Book Review: ‘Where India Goes’ Is A Sobering Account Of India’s Unsanitary Reality

When the authors of a book begin their narrative by dedicating it to “all the children who will be born in India before the end of open defecation”, the reader begins to get a sense of the gravity of a problem that public policy in the country refused to grapple with for many decades after independence. At long last, when the issue of open defecation figured in the mainstream political discourse, with Prime Minister Narendra Modi investing so much political capital in the mission to clean-up the country, there was good reason to harbour hope about a long-overdue social engineering process that would liberate the country of the scourge of open defecation. Despite sloganeering and ubiquitous clarion calls for swachhata, if there is very little palpable change in people’s defecation habits, then the situation begs serious investigation.

It is such an exercise that Dean Spears and Diane Coffey have undertaken in their book “Where India Goes: Abandoned Toilets, Stunted Development and the Costs of Caste“, in which they seek to put together the pieces of the jigsaw puzzle that is open defecation and offer plausible explanations for the state of affairs by drawing upon the findings of their research. The authors have chosen rural India as their site of investigation because of the sheer scale and acuteness of the problem in the countryside – 70% of rural households lack a latrine or toilet against 13% urban ones, according to the 2011 census. The obverse of this isn’t that urban India is doing enough to eliminate open defecation and therefore has to be kept out of the study. Far from it!

The chapter titled “The Puzzle: Why Rural India? clearly explains the rationale behind choosing rural north India, the reasons being both quantitative and qualitative. By unpacking the observations from the Sanitation Quality, Use, Access and Trends (SQUAT) survey, the subsequent chapters in the book ask many unpleasant questions and provide some uncomfortable answers. The following question gives a flavour of the unpleasantness:

The Indian economy has recently experienced years of rapid economic growth. Household surveys show that more and more Indians own assets such as fans, cell phones and motorcycles. So why economic progress is so incompletely reflected in India’s poor infant health?

There is a widespread belief that access and affordability are the barriers to achieving an open defecation mukt India. And it is precisely this understanding that informs the existing policy solution to end open defecation, which is construction of latrines in every household. Coffey and Spears systematically debunk some of the commonly cited explanations for open defecation. Using publicly available data for different countries, the authors show that:

“India’s high rates of open defecation cannot be explained by the fact that India is a developing country, not by its poverty, its access to water, its level of education, its governance, or the poor quality of latrines that the government often provides. Other countries achieve better sanitation with far worse inputs. India has a higher fraction of households that defecate in the open than almost any other developing country. 90% of countries that are poorer than India have lower rates of open defecation.

What is more disturbing is the fact that even those households that own a latrine unabashedly practice open defecation – 40% of households in the SQUAT survey’s sample that had a functional latrine had at least one member defecating in the open. There is a deeper structural reason that explains the unremitting prevalence of open defecation in India. Writing in The Telegraph in late 2013, historian and political commentator Mukul Kesavan remarked: “We are the basket case of outdoor excretion, its degree zero. How did we manage to ignore the issue for as long as we did? There is an answer to that question that sounds like a crude simplification but isn’t. That answer is caste. Indian society has been ordered and divided by rules of ritual purity and pollution for so long that it is hard for its governing class, however progressive its self-image, to empathize with people who lack the basic amenities that this class and the privileged castes that constitute it, take for granted.” The authors observe that people living in the countryside themselves have internalized the caste system and play by the rules governing ritual purity and pollution, thereby rationalizing a range of activities such as manual scavenging, that are downright degrading and discriminatory.

Manual scavengers picking up fecal waste from a dry toilet.

Chapters 3 and 4 explore the history of the vexed relationship between open defecation and untouchability, and the relentless struggles of the Dalit people to decouple vocation from caste. It is against the backdrop of this history that one has to see the pervasiveness of open defecation and the predisposition to go for expensive models among those who choose to build a latrine. The reluctance from above and the growing resistance from below to empty the latrine pits sum up the (slowly) changing dynamics of a social order that has perpetuated the twin evils of open defecation and manual scavenging. It is encouraging that Dalits are increasingly refusing to handle human excreta because doing that vitiates their battle for equality and dignity. The authors state quite categorically that “struggling against untouchability is working towards the end of open defecation in India, and vice versa.

