The Silent Crisis: Impact of Poor Sanitation on Women and Children in India

Every day, millions of women and children in India navigate a crisis that rarely makes front-page news – the absence of a toilet. Poor sanitation is not simply an infrastructure problem. It is a public health emergency, a gender rights issue, and a child welfare concern rolled into one. From disease transmission and malnutrition to physical danger and psychological distress, the consequences of inadequate sanitation fall most heavily on those least equipped to bear them: women, girls, and young children.

The scale of the problem
Children pay the highest health price
Sanitation, disease, and malnutrition: the hidden chain
Women’s health: a disproportionate burden
Reproductive and urinary tract infections
Menstrual hygiene: dignity denied
Safety, violence, and the danger of the open field
The psychological toll
Structural barriers: why toilets alone are not enough

The scale of the problem

India has made significant progress over the past decade. According to UNICEF, in 2015 nearly half of India’s population – around 568 million people – practised open defecation in fields, forests, or bodies of water. India alone accounted for half of the 1.2 billion people globally who defecated in the open. By 2019, an estimated 450 million fewer people lacked access to toilets, largely due to the government’s Swachh Bharat Mission (SBM), launched in October 2014, which resulted in over 100 million household toilets being built across 630,000 villages. Yet access and use are different things. The National Statistical Office’s 2019 report found that 28.7% of rural households still lacked toilet facilities, and even where toilets existed, a portion of households did not use them. The problem, then, is far from resolved – particularly for women and children who bear the sharpest end of sanitation insecurity.

Children pay the highest health price

The relationship between poor sanitation and child health in India is one of the most well-documented – and most troubling – in public health research. UNICEF reports that poor sanitation contributed to nearly 100,000 diarrhoeal deaths of children under five in India, and that inadequate WASH (Water, Sanitation and Hygiene) services in health facilities contribute to a neonatal mortality rate of 24 deaths per 1,000 live births, with sepsis alone accounting for 15% of all neonatal deaths.

Sanitation, disease, and malnutrition: the hidden chain

The link between open defecation and child malnutrition is often overlooked but is deeply consequential. When children are exposed to open defecation environments, they regularly come into contact with faecal matter through direct touch, contaminated water, and soil. The World Health Organization estimates that 50% of malnutrition is associated with repeated diarrhoea or intestinal worm infections from unsafe water or poor sanitation. This happens through a condition called environmental enteropathy – a chronic intestinal inflammation caused by repeated infection that prevents the body from absorbing calories and nutrients, even when food intake is adequate. The result is stunting, a form of chronic malnutrition where children are significantly shorter than normal for their age.

India’s stunting rates are strikingly high. The Population Reference Bureau notes that almost 62 million children – 48% – across all income groups in India are stunted, a rate higher than many countries in sub-Saharan Africa despite India’s stronger GDP growth. Research published in the National Center for Biotechnology Information confirms that unsafe disposal of stools is among the most significant contributing factors to both stunting and under-five mortality, with prevalence clearly higher in households where open defecation is practised. Crucially, states where 80% or more of the rural population can access toilets show much lower levels of childhood malnutrition than those where open defecation is common – a direct indicator of how sanitation infrastructure shapes child health outcomes.

Women’s health: a disproportionate burden

While children suffer visibly, women carry a burden that is often invisible – one that cuts across physical health, reproductive wellbeing, and mental health simultaneously. Research published in ScienceDirect shows that poor sanitation is more strongly associated with maternal deaths than even lack of clean water, particularly from infections related to pregnancy and childbirth. Since women are also the primary caregivers of children, they lose additional productive time to caring for sick children affected by sanitation-related diseases.

Reproductive and urinary tract infections

Women without access to private, clean toilets regularly suppress their food and water intake to reduce the need to defecate or urinate – a practice documented across rural and urban India. A study on adolescent girls in urban slums found that women without toilet access routinely withheld fluids, leading to dehydration, discomfort, and, at worst, urinary tract infections (UTIs). India Water Portal reports that 70% of surface water sources in India are polluted, and poor sanitation infrastructure – especially in urban slums – leads to faecal contamination of both soil and water, directly causing ailments like diarrhoea, intestinal worms, trachoma, and salmonella. For pregnant women, these risks multiply manifold, as frequent urination needs and weakened immunity make every trip to an open field a medical hazard.

Menstrual hygiene: dignity denied

For girls and women of reproductive age, poor sanitation creates an additional, deeply personal crisis around menstrual hygiene. In urban slums, nearly 70% of women cannot afford commercial sanitary pads and rely on reused cloth, which, in the absence of clean water and private spaces, becomes a direct cause of urinary and reproductive tract infections. Managing menstruation in open fields or filthy public toilets – without water, privacy, or disposal facilities – is not merely uncomfortable. It is medically dangerous and deeply humiliating.

The consequences extend to education. Research published in the Boston Congress of Public Health Review finds that 24% of adolescent girls in rural India drop out of school after their first menstrual cycle due to inadequate menstrual hygiene facilities. The National Family Health Survey (NFHS-5) also reveals that nearly one in four girls aged 15-19 has missed school during menstruation, citing pain, lack of facilities, or fear of embarrassment. Missing several days each month adds up to weeks of lost instruction annually, compounding learning gaps and pushing girls toward dropout – particularly in rural areas where school sanitation infrastructure remains weakest.

