Dear all,

About the French using squatting toilets this used to be more common in the past than nowadays. As an example there were only squatting toilets in primary school when I was a child. Women and girls do not like them very much because when you pee it splashes on your shoes and lower legs.
You can still find them in public toilets situated in isolated areas such as on motorways resting areas. The French name them "Turkish toilets".

During an assignment in West Africa, namely in Ghana and Côte d'Ivoire, I had the opportunity to conduct Focus Group Discussions and interviews with users of public toilets. The women repeatedly complained about contracting infections including using squatting toilets. I inquired further about this issue and some of the stakeholders explained that because of the heat inside the toilet cubicles there was a lot of fumes coming from the toilet pan and this resulted in significant contamination for women (including yeast infections). The women declared that infections had decreased since they had access to toilets in their HH.
I do not have scientific data to back these findings but there is a good ground for investigation in municipalities which have embarked on public toilets' improvement programs such as in Ghana. You could compare male and female toilet users health indicators between toilets which rank poorly, higher ranking toilets (as surveys on public toilets' quality / compliance with norms already exist on a monthly basis) and domestic toilets for example. It would be quite interesting from a public health point of view and also to increase our knowledge on public toilets' related infections.

Best regards
Cécile

Dear Elisabeth, Linda and all,

Thanks for the overview, and yes, let history tell which posture people will end up preferring in different situations and parts of the world for defecation and to urinate. I was in France and still found and used a squatting toilet in a bus station - but I guess you will find them only there, not in peoples private houses, nor in hotels. As I promised I did some inquiries on the 'infertility in women caused by infections from using a toilet seat', and as far as I was told, no scientific evidence is reported about infertility in women caused by bacteria or viruses transmitted trough toilet seats.

Dear Linda and Hester and all,

Linda you wrote: "if squat toilets reduce on the risks entailed in a woman's parts touching the bacterial infested toilet seat - i vote for that."

Yes, if this "if - then" statement is proven true then of course a squat toilet would be better. But I doubt that it has been proven yet. Like I said before, nobody likes to sit on a filthy toilet seat, that's for sure. But nobody wants to use a messed up squatting pan either (and I have seen plenty of those on photos as well - feces where the feet are meant to go etc.; people might be barefoot when using such a filthy toilet etc. - not good!). So I think a filthy toilet is gross and unhygienic, no matter whether it is a sitting or squatting type.

By the way, the woman's body parts (vagina) do not touch the toilet seat in any case, only the back of our thighs do, and that would be the same for men when they sit to defecate. (It's possible to "hover" over the toilet seat as well or to cover it with toilet paper in the case of filthy conditions)

But please don't think that I am trying to tell you that you should prefer sitting toilets. Far from it!! Everyone should use whatever they prefer. I was just speaking out against unfounded broad health claims against sitting toilets in general.

Hester: We can speak again in 20 years time and see if sitting toilets have become more common in some countries or not. I don't mind either way, I am curious how things will develop. As you say, there is a comfort element which may lead some people to prefer sitting toilets even if they grew up with squatting toilets. And vice versa there may be some people who switch to squatting toilets as they feel it empies the bowls better (and perhaps some scientists will eventually study this and give us evidence on one way or the other; so far the scientific evidence is not there).

But I didn't understand your mentioning of water availability? The question of water does not affect the decision of sitting versus squatting because both types of toilets can be set with lots of flushing water, or with little flushing water, or with no flushing water. The usage posture is independent of whether you want to have a flush toilet or a dry toilet.

I thought a fairly good overview about all the available toilet options is here in this Wikipedia article on toilets:
en.wikipedia.org/wiki/Toilet

Regards,
Elisabeth

Here's my experience using squat toilets in Türkiye which were common when I lived there decades ago as a child, and are still prevalent when I traveled there last decade.

Türks usually have a water spigot with a small water catchment bucket (to be mindful of managing this resource) in the stall and in the vicinity where one squats, so one can reach and turn the spigot without much difficulty. Simple and manageable, provided one has access to a water supply.

