Sanitation, Silence and the Cost of Neglect

Written by Dr. Fariha Gul : Academician, Researcher, Writer, Consultant

Public health crises rarely announce themselves with fanfare. More often, they unfold quietly, normalized by neglect and sustained by institutional indifference. The state of public toilets for girls and women across Pakistan, from rural schools to urban universities , is one such crisis, with far-reaching consequences for health, education and gender equity.

It is now well established that poor sanitation and unhygienic public toilets are a significant source of infections among girls and women. Recurrent urinary tract infections, reproductive tract infections and other preventable ailments are not merely medical concerns; they are symptoms of a deeper failure of governance and planning. When basic facilities are unsafe or unusable, the burden is borne disproportionately by women, often in silence.

This reality is particularly alarming when viewed alongside another well-documented public health priority: the need for vaccinating girls against the human papillomavirus (HPV) to prevent cervical cancer later in life. While vaccination campaigns are essential and long overdue, they cannot be treated as a standalone solution. Preventive healthcare does not begin and end with vaccines; it is inseparable from everyday environmental conditions. Exposing girls to unhygienic sanitation facilities while urging them to safeguard their future health reflects a policy contradiction that demands urgent correction.

The problem is frequently framed as a rural one, and indeed, many public schools in rural areas lack toilets altogether, or have facilities that are unusable due to poor maintenance. For adolescent girls, this often translates into absenteeism, early dropout and compromised dignity. However, the assumption that urban public sector institutions fare significantly better is misleading. In many public schools in cities, toilets exist on paper but not in practice. Broken infrastructure, lack of water, absence of cleaning staff and appalling hygiene render these spaces unusable, forcing students to either endure health risks or avoid using them altogether.

The situation deteriorates further at the level of public sector universities. Ironically, institutions meant to represent intellectual leadership and progressive values often display the most severe neglect. Many universities do not employ dedicated female sanitation staff to clean women’s toilets. As a result, female washrooms are either cleaned irregularly or not at all, creating conditions that are, by many accounts, worse than those found in rural schools. For female students and staff, this is not merely an inconvenience; it is a daily affront to their health, dignity and right to a safe learning environment.

The implications extend beyond sanitation. When universities fail to provide basic facilities, they undermine their own efforts to promote female participation in higher education. How can institutions claim to support women’s empowerment while ignoring such a fundamental requirement? The absence of gender-sensitive planning sends a clear, if unspoken, message about whose needs are prioritised and whose are considered expendable.

For the Ministry of Higher Education, the Higher Education Commission (HEC) and policymakers, this issue demands more than rhetorical commitment. It requires enforceable standards for sanitation infrastructure across all public sector educational institutions, from primary schools to universities. Dedicated budget lines for maintenance, mandatory hiring of trained female sanitation staff and regular third-party audits of hygiene conditions should not be optional measures; they should be minimum requirements.

Academics, too, have a role to play. Research on gender, public health and education must translate into institutional advocacy. Universities should become sites of reform rather than examples of neglect, integrating sanitation and preventive health into campus planning and policy.

At its core, the question is simple: can a state that fails to provide clean toilets for its girls credibly claim to invest in their future? Until sanitation is treated as a public health and educational priority, not a peripheral concern, efforts to protect women’s health, including vaccination campaigns, will remain incomplete. Silence and neglect, after all, are costly. And women continue to pay the price.