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Sanitation is fundamental for health and wellbeing yet cities, especially in the global South, face challenges in providing safely managed sanitation systems. Global and national sanitation campaigns tend to focus on the visible aspects of being ‘on grid’ in terms of toilet construction and connections but rarely address the dangerous, invisible aspects of being ‘off grid’ such as poor or unsafe excreta disposal and inadequate faecal sludge management (often considered to be second or third generation sanitation challenges). These, however, tend to disproportionately affect poor and marginalised people in off-grid locations in rapidly urbanising areas. This review paper engages critically with the growing literature on the challenges of faecal sludge management and circular economy solutions. Through the lens of exclusion and marginality, we review debates regarding access to safely managed sanitation, the burden of sanitation workers and safely recovering value from shit. We argue that sanitation systems often reproduce and exacerbate existing societal hierarchies and discriminations in terms of unequal access to safely managed sanitation and the burden of maintaining sanitation infrastructures. It is thus important for future research on faecal sludge management and resource recovery from shit to focus on issues of marginality and exclusion.