On a humid afternoon in May, a handful of local residents gathered in a one-room house in an unplanned housing estate in Mumbai. The women greeted each other and then sat on the small porch and the tiled floor inside, exchanging stories of the day’s events through the doorway. Their conversation was lighthearted until someone mentioned hydration and the mood changed. “We will not drink any more liquids today,” said 31-year-old Kalawati Yadav. “If we do, we might have the urge to urinate later in the evening.” By then, public toilets would be dirty from daily use, and without lighting, they would be dark. “It is not a safe time to leave,” Yadav said.
However, it is not much better during the day, because the facilities are rarely truly clean. According to the women, public toilets are usually dirty, unlit and without water. They are also in short supply. Two facilities, each with a dozen toilets—six for women and six for men—serve the entire settlement, Subhash Nagar, which covers about one-tenth of a square mile and was home to more than 9,000 people as of 2020. The municipal government is supposed to be responsible for sanitary conditions, but there is very little oversight. (City officials did not respond to multiple requests for comment.)
As a result, for the residents of Subhash Nagar and for millions of low-income residents across India, bathroom layouts are often dictated not by biological need, but by inadequate toilet infrastructure. Several women told Undark that they routinely hold their urine and avoid drinking fluids in an effort to reduce visits to facilities. These behaviors lead to stomach pains and constipation, but the women said they have no better options. Their neighborhood was not planned – it began as a collection of clapboard houses, which were later replaced by concrete structures – so the houses were not connected to septic tanks. There are no private toilets, and the owners cannot afford to regularly use the paid facilities in other parts of the city.
The plight is part of a larger story about India’s efforts to bring accessible and sanitary toilets to its population of 1.4 billion people. According to The Hindu, India’s daily newspaper, nearly half of all Indians practiced open defecation by 2013, with people going out into fields, bodies of water or other open spaces. Without public sanitation—especially septic tanks, but also water and cleaning supplies—pathogens spread easily, causing serious health problems. The UN deputy secretary-general called for an end to open defecation, and in 2014 Prime Minister Narendra Modi launched the Swachh Bharat Abhiyan, or Clean India Mission, an effort that led to the construction of more than 100 million toilets. Today, according to data from the World Bank, only 15 percent of the population practice open defecation.
Having new public toilets “is a step forward,” Sarita Vijay Panchang, a public health researcher who wrote her dissertation on urban sanitation in India in 2019, wrote in an email to Undark. But many of India’s public toilets are overcrowded, she noted. This leads to long lines, sewage spills and concerns about personal safety — all of which present their own set of public health problems.
Surveys show that the situation is particularly acute in urban areas like Mumbai. Safety concerns, as well as cultural norms, deter women from practicing open defecation as a substitute. (Men are more likely than women to practice open defecation even when public toilets are available.) Doctors and activists say the ongoing practice of discrimination based on caste and class adds to the damage, as some women are barred from using workplace toilets.
Kalawati Yadav (left) and Sangeeta Pandey (centre) stand outside a small shop owned by Sangeeta Wadula (right) in Mumbai’s Subhash Nagar slums. Yadav takes care of the shop for some time in the afternoon so that Wadule has time to use the community’s public toilets.
“Once plaster fell on me from the ceiling,” said Ambika Kalshetty, a 35-year-old homemaker, who works as a domestic helper in nearby apartments in a multi-storey building. The men’s toilets are built above the women’s toilets, she explained, and the men’s “occasionally leak on us – it’s disgusting”. She said she really doesn’t feel well until she gets home and washes herself thoroughly with soap and antiseptic.
Another woman, Sangeeta Pandey, recalled watching a pregnant woman faint while waiting in a long line for a communal toilet. “It was humiliating,” Pandey said, “but also, what could she do?”
Local activists worked to raise awareness and bring about improvements. However, the women gathered in Kalshetty’s home say that changes are slow and that for now they are managing a difficult situation on their own.
A few years ago, researchers surveyed more than 600 women in 33 slums in Maharashtra, the Indian state that includes Mumbai. They found that among those without adequate access to a toilet, more than 21 percent reported urinary retention, and more than 26 percent said they changed their meals to avoid using the toilet at night. These findings are supported by Panchang’s research in the region, which also found that women avoid urination and defecation when they feel their community toilets are unsafe.
Such changes in behavior can lead to negative health effects, said Suchitra Dalvie, a Mumbai-based gynecologist and women’s health activist. Frequent urination helps flush out all bacteria, which reduces the risk of urinary tract infections. (Women in Subash Nagar said they had UTIs regularly, some even every few months.)
Even the relatively well-off are affected. Dalvie recalled a conversation with the former Minister of State for Health, a young woman who often had to travel for work. The Minister of Health would limit her water intake, knowing that the public toilets she would encounter on the road might not be adequate. This is an example of how women’s issues are normalized in India, Dalvie said.
Toilet infrastructure is not just a matter of sanitation, said Deepa Pawar, a social activist who focuses on gender and youth issues in marginalized communities. “It’s a much bigger problem that encompasses issues of health, gender and social justice,” she said.
A lone drum for collecting used sanitary napkins in the women’s section of public toilets in the Subhash Nagar slums of Mumbai.
Pawar’s organization, Anubhuti, conducted several audits of toilets across Mumbai in 2017. Their audit of K/East Ward, a municipal district that includes Subhash Nagar, found conditions similar to those reported by Undark: damaged toilets, lack of water and inadequate cleaning services. And while the central government was asking for one dresser for every 30 people, the audit found far fewer.
Pawar grew up in the slums of Mumbai, so the issue is personal in nature. “When you use your toilet at home, there’s no struggle,” she said. But when using public restrooms, we have to contend with a number of concerns.
The problems worsened during the Covid quarantine, Pawar said, when many of the city’s free public toilets were closed. “They only maintained pay-to-use toilets. Where will the poor get the money to use those toilets if they are not allowed to work?” she asked. Nomadic communities, which make up nearly 10 percent of India’s population, have been particularly hard hit by the shutdown. These are communities that have traditionally migrated, and although many have now settled, they are economically weak and face discrimination.
Women and men in Subhash Nagar were also barred from using toilets during the lockdown, but said they used them anyway. And across Mumbai, many men simply defecated outside — a situation that prompted city officials to waive toilet fees for them, but not for women. “Women were essentially punished because of their gender, while men were given a free pass,” Pawar said.
As a member of a nomadic tribe, Pawar is well aware of the social dynamics that prevent some women from accessing basic services such as toilets. “During our campaigns, we question local officials about the differences in access to toilets for members of nomadic tribes like us, and they often respond by asking why we don’t use free public toilets in shopping malls instead,” she said.
The reality is that these spaces are intended for the middle and upper class, and people of lower socioeconomic status are not welcome there. “Will the bullock cart workers be allowed to enter the mall? Has our society inspired such kindness among those who work and visit these malls to allow nomadic workers into their compound?” she asked rhetorically.
Mumbai is a large commercial city that relies on the labor of women and marginalized communities, Dalvie said. Businesses, government and wealthy residents should therefore “adjust to the convenience” of everyone.
Going forward, Panchang would like to see India strive to build more home toilets that are connected to sewers. Residents will be able to maintain them well, and women will not have to pay such a high price for the country’s efforts to eliminate open defecation. “Public toilets,” she wrote in her e-mail, “are not a substitute for home toilets.”
