For about an hour and a half before she finishes work and gets the bus home, Jacqui won’t eat or drink anything. Once, while waiting at the bus stop, and suddenly needing the loo, she had to head to the other end of town; the public toilets nearby had closed. She didn’t make it in time. Jacqui, who has multiple sclerosis, which can affect bladder and bowel function, says: “I go everywhere with a spare pair of knickers and a packet of wipes, but it’s not something you want to do if you can help it.” Jacqui was diagnosed with MS five years ago, and in that time she has noticed a decline in the number of public toilets. Of the ones that are left, one only takes 20p coins, “and in this increasingly cashless society, you have to make sure you always go out with a 20p”. The other block of loos are “up two flights of stairs or the lift, so it’s not the most suitable access”. If she is out for the day, she will research where the loos are, and it has meant missing out on trips with friends, such as to an outdoor festival, where the loos just weren’t accessible enough. The MS Society has given her a card, which she shows in cafes requesting access to their loos when she’s not a customer, and every person she has flashed it to “has been wonderful”. But, she adds: “You use it as a last resort because you don’t really want to burst into a cafe in front of people and say: ‘Excuse me, I need to wee.’” Public toilets are in decline, and a public campaign is needed. According to Jack Shaw, a local government researcher, who obtained freedom of information data, the number of local-authority-provided public loos fell from 3,154 to 2,556 between 2015 and 2021. Raymond Martin, the managing director of the British Toilet Association, says: “We reckon we’ve lost 50% of all [standalone public] toilets across the country in the last 10 years. It’s a crisis situation.” It isn’t just disabled people and those with chronic illness who are affected, though the impact on them is disproportionately high, but all of us – older people, those with continence issues, pregnant women, toddlers, homeless people, those of us who suddenly just really need a wee. It affects taxi drivers, delivery drivers and outdoor workers. For those who need to know where the nearest loo is, it can tether us close to home or a small area, known as the “urinary leash”. Femi Adebowale, who has Crohn’s disease, an inflammatory bowel condition, plans his days and journeys around where the nearest loo is. “If I get invited to stuff and there’s no toilets, there’ll be less likelihood of me going,” he says. But even if he meticulously researches and plans, an out-of-order toilet, or one that has closed down, either permanently or temporarily due to Covid fears, is a problem. “I’ve had a few accidents. There was one that wasn’t long ago – I was on a train and had to get off, and where I thought there was a toilet, there wasn’t one.” He eventually found access to a toilet in the third place he tried. “When you know you’ve got to go, there’s a lot of fear around it and panic,” says Adebowale. “And when you have an accident, it feels quite humiliating. It just ruins the day, and the week sometimes.” Adebowale was diagnosed 10 years ago, when he was 16, and has noticed public loos disappearing in that time. “Places where I might have known from my teen years to have a toilet, now don’t. So it’s a lot harder. I have to try to find up-to-date information for a place I haven’t been for a while to see if the toilet still exists.” He gave evidence to the London Assembly health committee, which published a report last month, recommending public toilet provision should be a statutory duty for local authorities. It also called on the London mayor to encourage large businesses, such as retail chains, to allow the public to use their toilets and advertise the fact. There should also be good-quality information on where to find the nearest public loo, including what facilities, such as a baby-change table, it offers, and reviews of toilets for disabled people to ensure they are genuinely accessible. Of its survey of more than 3,000 Londoners, more than 90% said it was difficult to find a public toilet. There has been a reluctance among politicians to address it, says Martin. “Nobody wants the portfolio, nobody wants to be known as the minister for toilets.” But he points out that public conveniences are essential infrastructure, and in other countries, sanitation departments are a source of pride. “We call them a ‘convenience’, it’s a 19th-century term, and that implies toilets are a nice extra to have,” says Rosalind Stanwell-Smith, an honorary associate professor at the London School of Hygiene & Tropical Medicine. “And yet, when you need one, it’s absolutely essential. The decline won’t stop until we legally require them, and it’s quite shocking that there is no legislation to require public toilets. They’re as vital as streetlights and pavements. We really don’t want our streets filled with people just relieving themselves because there’s no toilets.” She thought perhaps the pandemic, and its focus on public health as well as basics such as handwashing, might help push the cause for public toilets. “But of course it made it worse.” When public toilets were closed en masse during the lockdowns, people were defecating in parks and on beaches. In the Highlands in Scotland, outdoor toileting became so bad that the council put plastic trowels in laybys to encourage people to bury their waste. Even with public toilets now open, Martin says “street fouling is increasing. In London it’s abysmal and they’re having to send out teams of people with sprayers and brushes to clean it out of doorways and off pavements.” Apart from being unpleasant and giving visitors a negative view of the capital, it’s a public health issue. “This is the 21st century, we’re a developed country –people need to go to the toilet when they need to go to the toilet.” The Victorians realised this. Clara Greed, an emerita professor of inclusive urban planning at the University of the West of England and a public loo researcher, says that public toilets really took off, “in the 19th century, particularly about the 1870s, where there was this massive public health movement to improve sewage and drainage and water supply, particularly because of cholera”. They provided more