The World’s Worst Toilet

About 3.5 billion people lack safely managed sanitation, meaning they don’t have private toilets connected to systems that safely treat or dispose of waste. Of these, roughly 419 million still practice open defecation.
Sources: UNICEF Data – Sanitation · JMP 2025 Report · WHO/UNICEF Fast Facts

It’s the highest service level defined by the WHO/UNICEF Joint Monitoring Programme. It means using an improved facility that is not shared with other households, where waste is either treated on-site or transported and treated off-site. Lower tiers include “basic” (improved but you may share nothing), “limited” (improved but shared), “unimproved,” and “open defecation.”
Source: UNICEF Data – Sanitation · WHO WASH Monitoring

Open defecation is relieving oneself in fields, forests, bushes, water bodies, or other open spaces rather than a toilet. It is most concentrated in sub-Saharan Africa and parts of South Asia. India historically had the largest number of people practicing it, though major government programs have reduced this significantly.

Open defecation was eliminated (<1%) in Latin America and the Caribbean as well as in Eastern and South-Eastern Asia, and nearly eliminated in Northern Africa and Western Asia.
Source: UNICEF Data – Sanitation

Poor sanitation is linked to transmission of diseases like cholera, diarrhea, dysentery, hepatitis A, typhoid, and polio. Inadequate sanitation contributes to hundreds of thousands of deaths annually, many of them children under five. It also affects nutrition, education (especially girls’ school attendance), economic productivity, and environmental quality.

People living in low-income countries, fragile contexts, rural communities, children, and minority ethnic and indigenous groups face the greatest disparities. People in least developed countries are more than twice as likely as people in other countries to lack basic drinking water and sanitation services.
Source: WHO/UNICEF Fast Facts

Poor sanitation is linked to transmission of diseases like cholera, diarrhea, dysentery, hepatitis A, typhoid, and polio. Inadequate sanitation contributes to hundreds of thousands of deaths annually, many of them children under five. It also affects nutrition, education (especially girls’ school attendance), economic productivity, and environmental quality.

Without safe, private toilets, women and girls face risks to safety and dignity, particularly when forced to go outdoors after dark. Lack of facilities for managing menstruation at schools contributes to girls missing class or dropping out. Pregnant women and the elderly are also disproportionately affected.

Sub-Saharan Africa, Central and Southern Asia, and parts of Oceania lag furthest behind. Rural areas generally have far worse access than urban areas, though rapid, unplanned urban growth has created large sanitation deficits in informal settlements and slums.

UN Sustainable Development Goal 6, target 6.2, aims to achieve access to adequate and equitable sanitation and hygiene for all and end open defecation by 2030, with special attention to the needs of women, girls, and vulnerable groups. Progress is off track; current rates would need to accelerate several-fold to meet the target.
Source: WHO WASH Monitoring

No. Flush toilets require reliable water and sewer infrastructure that many places lack. Alternatives include pit latrines, ventilated improved pit (VIP) latrines, composting toilets, and container-based sanitation. What matters is that waste is contained and safely managed, not the specific technology.

This progress still falls short of the SDG 6 threshold of safely managed services, which requires safe water to be available at home when needed, and for sanitation to include not only a toilet but a system to treat and manage excreta.
Source: WHO Bulletin – Unsafe WASH

Having a toilet is only the first step. In many places, waste from pits and septic tanks is never safely emptied, transported, or treated. Effectively, it ends up in the environment untreated. This “sanitation chain” gap means official toilet-access figures can overstate how safely waste is actually handled.

Yes, though on a smaller scale. Pockets of inadequate sanitation exist in rural, low-income, and marginalized communities in high-income countries, including failing septic systems and areas without sewer connections. Homelessness also creates urban sanitation access gaps.

Efforts include government-led campaigns (such as large-scale latrine-building programs), community-led total sanitation approaches that shift social norms, investment in fecal sludge management, low-cost and off-grid toilet technologies, and international funding through agencies and NGOs. World Toilet Day (November 19) is an annual UN observance to raise awareness.

Yes. Between 2015 and 2024, 1.2 billion people gained access to safely managed sanitation services, with global coverage increasing from 48% to 58%. The number of people practicing open defecation has dropped by 429 million and in urban areas it has been practically eliminated.
Source: The Water Diplomat · JMP 2025 Report

Between 2000 and 2024, the global population rose from 6.2 to 8.2 billion. Over this period, about a quarter of the population (2.2 billion) gained access to safely managed drinking water and a third (2.8 billion) to safely managed sanitation.
Source: JMP washdata.org

Options include supporting reputable sanitation-focused charities, raising awareness, and advocating for sanitation funding in development and aid budgets. Because the issue is largely one of infrastructure and policy, systemic investment matters most.