India's Sanitation Problem

Nationwide, at least two-thirds of India's 1.2 billion people still defecate in the open, and many do not understand the dire public health consequences. Diarrheal diseases kill 700,000 children in India every year while also contributing to widespread malnutrition and childhood growth stunting, as well as diseases like typhoid and cholera. (1)

In an attempt to improve upon this situation, Indian leaders are taking on the taboo of public hygiene, one of the country's great problems. Narendra Modi, India's prime minister, says building toilets is a priority over temples. His finance minister, Arun Jaitley, set a goal of ending defecating in the open by 2019. That will be 150 years since the birth of Mohandas Gandhi, who said good sanitation was more important than independence. (2) But as The Economist points out, “Pouring concrete will not in itself solve India's problems. Leaders need also to confront the cultural reasons for bad sanitation. Hindu tradition, seen for example in the 'Laws of Manu,' a Hindu text some 2,000 years old, encourages defecation in the open, far from home, to avoid ritual impurity. Caste division is another factor, as by tradition it was only the lowliest in society, 'untouchables', (now Dalits), who cleared human waste., Many people, notably in the Hindu-dominated Gangetic plains, today still show a preference for going in the open, even if they have latrines at home.” (2) A recent study published in the medical journal Lancet adds to emphasis for India to look beyond building toilet infrastructure and focus on educating the masses and changing centuries-old habits and people's preferences for doing their business outdoors. Researchers note that many of the 640 million Indians still defecating in the open might opt not to use a toilet even if they had one at home, thanks to widespread preferences for going outside. (3) Another study looked at attitudes toward sanitation in five Indian states and found that 40 percent of homes that had toilets also had at least one household member who openly defecated. Most said that it was because it was pleasurable, comfortable and convenient. Among people who defecate in the open, many survey respondents reported that open defecation would be at least as good for child health as latrine use by everyone in the village. These findings suggest that intensifying existing policies of latrine construction will not be enough to substantially reduce open defecation. Many respondents said that defecating in the open provides them an opportunity to take a morning walk, see their fields, and take in the fresh air. Many people regard open defecation as part of a wholesome, healthy, virtuous life. (4)

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Few understand there is a connection between their outdoor ablutions and the fact that each year, hundreds of thousands in India die from diarrheal diseases. While villagers remain ignorant of the dangers, about 100,000 tons of their excrement heads to markets every day on fruit and vegetables according to UNICEF. Each gram of feces in an open field contains 10 million viruses, 1 million bacteria, and 1,000 parasite cysts. (5) This suggests that the mere availability of government-built latrines will not end open defecation for decades yet. What is needed instead are public campaigns, in schools and in the media, to explain the health and economic benefits of using toilets and of better hygiene. Researchers found that only a quarter of rural householders understood that washing hands helps prevent diarrhea. (2) One last note—Electronic technology is accepted much quicker than proper sanitation. Far more people in India have access to a cell phone than to a toilet and improved sanitation. Roughly 336 million people (31 percent of the population) had access to improved sanitation in 2008. Meanwhile 545 million cell phones were connected to service in India's emerging economy. (6) References

1. Katy Daigle, “Advocates appalled that poor Indians still forced to clean human waste with bare hands,” huffingtonpost.com, August 25, 2014
2. “Sanitation in India: the final frontier,” The Economist, July 19, 2014
3. Thomas Clasen et al., “Effectiveness of a rural sanitation program on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomized trial,” Lancet, October 10, 2014
4. Diane Coffey et al., “Revealed preference for open defecation,” SQUAT Working Paper No1, June 26, 2014
5. Kartikay Mehrotra, “India's toilet race failing as villages don't use them,” bloomberg.com/news, August 3, 2014
6. “Greater access to cell phones than toilets,” United Nations University, April 2010