Around 524 million people, which is nearly half the population of India, defecate in the open. India accounts for 90 per cent of the people in South Asia and 59 per cent of the 1.1 billion people in the world who practise open defecation.
Open defecation poses a serious threat to the health of children in India. The practice is the main reason India reports the highest number of diarrhoeal deaths among children under-five in the world. Every year, diarrhoea kills 1,17,285 children under five in India. Children weakened by frequent diarrhoea episodes are more vulnerable to malnutrition, stunting,
and opportunistic infections such as pneumonia.
About 38 per cent of children in India suffer from some degree of malnutrition. Diarrhoea and worm infection are two major health conditions that affect school-age children impacting their learning abilities. Open defecation also puts at risk the dignity of women in India. Women feel constrained to relieve themselves only under the cover of dark for reasons of privacy to protect their dignity.
Open defecation exposes women to the danger of physical attacks and encounters such as snake bites. Poor sanitation also cripples national development: workers produce less, live shorter lives, save and invest less, and are less able to send their children to school.
Combatting a culture of Open Defecation:
In India, open defecation is a well-established traditional practice deeply ingrained from early childhood. Sanitation is not a socially acceptable topic, and as a result, people do not discuss it. Consequently, open defecation has persisted as a norm for many Indians. In addition to tradition and the communication taboo, the practice still exists due to poverty; many of the poorest people will not prioritise toilets and besides, many are living in rented homes without toilets.
Society does not view the lack of a toilet as unacceptable. Building and owning a toilet is not perceived as aspirational. Construction of toilets is still seen as the government’s responsibility, rather than a priority that individual households should take responsibility for. The challenge is to motivate people to see a toilet as fundamental to their social standing, status and well-being.
A significant gap also exists between knowledge and practice. Even when people are aware of the health risks related to poor sanitation (specifically of not using a toilet and practising good hygiene), they continue with unhealthy practices.
Open defecation in urban areas is driven by a number of reasons including, lack of space to build toilets in high-density settlements and tenants unwilling to invest in toilets where landlords do not provide them. In rural India, open defecation is prevalent among all socio-economic groups although the bottom two wealth quintiles practice it most.
One of the main challenges faced in the drive to eliminate open defecation is the inadequate human resource base for sanitation. In sub-districts where they are most needed, there are no dedicated frontline workers to promote and implement sanitation strategies. While some states have now began to recruit frontline workers, there are still no mechanisms for their training, management, and supervision.
Another key requirement is to integrate Social and Behaviour Change Communication (SBCC) elements into the government programme, Swatchh Bharat Mission (SBM). Gram Panchayats (village governments) who receive resources from the SBM do not benefit from an SBCC drive to stimulate demand for toilets.
Equally, community approaches that involve systematic and structured Information, Education, and Communication (IEC) and Inter-Personal Communication (IPC) elements are not yet integrated in the SBM. The absence of SBCC activities means that many households that receive toilets have not demanded them. As a result, not all members of the household use the toilets because they do not know their benefits. In a small number of cases, no members of the household use the toilets, illustrating the need for more community-level information about sanitation.
Silver lining in recent years
In spite of the large number of people still practising open defecation, the Government of India has made progress in reducing the practice. The 2010 JMP report showed that 54 per cent of people were practising open defecation, translating to around 637million people. According to the April 2014 update, this figure has come down to 48 per cent, or 595 million people, after taking into account population growth. It has now further come down to 524 million people, according to JMP update 2017.
Although access to sanitation in rural India is improving, the increase is not equitable. Open defecation is still almost universal among the poorest 20 per cent of the population.
Progress has also been made in creating awareness about the many benefits of toilets, but many barriers to uptake still remain in rural India. A study by consulting firm Monitor Deloitte in 2012 in Bihar state showed that the majority of people interviewed wanted a toilet and a number had taken steps to find out how to get one.
Awareness campaigns, media exposure, and pressure from school-age children, are some of the drivers of this awareness. Further, with a growing population and increasing agricultural cultivation and urbanization, the number of spaces available for open defecation continues to reduce.