It is no surprise, to those who have worked in the rural regions of South Asia that people continue to defecate openly. Behind a bush, near a stream or out in the open, people have defecated openly for centuries. Most men do it with the same ease and confidence that one would have for a morning jog. Most women wait for nightfall and travel to isolated places like jungles to relieve themselves making them highly vulnerable to assaults. It is much harder for the elderly and the disabled without a proper toilet nearby to relieve themselves. This practice is a consequence of various social and economic factors, lack of knowledge of communicable diseases, waste management or social hygiene. Compounding this is the fact that 2.5 billion people worldwide remain without proper sanitary facilities and around 2000 children die every day from the lack of proper sanitation. However, that seems to be changing for the better. Ever since the term came to popular use in this century, open defecation, and sanitation by extension, its roots and its consequences have started to be understood by a wider range of people.
Impact on Society
Although illiteracy, poverty, and unawareness of sanitary practices are statistically linked, its relation to health and well-being or lack thereof is poorly understood by people in rural areas. It is the main cause of the transmission of – otherwise completely preventable – communicable diseases. This is more so when open defecation is a major source of transmission for diseases like diarrhea, typhoid and cholera. These diseases claim hundreds of thousands of lives each year in such places. They also contribute to a decrease in school attendance of millions of children.
In fact, children are the worst affected group from improper sanitation and hygiene practices. Studies after studies have shown conclusively how children, especially in middle income countries, are the ones who have it the worst. This is especially concerning considering that a country like India, which is poised to be the youngest nation with about 160 million people in the working age group in 2020, being debilitated by a lack of education and sanitation might prove a demographic and economic disaster. Counteracting and eliminating open defecation requires – as has always required – providing the necessary equipment, resources and important widespread education and awareness to those who need it the most, who are also, the ones affected the most. The ill-effects of open defecation are amplified in places with a high population density – namely India, Indonesia, and Nigeria.
The Role of Social Norms
Cultural value systems play a vital role in South Asia regarding sanitation. If the attitudes and values of the community is not influenced first by creating an innate demand for sanitation, any investment in sanitation is only a temporary solution. For example, in some patriarchal cultures of India, the father-in-law and the daughter-in-law are prohibited to share the same toilet due to cultural or social reasons. They thus resort to open defecation. The irony of still sharing a toilet, albeit now a bigger toilet now as the environment, is however lost – a different, but nastier Tragedy of the Commons. The good news is that if these attitudes are successfully changed , half the battle is won already.
In other cultures, for instance, in Nepal, menstruating women – who by the very act of menstruating have been deemed ‘untouchable’ – cannot use the toilet at home and thus have to resort to open defecation. They are forced to sleep in dirty cow sheds, without proper shelter, heat in winter, or sanitation. The belief is that they become ‘death incarnate’ – wilting crops by her touch, drying wells by fetching water, bringing death and destruction to her family by staying in the house while menstruating. In fact, even the people who are campaigning against such a practice are themselves forced to be subject to it due to the deeply entrenched norms and superstitions that permeate these villages and remote areas. Paper-based declarations of change such as these fight a losing battle against the reality of everyday life.
This has riddled the subcontinent with many unfortunate consequences. One of those is an increase in the drop-out rate among girls during their puberty due to lack of segregated toilets and urinals in schools. This fuels the very source of their problems – a lack of education. This is especially troubling since girls aged 15-24 have a lower literacy rate than boys of the same age in all Asian countries barring Philippines and Mongolia. Almost four out five Afghani women are illiterate. This increases the risks associated with a lack of awareness of menstrual, reproductive and social issues. As a corollary, naïve, young and especially uneducated pubescent girls throughout South Asia are constant prey to kidnappers who will sway and persuade them to come to the cities for a ‘brighter future’ when in fact, they have far more sinister things in mind. These beliefs are enhanced by the group-think that illiteracy inculcates and most dangerously, by the insidious ways in which it works through the vicious chains of social conformity and normalization.
