Ending open defecation: Tough road ahead

India may pride itself for lifting the Asia Cup trophy for a record sixth time after beating host Bangladesh but it has lost to its neighbouring countries in the open-defecation-free (ODF) match. Bangladesh, followed by Sri Lanka, have effectively wiped out open defecation while India is still grappling with this basic issue.

In India, nearly half the rural population (595 million) does not use toilets. In an urban setting too, it is a common occurrence. The Government has set a target to end open defecation by 2019. Towards this end, it is taking various steps like building toilets, creating an awareness through social messages and involving celebrities to spread them.

But perhaps in a most unusual and innovative endeavour, the International Cricket Council (ICC) and UNICEF have joined hands to leverage the craze for cricket, and its vast reach, popularity and immense power. They are harnessing the cricket frenzy to build a social movement for sanitation and toilet use. The two organisations have formed Team Swachh, a national campaign for cleaner India, by involving cricketers and underprivileged children. Cricket has the power to transform and improve the lives of children—to empower them and also adolescents.

As part of this “Cricket for Good” partnership, a series of Team Swachh clinics is being held during the World Cup matches. Just ahead of the games, cricketers from 16 participating teams play cricket-based games with children from local NGOs at the specially-designed WASH (Water, Sanitation and Hygiene) clinics and stress on the importance of health sanitation and hygiene.

Relieving oneself outdoors poses a serious risk to health. Evidence suggests that open defecation leads to child stunting, diarrhoea, typhoid, worm infection and environmental enteropathy. One in every 10 deaths in India is linked to poor sanitation and low-income households bear the brunt, studies show.

The absence of toilets affects women and adolescent girls more. Going outdoors, they become vulnerable to harassment. In avoidance, women may decrease their food and water intake, which can lead to digestive problems, malnutrition and dehydration, studies depict. Due to lack of toilets or their maintenance, girls absent themselves from schools. Poor sanitation has serious consequences on their nutritional status. It also has significant, long-lasting repercussions on their overall, reproductive and sexual health.

To address this issue, under the Swachh Bharat mission, 12 crore toilets are slated to be built, and also, dysfunctional toilets reconstructed, in rural areas by 2019. So far, only 0.95 crore have been completed. However, not even half the existing toilets built under the mission are being used, a national survey shows. Most public toilets are in such a pitiable condition that users are forced to defecate in the open. 

In urban areas, of the 1.04 crore individual household toilets to be built by 2019, only 0.9 had been set up till December 2015. Here too, barely 50 percent is being used. As the Government progresses in its mission, it faces several hurdles. Surveyors recorded that construction of toilets has not brought about speedy behavioural changes. In rural areas, the reviewers found that households were using latrines for storing grains or as general storage space. So, can providing access to toilets lead to an open defecation-free India? It cannot, going by earlier experience. What is required is a total change in mindsets and behavioural patterns as proved by Bangladesh.

In Bangladesh, social norms are changing significantly. A household toilet is a status symbol; it signifies dignity and makes the family proud. People judge the status of a household after seeing the condition of latrine, according to Dr Nehal Karim, a social science professor at Dhaka University. In marriages, it is a deciding factor as its condition portrays the environment in which a boy or a girl grows up.

Bangladesh has reported a decrease in incidences of diarrhoea, besides significant reduction in the number of severely malnourished children. It achieved success through local community empowerment. The change was mainly due to its attention to collective behavioural shift rather than the construction of toilets. It focused on sanitation being a trigger to wider development benefits like livelihoods, food security, eliminating hunger, primary education, inequality and health. To bring about transformation, the concept involved provoking shame and disgust about poor sanitation. Such sustained behavioural change, mainly among rural people, went a long way in reducing open defecation.

For India, the road ahead is rather rough. Some of the impediments include lack of clarity and motivation at the local level. A much stronger hygiene promotion programme focusing on the sustainability of services in communities, households and schools need to be initiated. An integrated approach to hygiene, sanitation and water are crucial to deliver long-term changes. But, this requires continual intensive engagement with communities.

Instead of assessing the purpose, the Government is more concerned about achieving its target and hence, counting the number of toilets. The next main challenge, largely facing rural India, is behavioural. Besides changing mindsets, deeply-held cultural beliefs, habits and practices also need transformation. Until social norms impel behavioural changes in rural society, building toilets alone may not result in the desired change.