other models because it can clean itself automatically after use. Other than that, public toilets with female caretakers are preferable as users feel secure when a woman is sitting outside the toilet.’
From the foregoing quotes, it appears that while it may be useful to have automatic cleaning and modern self-cleaning toilets, women are sceptical about users’ ability to make proper use of these facilities. They feel the need of a human presence in the form of a caretaker to collect the money and ensure cleanliness, even if they are not responsible for the cleaning. The respondents indicated that they prefer to have female caretakers for exclusively women’s toilets as they feel safer from both personal and material harm. The feeling of security in using the exclusive women’s toilets with female caretakers appears to be quite high. This might be an important feature to introduce in order to make PTs more user-friendly for women. The presence of a female caretaker may also enhance the feeling of comfort and security during times of menstruation. Male caretakers could make the situation awkward for women users. Psychological discomfort in such sensitive spaces would deter sanitary practices.
Location and Maintenance
A large part of women’s experience comes from using sanitation facilities during travel or when they are outside their homes for a longer period of time. These experiences mould their perceptions, attitude and behaviour towards the use of PTs. Andal, a street vendor pointed out, ‘I once used a toilet at a bus stop but there was no hand wash facility, no proper maintenance but the user charge was ₹5.’ And Binita, the sanitation worker, pointed out:
Public toilets in Warangal are somewhat better compared to the ones I used in Hyderabad. But in Warangal, toilets do not provide soap for hand wash. They collect user charge of ₹5 but the maintenance is not up to the mark. Public toilets are used by many people, so they should be maintained properly and in a hygienic way so that people feel safe using them.
Hemalata, a housewife stated, ‘I have used public toilets in railway stations but not in the city. In railway stations they are not maintained properly.’ Srilata, a street vendor who spends a lot of time on the road, said:
Yes, the public toilet near my workplace is not maintained properly. There are no proper doors and latches. Bad odour comes from the toilets because they are not cleaned frequently. We feel shy to use public toilets here as it has the same entrance for men and women. No dustbins, hand washing facility, no soap. So I prefer to use toilets in other locations.
Meeta, a corporator, recalled, ‘I do not remember the places I used very long ago. The toilets there were not maintained properly and I used them because there was no other option.’
Geeta, a member of a local club explained:
I have used public toilets in Hyderabad and Delhi. Facilities in the toilets were good. In India we have parking problems so we cannot stop wherever we want and use a public toilet. It would be helpful if there are parking facilities for travellers near public toilets. At one time we used to find public toilets only at bus stops and railway stations but now they are available on roads. I found them neat and well maintained but soap was not provided.
On the other hand, Ishita, the business woman, had a bad experience. She said, ‘There is no proper maintenance, no water facility, only bad odour and, mosquitoes. It is very unhygienic to use such toilets. So, I prefer using toilets near petrol pumps, hotels or restaurants.’ Kirti, who works with Balavikas, said:
I never needed to use public toilets but once I used a toilet in a [commercial] complex and that was the worst experience I had of using a public toilet. Such complexes are built at huge expense but they lack proper toilet facilities. We visit complexes for shopping but their toilets are the worst, there is no space to keep our belongings and no kids’ waiting area and also no proper maintenance, no dustbins and no handwash facility.
Regarding pay-and-use toilets, Urmila, the government school teacher pointed out:
I have used toilets at bus stops. If the cost for a single use is ₹5, it is huge amount for villagers. It used to be ₹2 but now it has been increased to ₹5. Public toilets should be free of cost. This won’t be hard on poor people who think that instead of spending money they can use open spaces. Generally, pay- and- use toilets are clean. At bus stops such toilets provide water but no hand wash facility.
While travelling, most women use PTs usually at bus-stops, railway stations and petrol pumps. They don’t mind paying for the facilities. However, paying a bigger amount when facilities are poor and ill-maintained make women avoid these facilities and gives them a poor impression of PTs in general. Women feel the need for well-maintained toilets in public places such as railway stations and bus stops and are willing to pay a charge for the proper maintenance of toilets (Figure 4). They speak of pay- and- use toilets as an alternative to PTs in such locations.
Access to PTs during menstruation becomes even more critical. For maintaining hygiene during these days, women must have proper facilities to change and clean themselves, especially if they are travelling for long hours. The inability to maintain proper hygiene during menstruation while travelling may restrict women’s mobility, make them vulnerable to infections and even affect their work participation.
