Every year, during the month of October, UN-Habitat encourages us to engage in Urban October—a time for reflection and conversation about the challenges and opportunities created by the rapid pace of change in our cities and towns. Bangladesh has showcased exceptional improvements in infrastructural development with the help of numerous international partners and donors—but gaps persist in the equitable distribution of benefits from these developments.

Sitting in a barely lit room, I interviewed a young girl. She was about sixteen years old and lived in Kallyanpur Pora Bosti within that one tiny room with her father, mother, and younger sister. She spoke with great enthusiasm while recounting her experience at school and the dreams she holds for the future—but when we approached the topic of menstrual hygiene, she became uneasy. When asked why she did not use disposable sanitary napkins, despite knowing their benefits, her answer was simple: “Where do you expect me to dispose of them? I share this bedroom with my father… Am I supposed to change my pad in front of him?”

Just a couple of feet away from the room was a row of four toilets (without access to running water) assigned to almost 60 households within that block. The four toilets were allocated to 10–12 families each, with each family having between three and five members. She explained that for a woman, it was almost impossible to find enough time to change disposable pads in those toilets, as there was always someone waiting. Rather than enduring a constant barrage of knocks and remarks from outside, she felt it was best to use reusable cloth pads, which she could change in the shower area.

This is a common story for many girls in informal settlements, who hide reusable cloth pads behind doors, hoping they will dry out in the dark room in time for reuse. Some remain inside their dwellings, deciding not to go to school and withdrawing from public spaces and male family members who share the same living area. They do not feel safe using shared toilets to manage menstrual hygiene—facilities that often lack running water and adequate privacy.

Sanitation plays a significant role in quality of life, individual health, and overall public health in such a densely populated country as ours. Improved sanitation facilities are now found in 59% of all households—an impressive 15% increase from 2017–18. While this progress reflects the dedication of development agencies, a closer look reveals a pro-rich pattern, suggesting that higher socio-economic groups, due to increased disposable income, are more likely to access improved sanitation.

Shared Sanitation Facilities

Even in the most developed city, such as Dhaka, many people live in conditions that make it difficult to maintain a healthy and safe hygiene routine. Around 40.2% of Dhaka’s population—almost four million people—live in urban informal settlements characterised by inadequate sanitation, overcrowding, and poor housing. Most households in these settlements are recognised as having unimproved sanitation, as the JMP defines “improved” facilities as those not shared with another household. Yet overcrowding often means that five to ten families share a single toilet, resulting in long waits and conflicts during peak hours.

The Health Toll: A Cascade of Consequences

The health consequences of inadequate sanitation are well documented. Living in informal settlements increases the risk of waterborne diseases, reproductive tract infections, and parasitic infestations. Women are three times more likely than men to develop these conditions, according to a 2025 study across two urban municipalities. Evidence also links WASH insecurity with mental health disorders among women, particularly depression and anxiety.

Health impacts extend beyond illness. Women bear the burden of caring for sick family members, spending prolonged periods in close contact with those requiring care. This responsibility disproportionately falls on women, alongside managing households.

Barriers Beyond Infrastructure: Culture, Economics, and Exclusion

Entrenched gender roles assign WASH-related burdens to women while excluding them from decision-making on facility design and management. Lack of privacy in shared toilets forces unsafe menstrual hygiene practices, despite women’s awareness of healthier alternatives. Many wear pads for longer than recommended or rely on reusable pads to avoid disposal. Regardless of choice, lack of privacy often leads to reusing inadequately sanitised cloth pads, increasing health risks.

During morning routines, while men queue to leave for work, women often avoid toilets to escape rude remarks. Even when they gain access, constant knocking makes proper hygiene difficult. From a gendered perspective, shared toilets are often unhygienic, poorly lit, and far from home, exposing women to harassment or assault, particularly at night. To avoid these risks, many restrict food and water intake, leading to dehydration and further health complications. The lack of safe, private, and accessible sanitation is not merely inconvenient—it directly threatens women’s safety and dignity.

The struggle for safe and dignified sanitation in Bangladesh’s informal settlements is not only an infrastructural issue, but one of gender equity, public health, and basic human rights. While the nation celebrates progress in sanitation coverage, gains remain uneven, leaving women and girls to bear a disproportionate burden. Addressing these challenges requires more than technical fixes; it demands a holistic approach that tackles cultural taboos, empowers women in decision-making, and ensures equitable access to dignified WASH facilities. Until then, the safety, dignity, and well-being of millions of women and girls remain overlooked in Bangladesh’s development legacy.

Fabi Huda is a research associate at BRAC JPGSPH. She is a health policy analyst by training. She can be reached at [email protected].

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