Sanitation challenges

Toilets are urgently needed in rural India, but don't imagine they'll reduce rape

Open defecation causes great public health risks. But the new government first needs to address social attitudes, not infrastructure.

“Daughters and daughters-in-law should not go outside: build a latrine right in your house!” So reads the government slogan painted on village walls in rural Uttar Pradesh and Madhya Pradesh. Whenever we encounter these wall paintings, we cringe twice. First, how can the government willingly reinforce the archaic, patriarchal belief that young women should not be allowed out of the house? Second, how could it perpetuate the misunderstanding that latrines are only for women to use?

Most people in India – both men and women – defecate in the open. To elite Indians used to seeing fellow citizens squatting by the side of the road, this sometimes seems like a fact of life in a developing country.

But it is not. Almost nobody defecates in the open in China. Only a tiny fraction of people in Bangladesh defecate in the open, despite the fact that GDP per capita in Bangladesh is about half of what it is in India. Most strikingly, open defecation rates are much, much lower even in impoverished sub-Saharan Africa than in India.

India’s high rate of open defecation has dire consequences. Open defecation takes the lives of hundreds of thousands of children in India each year. It also stunts the children who survive: children who are exposed to the diseases spread by open defecation are unable to grow to their full physical and cognitive potential. Stunted children grow up to be adults who are less economically productive.

Although many people who defecate in the open think it is harmless, or maybe even good for them, they are wrong: the negative consequences of open defecation are a very big deal. These costs are borne by everyone in India, even those who use toilets or latrines. Fecal germs are what economists call an externality: they make you sick even if you yourself use a toilet.

The terrible health and economic consequences of open defecation explain why it is such a hot topic in India these days. Prime Minister Narendra Modi raised the profile of sanitation by announcing that eliminating open defecation by 2019 would be one of his government’s top priorities. Like many Indians, we are cautiously optimistic: we expect that he will make the effort necessary to reach this goal, but we also know that the challenge will be great.

We have spent the past several months interviewing people in over 3,000 households in rural north India about sanitation and produced statistical and economic research about the consequences of open defecation. Our research is clear: building toilets without addressing common norms, attitudes and beliefs around latrine use is unlikely to reduce open defecation in rural India. It may be surprising, but many, many people were happy to tell us that they prefer to defecate in the open. Over 40% of surveyed households with a working latrine have a household member who defecates in the open. Many, many households that could afford to build a latrine do not build one. Many people in rural India, including local leaders, do not consider latrines a priority.

In other countries where sanitation has improved, most latrines were built by families, not by the government. But this fact does not get the government off the hook in its bid to inspire change and fulfill its promise of making India an open defecation- free country. The government – and social leaders throughout the country – must lead a social movement to change people’s minds and behaviors.

Is open defecation particularly harmful for women?

In recent days, open defecation has been in the news because it is hoped that building toilets could reduce rape. Sexual violence in India is a tragedy, deserving of far more attention and effort. But we worry that those who hope that building toilets will significantly reduce rape may be misguided. On the one hand, they are misguided about the appropriate response to violence against women: we should not respond to rape by keeping young women in the house but by creating a society where all people – young and old, men and women – can move about freely and safely. On the other hand, people who think that building toilets will reduce rape are misguided because in rural India, building toilets does not mean that people will use them.

When we surveyed thousands of rural households, we asked men and women separately what they thought about toilets. Our survey shows that using a latrine does appear to be more important to women than to men: in households with a latrine, women are more likely to use it than men. One reason may be that most of such women can only go out for defecation early in the morning or after dark, while most men face no such social constraints. However, we should not be too quick to conclude that all women are eager to stop defecating in the open: for some women, it is one of few opportunities to get out of the house at all.

In fact, latrine use is not as much of a priority for women as those of us who are accustomed to using a toilet every day might think. Many women with access to latrines do not use them, and many women told us that they enjoy going out to defecate in the open. Averaging our figures for Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, 19% of women in households with latrines nevertheless defecate in the open, compared with 28% of men.

In our interviews, many households with latrines said that they built them for their young women to use. However, it seemed that they were not as concerned with keeping neighbors from seeing their young women defecating in the open as with preventing others from seeing their young women at all. Similarly, it may well be that women in rural India are vulnerable to harassment and assault while going to defecate outside merely because too many women in rural India are vulnerable to harassment and assault at all times.

Is open defecation an occasion when women are particularly vulnerable to sexual assault? Of 1,046 women whom we interviewed, 4.3% told us that someone had attempted to molest them while going to defecate. But, of the same group, 7.6% reported that someone had attempted to molest them while going to the market. The point is not that these events are necessarily comparable, or that these statistics have captured the full extent of violence against women; the point is that nobody is suggesting that women should stop going to markets. Ending sexual violence, ending open defecation, and ensuring social access to markets for people of all ranks and social positions are all important goals for India, but they are separate issues.

The costs of branding latrines for ladies

Why not use patriarchal attitudes to get latrines built if that is the way to spur toilet construction?

As should be clear by now, part of the answer is that toilet construction is not what we need. Toilet use is what we need. Latrines are for everyone, because men’s feces spread germs too. Achieving the construction of a few more latrines that only a daughter or daughter-in-law will use – at least until the pit fills or a pipe breaks because no one invests in maintaining the latrine – is not going to do much to improve the health or economic productivity of the population.

If the government continues to send the message that toilets are for women, it reinforces destructive social norms that limit women’s freedom and it misses the opportunity to tell people that everyone should use a latrine. Men need to be convinced that open defecation is not acceptable anymore: not for women or for themselves. It is not healthy. It is not modern. If men believe that they, too, should use latrines, they will be more likely to invest in constructing and maintaining one.

Urgently needed: A social movement

If the current calls for government-funded latrine construction as the solution to sexual violence turn into policy, it will neither reduce rape nor improve sanitation. Although it is true that many young women, disabled people and older people would be delighted to have a government latrine, these people are not the economic decisionmakers in rural households and villages – an unfortunate fact that will not be changed by any mere budgetary line in a government allocation. Ensuring the latrine use that would help ease the lives of vulnerable people – and would help prevent diseases that affect everyone – will require changing people’s minds about latrines.

Now is the time for the government to inspire the social movement needed to change people’s minds and behavior. Nobody knows quite how to achieve this, but this is the time to start conversations and try new approaches across rural India. Perhaps only a figure as popular as Prime Minister Modi can ignite the revolution in sanitation behavior that India so badly needs. The result would benefit all Indians: women, men and children.

 
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HBX Platform | Courses offered in the HBX CORe program
HBX Platform | Courses offered in the HBX CORe program

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HBX Interface | Students can view profiles of other students in their cohort
HBX Interface | Students can view profiles of other students in their cohort

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HBXers at ConneXt, with Prof. Bharat Anand
HBXers at ConneXt, with Prof. Bharat Anand

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