Water is essential for sustainable development, public health, and climate adaptation. Despite some progress, billions still lack access to safe drinking water and sanitation, with women and children facing the greatest impact. Poor access contributes to disease, child mortality, and lost economic opportunities. The UN promotes global action through initiatives like the Water Action Decade and the Water Action Agenda, focusing on improving access, governance, and investment.

Menstrual Hygiene Matters is a comprehensive resource developed by WaterAid to address the challenges of menstrual hygiene management (MHM) for women and girls in low- and middle-income countries. The guide comprises nine modules and toolkits that cover various aspects of MHM in different settings, such as communities, schools, and emergencies. It brings together global examples of good practices, offers guidance to build competence and confidence in addressing menstrual hygiene, and encourages advocacy to break the silence surrounding menstruation. The resource emphasizes that menstruation, though a natural process, is often surrounded by taboos and socio-cultural restrictions, leading to the neglect of MHM in WASH (Water, Sanitation, and Hygiene) and other sectors. This neglect results in women and girls being denied their rights to health, education, dignity, and gender equity. The guide aims to make the invisible visible by highlighting the importance of integrating MHM into WASH programs and ensuring that women and girls have access to the necessary facilities and information to manage menstruation hygienically and with dignity.

Although promotion of safe hygiene is the single most cost-effective means of preventing infectious disease, investment in hygiene is low both in the health and in the water and sanitation sectors. Evidence shows the benefit of improved hygiene, especially for improved handwashing and safe stool disposal. A growing understanding of what drives hygiene behaviour and creative partnerships are providing fresh approaches to change behaviour. However, some important gaps in our knowledge exist. For example, almost no trials of the effectiveness of interventions to improve food hygiene in developing countries are available. We also need to figure out how best to make safe hygiene practices matters of daily routine that are sustained by social norms on a mass scale. Full and active involvement of the health sector in getting safe hygiene to all homes, schools, and institutions will bring major gains to public health.

Access to clean water, sanitation, and hygiene (WASH) is a human right and a cornerstone of sustainable development (SDG 6). Despite progress, 2.2 billion people lack safe drinking water, and 4.2 billion lack proper sanitation. The COVID-19 pandemic underscored hygiene’s importance, yet 40% of schools and many healthcare facilities lack handwashing facilities, disproportionately affecting rural and low-income communities. While 71% of the global population now has safely managed water, disparities persist: Sub-Saharan Africa and South Asia lag furthest behind, with wealth and location dictating access. Improved data collection and equity-focused policies are vital to achieving universal WASH access by 2030.

Handwashing, a critical defense against diseases like COVID-19, remains inaccessible to over 2 billion people globally due to lack of clean water and sanitation. Despite decades of work by organizations like Water For People and IRC, a staggering $85 billion annual funding gap persists, hindering progress toward Sustainable Development Goal 6 (universal water and sanitation access by 2030). While COVID-19 spotlighted hygiene’s importance, 829,000 people die yearly from water-related issues—a silent crisis overshadowed by pandemic headlines. The article urges action: advocate for global health funding, support systemic change through coalitions like Agenda for Change, and raise awareness about water access as a public health priority.

The Menstrual Health and Hygiene (MHH) Resource Package by the World Bank’s Water Global Practice (2021) provides actionable tools to integrate MHH into water, sanitation, and hygiene (WASH) projects, emphasizing gender-inclusive design and multisectoral collaboration. Key focuses include: Hardware: Designing female-friendly sanitation facilities (e.g., private stalls, handwashing stations, waste disposal). Software: Addressing cultural taboos through education, behavior change campaigns, and policy reforms (e.g., tax exemptions for menstrual products). Cross-sector impact: Linking MHH to education (reducing school absenteeism), health (preventing infections), and economic empowerment (supporting women-led enterprises). The toolkit includes checklists, construction plans, policy frameworks, and monitoring indicators to ensure projects are inclusive, sustainable, and data-driven.

Hygiene promotion, defined as a systematic approach to adopting handwashing and safe fecal disposal, is critical for reducing diarrheal diseases, a leading cause of child mortality. Unlike hygiene education, promotion integrates broader strategies like community engagement and social marketing. The Hygiene Improvement Framework (USAID) emphasizes three pillars: behavior change campaigns, access to water/sanitation infrastructure, and supportive policies. Evidence highlights handwashing with soap reduces diarrheal risk by 42-47%, yet rigorous trials on behavior change interventions remain scarce. Approaches like Programme Saniya (marketing-based in Burkina Faso) and participatory methods (PHAST, Community Health Clubs) show success but face evaluation challenges. Monitoring should prioritize behavior over health outcomes due to confounding factors. Lessons stress combining education, community mobilization, and marketing, alongside sustained efforts and formative research to address contextual barriers.

This article addresses the often-overlooked disparities in WASH (Water, Sanitation, and Hygiene) services within high-income countries (HICs). While global efforts predominantly focus on low- and middle-income countries, this piece emphasizes that significant inequities persist in HICs, particularly among marginalized groups such as Indigenous populations, rural communities, and the homeless. These disparities are attributed to systemic issues, including inadequate infrastructure, policy neglect, and socio-economic barriers. The article calls for a reevaluation of assumptions regarding universal WASH access in affluent nations and advocates for targeted research, policy reforms, and inclusive practices to ensure equitable access for all.

This review examines menstrual hygiene management (MHM) waste disposal practices in low- and middle-income countries (LMICs), highlighting systemic neglect in sanitation systems. Despite growing use of disposable sanitary pads (linked to urbanization and affordability), improper disposal methods such as burning, burying, or flushing persist due to cultural taboos, inadequate facilities, and policy gaps. Menstrual waste (e.g., non-biodegradable pads) clogs sewer systems, burdens sanitation workers, and poses environmental/health risks. Incineration, while common, often lacks safety standards, risking toxic emissions. The review underscores the need for integrated solutions: user-centered infrastructure (e.g., bins, incinerators), policy reforms, and multi-sector collaboration to align MHM with Sustainable Development Goals (SDGs 3, 6, 12).