In this paper, it is argued that public toilets policy is a town planning issue, crucial to creating sustainable, efficient, accessible and equitable cities. Ways of integrating toilet provision into city-wide strategic planning policy and local urban design are discussed. The paper first reviews global sanitation issues, with particular reference to the needs of girls and women in respect of toilet provision. Over two billion people lack adequate toilet provision, and women are particularly badly affected. Fifty per cent of the world’s population is urbanised, and, of those, over 50 per cent of urban dwellers live in shanty towns and unplanned settlements, most of which are without adequate sanitation at home, at work and in schools. Fifty per cent of school girls in Africa leave school when menstruation starts, because of lack of school toilets, thus undermining education and development goals. Then comparisons are made with the public toilet situation in the West, with particular reference to inadequate provision in the United Kingdom. Historically, women have been given fewer facilities than men, but arguably their need is greater. A lack of toilets has implications for health and well-being and restricts mobility of an increasingly ageing population, those with disabilities and children, as well as undermining sustainability, transportation, inclusive urban design and regeneration policies.