Poonam is advised by her doctor to drink more water. However, she still avoids drinking water or tea. As a domestic worker, she can’t drink water whenever she wants because most of her employers do not allow her to use their toilets. Even when she does drink water, she holds back her urine. Gudia often arrives late for work because she has to wait in a queue to use the toilet. She shares a common toilet with six families, each having at least four members. First, she cleans the toilet since it smells bad from excessive use, and then she uses it. Seema’s situation is not much different. Seema, a construction worker, has to return to her tent to change her blood-soaked cloth pad each time she has a heavy flow because the construction site does not provide her or other women with a toilet. Even Nobina, an Assistant Professor, avoids drinking any liquids before leaving for work because she knows she will not have access to a public toilet for the 16 kilometres she travels. She prefers to stay dehydrated and unwell rather than deal with a full bladder. There is also a fear of crowded roads that could add to her troubles. Jyoti, who has a master’s degree in social work, left her job with an NGO focused on women’s empowerment after just six months because the building did not have separate toilets for men and women, which was quite embarrassing. The issue of proper sanitation and hygiene affects people from all classes but is often neglected. Many Poonams, Gudias, Seemas, Nobinas, and Jyotis are likely around us, telling the same or even worse stories. WHO states that public health, dignity, and social justice depend on having access to safe water, sanitation, and hygiene, known as WASH. This is a basic human right. However, WASH services do not impact everyone equally, so it is important to view these issues through a gender lens. Women and girls often shoulder a heavier burden in households, communities, and across social structures, frequently facing deficiencies in WASH services. WASH in India In India, a country with a large population and significant socioeconomic inequality, many women are left disadvantaged when WASH is not considered through a gender lens. Without proper sanitation infrastructure, safe water, toilets, or hygiene facilities, countless women are forced to engage in difficult, dangerous, and unhealthy routines. Providing gender-sensitive WASH is essential for promoting inclusive development and gender justice; it is not just a theoretical idea. Interventions that respond to gender needs are crucial for improving health outcomes and for promoting dignity, safety, education, and long-term empowerment. This is especially important since women are more affected by water scarcity, sanitation gaps, poverty, and social norms. Over the last 20 years, India has made significant progress in WASH due to coordinated efforts from governments, international organisations, and civil society. According to the WHO and UNICEF global report from 2024, India experienced one of the largest declines in open defecation worldwide between 2000 and 2024, with about 676 million fewer people engaging in this practice. Access to drinking water has also increased dramatically. According to the JMP report 2024, around 76.4% of Indians had access to safely managed drinking water services, up from roughly 37% at the start of the century. Sanitation access improved as well. Between 62.8% and 63% of Indians had access to safely managed sanitation services. These achievements represent hundreds of millions of people gaining piped water, toilets, and improved hygiene. This will help reduce disease, enhance children’s health, and improve their dignity and well-being. Many rural and urban households now have water on the premises, a toilet at home, and cleaner sanitation – advancements that earlier generations could only dream of. Despite these improvements, significant gaps remain, particularly for vulnerable groups: women, girls, marginalised social groups, and rural communities. Groundwater supplies over 80% of India’s domestic water, both in rural and urban areas, according to UN reports. Many regions face water stress with limited resources per person. Research indicates that climate change, irregular rainfall, excessive groundwater extraction, and poorly maintained water distribution undermine water supply reliability, especially in rural and remote areas. Issues like inconsistent supply, leaky pipes, inadequate maintenance, and outdated distribution systems often force people to store water, use communal taps, or draw from potentially contaminated sources. Access to restrooms does not guarantee they are safe or that waste is managed properly. Data shows that many restrooms lack handwashing stations, proper waste disposal, and a reliable water supply, particularly in rural or underserved areas. The disposal of faecal sludge and solid waste is still inadequate. Many homes do not have proper disposal systems, leading to groundwater contamination, environmental pollution, and other health issues. The benefits of sanitation and water access are diminished by the lack of hygiene infrastructure in many homes and institutions like schools and healthcare facilities, as they often lack handwashing stations, clean water, and soap. Disparities remain even in areas designated as “open-defecation free”, especially among tribal communities, Scheduled Castes/Tribes, and marginalised socioeconomic groups. While cities have better access to safely managed water and sanitation services, many rural households still struggle with unreliable water, poorly maintained toilets, and insufficient hygiene facilities. WASH Through a Gender Lens Gender, which interacts with caste, class, and geography, affects how these deficiencies are experienced, making it harder for women and girls to access services, maintain dignity, ensure safety, and achieve empowerment. Many gains in sanitation and water infrastructure are fragile, especially when faced with environmental challenges like climate change, drought, floods, or contamination. Without sustainable maintenance, a reliable water supply, and proper waste handling, recent improvements may be at risk of reversal or may remain only partial. In numerous rural areas of India, women take on the crucial but often overlooked task of collecting water for cooking, cleaning, bathing, and sanitation. In homes where taps are unreliable, hand pumps dry up, or wells are far away, gathering water becomes a tiring job that mainly falls on women. A survey of NSSO shows that in about 71% of rural households, women aged 15 and older are responsible for water collection alone. This responsibility adds up to nearly 210 hours each year, amounting to about 27 full days lost. This chronic lack of time, often ignored in development or economic discussions, deprives women and girls of opportunities for education, paid work, rest, social involvement, and leisure, deepening gender inequalities across generations. The absence of a dependable water supply and sanitation severely impacts dignity, privacy, and safety. When toilets are absent