Safety, violence, and the danger of the open field

One of the most severe – and least discussed – consequences of open defecation is the threat it poses to women’s physical safety. When there is no toilet at home, women must venture into fields, roads, or public spaces, often before dawn or after sunset to avoid being seen. The LSE International Development Blog documents how women are governed by unwritten rules about when and where they can defecate – essentially forcing them into darkness, which is precisely when they are most vulnerable to attack. Dalit women face additional threats, including harassment and violence from upper-caste landowners when using agricultural land.

The empirical evidence is stark. A study published in NCBI using India’s National Family Health Survey data found that women who practise open defecation are twice as likely to experience non-partner sexual violence (NPSV) compared to women with a household toilet – a risk association that is twice as strong as the link between open defecation and child diarrhoea. Research analysing 74,698 women from the NFHS-4 survey confirms that in rural India, women without private household sanitation have significantly greater odds of experiencing sexual violence, with an adjusted odds ratio of 2.45.

Urban contexts are no safer. Research on slum-dwelling women in Pune and Jaipur documented that harassment and violence are routine features of accessing public or community toilets, with women developing elaborate coping strategies – such as “body discipline,” restricting food and water intake, or travelling only in groups – just to manage their basic sanitation needs. Many women reported not disclosing their experiences of violence out of shame, fear of social stigma, or the desire to protect their family’s honour.

The psychological toll

Beyond the physical dangers, poor sanitation imposes a continuous psychological burden on women. Research published in NCBI on women in Bihar identifies higher risk of psychosocial stress as a direct consequence of inadequate sanitation access, manifesting across all life stages. A study from Western rural India found that a significantly higher proportion of women who practised open defecation – compared to those with latrine access – reported feeling worried, rushed, irritated, depressed, and tense. Among open defecators, 36% reported fear of accidents or animal attacks, and 5% feared sexual harassment. Women who lacked private sanitation facilities reported stress related to personal safety as a leading daily concern.

A qualitative study across five villages in Rajasthan found that women’s experience of open defecation is consistently shaped by fear, shame, lack of privacy, and a pervasive sense of indignity – all of which affect their overall quality of life. Women spoke of suppressing meals to avoid defecating in daylight, of fearing their honour would be compromised if seen by men, and of internalising these daily humiliations as a normal part of life. This normalisation of stress is itself a public health concern – one that standard health indicators rarely capture.

Structural barriers: why toilets alone are not enough

India’s Swachh Bharat Mission has delivered remarkable infrastructure gains, but the experience on the ground reveals a persistent gap between access and use. Data from Cornell’s TCI platform shows that despite the Swachh Bharat Swachh Vidyalaya initiative mandating separate functional toilets in schools, 39% of these toilets were often locked or lacked water facilities, limiting their practical use – especially for girls managing menstruation. The UN Department of Economic and Social Affairs notes that while SBM mobilised over 600,000 community volunteers and constructed over 100 million toilets, sustained behavioural change requires far more than construction – it demands water supply, maintenance, lighting, locks, and waste disposal facilities that protect women’s dignity.

The LSE analysis is direct on this point: constructing latrines remains insufficient without poverty alleviation programmes, access to hygienic menstrual products, adequate lighting, potable water, functioning locks, and the dismantling of taboos around sanitation and menstruation. More critically, research from Bihar makes clear that involving women in the design and placement of toilets – not just as recipients of infrastructure, but as active decision-makers – is essential for sustained success. When women’s autonomy within the household is limited by social norms, their ability to advocate for or even use safe sanitation facilities is also curtailed, creating a cycle where gender inequality and sanitation insecurity reinforce each other.

The evidence is unambiguous: for women and children in India, poor sanitation is not a background inconvenience. It is a front-line threat to survival, health, safety, education, and dignity. Every statistic – every stunted child, every young girl who drops out of school, every woman who walks into an open field at night and does not feel safe – points to the same conclusion. Sanitation is not a development footnote. It is a human rights issue, and it demands to be treated as one.

What do you think? When sanitation infrastructure like toilets is built but women still face violence, health risks, and social stigma – is the infrastructure problem truly solved? And given that girls who lack safe school toilets are significantly more likely to drop out after puberty, should menstrual hygiene management be formally embedded in India’s national education policy alongside the health sector?

How useful was this post?

Click on a star to rate it!

Average rating 0 / 5. Vote count: 0

No votes so far! Be the first to rate this post.

References

PDF 📄

Table of Contents

The scale of the problem 🔗

Children pay the highest health price 🔗

Sanitation, disease, and malnutrition: the hidden chain 🔗

Women’s health: a disproportionate burden 🔗

Reproductive and urinary tract infections 🔗

Menstrual hygiene: dignity denied 🔗

Safety, violence, and the danger of the open field 🔗

The psychological toll 🔗

Structural barriers: why toilets alone are not enough 🔗