Introduction The launch of the Water and Sanitation Decade (1980-90) marked the first attempt to place urban sanitation within national governments and international organizations’ development agendas. Since then, inclusion of sanitation within the Millennium Development Goals (MDGs), the Sustainable Development Goals (SDGs), and global campaigns such as the UN Sanitation Year (2008), the End of Open Defecation Campaign, and World Toilet Day have institutionalized sanitation as one of the core development goals until 2030 and beyond. However, the results of many of these sanitation development initiatives have been disappointing. Regional statistics show alarming results for Sub-Saharan Africa, where urban population growth has outpaced gains in sanitation coverage since the 1990s; 14 out of 46 countries declined in sanitation coverage (UNICEF/WHO, 2015: 17). The MDGs were unable to eliminate inequalities in access to sanitation between rich and poor urban dwellers in most countries (UNICEF/WHO 2015). Depressing as this is, the MDGs have focused only on distributive outcomes (access to infrastructure), overlooking other dimensions of sanitation inequality. Failing to address these dimensions hampers development interventions which aim to reduce these inequalities: sub-surface flows of untreated wastewaters contaminate urban poor settlements’ shallow groundwater sources, displacing health risks onto the poorest, and reducing developmental opportunities for children and adults who themselves may already be using “improved” sanitation services (Graham and Polizzotto, 2013); building onsite sanitation infrastructure and improved access to latrines without provision for emptying or sludge removal services compromises long-term health benefits from “improved” sanitation (Jenkins et al., 2015; Tsinda et al., 2013). Finally, dimensions of access must include consideration of safety and comfort plus any particular needs of urban poor residents who are marginalized by age, disabilities, gender, or other social relations, so they can use the infrastructure provided (Hulland et al., 2015; Wilbur and Jones, 2014). Ignoring these dimensions of environmental and social inequalities can reverse any positive gains in terms of increased distribution of infrastructure. In this chapter, we develop the concept of sanitation justice to capture these dimensions of inequalities and their relations, which are often overlooked in debates on development targets for sanitation. In Section 2 we briefly review analyses of inequalities in relation to sanitation already present in the ecological justice literature, specifically urban political ecology and environmental justice. We draw from this literature to define three dimensions of sanitation justice: distributive, procedural, and recognitional justice.