Evaluating menstrual-friendly public bathrooms in Atlanta, Georgia: An audit of availability, accessibility, and resources

Public toilets are essential urban infrastructure that enable people who menstruate to participate in public life with dignity and comfort. However, little is known about whether publicly accessible toilets adequately support menstrual health and hygiene, particularly in high-income urban settings where privately operated facilities often function as de facto public infrastructure. This study assessed the menstrual friendliness of publicly accessible toilets in Atlanta, Georgia. We also examined differences by funding source (i.e., government versus private) and neighborhood type. We conducted field-based audits of women’s, gender-neutral, and family toilets across 15 areas. Using an adapted Menstrual Friendly Public Toilet framework, we evaluated six dimensions: cleanliness, privacy and safety, structural features, general resources, accessibility, and menstrual health and hygiene resources. We calculated domain-specific and overall scores and compared government- and privately funded facilities, with additional descriptive comparisons across business, residential, tourist, and transit neighborhoods. We audited 125 toilet facilities across 112 locations. The overall mean Menstrual Friendly Public Toilet Index was 0.797. Cleanliness (0.974), privacy and safety (0.954), structure (0.930), and general resources (0.899) scored relatively high, whereas accessibility (0.622) and menstrual health and hygiene resources (0.490) scored lowest. Only 4.0% of facilities provided menstrual products or a functional dispenser. Overall scores did not differ significantly by funding source, although government-funded facilities had higher structural feature scores than privately funded facilities (0.952 versus 0.913; p=0.027). Menstrual health and hygiene resource scores varied across neighborhood types, ranging from 0.200 in the residential area to 0.775 in the tourist area. These findings demonstrate that the availability of clean and functional bathrooms does not necessarily ensure people can fully meet and manage their menstrual needs. Addressing gaps in accessibility and menstrual-specific resources will require coordinated attention to both government- and privately managed facilities, as well as consideration of neighborhood context to support menstrual health and equitable participation in urban public spaces.