Oh shit!

The ill effects of the almost institutional practice of open-air defecation can no longer be ignored, and to clean up the government might have to dirty its hands 

Lily Tekseng Delhi


India’s biggest shame lies in how its people unabashedly conduct their excretory functions. “Most people who live in India defecate in the open. Most people worldwide who defecate in the open live in India,” says a paper co-written by seven scholars, including Diane Coffey, Sangita Vyas and Dean Spears. Open-air defecation is a national activity, if inferences are to be drawn from the 2014 combined report by WHO and UNESCO, “Progress on Drinking Water & Sanitation, 2014”. According to the report, about 597 million people—i.e., roughly 60 per cent of the population—defecate in the open in India, a number so high that many scholars and sanitation workers have warned against a foreseeable human capital, health and gender crisis.

For a country where Gandhi lived and stressed the necessity of hygiene and sanitation, where the man himself is still revered unconditionally, his earnest prescriptions on sanitation and cleanliness are not taken very seriously. Often, people who defecate in the open think it is being more attuned with nature, healthy and, in rural areas, a good way to keep a watch on farms. The correlation between public health and open-air defecation is not clear to the people who defecate in the open, especially in rural areas, where 67 per cent of families do not have access to toilets. Of those who do have access to toilets, at least one member of the family still defecates in the open.

The adverse repercussions of open-air defecation have been stressed time and again by sanitation workers and scholars alike. Earlier this year, the abduction and murder of two low-caste girls in Badaun, Uttar Pradesh, while they were on their way to relieve themselves in the fields at dusk brought attention to the vulnerabilities that females are subjected to in the absence of toilets. Threat of violence, shame, inadequate menstrual hygiene management and diseases become routine exposures in the lack of access to toilet facilities.

Owing to high population density, any area marked for open-air defecation cannot be too far away from human settlements, thereby exposing people to diarrhoea, enteropathy, physical and cognitive underdevelopment, and other communicable diseases. Children are the most vulnerable in this regard. According to reports, 1,600 children under the age of five die every day in India, the highest number in the world. This has been termed as the “Asian Enigma”, i.e., despite relative economic prosperity and better progress in the factors that positively affect childhood nutrition, the nutritional status of children in South Asia is much lower than their counterparts in sub-Saharan Africa.

Some have traced the cause of the Asian Enigma to the status of women, illiteracy, and lack of childcare and nutritional knowledge. A recent study, however, draws a direct relation between open-air defecation and the Asian Enigma. Dr Dean Spears and his colleagues at the Research Institute for Compassionate Economics (RICE) have suggested that open-air defecation is directly related to childhood stunting and enteropathy. Stunting is an indicator of malnutrition and it is a public problem in India. Indian children are marked by low birth-weight and subsequent growth despite economic and dietary improvements. Indian children are shorter on average than children in Africa even though people are poorer on average in Africa. Also, babies adopted from India into developed countries grow much taller.

Interestingly, it also explains the mystery of low child mortality rates in Muslim communities in India vis-a-vis Hindu communities, which are on average richer and more educated. The child mortality rate in Muslim communities is 18 per cent lower than among Hindu communities since  the 1960s. Muslims are about 40 per cent more likely than Hindus to use pit latrines or toilets and also have Muslim neighbours who follow the same practice—a figure that explains the disparity in child mortality between the two communities.

India’s immediate neighbours have, on the contrary, witnessed a steady decline in open-air defecation. Nepal, Pakistan and Bangladesh enjoy a trend of decreasing open-air  defecation (25 per cent and more, according to a 2013 WHO report). Despite Gandhi’s earnest appeal and promotion of cleanliness and good sanitary practices, the Government of India only began an elaborate effort as recently as 1986, when the Central Rural Sanitation Programme (CRSP) was launched. It was soon followed by another sanitation programme, the Total Sanitation Campaign (TCS), also known as the Nirmal Bharat Abhiyan, in 1991; and in 2013, manual scavenging was banned in India.

Prime Minister Modi’s current Swachch Bharat or Clean India campaign has shifted the focus back on to sanitation by increasing the sector’s budget allocation and by calling on the private sector to actively participate in line with their Corporate Social Responsibility (CSR). The Swachch Bharat campaign started on September 25, and has set the target of achieving (among a list of other things) an India free of open-air defecation by 2019—Gandhi’s 150th birth anniversary.

The current government is ambitious regarding sanitation, but the challenges it faces are enormous. Owing to the urban pull factor and consequent migration, the number and size of slums and squat settlements are growing at an alarming rate. This is not being met with adequate water supply, garbage disposal systems and access to toilets. According to the 2011 census, 13 per cent of urban households do not have access to toilets. Very high population density means that this has serious consequences, not only for people who defecate in the open, but also for all the other settlements in the vicinity.

While urban areas seem to be marked by a demand for toilets and other necessary civic amenities and their unfortunate lack, there seems to be sturdier resistance to toilet usage in rural areas. Centuries of traditional beliefs concerning purity and pollution manifest themselves more strongly in the rural areas, where people think it impure to have human faeces under the same roof as the home where they eat and sleep. Soon after the government passed legislation against manual scavenging, many night soil workers complained about the sudden lack of economic opportunities. The classification of labour based on purity and pollution is still deep-rooted; the higher castes can’t imagine managing their own faecal output, and the lower castes struggle to adapt swiftly into a
new economy.

People’s preference for open-air defecation was also highlighted in the study by  Coffey, Vyas and Spears, et al. It has been found that Indians have an expensive concept of toilets—i.e., that toilets are expensive assets, even luxuries. For example, Haryana is richer than all the Gangetic states and, interestingly, also has more toilet coverage, according to a study. Often, toilets are built to accommodate maturing daughters, new brides or old parents—more an affordable convenience  than a necessity for the containment and disposal of faeces in order to reduce the proliferation of diseases. In contrast, countries much poorer than India, such as the Republic of Congo, Malawi, Burundi, Rwanda, Kenya, Bangladesh and Nepal are doing far better with regard to toilet accessibility, and their peoples show an awareness of the connection between open-air defecation and health hazards.

In Bangladesh, the building cost of a toilet is about `2,500 in purchasing power; in Indonesia, a country richer than India, it costs `4,492. In India, the government provides `10,000 to each household for toilet construction under the older scheme. However, most people in the north Indian states (where the survey for the study was done) quote the price for a cheap toilet as at least `21,000 on average.

Open-air defecation has long-term and serious consequences for a country’s human capital, which in the long run affect the productivity of the country. India has the lowest ‘middle rung’ population, i.e., the middle group who use unimproved and/or shared sanitation, as classified under international toilet standards (the lower rung comprising open-air defecation and the upper rung comprising improved sanitation). Bangladesh has 45 per cent of the population in the middle rung; sub-Saharan Africa’s middle rung is also 45 per cent of its population; India has only 16 per cent in the middle rung (something which has come to be called ‘the missing middle rung’).

The mission to eradicate open-air defecation and instate cleanliness must extend beyond photo-ops in which workers litter for ministers to clean up, and become more imaginatively engaged than merely increasing monetary assistance for each toilet.

This story is from the print issue of Hardnews: OCTOBER 2014