What do we want to know and why?

The education of girls is recognised as an investment with many valuable returns, including the health and economic prosperity of women, their families and nations (Herz 2004). Despite recent progress in increasing girls' enrolment, statistics from 157 countries indicate that only one country out of three had reached gender parity in both primary and secondary education in 2008 (UNESCO 2010). Thus there is much interest in identifying the most effective ways of increasing girls’ enrolment and completion, including school sanitation facilities, which have been cited as a factor that can impede girls‘ access to their education.

What did we find?

We did not identify any studies that evaluated the impact of separate sex toilets for girls at schools, on either educational or health outcomes. We conclude that existing studies cannot answer the key review questions for the following reasons:

1. All schools in the study had separate-sex toilets, thereby precluding a comparison with other arrangements, such as shared toilets or no toilets;
2. All schools in the study had shared toilets;
3. The outcomes were not disaggregated by sex (this was confirmed by author contact in the case of 10 studies which described separate-sex toilets and educational or health outcomes, but did not report outcomes separately for girls);
4. Separate-sex toilets were included as part of a comprehensive package of Water, Sanitation and Health (WASH) interventions, and the study was not designed to disentangle the effects of single components.

What are the implications? 

• Map government policies related to toilet provision (e.g., ratios of latrines to pupils) and conditions (including whether and how toilets should be separated for girls and boys), and comparing regulations with reality (documented through audit data).
• Build strong monitoring and evaluation plans - including the collection of attendance data - into programmes to improve WASH conditions and menstrual management in schools, ideally from the design stage.
• Conduct at least two new well-designed, cluster-randomised trials to generate sound evidence from different contexts, where cultural and environmental factors differ (e.g., religion and access to water, respectively). Such studies could investigate whether and how a comprehensive school sanitation and hygiene intervention impacts both educational outcomes and health outcomes, and would ideally incorporate:
  • process evaluation, to assess changes in toilet provision (ratios) and conditions (whether they are adequate and acceptable)
  • behaviour change (including the use of toilets by girls and boys)
  • qualitative research to help explain the mechanism and context of the findings.

How did we get these results?

We systematically searched for studies that could answer the review questions. The search involved 11 electronic bibliographic databases and 11 key educational, health and sanitation websites. Of the 5082 studies identified through databases or hand searching, and screened on title and abstract, 406 were screened on full-text and 73 coded to gauge whether they answered any of the key questions. Authors were also contacted to request sex-specific data before making a final screening judgement.

The EPPI Centre reference number for this report is 1911.

This report should be cited as: Birdthistle I, Dickson K, Freeman M, Javidi L (2011) What impact does the provision of separate toilets for girls at schools have on their primary and secondary school enrolment, attendance and completion? A systematic review of the evidence. London: EPPI Centre, Social Science Research Unit, Institute of Education, University of London.

ISBN: 978-1-907345-17-3