Open defecation, a menace to public health and disgrace to dignity

  • Feb 01 , 2017

Every morning Radha wakes up before the break of the dawn and heads towards a dense thicket at the edge of the village. Her next chance to attend to nature’s call would come when the sun sets. Six decades after independence, her village still doesn’t have sanitary toilets. Almost 600 million people in India lack access to toilets. Besides having an extremely deleterious effect on the state of public sanitation, lack of toilets has grave socio-economic dimensions as well.

Daily struggle in our cities’ slums

Over 65 million people in India live in urban slums. While slum dwellers are more likely to have access to sanitary toilets than their rural counterparts, their predicament is aggravated manifolds by the lack of open fields in urban areas. It is a commonplace to see slum dwellers squatted beside railway tracks in the early dawn. Open defecation in urban areas also leads to additional challenges for municipal sewage disposal. To the uninitiated the problem of lack of access to sanitary toilets might seem mainly an issue of inconvenience for the poor, however, research has revealed that it could lead to multifarious unsuspected health challenges for the poor.

Poor sanitation leads to malnutrition

It has been estimated that globally one in four children under the age of five suffer from stunting. A form of malnutrition, stunting causes children to be shorter than their peers of the same age group. Stunting weakens the immune system leading to greater susceptibility to diseases and also affects children’s intellectual development adversely. The seriousness of this problem is reflected by the fact that as many as 48 per cent of children in India were found to be suffering from various degrees of stunting. More surprising still was the revelation that the incidence of this condition does not depend too significantly upon the income group to which the children belong. This finding strongly brings home the old wisdom that health care and sanitation are public issues. We cannot sit calmly within the confines of our clean homes and hope that lack of sanitation affects only those who are less endowed.

Photo Courtesy: The Logical Indian

Studies have shown that the real cause for the incidence of malnutrition in India is not the lack of food. It is now an accepted scientific wisdom that there is a link between the lack of sanitary toilets and malnutrition. Defecation in the open leads to contamination of drinking water, which in turn increases the risk of diarrhea among small children. Lack of proper toilets is also a reason why many skip washing their hands after defecating. According to an estimate published by the WHO, in almost 50 per cent cases malnutrition among children is caused by diarrhea and/or intestinal worms contracted from water contaminated by feces dumped in the open. The incidence of diarrhea and intestinal infections leading to malnutrition can drop drastically through access to sanitary toilets and clean drinking water.

Sewage hazard

Access to clean drinking water is severely affected by poor sewage management in urban areas. While sewage management is almost non-existent in smaller urban settlements, in bigger cities too its efficacy varies a great deal from locality to locality. While our cities are ready to burst at the seams due to migration from rural areas, infrastructure has struggled to catch on. The number of sewage treatment plants is still inadequate. Just around 30 per cent of sewage water in India is treated resulting in most of the urban waste flowing into rivers. Quite unsurprisingly, today over 70 per cent of our surface water is contaminated. Given this grave situation we need a massive strategic investment to tackle this problem but unfortunately, no amount of doomsday prophesying seems to shake us out of our complacent collective stupor.

Lack of awareness in rural areas

Despite efforts by the government, awareness regarding the usefulness and necessity of sanitary toilets remains low in the rural areas. Studies have shown that in many instances, funds obtained from the government are diverted elsewhere. While diversion/misutilisation of subsidies isn’t entirely unexpected in a poor society, a more disturbing tendency is to convert toilets into storages for grains, fodder or cattle pens. This reflects the low priority that rural India attaches to the significance of sanitary toilets. Keeping this finding in mind, in recent years the government has shifted part of its focus from providing subsidies to increasing awareness about the need for sanitary toilets

Photo Courtesy: Hindu BusinessLine

Related to unequal gender relations

Even though the lack of sanitary toilets affects women more, mostly they are deprived of decision-making in this regard. While public defecation is culturally more acceptable for men, women must go out before dawn or wait till sunset to relieve themselves. This ‘imprisonment by daylight’ not just reinforces gender injustice; it also leads to serious health hazards like the infection of the urinary tract. In some instances, women might modify their diets to avoid frequent calls leading to nutritional imbalances which in turn cause long-term health problems. This reluctance to go out frequently isn’t misplaced, given the fact that most incidents of assault and rape occur while women are out to defecate. Sociologists have pointed out that is a definite relationship between gendered crimes and lack of toilets.

Community toilets might not be the solution

While the government has been acting proactively to eradicate open defecation in rural areas, certain simple oversights regarding societal norms could hinder otherwise well-intentioned projects. A lot of energy and valuable resource has been invested in developing ‘community toilets’. However, many surveys point out that they might not be the best solution in the rural context. A study from rural areas in Haryana points out that many women, as well as men, feel reluctant to use community toilets. Whereas the likelihood of defecating in the open came down drastically wherever the toilets were built in-house. Often development agencies tend to presume villages to be homogenous communities, however, in reality, a gamut of social and cultural factors and power are in the play. Caste divide means that community toilets are less likely to be available to less empowered communities. Force of habit too is often underestimated as a factor. It is often seen that at least some members of a family prefer to go out to defecate despite the presence of toilets in their household. Lack of running water and ‘convenience and comfort’ of defecating in the open are cited as a reason. This goes to show that the approach towards eradicating defecation in the open ought to be holistic and well rounded. Consciousness raising campaigns too are likely to play a much more crucial role than hitherto suspected by policy makers.

Photo Courtesy: News 18

Implications for girl children’s education

According to 2014 Annual Status of Education Report (ASER), as many as 45 per cent of government run schools do not have proper toilets. Another report published by Mint establishes a definite correlation between lack of toilets and girls dropping out of schools at a middle school and high school level. Due to the lack of toilets students are often forced to defecate in the nearby fields and playgrounds. While girl children can still manage this, by the time they reach adolescence it becomes increasingly difficult, at times due to parental pressure to continue attending school. In some instances, toilets might be present but a lack of proper maintenance or water supply makes them impossible to use.

Besides schools also need separate facilities for physically challenged children and menstruating girls. Such simple facilities like private areas for changing pads, regular supply of running water and proper arrangement for disposing of menstrual waste do not cost much, but they could go a long way towards ensuring that girl children do not have to drop out from school.


Defecating in the open is a very serious public health challenge that particularly affects the rural and urban poor. But as we have seen above, the state of public health affects all irrespective of their socio-economic status. This being true notwithstanding, its implications are particularly hazardous for women. Though this hazard appears to be mainly medical in nature, we can ill afford to ignore its social and cultural dimensions. Therefore, it would be more fruitful to look upon the medical-social-cultural-economic as an indistinguishable intermeshed whole. We cannot tackle anyone of them without at the same time grappling with all the rest. Despite years of efforts, we are still far from winning this battle. At a time when the Indian economy is all set to make a leap forward, we would not want to be held back by a problem the solution to which is well within our grasp. It would be a mistake to presume that health problems do not affect our economy. Without a healthy workforce and without ensuring gender justice, our economic growth would remain a mere number to please economists, and before long these same problems would take the wind out the sails which are driving our economy.