Transgender Inclusive Sanitation in South Asia

5 min read
Asia-Pacific Transgender Network
Image: Asia-Pacific Transgender Network

Reaching everyone with decent toilets means reaching everyone, whatever their age, gender or specific needs. To contribute to that, WaterAid's Priya Nath, Andrés Hueso and Raman VR have been part of a broad group of activists, academics and other organisations working to better understand the sanitation needs of transgender people in South Asia.

Going to the toilet, which we all do many times a day, should be a relatively stress-free experience. However, for many people around the world the call of nature is immediately followed by thoughts of a) where can I go? and b) is it safe to go?

Building on the recognition of access to sanitation as a human right, the global Sustainable Development Goals (SDGs) have made it a target and priority to ensure everyone has access to adequate and equitable sanitation and hygiene by 2030. The SDGs specify that we must put the people who are hardest to reach first, and that we must leave no one behind.

These are big and bold ambitions. Achieving them requires us to first understand where and why people are being excluded or put at risk when trying to go to the toilet.

Water, sanitation and hygiene (WASH) sector stakeholders have made some good progress in better understanding and prioritising the WASH requirements of women and girls, and of persons with disabilities. There is still a long way to go to ensure that these groups are included, but as a sector our awareness of the problem and our capacity and willingness to contribute to the solutions have grown and are growing.

Who are we missing?

An area that we in WaterAid and many others in the sector have largely neglected, however, is thinking about the sanitation and hygiene access and requirements of transgender people.

The World Health Organization defines transgender people as persons who identify themselves in a different gender than that assigned to them at birth. They are often marginalised by society in most spheres of life, including in employment, housing and healthcare. Access to WASH is no different. When using public, community or institutional toilets around the world, which are often sex-segregated, transgender people face not only exclusion but also verbal harassment, physical abuse and sometimes even arrest, according to the former Special Rapporteur on the Human Rights to Safe Drinking Water and Sanitation Catarina de Albuquerque. Yet within the WASH sector a recent literature review showed that little research or work has addressed this.

WaterAid recently took steps to increase our understanding of transgender experiences of sanitation and to consider solutions that we can contribute to.

Some of the WaterAid team members, including two of the authors here, have worked with a group of WASH organisations, transgender activists and academics on an article recently published in WaterLines entitled 'Transgender-inclusive sanitation: insights from South Asia'. The article introduces some of the histories and identities of transgender communities in the region, and includes some recent experiences of transgender-inclusive sanitation initiatives.

It uses case studies from Nepal and India to offer insight into how gender identity affects sanitation users’ experiences. Finally, the paper explores the impact of stigma and discrimination against transgender people on WASH issues, and highlights how transgender people are and can be drivers and champions of change in WASH.

How do we achieve a transgender-inclusive WASH sector

The authors set out recommendations for how the sector can start to be more transgender-inclusive, underlining that context and consultation with transgender people is the key to ensuring their inclusion and determining the best solutions for each setting. For example, although in some contexts a separate third gender block might be an appropriate solution for public toilets, in others the appropriate way forward might be an additional gender-neutral toilet cubicle, while in still other spaces, neither may be an appropriate, safe or desirable option. In all instances; 1) understanding the terminology; 2) avoiding further stigmatisation or exposure to vulnerability; and 3) considering sanitation within the overall experiences of someone’s life and reality are essential rules for ensuring transgender inclusion in WASH.

Collaborating to stimulate change

Beyond co-authoring the paper, and driven by this desire to better understand contexts and experiences of sanitation among transgender communities, WaterAid has also joined various collaborative initiatives.

First of these was a collaboration with the Freshwater Action Network South Asia (FANSA) and the Water Supply and Sanitation Collaborative Council (WSSCC), for a face-to-face consultation with transgender communities in India. During this consultation, held in Chennai in March 2018, priority needs that the participants raised included: improved living conditions with access to community toilet complexes with bathing facilities; gender-neutral toilets in bus stations as well as other public and work places that are well-lit and safe, with reduced possibility of sexual harassment; and a more accepting, non-stigmatising environment.

Participants also put themselves forward to help create WASH awareness and carry out behaviour change communication for their own peers as well as the wider community. The results and lessons from these consultations were shared at the SACOSAN VII conference in Islamabad, Pakistan, in April 2018.

In addition, WaterAid is also collaborating with the rural sanitation campaign in India (Swachh Bharat Mission) in India at the national level and in select states, in order to develop a policy framework for providing inclusive and accessible WASH facilities for persons with disabilities and transgender people. As part of that effort, a joint consultation – also involving UNICEF and South Eastern Coal Field Limited CSR – took place in the state of Chhattisgarh, where persons with disabilities and transgender people suggested including gender-neutral accessible toilets in all public and community toilets.


Priya Nath is Equality, Inclusion and Rights Advisor at WaterAid UK, Andrés Hueso is Senior Policy Analyst (Sanitation) at WaterAid and tweets as @andreshuesoWA, and Raman VR is Head of Policy at WaterAid India.