The Deeper Truth
Chhaupadi, stigma of infertility and lack of sanitation are only symptoms of the tryst between poverty and illiteracy. And what better way to foretell the outcome of such a tryst, than the history of our subcontinent – a history riddled with gender subordination, disparate inequality, dowry and domestic violence, witch hunts and honor killings. We bear, as Charles Darwin put it, ‘the indelible stamp of our lowly origin’, and the origin of our current crude practices come from societies who, unable to answer the vast and terrifying unknowns of the world, made their own explanations, imputing flawed logic to events they could not explain.
What is of import is that the power of these beliefs lie in their inclusion in the sphere of ‘culture’ that is the pith of collectivist societies that comprise South Asia. This has been a major factor in influencing and changing social norms and behavior. For instance, the existence and condition of latrines and toilets reveal the status and environment where a boy or a girl grew up. Campaigns across India with slogans like ‘We don’t give our daughter’s hand in marriage to boys from a village where open defecation is practiced’ hit the nail hard by using culture and established social norms against open defecation and unsanitary practices.
The logistics also place a huge challenge. Most people in South Asia are simply extraordinarily poor to be able to afford and maintain sanitary household toilets. Governmental and non-governmental efforts have been expressive. However, establishing community toilets and managing them still aren’t major concerns in most places when you have half a dozen children to feed, farms to tend to, loan sharks to avoid and huge swaths of land at your ‘disposal’. As WASH experts lament, ‘What incentive is there for them to run a community toilet when the community can itself easily become a toilet?’ Most importantly, sanitation is only a part of WASH. All three areas in WASH support, strengthen and dovetail into one another. If one of the pieces goes awry, the progress of the other two are stunted. But when they do synchronize, things work much more efficiently.
Path to Progress
Even a cursory glance at this situation by anyone outside of the region can tell that we have a lot of work ahead of us – as social entrepreneurs, rural developers, teachers, workers, students, policy makers and concerned citizens.The good news is that a lot of good work is being done. NGO and governmental efforts have been steadily increasing in almost all developing countries but their effects are very different. The Govt. of India, through the ‘Swachh Bharat Abhiyan’ purports to achieve nation-wide ODF (open defecation free) status by October 2, 2019 – the 150th birthday of Gandhi. This comes as a glad tiding when more than a third of the Indian population continues to defecate openly, the majority of which occurs in rural areas.
Across the border to the north, more than half of Nepal’s districts have been declared open defecation free (ODF) through joint initiatives by the government and the public sector. However, it unlikely they will be able to complete their nation-wide ODF status initiative by this year’s end as promised. Indonesia has used its burgeoning urban youth to act as advocates of ODF in their communities, creating a compelling campaign. Bangladesh, a country with a similar profile to its neighbors has managed to almost eliminate open defecation. Sri Lanka has eliminated open defecation completely. With more emphasis on rural development in the coming decade, progress on these terms will be picking up the pace and improved sanitation is sure to follow.
Who Should Lead The Charge?
Emboldened by such progress, there is a growing realization that the responsibility of widespread and ingrained sanitation need not, and should not, be simply relegated to INGOs and the governments for fixing this issue. The prerequisite values of social hygiene, sanitary well-being and social disapproval for open defecation is still lacking in the most rural and prone areas. For these values to exist, they require good infrastructure, education and an entrenched awareness of the issues at hand – all of which take time, money and resources to sustain. A growing alternative to externally funded projects and donations is the Community Approach to Total Sanitation.
Notwithstanding the above, there is still a very strong case for public and governmental intervention. The incentives for the poor don’t work out in the favor of sanitation, ironically, because of the huge positive externality that is accrued on the community from proper sanitation followed by others in the community. A study shows how half of the effect from the reduction of diarrhea incidences result simply from others adopting sanitation. Furthermore, money spent on sanitation is money not spent on valuable goods and services like food and education. The cost of a decently built toilet can reach above $100 – a purchase not easily feasible for people in the most rural areas.
As was the case with Bangladesh and Indonesia, innovative measures, widespread awareness, thorough participation of both public and private sectors, and a healthy dose of skeptical inquiry among the public through awareness campaigns will certainly pave a better road towards ODF, ensuring a decrease in child mortality, stunting. What is needed, and what real world shows works, is a partnership and understanding between the three forces – governmental aid, non-governmental support and community self-reliance. This is a hard undertaking for all sides but the balance, once attained, should accelerate the movement towards total sanitation for everybody.