Improving access to public toilets in South African urban settlements may reduce both the incidence of sexual assaults by nearly 30 percent and the overall cost to society, a study by researchers at the Yale schools of public health and management found.
The research is published in the current issue of journal PLOS ONE.
Development and human rights organizations have pointed to inadequate local sanitation facilities as a key factor in a woman’s risk for physical or sexual assault. Many women in South Africa are forced to travel out of their homes to public toilets, where they are more vulnerable to attack from sexual predators.
Lead author Gregg Gonsalves—a lecturer at the Yale Law School and a Ph.D. candidate at the Yale School of Public Health—said the study is the first quantitative analysis of the link between sexual violence and sanitation and its impact on women and society. “We hope these findings spur other research to document the phenomenon in greater detail and to strengthen the evidence base for policy making,” Gonsalves said.
Researchers developed a mathematical model that links the risk of a sexual assault to the number of available sanitation facilities and the total time a woman must spend walking to or from a toilet. The model was applied to Khayelitsha, an urban township in Cape Town where health and safety issues associated with inadequate sanitation are the subject of ongoing public debate. To create the model, the team used publicly available data on population size and density, the epidemiology of sexual assault, and the geography and logistics of toilet usage.
Between 2003-2012, an average of 635 toilet-related sexual assaults were reported in Khayelitsha each year, resulting in combined annual social costs of $40 million. According to the new Yale analysis, increasing the number of toilets from 5,600 to 11,300 would reduce sexual assaults nearly 30 percent and decrease costs to $35 million. Higher toilet installation and maintenance costs would be more than offset by lower costs associated with sexual assault. Further increasing the number of toilets to 21,400 would decrease sexual assaults by nearly 49 percent, at no additional cost to society.
The research has global implications. The link between inadequate sanitation and sexual violence has been documented in cities from Kenya to India as well as in other makeshift urban settlements (e.g., refugee and disaster-relief camps) in the developing world. The Yale paper, for the first time, quantifies that link and estimates both the health and economic impact of improved sanitation.
“Our findings are all-the-more striking because we did not take into account the many additional health benefits of improving sanitation in resource-constrained urban areas, particularly the potential reductions in morbidity and mortality associated with water-borne infectious diseases,” said Gonsalves.
Other study authors are Edward H. Kaplan of the Yale School of Management and A. David Paltiel of the Yale School of Public Health. The project was supported in part by the National Institute on Drug Abuse grant RO1DA15612.