Qualitative survey on squatting toilets and anal cleansing with water with a special emphasis on Muslim and Buddhist countries by using the SuSanA discussion forum

Only little information exists about the use of squat toilets in different regions of the world. This survey uses the experience of professionals and practitioners involved in different water and sanitation programs to collect more information about the use and prevalence of squatting toilets, with an emphasis on Muslim and Buddhist countries.
The purpose of the survey was to get semi-quantitative data about the use of squatting toilets in different countries and in different environments. Furthermore the data was collected in order to provide inputs for updating the Wikipedia article on squatting toilets:
https://en.wikipedia.org/wiki/Squat_toilet

Methodology:
Professionals and practitioners were contacted via the SuSanA Discussion Forum.
The members were asked about their estimation of numbers of squatting toilets in a) public, b) private, c) rural, d) urban spaces. Another question concerned the use of water for anal cleansing. Professionals and practitioners were able to answer with numbers according to their personal estimation or by verbal descriptions. Those statements were translated into semi-quantitative data. The prevalence of squatting toilets was divided in three sizes ranging from “low” (0 to 20%) over “middle” (21 to 79%), to “high” (80 to 100%).

Conclusions:
The following main conclusions can be drawn (keeping in mind that the number of responses is still quite small and further research is needed):

- For Latin America, only information for one country (Mexico) was provided in a “structured” way, and squatting toilets have a low prevalence there.
• Information for other Latin American countries was also provided by three forum members before the start of the survey, however, the information is less clear and somewhat contradictory. The presence of squatting toilets in Latin America seems to be very low although they can be found in the Andean mountain ranges in Peru.
• Contradictory estimations exist about how common squatting toilets are in rural areas of Bolivia and Peru.

- For Asia and Pacific, answers were obtained from the following ten countries: Australia, Cambodia, China, India, Indonesia, Malaysia, Nepal, Pakistan, Thailand, and Vietnam.
• In general, countries where anal cleansing with water is common (e.g. Muslim or Hindu cultures), prevalence of squatting toilets is high or medium. Also, all toilet types (sitting and squatting) in those countries are normally provided with some form of anal cleansing devices with water (such as a bidet shower), or at least a provision for anal cleansing with water (people taking their own jug of water into the toilet cubicle with them).In predominantly Muslim countries where anal cleansing with water is the norm, all toilet types (sitting and squatting) are provided with anal cleansing devices.
• In many countries there seems to be a trend towards more sitting toilets (this was mentioned for India, Indonesia, Malaysia, Nepal, Pakistan, Thailand).
• Remarkable is the emphasis on class differences. Wealthy areas and “high class” hotels, offices and airports are associated with more sitting toilets in contrary to low income areas.
• One exception to the region is Australia where no squatting toilets are to be found, but this is not surprising given the European history of the country.
• Concerning the differences between rural and urban areas, squatting toilets seem to be always more common in rural areas than in urban areas. This applies to Cambodia, China, India, Indonesia, Malaysia, Nepal, Pakistan, Thailand and Vietnam. Reasons might be the lack of appropriate water infrastructure (in the case of squatting toilets without a water seal compared to water flushed sitting toilets) , traditions that do not change as fast in rural areas, or lower socio-economic status of rural residents (if squatting toilets are cheaper than sitting toilets).

- For Caucasus / Central Asia, answers were obtained only for Ukraine. Sitting toilets there are associated with flush toilets connected to centralised sewage systems.
• In private homes water flush toilets are almost always sitting toilets.
• Prevalence of squatting toilets is generally low but they can be found in some public areas.
• In rural areas “outhouse dry toilets” (pit latrines) can be found that are constructed for squatting.

- For Northern Africa and Middle East, answers were obtained from the following countries: Afghanistan, Egypt, Iran, Jordan, Morocco, United Arab Emirates.
• In most of those countries, anal cleansing with water is common.
• Generally, it seems that in those countries both types of toilets, sitting and squatting, are common.
• There seems to be a trend either to a mix of squatting and sitting toilets or to more sitting toilets.
• Interesting is the high prevalence of anal cleansing with water in the United Arab Emirates whereas the prevalence of squatting toilets is low. This can be an indication that anal cleansing is not necessarily connected to squatting toilets.
• Only little information was given about the differences between rural and urban areas. Based on the comments about Egypt it can be assumed that the prevalence of squatting toilets in rural areas is higher than in urban areas.

- For Sub-Saharan Africa, answers were obtained from the following countries: Kenya, Rwanda, Somalia, Tanzania and Uganda.
• Squatting toilets seem to be very common in those countries.
• The prevalence of squatting toilets seems to be higher in rural than in urban areas (this was stated for Kenya, Tanzania, Uganda).
• A trend to more sitting toilets seems to occur especially in urban (wealthy) areas.

- For Europe, answers were obtained from Germany and France. While squatting toilets in Germany are basically non-existing, they can be found in France sometimes in public spaces.

- General comparison between public and private toilets:
• Squatting toilets are regarded by some people as more hygienic than sitting toilets (mentioned for Indonesia, Pakistan and Tanzania). Also, squatting toilets are easier to clean (mentioned for Nepal and Rwanda). These might be reasons why squatting toilets are preferred in public settings. Namely it is France, Kenya and Malaysia where the prevalence of squatting toilets in public areas seems to be higher than in private.
• Typical public places with squatting toilets are schools (mentioned for Vietnam, Tanzania, Jordan, France, Ukraine) while other public toilets in new offices or “high class” hotels are mainly sitting ones.
• In private homes the choice for a sitting toilet can be explained by different factors. One is the “image” of sitting toilets: They are perceived to be modern, to be as a sign of status or a sign of progress (mentioned for South India, Indonesia and Ukraine). Another factor is the convenience of sitting toilets, especially for people with movement difficulties (mentioned for Iran, Pakistan and Somalia). These can be further reasons for a lower number of squatting toilets in private compared to public areas. Also, it seems like these motivations play a more important role in urban than in rural areas.
• Due to hygienic reasons, households with many people who have to share one toilet would feel undesirable about a sitting toilet (mentioned for Pakistan).

Bibliographic information

von Münch, E. Milosevic, D. (2015). Qualitative survey on squatting toilets and anal cleansing with water with a special emphasis on Muslim and Buddhist countries by using the SuSanA discussion forum. Ostella Consulting, Schwalbach, Germany

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