Out of order: the state of the world's toilets

15 November 2017
Ethiopia, India, Madagascar, Toilets, Inequality
Image: WaterAid/Ronny Sen

The fact that one in three people in the world have nowhere safe to go to the bathroom is unacceptable. This is a human rights issue. Everyone has a right to health and dignity.
Sarina Prabasi, CEO, WaterAid - US

New York, NY — Globally, one in three people do not have access to a decent toilet, reveals WaterAid’s 2017 report, “Out of Order: The State of the World’s Toilets.”


Released ahead of World Toilet Day on November 19, WaterAid’s third annual report reveals that women and girls bear the brunt of the global sanitation crisis. For more than 1.1 billion women and girls, a lack of toilets results in an increased risk of poor health, limited education, harassment and even attack.


Ethiopia ranks the worst worldwide with the highest percentage of its population living without toilets, followed by Chad and Madagascar. India remains the nation with the most people without toilets.


A staggering 93% of Ethiopia’s population still have no access to a basic toilet, the highest percentage of people living without decent toilets of anywhere in the world. Ethiopia has also made the most progress in reducing open defecation, reducing the proportion of people defecating in the open from nearly 80% in 2000 to 27% in 2015, largely by investing in rudimentary community latrines.


India tops the list for the longest line for the toilet. With more than 355 million women and girls still waiting for access to basic sanitation, the line would stretch around the earth more than four times. However, there has been immense progress in improving access to sanitation through the Swachh Bharat (Clean India) Mission, helping put India in the top 10 for reducing open defecation and improving access to basic sanitation. As WaterAid’s report shows, there is still a long way to go to reach everyone.


WaterAid’s report comes on the heels of the U.S. government’s announcement of its Global Water Strategy, which prioritizes the needs of girls and women. This Strategy has the potential to accelerate the progress WaterAid’s report finds is needed most, and we look forward to working with the Administration and Congress to see these commitments upheld.

Among the other findings:

  • All 10 of the world’s worst countries for access to basic sanitation are in sub-Saharan Africa, where only 28% of people have a decent toilet, and children are 14 times more likely to die before the age of five than in developed regions. In sub-Saharan Africa, one in ten girls miss school during their period.


  • Djibouti, a major route for refugees from the Yemen war, has the worst figures for open defecation, with a 7.2% increase since 2000.


  • Madagascar – known as an ‘aid orphan’ due to its reputation for political instability – features in the top three for the most people without decent toilets as well as for failing to address open defecation.


  • Between 2000 and 2015, the number of people in the world defecating in the open dropped from 1.2 billion (20% of the global population) to 892 million (12%). Despite this progress, it is still a huge problem, resulting in enough faeces to fill seven bathtubs every second going into the environment untreated.


  • Cambodia has emerged from decades of conflict to become one of the fastest growing economies in Asia. It comes in second for progress in reducing open defecation as well as improving access to basic sanitation.

Sarina Prabasi, WaterAid’s U.S. Chief Executive Officer, said:


“In the United States, it’s easy to take a toilet for granted. The fact that one in three people in the world have nowhere safe to go to the bathroom is unacceptable. This is a human rights issue. Everyone has a right to health and dignity.

Not having access to a toilet is particularly hard for women and girls. They are at risk of harassment and attack when finding somewhere to relieve themselves or manage menstruation. Once they start their periods, girls are more likely to miss classes or drop out if there is not a decent toilet at school.

The Sustainable Development Goals promise that by 2030 everyone will have a safe toilet, but we aren’t making progress fast enough to meet that goal. More aid needs to be directed to underserved communities. And stigmas and taboos around women and sanitation must be challenged. With increased skills and confidence, women will be able to play a visible role in making lasting change happen in their communities.”


This World Toilet Day, WaterAid is calling for governments to:

  • Invest more money and spend it transparently and efficiently, paying particular attention to the needs of women and girls and focusing on the needs of the poorest, not on politics.


  • Promote the value of sanitation for gender equality and female empowerment, and involve women as leaders to ensure solutions address the challenges women and girls face.


  • Improve coordination to create gender-friendly toilets in all schools, healthcare facilities, work environments and public spaces, within both donor and national partner governments.


  • Combine plans to improve access to sanitation with efforts to redistribute water and hygiene work, which is predominantly the responsibility of women and girls.


Read the ‘Out of Order’ report: http://www.wateraid.org/wtd2017

Download photos: https://wateraid.assetbank-server.com/assetbank-wateraid/images/assetbox/e3653d0d-0a3c-4eee-a70a-5fdfe1e8e506/assetbox.html


In the US: Emily Haile, Senior Communications and Media Manager, [email protected]


Notes to Editors:


WaterAid is working to make clean water, decent toilets and good hygiene normal for everyone, everywhere within a generation. The international nonprofit organization works in 34 countries to change the lives of the poorest and most marginalized people.

Since 1981, WaterAid has reached 25.8 million people with clean water and 25.1 million people with decent toilets. For more information, visit www.wateraid.org, follow @WaterAidAmerica on Twitter, or find WaterAid America on Facebook at https://www.facebook.com/WaterAidAmerica/.

  • 785 million people in the world – one in nine – do not have clean water close to home.[1]
  • 2 billion people in the world – almost one in three – do not have a decent toilet of their own.[2]
  • Around 310,000 children under five die every year from diarrheal diseases caused by poor water and sanitation. That's over 800 children a day, or one child every two minutes.[3]
  • Every $1 invested in water and toilets returns an average of $4 in increased productivity.[4]
  • Just $25 can provide one person with clean water.[5]
  • To find out if countries are keeping their promises on water and sanitation, see the online database www.WASHwatch.org
  • The U.S. Global Water Strategy is available at https://www.globalwaters.org/resources/assets/us-government-global-water-strategy

[1] WHO/UNICEF (2019) Progress on household drinking water, sanitation and hygiene 2000-2017. Joint Monitoring Programme. Geneva: World Health Organisation.

[2] WHO/UNICEF (2019) Progress on household drinking water, sanitation and hygiene 2000-2017. Joint Monitoring Programme. Geneva: World Health Organisation.

[3] washwatch.org

[4] World Health organization (2012) Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage

[5] www.wateraid.org