Access to Public Toilets
Access to PTs and their location are a major concern for women who need sanitation facilities outside their homes. The graph in Figure 5 indicates that women prefer to use toilets on the main roads, arterial roads or even in slightly interior areas, so long as there are signboards and lighting in these places.
The women respondents had different opinions regarding the location of PTs and how this would affect access. Manisha, the school employee, commented, ‘If a public toilet is on the main road, women feel shy to use it because it is always surrounded by men and they feel that the men are watching them, it is better to place toilets on internal roads’. Srilata, the street vendor, said:
Toilets should be located on arterial roads. If they are situated on the main road men will be always be watching. When girls go to public toilets some men will keep watching them and they wait outside for the girl. These types of problems are seen more in Warangal.
Sujata, the programme manager, pointed out, ‘Toilets should be located on arterial roads. On main roads they should at least not face the main road. Toilets near the Collector’s office face the main roads and women feel insecure and uncomfortable being seen near them’. Sowmya, the street vendor, also echoed the same opinion, ‘Toilets should be situated on arterial roads because if they are located on main roads people always watch women. So, toilets should be placed a little inside’. Sangita, the cook thought the same. ‘Toilets should be available in slightly interior areas because most women don’t like to be seen using them on the main roads’. But Urmila, the school teacher, pointed out that,
It is better to have [toilets] on main roads. [Toilets on] internal roads … would be hard to find. Public toilets should be easy to access. Proper lighting should be assured. [When] using toilets [located] on main roads we need not worry about safety. A caretaker is enough. Not only this, open defecation would also decrease if toilets are located on main roads.
There seems to be a case for locating toilets on both arterial and main roads. Most women feel self-conscious about approaching a PT in plain sight, especially if they feel that there are a lot of men around and they are being watched. But at the same time, they feel secure if the toilet is on the main road. In light of these suggestions it might be a good idea to locate toilets where they are easily accessible from the main road but at the same time provide privacy and security for women. Perhaps, as Kalpana, a sanitary sweeper pointed out, ‘The caretaker must be a woman. Toilets should be set in slightly interior locations Women avoid using toilets on main roads as well as in secluded interior places’.
Infrastructure
Women feel the need for Indian style commodes more than for Western models, although they agreed that the latter are useful for older women who may not be able to bend their knees and squat (Figure 6). Kirti pointed out:
I usually prefer the Indian commode because it is safe, comfortable and hygienic but public toilets are for all types of people so one Indian commode and one Western commode with shower facility would give choices for all users. Since Warangal is famous for tourism, bathing facilities will be useful for tourists who usually check into hotels only for the purpose of bathing.
Binita said, ‘We usually use Indian style commodes in our homes. Western commodes are mostly for high class people … we feel uncomfortable using them. An Indian commode is preferable. Exclusive toilets for women could provide both models’, Meena, a student, preferred the Indian commode. Manisha, the school employee, also felt that an Indian toilet is better. ‘A Western toilet smells bad…’
While Urmila pointed out that uneducated women, villagers and old women do not know how to use a Western commode and they make it dirty, Sujata felt that
One of each model should be provided in toilets meant exclusively for women. Nowadays a lot of women suffer from knee problems but [on the whole] the Indian toilet is the best, and most hygienic.
Kirti also pointed out that ‘the Indian commode is more hygienic in public toilets ….’
Sangita and Lalita on the other hand felt that ‘After a certain age we cannot use the Indian commode. So, the Western type would be a good alternative.’ Sowmya was of the opinion that the ‘Indian commode is better but for old people the Western commode is comfortable. There is no need for a shower’. Hemalata said, ‘My preference is for a Western commode in public toilets. It is better to also provide a geyser for warm water in the winter season.’
Sowmya also pointed out, ‘a shower facility is good for all users and as Warangal has a floating population, a bathing facility should be useful’. However, Ishita felt that ‘women may not use a shower in public toilets for reasons of safety, so a shower facility may not be required’.
From the foregoing opinions, we may infer that in areas like Warangal women feel that Indian commodes are more hygienic and easier to clean and maintain. However, they also acknowledge the fact that in some cases, where women are infirm due to old age and other ailments, a Western commode might be more useful. Running water and hand-washing facilities, dustbins and a mirror in PTs are considered very necessary. While shower facilities do not have an enthusiastic following, some women think it might be useful for travellers. The consensus was that depending on the location, a judicious combination of Indian and Western commodes and wash/shower facilities ought to be provided.
Complete Network
The topics are linked to each other, and hence a network analysis was carried out to identify the strongest links (Figure 7).
