This post has been self-published on Youth Ki Awaaz by Raghunath Nageswaran. Just like them, anyone can publish on Youth Ki Awaaz.

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

More from Raghunath Nageswaran

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.

You must be to comment.

More from Raghunath Nageswaran

Similar Posts

By Mallika Khosla

By Jaya Pandey

By sukanya deogam

Wondering what to write about?

Here are some topics to get you started

Share your details to download the report.









We promise not to spam or send irrelevant information.

Share your details to download the report.









We promise not to spam or send irrelevant information.

An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

Share your details to download the report.









We promise not to spam or send irrelevant information.

A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

Sign up for the Youth Ki Awaaz Prime Ministerial Brief below