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Despite COVID-19 putting the spotlight on the importance of hand hygiene to prevent the spread of disease, three billion people worldwide, including hundreds of millions of school-going children, do not have access to handwashing facilities with soap. People living in rural areas, urban slums, disaster-prone areas and low-income countries are the most vulnerable and the most affected.

Nearly half of all schools do not have basic hygiene services, with1 in 3 primary schools lacking basic sanitation and water. Children who cannot wash their hands face a greater risk of infection and diarrhoeal disease than those who can, putting them at risk of missing more school days.

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UNICEF promotes community-based handwashing through a variety of media and through campaigns like Global Handwashing Day, which reaches hundreds of millions of people every year. Our people-based approach has helped entire communities eliminate the dangerous practice of open defecation, many of whom reached Open Defecation Free status in 2019.

We work directly with schools and health-care facilities to improve access to basic water, sanitation and handwashing facilities, and to establish protocols for preventing and controlling infections. We support menstrual health and hygiene in schools by constructing private, secure sanitation and washing facilities as well as menstrual pad disposal facilities. We also provide education and support services that help more girls better manage their menstruation cycle.

Access to WASH needs to be provided at the household level but also in non-household settings like schools, healthcare facilities, workplaces (including prisons), temporary use settings, mass gatherings, and for dislocated populations.[6] In schools, group handwashing facilities and behaviors are a promising approach to improve hygiene. Lack of WASH facilities at schools can prevent students (especially girls) from attending school, reducing their educational achievements and future work productivity.[7]

Access to sanitation services is included in Target 6.2 of Sustainable Development Goal 6 which is: "By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations."[10] This target has one indicator: Indicator 6.2.1 is the "Proportion of population using (a) safely managed sanitation services and (b) a hand-washing facility with soap and water".[10]

In 2017, the global situation was reported as follows: Only 1 in 4 people in low-income countries had handwashing facilities with soap and water at home; only 14% of people in Sub-Saharan Africa have handwashing facilities.[3] Worldwide, at least 500 million women and girls lack adequate, safe, and private facilities for managing menstrual hygiene.[27]

Numerous studies have shown that improvements in drinking water and sanitation (WASH) lead to decreased risks of diarrhea.[41] Such improvements might include for example use of water filters, provision of high-quality piped water and sewer connections.[41] Diarrhea can be prevented - and the lives of 525,000 children annually be saved (estimate for 2017) - by improved sanitation, clean drinking water, and hand washing with soap.[42] In 2008 the same figure was estimated as 1.5 million children.[43]

Supervised daily group handwashing in schools is an effective strategy for building good hygiene habits, with the potential to lead to positive health and education outcomes for children.[69] This has for example been implemented in the "Essential Health Care Program" by the Department of Education in the Philippines.[70] Mass deworming twice a year, supplemented by washing hands daily with soap and brushing teeth daily with fluoride, is at the core of this national program. It has also been successfully implemented in Indonesia.[71][72]

According to the World Health Organization, data from 54 countries in low and middle income settings representing 66,101 health facilities show that 38% of health care facilities lack improved water sources, 19% lack improved sanitation while 35% lack access to water and soap for handwashing. The absence of basic WASH amenities compromises the ability to provide routine services and hinders the ability to prevent and control infections. The provision of water in health facilities was the lowest in Africa, where 42% of healthcare facilities lack an improved source of water on-site or nearby. The provision of sanitation is lowest in the Americas with 43% of health care facilities lacking adequate services.[73]

Many scholars have attempted to summarize the evidence of WASH interventions from the limited number of high quality studies. Hygiene interventions, in particular those focusing on the promotion of handwashing, appear to be especially effective in reducing morbidity. A meta-analysis of the literature found that handwashing interventions reduced the relative risk of diarrhea by approximately 40%.[102][101] Similarly, handwashing promotion has been found to be associated with a 47% decrease in morbidity. However, a challenge with WASH behavioral intervention studies is an inability to ensure compliance with such interventions, especially when studies rely on self-reporting of disease rates. This prevents researchers from concluding a causal relationship between decreased morbidity and the intervention. For example, researchers may conclude that educating communities about handwashing is effective at reducing disease, but cannot conclude that handwashing reduces disease.[101] Point-of-use water supply and point-of-use water quality interventions also show similar effectiveness to handwashing, with those that include provision of safe storage containers demonstrating increased disease reduction in infants.[5]

Awareness raising for the importance of WASH takes place through several United Nations international observance days, namely World Water Day, Menstrual Hygiene Day, World Toilet Day and Global Handwashing Day.

