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Truly ‘Swachh’? India’s Sanitation Strategies REALLY Need An Overhaul

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Out of the 17 Sustainable Development Goals (SDGs), SDG 6 specifically refers to ‘clean water and sanitation,’ wherein there are 8 targets and 11 indicators. World Toilet Day has been celebrated every year, on 19 November, since 2001. In the development world, toilet infrastructure and the ease of having an access to toilets are not only indicative of the socio-economic status of a region but are also determinative of the fact as to how societies see inclusiveness and have respect for individual dignity and human rights.

Swachh Bharat
Representational image/Photo: Flickr

While the Government of India’s Swachh Bharat Abhiyaan has been successful in creating a buzz around sanitation needs, yet a lot needs to be done. This flagship programme has encouraged in expanding the toilet infrastructure through the construction of Individual Household Latrines (IHHL), community toilets (CT) and public toilets (PT), thus making an effort to reduce the burden of water-borne diseases because of unsanitary practices.

India is a huge country and pan-India solutions put a strain on sustainability because geography, planning, cultural context needs to be taken into account for best results.

The Ministry of Housing and Urban Affairs (MoHUA) comes out with its annual ‘Swachh Survekshan’ which is deemed to be the world’s largest sanitation survey and ranks different urban local bodies (ULBs) across various indicators of cleanliness. Through this survey different cities have been earning the tag of being open defecation free. Swachh Survekshan 2020 laid out the definitions for ODF (open defecation free), ODF+, ODF++ cities with an added focus on declaring a few wards, zones or cities water-plus.

If a ULB is declared ‘water-plus’, it essentially means all wastewater released from households, commercial establishments, drains, nallahs and others are treated to a satisfactory level (as per CPCB norms), before releasing it into the environment. Further, the adequate capacity of wastewater and sewage treatment facilities is to be ensured. Infrastructure should be maintained properly and cost recovery ensured through reuse or recycling of treated wastewater to ensure sustainability.

Toilets: A Medium For Sanitation And ‘Health Democracy’

Women have always been left behind in sanitation needs that compromise with their health. For instance, the needs around menstrual hygiene that are looked down upon or mocked at. This topic found it difficult to occupy space as a topic of discussion and dispensation in the surveys of Swachh Survekshan all these years.

Most of these issues are not addressed because of a patriarchal setting, and even after more than seventy years of independence, somehow launching rockets into space seems easier than achieving total sanitation! While this might look like comparing apples to oranges but both the instances have their answer in politics. How a citizen views it through different lenses and dimensions would build the respective debates and discourses.

There were a few old advertisements starring Vidya Balan that emphasised on the need to build toilets (Shauchalya Banao) to curb open defecation that was designed under the campaign of ‘Jahan Soch Wahan Shauchalya’. These advertisements were women-centric and gave the message of how women and girls were affected by it. It is interesting to note that, open defecation as a practice in the wee hours of the day is also a time for socialisation among women because after attending to nature’s call they are pushed into the four walls of their homes to nurture and attend to the domestic chores.

Not having an access to toilets is another major reason for girls dropping out of schools. In many areas, parents willingly send their children to school because they are ensured free mid-day meals and basic sanitation needs through toilets. This clearly makes toilets as a make-or-break point to win the hearts of the downtrodden and also to win politics!

The state of Uttar Pradesh, which mostly attracts news headlines for all the wrong reasons, has some positive news on the aspect of sanitation. The Firozabad district has paved a way for sanitation democracy through ‘Toilet Parliament’ or Toilet Sansad that addresses the issues surrounding health and hygiene and making the place open defecation free. It has been a grassroots level development by forming a committee via democratic elections.

It comprises villagers who own a toilet, including the sarpanch, sanitary workers, village secretary, school headmasters, Asha, Anganwadi, Auxiliary Nurse Midwife (ANM) and retired government employees, Swachh ambassadors. The committee is also responsible for conducting awareness drives around water, sanitation and hygiene (WASH), handling of menstrual waste, encouraging people to strictly use toilets to end open defecation, and more.