The overall structure of the network suggests that there is a strong link among women’s feelings of security, comfort in using the waiting rooms and the presence of a woman caretaker. There is a strong link among water supply, basic sanitation facilities and hand wash, which is again closely linked to water facilities, maintenance and exclusive women’s toilets. Indian commodes, Western commodes and a shower facility were listed as requirements. It was recommended that PTs need to be located at railway stations, petrol pumps and bus stops.
The analysis of linked concepts and narratives indicate that women looking for sanitation facilities in public places are quite distressed with the existing state of facilities, location and infrastructure. There is a huge scope and potential to develop and improve sanitation and hygiene facilities in public spaces so that they respond to women’s specific needs.
Discussion
The article identifies and defines various themes developed as part of the qualitative study and indicates the relationship among these themes in understanding the scope of the issue. The five themes etched out in the form of narratives from the respondents’ own words help develop a broad idea of the thoughts and emotions of women in Warangal on the PT usage. The article also captures the wish list of these women for more useful sanitation facilities.
To recapitulate, some of the needs of women elicited from the interviews are described in the following:
Basic needs in women’s toilets include running water supply and hand-wash facilities, including soap. The toilets have to be properly maintained with provision for the hygienic disposal of sanitary pads. Women feel more secure if there is a female caretaker. Although they don’t expect the caretaker to clean toilets, they believe that toilets would be better maintained under their supervision. Women also feel secure while waiting or resting with a female caretaker nearby. The PTs are accessed by women travellers, who expect clean and well-maintained toilets with adequate water supply at bus stops, railway stations and petrol pumps. While women would like PTs to be located where it is easily accessible such as at a main road, they also feel awkward to be seen going into a toilet on the main road. Hence, they prefer to use a toilet located slightly off the main road with less traffic and loiterers in the vicinity. Women prefer to have both Indian and Western type commodes to choose from. Shower and wash facilities are also desired—especially if they are travellers who have spent a long time on the road. The caretaker is regarded as a necessary part of the infrastructure. Women have specific sanitation and hygiene requirements associated with their menstrual cycle. During their menstrual period, a clean toilet with running water, hand-washing facility, soap and access to clean menstrual hygiene products, as well as facilities for safe disposal of menstrual waste, become critical requirements. The lack of these facilities not only affects the individual woman but also the general hygiene of the facility leading to the spread of infections. Good sanitary facilities must address the specific requirements of menstruating women to make them feel safe and to enable their mobility by ensuring availability of such toilets at bus stops and railway stations.
The study indicates that women want clean and well-maintained toilets but do not expect the caretakers to clean the toilet. Most women were comfortable with self-cleaning e-toilets but were unsure of the efficacy of these toilets which have come up all over the country. There are different maintenance models for PTs, and the usage and maintenance of the facilities is a function of the type of model in terms of construction and maintenance. The design of the toilet, including elements of ventilation, access, lighting and so on, could have a bearing on the usage behaviour. It would be useful to study the user behaviour across different models and designs. Gender-segregated user data could be collected to examine usage patterns in these PTs.
Conclusion
Findings from this research have contributed specifically to the assessment of sanitation needs of women in public places. As a one-of-a-kind study taken up to solve specific issues in this area, the study has been immensely useful in making a case for the implementation of PTs for women. The city government took note of the study and followed up with an initiative to design and set up sanitation facilities for women in Warangal city. The experience gained would influence similar initiatives and programmes in other cities in India likely to be undertaken in the wake of the Swachh Bharat Mission. Three immediate outcomes of the study are as follows:
Warangal city has initiated construction of exclusive toilets for women, under the name ‘she toilets’. Four toilets are being constructed under public/private partnership and five toilets are being constructed by the GWMC. The minister of urban affairs announced that all the towns of Telangana will have she toilets.
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Hyderabad has also installed 14 she toilets.
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This study paves the way for more investigations in different regions which could lead to region-specific solutions for providing women with PTs exclusively for their use.
It is evident that a study of this type was necessary to bring home the need for exclusive women’s toilets and influence the disbursement of funds for building such toilets. Moreover, when women become aware of and articulate their sanitation needs in public areas, they take these hygiene standards into their homes as well.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The author received no financial support for the research, authorship and/or publication of this article.
Open-Ended In-Depth Interview Guide
Usage of toilets outside of India, in India, while travelling? (why/why not)
In Warangal? Design features of toilets Preferences for type of facilities Feeling of safety and security Feeling of cleanliness and hygiene Preferred toilet basin—Western/Indian Willingness to pay for caretakers and cleaning services Exposure to alternative toilet facilities inside and outside India