By From The Print, www.economist.com July 19, 2014
Fixing dreadful sanitation in India requires not just building latrines but also changing habits
Fixing dreadful sanitation in India requires not just building latrines but also changing habits
CHEER any Indian leader who takes on the taboo of public hygiene. India’s
finance minister, Arun Jaitley, used this July 2014 budget to set a goal of
ending defecating in the open by 2019. That will be 150 years since the birth
of Mohandas Gandhi, who said good sanitation was more important than
independence.
Ending open defecation would bring immense benefits. Some 130m
households lack toilets. More than 72% of rural people relieve themselves
behind bushes, in fields or by roadsides. The share is barely shrinking. Of the
1 billion people in the world who have no toilet, India accounts for nearly
600m.
The costs are high. Public safety is one underappreciated problem, as
young women have to leave their rural homes after dark. In May two teenage
girls in Uttar Pradesh visiting a field used as a communal toilet were raped,
murdered and strung up from a tree. That case won notoriety for its extreme
barbarity, but similar attacks are distressingly common.
A broader matter is public health. Open defecation is disastrous when practiced
by groups in close contact with each other. Because India’s population is huge,
growing rapidly and densely settled, it is impossible even in rural areas to
keep human faeces from crops, wells, food and children’s hands. Ingested
bacteria and worms spread diseases, especially of the intestine. They cause
enteropathy, a chronic illness that prevents the body from absorbing calories
and nutrients. That helps to explain why, in spite of rising incomes and better
diets, rates of child malnourishment in India do not improve faster. UNICEF
estimates that nearly one-half of Indian children remain malnourished. Hundreds of thousands of them die from preventable conditions each year,
especially in the north, which has most of the open defecation (see map below).
Faeces in groundwater spread diseases such as encephalitis, an annual
post-monsoon scourge in eastern Uttar Pradesh. Diarrhea leaves Indians’ bodies
smaller on average than those of people in poorer countries where people eat
fewer calories, notably in Africa. Underweight mothers produce stunted babies
prone to sickness who may fail to develop to their full cognitive potential.
Dean Spears, a Delhi-based economist, says the costs of all this, in incomes
and taxes forfeited, are far greater than the price of fixing it.
How to do so? India fares worse on sanitation than a host of poorer
places including Afghanistan, Burundi and Congo, partly because too many of its
leaders are too squeamish to face up to the issue. Thankfully, that appears now
to be changing. The government, gung-ho for infrastructure, has just said it
will build 5.2m toilets by September, or one every second. Pouring concrete will not in itself solve India’s problems. Leaders need
also to confront the cultural reasons for bad sanitation. Hindu tradition, seen
for example in the “Laws of Manu”, a Hindu text some 2,000 years old,
encourages defecation in the open, far from home, to avoid ritual impurity.
Caste division is another factor, as by tradition it was only the lowliest in
society, “untouchables” (now Dalits), who cleared human waste. Many
people, notably in the Hindu-dominated Gangetic plains, today still show a
preference for going in the open—even if they have latrines at home.
Evidence is growing that India must urgently correct its cultural
practices, though it is sensitive to say so. Studies of India’s population show
how since at least the 1960s child mortality rates have consistently been
higher in Hindu families than Muslim ones—though Muslims typically are poorer,
less educated and have less access to clean water. Today, out of every 100
children, 1.7 more Muslim than Hindu ones survive to five years, a big gap.
Mr Spears and his colleagues argue that this can be explained only by differences
in sanitation habits. A 2005 government survey, the most recent national one,
found that 67% of all Hindu households, rural and urban, practiced open
defecation, compared with just 42% of Muslim ones. (In rare places where there
is more open defecation among Muslims than Hindus, the mortality gap is
reversed.) A new household survey of nearly 23,000 north Indians offers more
evidence, especially from Hindu households. Led by Diane Coffey, an economist
at Princeton, it found that even among households with a working latrine, more
than 40% reported that at least one family member preferred to defecate in the
open. Those with a government-built toilet were especially likely to choose a
bush instead.
In an unpublished parallel survey of Hindu-dominated villages in north
India and Nepal, respondents lauded open defecation as wholesome, healthy, and
social. By contrast, latrines were seen as potentially impure, especially if
near the home. Men often described them as for use only by women, the infirm,
and the elderly. In short, demand for latrines is constrained.
This suggests that the mere availability of government-built latrines
will not end open defecation for decades yet. What is needed instead are public
campaigns, in schools and in the media, to explain the health and economic
benefits of using toilets and of better hygiene. Researchers found that only a
quarter of rural householders understood that washing hands helps prevent diarrhea.
Such campaigns not only mean government-built latrines have a better
chance of being used; they would also encourage households to build them for
themselves. Precisely how to raise awareness about a touchy subject is not
clear, but some at least are trying. A catchy animated music video put out by UNICEF
urges Indians to “take the poo to the loo”. The intention is right, even if the
dancing turds will not immediately be to everyone’s taste.
