The education of women is believed to contribute not only to their individual and household prosperity and health but more generally to the development of their nations. However, despite growing efforts to reduce gender disparity in education, according to UNESCO, half of 157 countries in the world will not be able to achieve the Millennium Development Goal of reducing gender disparity in primary and secondary education by 2015. Different studies have identified several factors influencing absenteeism or dropout of girls from school. One such factor is poor sanitation, especially not having separate girls' toilets, which can discourage girls from coming to school. To date, various gender-sensitive water, sanitation and hygiene (WASH) interventions have been implemented by many organizations to remove this barrier to attending school.
To synthesise evidence and evaluate the impact of providing separate toilets for girls on their primary and secondary school enrolment and attendance.
The authors planned to include empirical studies assessing the impact of school-based WASH interventions for girls in the age group of 4 to 18 years on either educational or health outcomes in lower middle income countries. The authors did not set any restriction of inclusion on the basis of language or date. The authors conducted a systematic search for published literature in electronic databases, including PubMed, LILACS and the Social Sciences Citation Index. The authors also searched for unpublished literature checking the Web sites of different relevant organizations, including the World Health Organization. Additionally, they contacted subject experts and checked reference lists and citations for additional studies.
This is an empty review and does not include any study results. The authors initially identified 78 interventions from 82 studies. After further review, only 10 studies evaluated toilet provision and measured health or educational outcomes. However, none of them assessed the impact of separate girls' toilets in schools on their enrolment or attendance, and therefore the authors excluded them. There are also a few studies based in schools with separate girls' toilets (not joint toilets for girls and boys), but the impact of those could not be assessed because they did not use a comparison groups. Indeed, educational outcomes in such studies were not bifurcated according to sex, and the relative effect of separate toilets intervention could not be segregated, because it is part of larger WASH interventions. The authors highlight the need for rigorous impact evaluations, including randomized controlled trials with process evaluation or qualitative research assessing the impact of separate girls' toilet provision on educational outcomes separated by gender. The authors also recommend researching further on existing literature by conducting a review of reviews of WASH interventions with a gender perspective. Finally, the authors present a framework for future research alongside the causal pathways to facilitate the development of future studies on the subject.
The systematic review has relatively clear inclusion criteria, and the authors carried out comprehensive searches for published literature to reduce risk of bias in study selection. However, the search for unpublished literature was not sufficiently comprehensive, and as a result the team omitted one impact study from Pakistan, which found that 'having separate toilets in co-educational schools did not affect the attainment rate for boys but increased it for girls. It did not affect the failure rate for boys but lowered it for girls. It had no impact on the dropout rate' (p.59).