Dear all,

Elisabeth, I totally agree that if we talk about the link between sanitation and health, scientific evidence is needed to verify statements on cause-effect relations. I reacted to the discussion because I wanted to give value to a post coming from Uganda, from a practical experience of a group of women who feel unsafe using a sitting toilet. Their choice is to go to a squatting toilet instead, it is their preference, as women who grew up in Uganda and have a life time experience using toilets and having to take care of their own personal health. At the same time, their negative experiences with dirty sitting toilets seems to be shared with more people in Uganda, to an extend that government is willing to take measures, taking into account the preference of (at least a group of) public toilet users. I never before heard of infertility in women caused by contact with a toilet seat, but I will ask a friend who is gynecologist, she will answer me and then I will come back to this forum with my findings. As for the French, it is true that they won the World Cup, but for the squatting: I think that in general, if households have money and continuous water supply, they will go for comfort, and the same for countries with sufficient resources to build and maintain public toilets and provide continuous water supply. But: how many fast growing cities in the world have continuous water supply? Also, will sitting toilets be considered the best option by all people on the globe? Personal or cultural preferences may differ from one country to the other.

Dear Elizabeth,

There is a basis for what i shared but for the sake of scientific validation i am to research and present more of this. The basis was from a personal experience i have suffered recurrently that led me discuss with women in a workplace of 283 people who were sharing the toilets. The outcome of this discussion was.....there was a high rate of infections especially where there was no provision of disinfectants for the women to use before using the same toilet seat with affected persons. I want us to consider seriously the fact that women's anatomy is open and that makes it more susceptible to infections in a busy place where the stance ratio is high. Besides this there those moments when there is a splash from the toilet bowl. Emphasis should be on disinfection, but if squat toilets reduce on the risks entailed in a woman's parts touching the bacterial infested toilet seat - i vote for that.

Hi Ashok,

Thanks for raising those points. The "disinfection issue" is not an easy one - where and what needs disinfection... perhaps the door handle is filthier than the toilet seat... Next time you handle money you potentially touch something filthy again etc. Hence the point of handwashing with soap "at critical times", e.g. before eating, after using the toilet. Just disinfecting the toilet seat might have little practical benefits in the scheme of things.


Hi Hester,

I wanted to come back to two points that you made:

And for my understanding: if Linda says she has evidence from infections caused by unclean sitting toilets, why would we not believe her?

--> This is nothing personal against Linda. There are all sorts of health claims floating around in the internet. You'd be gullable if you believed every single one of them. I just said that I'd like to see some scientific evidence please, or otherwise her statement should be clearly marked as "hear say" or perhaps as "anecdotal evidence". Remember the statement that I questioned was:
"Three in 10 women using these toilets without proper disinfection is bound to have recurrent infections. As opposed to those who use squat hole toilets. These infections according to the State Minister of Health Uganda, Hon. Sarah Opendi are a cause of infertility causing women 's Fallopian tubes to clog." (there are many health myths floating around regarding infertility in Africa; that's why I get extra suspicious when I see fertility mentioned in this context)

Do you not question such health claims when they get thrown at you? I have become very careful with believing anything regarding health, based on my work with Wikipedia Medicine. Any health-related claim in Wikipedia requires one or more reliable sources. I think that's very good practice. See here what is a reliable source in that context:
en.wikipedia.org/wiki/Wikipedia:Identify...e_sources_(medicine)

Sure, a discussion forum is not Wikipedia. Here we can voice opinions, guesses, hypotheses, stories, possible linkages and anecdotal evidence. That's fine. But it should be clearly identifiable as such.

You also said:

For some reason, the good old French have squatted for ages and still do, to a large extend - and they won the World Soccer games. Could we ask a French woman about the experiences in her country, and the reason why many French prefer squatting over sitting on toilets?

I don't think this is correct unless there are pockets of France that I haven't travelled to yet and where that is the case. On all my trips to France, I have never come across a squat toilet except for once at a camping park in the South of France about 30 years ago. There is an increasing Muslim population in France though (I think) so perhaps squat toilets with water hoses for washing with water are being installed in public spaces to cater for their needs? Is that what you have observed?

