New York City Public Toilets Do Not Meet Needs of Women Experiencing Homelessness

Public toilet facilities in Manhattan do not meet the needs of women experiencing homelessness in terms of accessibility, cleanliness, privacy, or resource provision. especially with regard to managing their periods, according to a new study by Columbia University Mailman School of Public Health and CUNY School of Public Health. Neighborhoods that had higher shares of vulnerable residents tended to have lower-quality public toilet facilities with lower menstrual management-related resources. Until now, little research has explored access to public toilets in the U.S. for people experiencing homelessness, especially with regard to women managing their menstruation. The results are published online in the journal PLOS ONE.

“Our study sought to better understand the lived experiences of menstrual management among people experiencing homelessness, especially with respect to women managing their menstruation,” said Marni Sommer, DrPH, MSN, RN, associate professor of Sociomedical Sciences at Columbia Mailman School, and senior author.

Working with the Coalition for the Homeless, Sommer and colleagues conducted a mixed-methods analysis in the Summer of 2019 that sought to capture, at the individual, institutional, and ecological levels, the nature of menstrual management on the part of those experiencing homelessness, and how the local context may shape those experiences. This included key informant interviews with staff of government agencies and homeless service organizations as well as in-depth interviews with women experiencing homelessness who menstruate. Audits of public toilet facilities were also performed in a select number of sites across the borough of Manhattan in New York City.

The most prevalent challenges that emerged from the research pertained to accessibility to restrooms, availability of resources, cleanliness, and safety issues. These were critical issues for the study participants and prospective users, both for those living on the street and those living in shelters, the latter of whom also need facilities as they move around the city when seeking out services or employment. The analyses also revealed insufficiently provided, maintained, and resourced public toilets for managing menstruation in high-needs areas.

“Menstrual hygiene resources such as pads, tampons, and toilet stall disposal bins, were found to be difficult to access in public toilets, a reality further exacerbated by the finding that these resources are even scarcer in areas of lower-income residents,” said Andrew Maroko, PhD, associate professor of Environmental, Occupational and Geospatial Health Sciences at the CUNY School of Public Health, and first author. “Safe access to clean public toilets is essential for anyone, housed or otherwise. If anything, the COVID-19 pandemic intensified such concerns.”

Participants complained about the limited numbers of public toilets throughout the city, and their restricted hours of operation, such as those located in the city’s parks. They noted that access to public toilets may include hidden costs or location-specific permissions – whether economic (e.g., pay for subway access) or social (e.g., ask an attendant at a museum). As the public toilet audits conducted during the study revealed: over 75 percent of the restrooms required researchers to first enter or gain access to an establishment such as a museum, library, some park facilities, or transit stations - which may not require payment but may be experienced differently based on one’s ability to “pass” as not homeless.

“Access to safe, clean water and sanitation is globally recognized as essential for public health, and readily accessible public toilets are considered modern necessities. In essence, a toilet should be accessible to members of the public, without social or physical barriers preventing usage,” said Sommer.

Co-authors are Kim Hopper, Caitlin Gruer and Maayan Jaffe, Columbia Mailman School; and Erica Zehn CUNY School of Public Health.

The study was supported by the Sid and Helaine Lerner MHM Faculty Support Fund and Osprey Foundation.