For Szabo, the low-wash habit began when he bought his first pair of raw denim jeans in 2010. Travelling from his native Canada to Europe, he brought his jeans for the six-month trip. "It was a quirk about me that I had these stinky jeans," he tells BBC Culture. "They smelled awful." In Budapest he met his future wife, and the jeans became a character in their relationship. "My jeans would be in, like, a pile on the floor at the end of the bed," he remembers. "You walked into the room, you could smell [them]... I was very fortunate that my wife was as interested in me as she was."

Among the competitors in the Indigo Invitational, which starts its fourth year next January, more than nine out of 10 participants delay the first wash of their trousers until they have been worn 150 or 200 times, Szabo estimates. "Some of these pairs, as it's coming up on the end of the year, I wouldn't want to handle up close," he says. "They would probably smell wrong." A few of his raw denim friends go even further, abiding by what he calls a "never-wash philosophy". "[For one of them], in very tight spaces like a small elevator or something like that, if the dude is wearing certain pairs you can smell it a little bit," he says. "Some of his best faded examples are also displayed in jeans trade shows. [They have] an aroma... It's not an unpleasant smell, per se, but it's a smell."

Instead of turning to the washing machine, raw denim wearers learn other ways to care for their garments, like exposing them to UV rays ("I call it the sun bath," Szabo says) or just airing them overnight. Szabo himself uses the washing machine, too. "As soon as [my wife] can smell my jeans, she tells me, and they immediately go in the washroom."

Jeans wearers are not the only people cutting down on laundry. In 2019, designer Stella McCartney caused headlines by detailing her low-clothes-cleaning habits, telling the Guardian: "Basically, in life, rule of thumb: if you don't absolutely have to clean anything, don't clean it. I wouldn't change my bra every day and I don't just chuck stuff into a washing machine because it's been worn. I am incredibly hygienic myself, but I'm not a fan of dry cleaning or any cleaning, really."

One of Wool&'s customers is Chelsea Harry from Connecticut, US. "I grew up in a house where you wash everything after one use," she tells BBC Culture. "Towel after one use, your pyjamas after one use." One summer, Harry lived with her grandmother, who taught her to put her pyjamas under her pillow in the morning and wear them again the next night. Later, she met her husband, who, she says, "hardly ever washes any clothes". Then, during the pandemic, Harry started hiking. This is when things really changed. "Obviously you can't shower after you've been hiking all day and you're sleeping in a hammock or tent," she says. Others in the hiking community recommended Ex Officio underwear, which can be worn over subsequent days or washed and dried quickly. Using this and other wool clothing, Harry discovered she could hike and backpack for days and still feel comfortable. "Then," she says, "I started to think: Why don't I do this in my everyday life?" And that was that.

"One of the worst things that you can do to a garment, in terms of its durability, is wash it." So says Mark Sumner, a lecturer in sustainable fashion at the University of Leeds. During a wash, he says, garments can tear, shrink and lose colour. With his colleague Mark Taylor, Sumner studies how microfibres from household laundry end up in marine animals. But while he says reducing the frequency of our clothes washing is the right choice for the environment, he doesn't advocate a complete washing machine moratorium.

"We don't want people to think that they can't wash stuff because... they're destroying the planet," Sumner tells BBC Culture. "It's about trying to get the balance right." Washing clothes is important for medical and hygiene reasons, he says, for example for people suffering from eczema who are trying to avoid irritation caused when our natural skin bacteria multiply inside our clothing. It's also important for people's self-esteem "to not feel embarrassed about their clothes because they're dirty or smelly". 006ab0faaa