Could we hear from our French forum members? Is Heather right to say that many French prefer squatting over sitting on toilets?

For those wanting to know more about squat toilets and where they are common there is a fairly good Wikipedia article about it:
en.wikipedia.org/wiki/Squat_toilet (see also its talk page if you want to see what the editors of this article discussed during its development: en.wikipedia.org/wiki/Talk:Squat_toilet)

See you,
Elisabeth

Let me add to the confusion going on the subject of Sitting vs squatting

I am going to talk about our habits in the wash room and hand washing. Lot of emphasis is placed on hand washing with soap, that too for sufficient time and all over. There are a lot of videos on the subject by National and International Bodies.

BUT

After we get up from the seat after ablution with water, cleaning with paper or any other material and our hands dirty,
1. We straiten our clothes,
2. Tie the ribbon of Pyjama, Salwar etc., or fix the zip and buttons of pants and jeans,
3. If one is having an under wear, that too is to be placed and tied properly,
4. We open the door by its handle,
5. We close the door,
6. We walk to the wash basin and open the tap.
We do all this with our dirty hands, before we wash them.

Am I wrong in thinking that there should be a wash basin right along with the toilet seat so that we can wash our hands before leaving the seat.
We may wash them again after coming out of the toilet cubicle, if we so want.
The wash basin may be flush with the wall and may be rotated on a pivot, to come in front. Or some other arrangement.
The problem is more aggravated in rural scene where the person has to walk back home from the field and at times even children playing with them and so their clothes.

The possibility of Using the hand wash water with soap etc. can also be used for flushing the urinals.
The same can be done in Toilets also if septic tanks are not being used.

Disinfection is core to urinals, squats or sit on toilets. And its the factor that determines an increase in infections if missing. Currently it is not quite focused on.

Talking about how to prevent infections from toilet use, either by toilet seats or latrines: could urinals for women help to prevent the splashing while using public latrines, which is reported (I heard it recently from Tanzania where squatting is the common practice) as a cause of infections? Any experiences with this technology? I know it is applied at some schools.

Sure, I am biased, I do admit. I myself, if I were in charge of investment decisions (like the Ugandan ministry which was mentioned earlier), in situations where there is a challenge in guarantying cleanliness. I would opt for a dual model: a row of squatting toilets and one or two sitting toilets for elderly people / people who do not like squatting, for whatever reason. A challenge in guarantying cleanliness can be caused by:
-frequency of use of the toilets (public toilets in (informal) urban areas, where many houses lack toilet facilities and people are queuing for the public toilet building at peak hours);
-scarcity of water (which is the case in many African and Asian cities, large part of the year);
-scarcity of budget allocated to cleaning of toilets - which is the case in many countries;
-cultural preferences for squatting - which is the case in many countries.

So this is my bias. I would wish a world in which every household would possess a bathroom with running water 24 hours a day, during the whole year, and then, they could as well invest in a sitting toilet. Sitting toilets are aspirational, for many people. But in this imperfect world, this aspiration is more a dream than a realistic goal. I remember a 'model school' in Ghana, adopted by the First Lady, with a beautiful row of small toilet pots for the smallest children. But: not in use, because the school could not pay the water bill. This is a reality in our far from perfect world, which makes me have a preference for squatting toilets in the cases I mentioned.

I have no doubts about the dangers of infections and the paper put forward illustrates that, but to put the blame on sitting toilets when with squatting the risk factors are the same leaves me with no alternative than to think this is just bias.

Where does the contamination come from with a sitting toilet ? From the user I imagine, and the same thing applies to a squatting toilet particularly with children. A squat plate can harbour just about the same level of contamination or ever more as the area is larger. You don't sit on a squat plate but you do squat adjacent to the throat so contamination risks are higher through misdirection as you are above the plate.
Where then does the contamination actually come from when sitting ? The Pedestal walls and throat can be spoiled but this is equal to the risks when considering a squat plate. So to me if a sitting pedestal seat is carrying contamination it can only come from someone squatting when they should be sitting. In those circumstances how is the Pedestal at fault ?
Ross