The focus on declaring areas open defecation-free also ensures to keep a check on groundwater contamination, as a large population in the country is dependent upon groundwater for their sanitation and other domestic needs.

The ‘F-Diagram’

Diarrhoea is a major cause of death among children under the age of five in South Asia and the least developing countries (LDCs). Water-related illnesses that are linked (directly and indirectly) to WASH practices are grouped into the following:

  1. Virus-laden: Water-borne diseases are transmitted through the ingestion of water contaminated with human or animal faeces containing pathogenic bacteria or viruses. Some examples are dysentery, typhoid, cholera, and other diarrheal diseases.
  2. Water-washed: Water-washed diseases are caused by a lack of water for personal and domestic cleanliness or contact with contaminated water. Some examples include skin and eye infections such as trachoma and scabies.
  3. Host-based: Water-based diseases are transmitted via an intermediate host which lives in water and causes illness in humans who ingest the water or use it for washing. Some examples are guinea worm and schistosomiasis.
  4. Insect-borne: Water-related insect vector diseases are transmitted by insects which breed in water or bite near water. These diseases are not associated with lack of access to clean water, but their spread is often facilitated by the construction of large-scale irrigation systems and reservoirs that create conditions favourable to their hosts. Examples of these diseases include malaria, dengue, yellow fever, and filariasis.
    These vector-borne diseases have seen a high rise with every passing year due to a changing climate.

It is a burden on public health, especially in a pandemic-hit world when there has been a huge focus on hand-washing and related WASH practices more than ever before. And all of this requires access to water. When a majority of the country’s population is poor, they are pushed into social compression which is fraught with inequalities and inequity and unequal distribution of basic resources like water.

It also gives rise to disease-burden which can be further understood with the help of an ‘f-diagram’ which explains the causes of diseases all beginning with the letter f, viz., faeces, fluids, fingers, flies, fields, floods and food. This can be tackled very effectively by creating WASH barriers, which means ensuring access to clean water, having toilets in place and having hygienic sanitary practices before and after, while preparing food and consuming it.

A few days ago, an article was published which showed the correlation of bad hygiene practices to better immunity, hence, making India fight COVID-19 better in comparison to the developed world. This is laughable and sad at the same time and a reminder that so much more needs to be done in the health and hygiene sector.

Talking about toilets also brings in question the evil practice of manual scavenging which is a reality, no matter the denial. It has been a centuries-old casteist practice which in real terms is a crisis of human dignity. It is here that the best practices like the use of a robotic scavenger like Bandicoot needs to be scaled up.

Turning The Sanitation Crisis Into A Sustainable Business

Representational image.

Just as the crisis of COVID-19 has brought in great business opportunities to let the masses consume hygiene products like masks and sanitisers; likewise, I feel that fear needs to be injected in the minds of people for adopting sustainable sanitation practices.

A sanitation crisis in the developing world could be used as an opportunity to create jobs in the sanitation business, both in the rural and urban areas with a special focus on marginalized communities. For instance, slums in cities need a sanitation infrastructure in place.

A report by USAID in March 2020 talks about sustainable sanitation enterprises in rural Bihar. It explores the idea of scaling up market-based sanitation (MBS) that essentially looks into the barriers of a market system, viz., the core sanitation market, the business environment and the broader context.

To cater to such needs or demands, sustainability as a concept becomes difficult to execute, both at an environment and economic level. For example, the manufacture and supply of cement rings, water equipment, etc for building toilets could be an option for job creation in the upcoming sustainable sanitation businesses.

Moreover, research on incorporating locally available materials for building toilets that are accessible and will be cost-effective is much needed. Hence, sanitation infrastructure has to be made affordable to ensure viability and sustainability on all fronts.

Having the right toilet infrastructure in place, with gender-sensitive toilet designs be it IHHL, community toilets and public toilets could also help in mitigating the impacts of extreme weather events like floods due to climate change. Sustainable sanitation is an adaptive strategy for communities to become resilient and it is here that smart cities need to come into picture wherein treated wastewater utilisation happens to reduce water stress. There has to be a focus on behavioural change targeting all sections of the society.

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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.

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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, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’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.

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