toilets for men “because it was seen that men were out and about, going to work, and it was considered improper for women to be out on their own or to encourage it. So the great inequality started very early on.” Toilets became a feminist issue, and women campaigned for public loos. “Women felt very restricted in their movements because of the lack of toilets. You had department stores, and some restaurants, various places where women could go shopping and use the toilets, but it was still quite restrictive.” In the 1920s and 30s, says Greed, there was “almost a civic pride in providing toilets, but there were still fewer facilities for women”. Because you could fit more urinals into blocks than cubicles, “women got about half the level of provision as men. That’s why we still have queues, and this [comes from] the early 20th century. It was very heavily weighted against women.” Women also had to pay to use many facilities, when men did not. Public toilets are still a political issue, with the move towards gender-neutral facilities marking the latest loo revolution. While the intention is good and, if done properly, should cater for everyone, in practice it has sometimes meant little more than switching the sign on the door. Rather than starting again and building private self-contained cubicles – which would benefit everyone, including trans people, parents with children, disabled people, those who need help, men who find gents’ toilets intimidating places – often women find they are sharing their spaces with men, while men also retain access to the loos containing urinals. The postwar reconstruction of the 1950s, and the building of new towns, brought more public loos. “By about the 1980s, you began to get a decline in public funding and local authorities began to close public toilets in order to save money. And this was because the 1936 Public Health Act gave local authorities the power to provide toilets if they wish, but it wasn’t mandatory. So public toilets were one of the first things to go.” The slashing of local authority budgets during austerity made it even worse, says Martin. In the long term, he says, it makes no sense. Having good public conveniences “brings visitors and tourism to town centres – they’re things that councils want”. The loss of public toilets also means, says Jyotsna Vohra, the director of policy at the Royal Society for Public Health (RSPH), “the burden falls disproportionately on people experiencing other health inequalities. We know nearly two in five people with long-term medical conditions, such as bladder and bowel disease, are tied to their homes because of fear or knowledge of a lack of facilities nearby.” For the general public, it’s as high as one in five. “This directly hampers the UK’s wider public health efforts, such as keeping people physically active and socially engaged with their community.” The RSPH found more than half of the people it surveyed reported restricting their fluid intake occasionally or frequently in order to avoid needing the loo when they may not be able to find one. “Toilets are often seen as a taboo and trivial subject, but they require serious political and public debate,” says Vohra. “Putting the provision of public toilets on a statutory footing alongside funding for local authorities will help to address an obvious gap in public health.” There have been moves to make toilets more available for some sectors. The Department for Transport and the Health and Safety Executive recently published a letter to remind businesses of their obligation to provide access to toilet and hand-washing facilities to visiting delivery drivers (many workers reported being turned away). But the general public are still underserved. In some places, the local community has taken over the running of public loos. “I think they’re absolutely wonderful,” says Martin, of the local residents who run facilities, “but I don’t think it’s right.” It’s the same for schemes whereby businesses, such as cafes, and community organisations are paid to allow the public to use their loos – good in principle, but it can vary by area, opening hours may not be ideal and the toilets may not be accessible. Martin wants to see a statutory requirement, and funding, for public toilets. In the meantime, he says, “we’ve got to stop the closures. And get the toilets that are still available – about 2,600 that we know of – up to spec.” There are always questions of how to pay for them, says Stanwell-Smith. “Are we paying for good paving, good streetlights, sanitation? Of course we do. We pay for our water, and for drains. It should be on a par with that and legally controlled in the same way.” A penny tax on every journey could help fund them, she suggests. In previous centuries, she points out, public toilets were bequeathed by rich philanthropists. “It hasn’t become as respectable [now],” she says. “I once had an interesting conversation with a royal equerry. I said, would there be a member of the royal family who you think could support this? He said: ‘Never’. Why is it so embarrassing? How come we can talk about anything else and not toilets? Why would they think they’d be laughed at? Hopefully we wouldn’t, but being British we might.” Public toilets could be designed by the best architects and become attractions in their own right, she says. Having to plan where and when he can go to places, and knowing where the nearest public toilet is, “just makes everything longer and a lot more emotionally draining”, says Adebowale. More public toilets would obviously help, he says, and so would big chains getting involved – McDonald’s, say – and announcing that anyone with a need would be welcomed. It can be stressful having to ask to use the loo somewhere, he says – he has a card from Crohn’s and Colitis UK that he can show to cafes or restaurants when asking to use their loo, but it hasn’t always been very helpful. “A lot of people just don’t know about not just Crohn’s disease, but any chronic illness – there’s not enough awareness. A lot of people aren’t very compassionate about the fact that we have a need. It feels like a coin toss whether they will let me [use the loo] or not. I’m more likely to go in a place if I feel I can get past the staff without being noticed. It’s not nice having to ask to use the toilet, when it feels like a basic human right.”