or not functioning, often due to lack of water, women and girls must resort to defecating in the open. This often means going to open fields or secluded spots, particularly at night, which exposes them to risks of harassment, violence, or animal attacks. Even when toilets are built under national sanitation programmes, a lack of water for flushing or cleaning, missing hand-washing facilities, and no safe way to dispose of menstrual waste often make them unusable. As a result, many women avoid using them, especially during menstruation. This increases health risks and undermines their dignity. Furthermore, poor menstrual hygiene management (MHM) remains a significant challenge that is often overlooked. In many rural schools and homes, there are no gender-segregated toilets, clean water supplies, or disposal facilities for sanitary pads. Consequently, girls frequently miss school during their periods, which disrupts their education, lowers their confidence, and has long-term effects on gender equality. Inadequate WASH (water, sanitation, hygiene) infrastructure, combined with deep-rooted gender norms and societal taboos, denies millions of women and girls not only their basic right to water and sanitation but also their dignity, safety, education, health, and chances for empowerment. Menstruation is still stigmatised in many communities. Despite the high number of women of menstruating age, safe menstrual hygiene management (MHM) systems are often lacking. Private toilets, clean water, and ways to dispose of sanitary products, especially in rural areas or underserved urban settlements, are often insufficient or entirely missing. Without proper disposal options, many sanitary pads are burned, thrown in open spaces, or dumped in water bodies, which creates environmental hazards and health risks. In schools and public places, poor sanitation and the absence of gender-segregated toilets discourage girls from attending during their periods. This leads to absenteeism and higher dropout rates, reinforcing gender inequality in education and future opportunities. Beyond time and energy, poor WASH infrastructure poses serious risks to dignity, safety, and health. The lack of private toilets forces many women and girls to relieve themselves in open fields or shared facilities, exposing them to harassment, violence, or animals, particularly when going out at night or early in the morning. Inadequate hygiene and the absence of safe menstrual management facilities further deprive women and girls of privacy, dignity, and reproductive health. In schools or villages lacking gender-sensitive sanitation (separate toilets, water for washing, and safe disposal of sanitary waste), many adolescent girls skip school or drop out altogether, harming their education and future opportunities. WASH and Human Health Poor WASH conditions have serious, long-lasting effects on human health, especially for children and mothers. They hold entire communities back, trapping them in cycles of disease, malnutrition, poverty, and lost chances. Unsafe or contaminated water, inadequate sanitation, and poor hygiene lead to waterborne illnesses like diarrhoea, cholera, dysentery, and typhoid, as well as intestinal worm infections and other parasitic diseases. Children under five are especially at risk. Frequent diarrhoea or parasitic infections, often due to unsafe water or open defecation, hinder nutrient absorption. This can result in undernutrition, stunting, wasting, and delays in cognitive development. In addition, poor sanitation and hygiene during pregnancy, childbirth, and neonatal care, whether in hospitals or at home, lead to maternal complications, neonatal sepsis, infections, and higher risks of death. Beyond the direct health effects, poor WASH greatly weakens human capital. Frequent illness and undernutrition limit children’s ability to grow, learn, and thrive. Adults miss work or school due to sickness, which reduces productivity, harms economic opportunities, and keeps cycles of inequality and poverty going. WASH and Climate Crisis Climate change, unpredictable rainfall, seasonal droughts, groundwater depletion, and environmental stress worsen water scarcity. This makes safe water supply unreliable for many households (UNICEF). During floods or extreme weather events, sanitation systems such as toilets and sewage systems may be damaged or submerged. Water sources can become contaminated, making hygiene harder to maintain. In these situations, communities often turn to unsafe water sources or open defecation, reversing years of progress. Without sustainable water management, upkeep of sanitation systems, and climate-resilient WASH planning, the progress made might not last. Vulnerable groups, especially women, children, and marginalised communities, may continue to face constant risk. Way Forward Investing in WASH with a gender-sensitive approach involves creating reliable water supplies, private toilets, hygiene facilities, and safe menstrual management infrastructure. This effort is not just about improving infrastructure; it can drive social change. When women no longer have to spend hours fetching water or face humiliation and danger due to poor sanitation, their health and dignity improve. They gain more free time, allowing for greater mobility, education, and economic involvement. Children grow up healthier, girls remain in school, and communities become more resilient, equitable, and productive. Moreover, gender-responsive WASH enhances resilience against disease, climate change, and environmental degradation by encouraging safe water use, hygiene, waste management, and sustainable sanitation. As the global community works towards the Sustainable Development Goals, which include universal access to water and sanitation, gender equality, and good health, WASH is at the centre of these efforts. The word hygiene comes from the Greek goddess Hygieia, who was linked to cleanliness and good health. Recently, the Swachh Bharat Abhiyan campaign featured Goddess Lakshmi as a symbol of cleanliness, with the tagline “Do Not Let Her Go”. This reflects a contradiction in human nature. On one hand, we portray female goddesses as champions of hygiene and sanitation. On the other hand, we do very little to address the serious issue of sanitation. In India, a large and diverse country with significant structural inequalities, gender-sensitive WASH needs to move from a side issue to an important aspect of development policy. Without continuous investment, careful design, community engagement, inclusive decision-making, and monitoring, the challenges faced by women and girls will continue. This will keep the cycles of poverty, exclusion, and injustice in place. It is crucial that every woman and girl has access to safe water, clean sanitation, and hygienic facilities for dignity, equality, and sustainable development. This article is written by Prof. Trishna Sarkar, Assistant Professor, Department of Economics, Dr. B.R. Ambedkar College, University of Delhi [Published in NIWAS Vartika - Vol-I, Issue-3 (Oct-Dec'25): A WASH magazine by SPM NIWAS, MoJS, GoI]