Poor sanitation in a developing country like Ghana is a threat to public health, especially in the face of improper waste management.

Access to improved sanitation facilities in Ghana is estimated at 15 per cent against the Millennium Development Goals (MDGs) target of 54 per cent which had been projected to be attained in 2015.

High poverty levels, non-enforcement of sanitation laws, and lack of innovation among relevant government agencies have been identified as factors militating against healthy environment.

Open defecation is at very alarming proportions in Ghana, with current data suggesting 19 percent of the populace has no access to toilet facilities.

Statistics show 10 percent of the people in the Ashanti Region practice open defecation, 16 per cent in the Bono Ahafo Region and 12 percent in Western Region.

Absence of toilet facilities, especially in public schools give even more cause for concern to sanitation experts and other well-meaning citizens.

Pupils and students, particularly, females of puberty age find the school environment unfriendly when toilet facilities are non-existent or, at best, lack privacy or are unsafe.

Twenty-four year old Ayisha had an unpleasant experience of during her third trimester field work at Domeabra, near Agona in the Sekyere-South District of the Ashanti Region.

The helpless student and her colleagues had no choice but to join hundreds of their hosts on ‘free range’.

“Respectively, I had to ask my friends to stand behind me and alert me when someone headed towards us,” she recounts.

In one instance, Ayisha had to end it all abruptly and pull her dress up at the sight of a male adult who was also in the ‘field’ to ‘do the thing’. “It was an embarrassing moment. I could not continue again,” she continues.

Sometimes, she says, one has to endure the terrible experience of ‘holding up’ until a practitioner of the opposite sex is done before the other person takes their turn.

Ayisha certainly was not in it alone. Her colleague, 22-year old Rashida has a story to share from Kyebi in the Sekyere Central District, also in the Ashanti Region.

Surprisingly, there is a toilet facility in the community but it is meant for only men who use it in evening for convenience and privacy, due to its location.

Women like Rashida have had to trek to the bush to ‘free’ themselves, and that came with a lot of risk.

‘’It takes only a valiant lady to “kill” fear and shyness to visit the bush in the name of easing herself, she believes.

On many occasions, Rashida and her friends had device various strategies, including pretending to do something else anytime they ‘clashed’ with a male on an ‘expedition’.

For two months, they went through ‘free range’, far away from her base in Tamale in the Northern Region.

“I was disappointed and confused anytime I saw someone coming,” she says.

The fear and shy constantly come with the spy the rural folks normally show. Their look, sometimes, these ladies are tempted to conclude that, they are discussing the actual destination.

  “Frankly, I was happy to leave the community. In fact, I don’t remember the last time I openly defecated. That should be when I was a small girl,” Rashida looks back.

“Sometimes, you think they saw everything about you and you would not want to meet these people again. You always have at the back of your mind that, they had seen your nakedness,” lament one of Rashida’s colleagues.

These women feel the psychological effect of always carrying images of men who saw them easing themselves, and it continues to haunt them.

Open defecation is normal for rural women in parts of Ghana. Some even say it is more convenient than using a toilet facility.

Researchers, however, warn pregnant women who defecate in the open are more likely to have premature or low- weight babies than those who use toilets.

A study by public health experts at the London School of Hygiene and Tropical Medicine and the University of Iowa in the United States, gives what the researchers say is the first evidence linking poor sanitation to a higher risk of adverse pregnancy outcome.

That is not the only challenge women go through practising open defecation. Their dignity and privacy is being threatened in various ways.

Vice-Chancellor for the University of Energy and Natural Resources, Professor Mrs. Esi Awuah, says the need for improved sanitation is very critical, especially, for women.

“Open defecation for women is very dangerous. Women need privacy to do their own thing,” she emphasized.

She believes people should look beyond government for provision of toilets, adding heads of household must prioritize the issue in order to protect the health and dignity of their wives and daughters.

“Officials should be up and doing to ensure that they implement the bylaws on sanitation while individual members of households should try to provide toilet facilities in their households,” Professor Awuah advises.

An official at the Ministry of Local Government, Kweku Quansah, says the huge gap between people with access to toilet facilities and those who don’t have is a big challenge.

Ghana loses a total of GH 290 million to health care every year, which could partly be blamed on poor sanitation practices.

It is therefore important for the nation to invest in sanitation to improve environmental safety, especially, by ensuring open defecation is stopped.

Program Manager with International Water and Sanitation Centre (IRC), Kwaku Asubonteng, describes as unfortunate the lack of access to a toilet facilities for many Ghanaians, leaving mostly the poor engage in open defecation.

With the current figure of nineteen percent of Ghanaians who do not have access to public toilet, Upper- East Region leads with about 89 percent of the shortfall.