What impact does the provision of separate toilets for girls at school have on their primary and secondary school enrolment, attendance and completion?

Birdthistle, I., Dickson, K., Freeman, M. and Javidi, L.. (2011). MARCH Centre at LSHTM and EPPI-Centre, University of London

DFID’s 2008 Water Policy

Includes the aim, working with others, to “ensure that every school has a safe water supply and well maintained toilets, separate for boys and girls”.

• Installing toilets in schools has been shown to improve girl’s attendance – often as much as major educational reform.

• In the mid 1990s, for example UNICEF found that providing toilets in schools in Bangladesh boosted girls’ attendance by 11 per cent.

Why focus on toilets for girls in schools?

To identify and synthesize evidence of the impact of separate toilets for girls on their enrolment and attendance in schools.

Primary aim of the systematic review

Systematic Review

• Answer important questions by looking at prior research

• Bring together and pool the findings of primary research

• Synthesis of the findings of all the studies included in the review in order to answer the review questions

Systematic Review cont ...

• It follows a principled method and a research question with a protocol and reflection on strengths

• Reduces bias and error• It is replicable and updateable

Why is DFID funding systematic reviews?• Increase evidence-

informed decision making.

• Increase the value for money of policy by basing decisions on a rigorous understanding of what works.

• Support the creation and dissemination of systematic reviews as public goods.

The primary audience of DFID’s funded systematic reviews?

DFID policy makers, DFID advisors, developing country policy makers and development programme managers

A two-stage systematic review model was used

Stage one: identify studies investigating school-based water, sanitation and hygiene interventions.

Stage two: whether we have evidence to answer these questions:

Q1a: Is there is an impact of providing single-sex toilets on the enrolment, attendance and/or completion of girls in primary or secondary schools?

Q1b) Is there evidence of associations between separate toilets and girls' educational outcomes?

Stage two: Other objectives

ii) to provide a conceptual map of mediating factors by which separate toilets may impact educational outcomes (Q2);

iii) to build a map of all school WASH studies identified (Q3 )

The report found that "there is evidence neither for nor against the impact of separate toilets for girls on their educational outcomes".

The provision of separate-sex toilets may be necessary but not sufficient to impact girls' educational outcomes

Further research priorities would benefit from examining whether any school-based WASH interventions have an impact on girls' educational outcomes?

Conclusions

To conduct at least two well-designed, cluster-randomised trials from different contexts, where cultural and environmental factors differ (e.g., religion and access to water, respectively) in order to generate a sound evidence base.

Suggested further work

Do we need more evidence for WASH in Schools?

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