School toilets use: the perspective of French school doctors

BACKGROUND: Access to school toilets, seems no more an issue in France. However, presence does not mean use. We will illustrate the underuse of school toilets by pupils from the perspective of school doctors (SD). In France, prior being in post, SD are trained for a year, during which they have to work on a relevant school health topic, here school toilets. RESULTS: Almost 40 years ago, visiting over 500 rural primary schools, a SD found 14% of toilets in an << intolerable state >>. Children complaints were in accordance. Twenty years later, in a questionnaire (126 girls; urban secondary school), another SD found that 31% do not use school toilets, 45% do not feel secure, 91% find them dirty and smelly, 9,5% experience bladder weakness. Daily observations of toilets revealed a conflict between disciplinary rules and students’ fundamental needs. In 2018, 2119 questionnaires of parents about their children's behaviours and perceptions about school toilets found an overall use of 87% while 69% of pupils had an appropriate use for urine. The main obstacles reported to use were lack of hygiene and comfort (51%), lack of security or privacy (33%) and limited accessibility (28%). Last, in 2022, 24 SD conducted a collaborative project on school toilets. In a health promotion perspective, they collected data from 164 adults and 225 pupils. They agreed on one global aim: “School toilets, a place of challenges and a reflection of the well-being of each and every one”; one health priority: “Ensuring appropriate and respectful access for pupils’ needs”, and one general objective: “Mobilize all actors to ensure access to toilets and uses that respect the basic needs of pupils”. Currently two SD are developing a questionnaire assessing the state of schools toilets. CONCLUSIONS: still and even in France, pupils underuse school toilets, causing medical problems, lowering school well-being with the risk to endanger learning availability, confirming that this is a true public health issue.