Nandatai and her 16 year old daughter Phula creep out of their houses quietly in the wee hours of the morning into the dark fields to relieve themselves before everyone wakes up. It is an everyday story as this is the only time in the day that they have privacy. “It is so shameful to go out in the fields during the day”, says Nandatai. “We have to hold our urine till it gets dark. How can we go out in the day time when there are so many men around? It is not easy at night too, we do have to face safety concerns”!
Nirmala in the city faces similar problems when she travels back from her home over the weekends, which is a few hours away from the main city. She has to wait until she gets to her office to find a toilet. “It is so uncomfortable to hold yourself for such along time from morning till I reach the office. I don’t even drink water or eat breakfast in the fear that I might need to use the toilet as there is no decent place to relieve myself on the way”, she says.
Rural and urban India aren't so different, after all, especially in the context of women and lack of access to sanitation facilities despite the developmental strides the country has been making in recent years. Not just this, but India has been found to lead the world in open defecation according to a recent report by the United Nations . As high as 300 million women in the country defecate out in the open due to lack of toilets! 
Man or woman - does it matter when it comes to sanitation?
Yes, it does. While the burden of bad sanitation affects both men and women, its consequences are far worse for women and result not only in the form of poor health but also in terms of limitations on mobility and freedom.
Lack of toilets affects women from all walks of life and under different circumstances. In rural areas, where most people have to defecate in the oprn, women are often subject to harassment or face the risk of assault when they go long distances to relieve themselves before sunrise or after sunset. To avoid the need to urinate, women often do not drink water for the whole day, which can result in high rates of urinary-tract infections, heatstroke, kidney infections while holding the urge to defecate can lead to chronic constipation and intestinal damage along with a great deal of psychological stress and pain .
Many women avoid eating a full meal as they do not have a place to relieve themselves during the day putting them at the risk of malnutrition . Coping with menstruation in the absence of privacy, water or sanitary products also has disastrous consequences for women leading to a range of illnesses such as pelvic inflammatory diseases and reproductive tract infections  that can have huge health and economic impacts. Lack of appropriate user-friendly toilets in public places also imposes restrictions on free mobility of young girls and women in urban areas leading to a high dropout rate of girls from schools in rural areas.
Rape isn't the only issue!
Other than breaking news related to the rapes of two girls from Uttar Pradesh when they had been out to relieve themselves, the gendered dimensions of the impact of the lack of sanitation facilities on the health of women continue to be underplayed or remain invisible in discourses on toilet use in urban or rural areas in the country.
For example, a recent study has found that a large proportion of rural Indians prefer to defecate out in the open. However, the study also reveals that it is mostly the adult men in the house and not women who show this preference. For women, concerns of privacy, shame and cultural notions of purity and pollution about their bodies prevail . Yet, many women in India are forced to defecate out in the open.
Negativity around womens' bodies
This lack of consideration for the sanitation needs of women has also to do with how women’s bodies and their associated reproductive functions have traditionally been viewed in Indian society. Women’s bodies and their reproductive functions such as menstruation, lactation, ovulation and childbirth have historically been viewed negatively. They are seen as polluting and sources of ritual contamination at particular times of the month, and many a time people prefer to remain silent or are reluctant even to speak about sanitation [5, 6]. Frank and open discussions on female sexuality, the reproductive and sanitation needs of women and menstrual hygiene still continue to be absent in a majority of the public discourses on the health of women.
This prevailing silence on one of the most important needs of women also then reflects in the way in which toilets, when available, are constructed as well as designed and located in different places in India. For example, studies show that poor consideration of gender-based factors such as location of the toilets and security concerns, extra charges for women, lack of attention to accessibility factors such as separate entrance for women, have further led to reduced use of toilets among women .
Gender-blind nature of policies and programmes
This lack of gender sensitivity to the sanitation issue is also reflected in the gender-blind nature of the policies and schemes on urban water and sanitation, which do not recognise the gender-based disadvantages in accessing safe water supply and sanitation .
For example, a research study on Gender Responsive Budget Analysis of public provisioning of water and sanitation services concludes that the efforts made at bringing out Gender Responsive Budgeting in India has been a cosmetic exercise. Although a Gender Budget Statement (GBS) is released by the government every year, essential services such as water and sanitation are not reflected in it .
At the Union level too, the Department of Drinking Water and Sanitation (DDWS) and the Department of Urban Development (DoUD) fail to report on their separate allocations for gender welfare in the GBS. This makes it difficult to assess women’s share in water and sanitation services in rural and urban areas. The study identifies the strong need for both the governments and their respective departments to report in the GBS so that the true picture of gender-disaggregated allocations for water and sanitation can be revealed and further examined .
It is time we realise that sanitation is not just a development target that can be achieved by increasing the number of toilets. It is a reflection of how we view ourselves, both men and women, as equal members of society. It is a reflection of how unequal and insensitive we are as a society, to the needs of women, representing half of our population. Rape cases alone cannot dominate discussions on sanitation as they push genuine conversations on sanitation needs of women under the carpet.
The present government must recognise gender as an important dimension in the sanitation discourse and work towards recognising the need for sanitation among women as a fundamental human right and act towards it, rather than allowing it to pass as another instance of a temporary media hype, only to be discarded later.
1. United Nations (2014) The Millenium Development Goals Report. Downloaded on the 12th of September 2014.
2. NDTV (2014) India's Sanitation Crisis: Women Worst Victims of Poor Sanitation . Downloaded on the 20th of October 2014.
3.Hannah Diverde (2013) The sanitary situation and its health effects on women exposed to occupational heat in Chennai, India. Master's thesis in Environment and health, UMEA UNiversity, Sweden. Downloaded on 24th October 2014.
4. Diane Coffey, Aashish Gupta, Payal Hathi, Nidhi Khurana, Dean Spears, Nikhil Srivastav, and Sangita Vyas (2014) Sanitation quality, use, access and trends. SQUAT Working paper No 1. Downloaded on the 10th of September 2014.
5 Bandopadhyaya, Mridula (2009) Impact of ritual pollution on lactation and breastfeeding practices in rural West Bengal, India. International Breastfeeding Journal 2009, 4:2. Downloaded on 20th October 2014.
6. Mcfarlane Colin (2014) The everywhere of sanitation: violence, oppression and the body. Downloaded on 20th October 2014.
7. Indiatogether (2011) Reaching the unserved in cities. Downloaded on 20h October 2014.
8. Panda and Agrawal (2012) Gender Responsive Budget Analysis in Water and Sanitation:
A Study of Two Resettlement Colonies (Jhuggi Jhopri Clusters) in Delhi. Downloaded on 20th October 2014.