Before the 20th century in Europe, sewers usually discharged into a body of water such as a river, lake, or ocean. There was no treatment, so the breakdown of the human waste was left to the ecosystem. This could lead to satisfactory results if the assimilative capacity of the ecosystem is sufficient which is nowadays not often the case due to increasing population density.
Today, the situation in urban areas of industrialized countries is usually that sewers route their contents to a sewage treatment plant rather than directly to a body of water. In many developing countries, however, the bulk of municipal and industrial wastewater is discharged to rivers and the ocean without any treatment or after preliminary treatment or primary treatment only. Doing so can lead to water pollution. Few reliable figures exist on the share of the wastewater collected in sewers that is being treated in the world. A global estimate by UNDP and UN-Habitat in 2010 was that 90% of all wastewater generated is released into the environment untreated. A more recent study in 2021 estimated that globally, about 52% of sewage is treated. However, sewage treatment rates are highly unequal for different countries around the world. For example, while high-income countries treat approximately 74% of their sewage, developing countries treat an average of just 4.2%. As of 2022, without sufficient treatment, more than 80% of all wastewater generated globally is released into the environment. High-income nations treat, on average, 70% of the wastewater they produce, according to UN Water. Only 8% of wastewater produced in low-income nations receives any sort of treatment. 
The Joint Monitoring Programme (JMP) for Water Supply and Sanitation by WHO and UNICEF report in 2021 that 82% of people with sewer connections are connected to sewage treatment plants providing at least secondary treatment.However, this value varies widely between regions. For example, in Europe, North America, Northern Africa and Western Asia, a total of 31 countries had universal (>99%) wastewater treatment. However, in Albania, Bermuda, North Macedonia and Serbia "less than 50% of sewered wastewater received secondary or better treatment" and in Algeria, Lebanon and Libya the value was less than 20% of sewered wastewater that was being treated. The report also found that "globally, 594 million people have sewer connections that don't receive sufficient treatment. Many more are connected to wastewater treatment plants that do not provide effective treatment or comply with effluent requirements.".