Restrooms

The term restroom is a uniquely American word from the early 1900s. Coming from a history of upscale restaurants offering a place for guests to “rest” comfortably near the toilet area. In K-12 schools, restrooms are not just as places of bodily necessity but self-expression, socialization, and relief from academic stress.

Hygienic restrooms are also essential for student and staff safety. As Water, Sanitation, and Hygiene Strategy, the World Health Organization (WHO) recognizes access to toilets as a priority for public health.

Today and to support future-ready goals, holistically healthy restrooms require cleanliness, sanitation, and a dedicated approach to inclusivity.

Top Health Considerations

01. Sanitation

02.

Physical Accessibility

03. User Diversity

R.5

Touchless fixtures

Sanitation

Schools with clean sanitation facilities can promote health. A systematic review found poor sanitation facilities were associated with higher rates of infectious, gastrointestinal, neuro-cognitive, and psychological illnesses. (168) (169) Per the study “ensuring ready access to hygienic toilets that offer privacy to users has great potential to beneficially impact children’s health.” Additionally, a 2018 Society for Women’s Health Research survey noted students lack consistent and reliable access to restrooms. (170) Holding in urine has detrimental health effects, such as increased bacteria spread, weakened bladder muscles, leakage, and makes people more susceptible to urinary tract infections.

According to the American Urological Association, 1 in 5 young girls have bladder and bowel dysfunction and carry these problems into adulthood. (171) School restrooms need to offer basic supplies to promote healthy sanitation. (172)

Per the CDC, in 2019, 22 million school days were lost annually due to the common cold. (172) This number could be reduced with proper hygiene and handwashing behavior. Handwashing at least four times daily can reduce gastro-intestinal illnesses and related absences by more than 50% according to a Detroit study. (173) The National Association of State Board of Education suggests, “at a minimum, schools should have a hand washing policy for students and teachers.” (174) Signage can promote the policy, as 57% of students say they are more likely to wash their hands if there is a reminder. (175)

Physical Accessibility

In 2020, the Government Accountability Office found that two-thirds of K-12 school districts have “facilities with physical barriers that may limit access.” (176) This is a problem, as highlighted in a 2016 investigation by the US Department of Justice where 83 percent of public schools in New York City have non Americans with Disabilities Act (ADA)- compliant spaces. (177) Restrooms were one of the most common areas with barriers. The team observed restrooms with “sinks with exposed pipes that could pose a burn risk to wheelchair users, or fixtures too high to be reached by a person using a wheelchair”. While ADA standards for physical disability is required by building code for new construction, existing buildings pose a challenge. School district officials in the GAO report noted “retrofitting restrooms to eliminate all barriers can be cost prohibitive.” While cost is a driving factor in design, it also sends a message to the 7.2 million students ages 3-21 who receive special education services under the Individuals with Disabilities Education Act (IDEA). (178)

User Diversity

Gender: Studies have found transgender youth are more likely to face mental health challenges than cisgender youths. (179) A cross-sectional study of transgender and/or nonbinary youths found that 58% reported feeling discouraged from using the restroom that corresponded to their gender identity. (180) Among those who experienced bathroom discrimination, 85% reported depression and 60% seriously considered suicide. As a result, many students avoid using the restroom entirely. Yet studies show that welcoming, safe school environments result in lower rates of depression and suicidal thoughts. (181)

Age and Development: Adolescence begins with puberty and is characterized by significant changes in hormone levels, physical appearance, and psychological and social characteristics. Adolescence is associated with a specific vulnerability to mental image disorder and body dissatisfaction. (182) Puberty physical and mental body changes leave students vulnerable to increased anxiety, which can negatively affect academics and socio-emotional development. To promote positive body image, many schools have begun to remove mirrors in the bathrooms. In their place, high school students have added words of affirmation. (183) Instead of seeing this graffiti as a negative, these graphics are a place where students express themselves through scribbles. Bathroom walls become an inspiring space to encourage a sense of belonging for all.

Religion: Public schools reflect a wide variety of religions and views. A 2019 study of American teenagers found that 53 percent of students see others wearing jewelry or clothing with religious symbols. (184) Religious expression is relatively common in public schools. Yet, some non-gendered bathrooms can contradict cultural ideas around modesty, gender, and gender segregation. For example, some religions and cultures prohibit sharing intimate spaces like toilets with unrelated people of the other sex. Other religions require additional washing and bathing. Understanding the school’s population allows for inclusive decisions to be made to ultimately show a welcoming atmosphere.