The first time I witnessed open defecation in India was in December 2003. I was in high school in the US, and my parents and I were on holiday visiting our relatives in New Delhi. During the visit, we decided to take a train to Agra to see the Taj Mahal. I remember looking outside of the window at one point and seeing a field full of people defecating. I was so struck by what I saw that I actually wrote my college entrance essay about this scene. But in that essay, my inchoate understanding of the issue led me to suggest that what I had witnessed was a ‘cultural preference’.
Almost a decade later when I arrived in Sukhpur, in the Supaul district of Bihar, to work with two rural community activists on nutrition programs for school children (as a way to combat stunted growth, iron deficiency) I realised that their needs were far different. Parents, doctors, and community health workers in the community kept telling us that the greatest need in their community was toilets.
They were fed up with enduring the indignity of having to walk to the fields to find a safe place to defecate. Furthermore, community members explicitly expressed their understanding of how open defecation is detrimental to their health. In fact, faecal contamination spread by open defecation is known to cause diarrhoea, infectious hepatitis, and cholera, among other very serious maladies. It is estimated that 300,000 children under the age of five die each year in India from diarrheal disease alone, and many more suffer from physical and cognitive developmental delays. Thus, there is an urgent need to prevent open defecation.
I started Sanitation and Health Rights in India (SHRI) to address these issues as a way to end open defecation. SHRI constructs community sanitation facilities in rural communities where households do not own enough land for individual household latrine (IHHL) construction.
When I enquired why most people do not own toilets, community members responded by saying that many were simply too poor. As of 2014-2015, the per capita income in Bihar was just 40.6% of the national average (approximately INR 35,000). Thus many families are unable to take advantage of the government’s toilet subsidy program as they cannot afford the upfront cost of toilet construction. Additionally, many families said they do not own enough land. The average rural family in Bihar owns only 31 square metres of dwelling space, which is split amongst five people. Lastly, many families indicated that if they did build a toilet, they would be responsible for managing the waste, not something that anyone wants to be responsible for. Given the combination of these factors, it should come as no surprise then that even after three years of Swachh Bharat Abhiyan, only 32.35% of households in Bihar have toilets, while less than 60% of households in Jharkhand have a toilet. These conversations convinced me that there was no ‘cultural preference’ for open defecation. Rather, India’s rural families were encumbered by large structural barriers that often deter toilet ownership and use.
Each sanitation facility constructed by SHRI comprises 16 toilets (eight for men, eight for women) that are free to use. Waste is stored in a biogas digester (a large underground tank) where it decomposes to produce methane gas, which SHRI uses to generate electricity to power water filtration plants. This absolves families from having to manage their own waste and also helps community members gain access to safe drinking water (for a nominal fee), another essential service. SHRI uses the revenue to sustain and maintain its toilets, a key predictor of sustained toilet use. SHRI currently operates five of these facilities in Bihar and Jharkhand. The toilets at these facilities are used nearly 4,000 times every day, and SHRI sells close to 1 lakh litres of safe drinking water each month. Countless community members have expressed how these facilities have significantly heightened their sense of safety and privacy. Furthermore, community members are experiencing improved health. Cases of diarrhoea have dropped because of improved access to both toilets and safe drinking water.
However, there is obviously still a lot to be done before India can realise its dream of becoming open defecation free. Community sanitation, such as SHRI, is just one option. But IHHLs are better suited for the elderly, the very young, and the differently abled. We need to make sure that these people are actually gaining access to toilets, not just on government reports. And when they do gain access to toilets, we need to ensure that provisions for waste management are also made. Again, wealthier urban Indians already enjoy this service. India’s indigent communities should not have to settle for anything less.
Furthermore, we need to look beyond “traditional” health indicators as the justification for toilets. Under-five morbidity and mortality, which is adversely impacted by faecal contamination, is absolutely something we should aim to prevent. But access to toilets, at home, in school, and the places of employment are incredibly important for women and girls as it not only preserves their right for safety and dignity, a basic human right but also ensures a private space to manage their menstrual health.
Thus, we all need to understand India’s sanitation crisis as one born out of structural inadequacies, not ‘cultural preference’. Our solutions, then, should aim to holistically address those structural barriers to improve access to sanitation services. And we must view toilets and sanitation as a basic human right, one whose benefits extend well beyond the realm of preventing water-borne illnesses.