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Think of this the next time you're walking down the street, desperately needing to spend a penny (substitute your favourite euphemism for eliminating bodily waste here). While it may be increasingly difficult to find a public washroom in Canada, as it is in many North American cities, there's usually a gas station or a McDonald's or a hotel to duck into.

Most people in the world aren't so lucky. Two and a half billion of us don't have access to a clean, safe toilet, and one billion still practise "open defecation," which is, yes, exactly what it sounds like. I'd prefer to use the good, solid slang word for this most human activity, but the fact that I can't in this family newspaper says everything about the coyness that still surrounds it.

World Toilet Day will be celebrated this Wednesday (feel free to buy a cake). The United Nations-sponsored initiative aims to replace silence with action, and to ensure that political leaders meet their Millennium Development Goal of improving sanitation for the world's poorest. This is not a sexy topic to be discussed over high-powered G20 breakfasts, as you might guess. A wise children's book tells us that Everyone Poops – but for some, that involves safety and Charmin-wrapped comfort. For many others, it means disease, misery and danger – especially for women.

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"Rich toileted people; poor toiletless masses," is how Rose George puts it in her book The Big Necessity: The Unmentionable World of Human Waste. She notes that about 2,000 children around the world die of diarrhea every day, much of it attributable to hygiene-related disease. At one point in her book, Ms. George visits a village in India and asks the chief to name all the people who have died recently of cholera. He writes simply, "Ten small sons." (That village has since had latrines built.)

Lack of sanitation is bad enough for small sons, but it's worse for daughters. In the West, bathroom-related discrimination usually begins and ends with women complaining about lack of stalls while they stand fuming in a long line. But in parts of the world where there are no toilets to complain about, women searching for a place to relieve themselves find harassment, assault and worse.

Two girls were raped and murdered earlier this year in a village in Uttar Pradesh, India, while returning from a field where they'd gone to the bathroom. The story made headlines around the world, perhaps because of the savagery of the crime. But it wasn't uncommon; women in slums face that kind of violence all the time.

"A woman would not feel safe walking to the toilet. Men rape women there at night," one woman in Kampala, Uganda, told researchers at WaterAid, who gathered similar testimony for a report called Nowhere to Go. Another woman in her 50s in Bhopal, India, talked about how a group of men tried to assault her as she walked to a field. Yet another said she wouldn't let her daughters walk by themselves to the communal toilets, so she accompanied them each time – thus having to make the trip several times each day.

The WaterAid researchers found that "94 per cent of the women in Bhopal faced violence or harassment when they were going out to defecate, and more than a third had been physically assaulted." The discrimination takes other forms too: A significant portion of girls in the developing world drop out of school when they begin to menstruate, because there's no toilet or running water for them to use.

As British academic Clara Greed said in a speech last year, "toilets are one of the last gender frontiers in terms of inequality." Prof. Greed, who teaches urban planning at the University of the West of England, coined the piquant term "the bladder's leash" to describe the way vulnerable members of the population, like the elderly and disabled, are kept at home by a lack of public facilities. But as annoying as the problem is in Britain (or Canada), she says, it is far worse for women in the developing world, who are not just inconvenienced, but endangered. Her advice for women who want to make change? Make a career in plumbing, engineering, urban planning or architecture – all fields where it is mainly men deciding where the penny is spent.

Or, in the meanwhile, celebrate World Toilet Day, with a thought for those millions of people who have nowhere to go, and an unpleasant job getting there.

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