The burden of bad sanitation affects almost all poor people but it falls disproportionately on females: in urban areas, there is a fee for most public washrooms, but men can use urinals for free and they frequently relieve themselves in public when facilities are lacking. In rural areas, where most people have to defecate openly, women are often subject to harassment or assault when they relieve themselves. To avoid the need to urinate, they often withhold hydration, a practice resulting in high rates of urinary-tract infections, heatstroke and other health problems. And coping with menstruation in the absence of privacy, water or sanitary products can be a nightmare…

The impact of poor sanitation — and its economic consequences — is well-known. Diarrhea alone causes at least 800,000 child deaths per year in the developing world. Reductions in infant and maternal deaths are clear when access to sanitation and water is improved, and there are many “spillover” benefits of sanitation that extend beyond a reduction in fecal-borne disease. In other words, providing more toilets reduces illness and death from diseases that are not caused by a lack of toilets. This phenomenon (called the Wills-Reinecke multiplier) was first noticed when deaths from all infectious diseases, and not just typhoid, decreased after the water supply was improved in 19th century Massachusetts, and is probably explained by the body’s improved capacity to fight infection when it’s not under chronic attack by pathogens specifically in dirty water.