As someone who has worked on water, sanitation and hygiene (WASH) for years, I was familiar with the global statistics. I knew that billions of people still lack access to safely managed sanitation. I understood the links between sanitation, health, dignity and gender equality. Yet pregnancy made me experience sanitation in a completely different way.
Suddenly, access to a toilet determined how long I could stay out, where I could go, or whether I preferred to stay close to home.
Like many pregnant women, I found myself needing a toilet far more frequently than before. As the baby grew, the pressure on my bladder increased, making regular toilet breaks unavoidable. At the same time, staying well hydrated became even more important during the summer heat, ironically increasing the need for frequent restroom visits. However, in many cities - including those in high-income countries - public toilets are scarce. Even when one is available, it may be poorly maintained, unclean or simply feel unsafe or uncomfortable to use. As a result, the only practical option is to enter a café or restaurant and buy something, even if you neither need nor want it. And honestly…Why should I have to order a coffee, a bottle of water or a snack I do not even want, simply because I need to use the bathroom? Going to the toilet is a basic human need, not something that should depend on whether I am willing or able to spend money. Department stores, libraries or museums become informal parts of your personal "sanitation map." For anyone who is pregnant, travelling with small children, living with certain health conditions, or simply getting older, this lack of accessible sanitation can quietly limit participation in everyday life.
This experience reminded me that sanitation is fundamentally about inclusion.
When we discuss sanitation, we often focus (and rightly so) on preventing disease, protecting water resources or achieving the Sustainable Development Goals (SDGs). But sanitation also determines who can comfortably participate in public life. Can a pregnant woman spend an afternoon in the city without constantly worrying about the next toilet? Can older adults remain active in their communities? Can families with toddlers or young children enjoy a day out without stress? Can people with chronic illnesses, disabilities or temporary health conditions leave the house with confidence? The answer depends, in part, on something as ordinary as a clean, accessible toilet.
Globally, these challenges are, of course, far greater. For millions of pregnant women, inadequate sanitation is not merely inconvenient: It poses serious health risks. Lack of safe, private toilets can increase the risk of urinary tract infections, contribute to poor maternal health outcomes, and expose women to unsafe conditions when sanitation facilities are distant, poorly maintained or unavailable. Privacy, menstrual hygiene, handwashing facilities, and safe sanitation all play an essential role in ensuring healthy pregnancies and protecting maternal dignity. Pregnancy, however, also offers an important lesson for those of us who usually take sanitation for granted. It reminds us that our sanitation needs change throughout our lives. They change during pregnancy, after childbirth, in childhood, with illness, with disability, and as we age. This shows us the need for designing sanitation systems or initiatives that accommodate these changing needs.
One promising approach that deserves more attention is the "Nette Toilette" ("Nice Toilet") initiative, in which cafés, restaurants and shops voluntarily make their restrooms available to the public. By partnering with local businesses instead of relying solely on public facilities, cities can significantly improve access to clean, safe toilets at relatively low cost.
Today, I no longer plan every outing around toilets. But I have kept my mental map. And perhaps more importantly, I have gained a new appreciation for something I thought I already understood: sanitation is not only about infrastructure, but also about enabling people to move freely, participate fully, and live with dignity - throughout every stage of life.
Cities should therefore treat public toilets as essential social infrastructure: planned, funded, and maintained with the same seriousness as benches, lighting, pavements, and public transport. Inclusive cities require sanitation strategies that reflect the changing needs people experience throughout life.
Of course, pregnancy was only the beginning. Parenthood brings a whole new set of sanitation-related adventures: finding changing tables, breastfeeding-friendly spaces, and toilets you can actually use with a baby in tow. Why are changing tables still so often located exclusively in women's restrooms? That deserves a blog post of its own…