Clearly, it is high time caste Hindus are made to understand that latrine pits take longer to fill up and that it would make enormous social and economic sense to adopt a two-pit latrine system. Such an arrangement obviates the need to empty the pits at regular intervals while making manual scavenging socially unnecessary as deeper pits are not emptied by hand but by using machines. To drive home the point that untouchability is not just about doing chores that are ritually polluting and economically unrewarding, the authors impress upon the poignant fact that “…untouchability is about far more than the physical unpleasantness of performing certain kinds of work. It is about the social and economic system that exploits, excludes and humiliates some people and privilege others.

As the authors frame sanitation as a public good, it becomes pertinent to note that open defecation is a classic example of three kinds of failures – market failure, government failure and social failure. A public good is one whose benefits are shared by everyone including those who don’t pay for it, so clearly there’s no place for the market mechanism here. Because it is a public good, private players wouldn’t have an incentive to provide proper sanitation and the state has to step in to fill the lacuna. Here lies the problem – because the practice of open defecation has cultural roots, the state simply can’t erect physical structures and expect a dramatic change in people’s attitudes and behaviour.

Public goods are collectively demanded by the people and supplied by the state. In the case of sanitation, there appears to be very little collective demand for latrines and the supply side’s response is misplaced. As a result, negative externalities are generated due to the collective failure of the market, the state and the household, aggravating the disease environment and inflicting serious damage on child health. Chapters 5 and 6 explain the consequences of early-life exposure to open defecation for the physical, epidemiological and cognitive development of the child, and they make for a compelling read. The authors are aware of the possibility that their arguments can be misconstrued as victim-blaming, so they make it a point to steer clear of any such misreading: “When people who could make and use a simple latrine defecate in the open instead, they are hurting their neighbours’ children, even if nobody objects. Recognizing this is not ‘blaming the victim’ – the victims are today’s babies.

One of the foundational tenets of mainstream economics is that people respond to incentives. But as a phalanx of recent research in economics concerning people’s behaviour has shown, how the incentives are framed equally matter in making people respond in a desirable way. To achieve this end, it is important to broaden the information base that people use to make decisions. If people have very little information about the debilitating consequences of open defecation on the development of the child, then clearly rituals trump rationality. It is this particular aspect that has been short-changed in the hoopla surrounding the Swachh Bharat Abhiyan. The authors draw attention to the blissful lack of commitment on the part of the government to create enough awareness about the potential benefits of eliminating open defecation:

Its guidelines limit the amount that can be spent on ‘Information, Education and Communication (IEC)’. The guidelines specify that no more than 8% of the overall budget can be spent on IEC. The amount that is in fact spent on behaviour change is even less than this: In 2016-17, Accountability Initiative found that only about 1 per cent of the Swachh Bharat Mission budget was spent on trying to convince people to use latrines.

That latrine construction or ownership doesn’t translate into latrine usage has been shown by official and independent surveys. But consider the fact that there is no national level survey that seeks to estimate person-level open defecation figures and that there hasn’t been any effort on the part of the state to track how many people defecate in the open, the ambitious plan to eliminate open defecation by 2019 notwithstanding.

Building institutional capacity to collect reliable data and designing the right incentives to effect desirable changes in people’s behaviour to shun open defecation is a tall order. Formulating appropriate solutions necessitates a serious rethink of the objectives of the existing sanitation programme and that can happen only when the governing elite develops the courage to take on the elephant in the bedroom, which is the caste system. This book is a commendable effort in providing a truthful account of the nitty-gritty of open defecation in India, while calling out the misdirected efforts of the state in addressing the problem.

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