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Why do millions go without toilets?

Over a third of the world's population lack access to proper sanitation, says a recent WHO report
Over a third of the world's population lack access to proper sanitation, says a recent WHO report

Did you know that a single gram of human waste can harbour 10 million viruses and 1 million bacteria? Despite this, open defecation continues in many parts of the world not only due to lack of access but also because of cultural resistance to toilet facilities. With poor sanitation posing serious health hazards as well as a security risk for girls, guest blogger Isabelle argues that attitudes need to change.

Many of the world’s rural and poorer communities are experiencing what could effectively be called a ‘sanitation crisis’. A 2014 World Health Organization (WHO) report, on Drinking Water and Sanitation, notes that 2.5 billion people don’t have access to proper sanitation – including toilets or latrines. This has numerous consequences for human health, dignity and safety, the environment, and social & economic development.

19th November marks World Toilet Day; an important event because 1 billion people in the world still practise open defecation. Unfortunately, one country accounts for more than half of that statistic. Open defecation is a global problem, but in India it is compounded by other factors such as the high population density and low demand for latrine use.

A national problem

Nearly 600 million individuals in India defecate in the open. I lived in India for a short period of time, and walking was my primary mode of transport. I could barely go anywhere without stumbling upon faeces (human or animal) every few metres. Even in the more “respectable” neighbourhoods, the sight – and smell – of waste is conspicuous. It’s found in public spaces, bodies of water, and fields. According to a Forbes article, this means that 65 million kilograms of human waste ends up in people’s living environments every single day.

It has become such a problem that the Indian Prime Minister has vowed to end the practice. By 2019, 111 million toilets will be built; he pledges to provide toilet facilities for girls and boys in each school, and says that within the next four years, India should have a toilet in every household. This is essential because open defecation brings with it a range of hazards.

Multiple risks

The theme of this year’s World Toilet Day is “Equality, Dignity and the Link between Gender-Based Violence and Sanitation”. I find this very appropriate, because one of the biggest problems associated with open defecation is the threat of sexual violence towards females. This year, a case from the state of Uttar Pradesh in India became widely publicised. Two girls from a village went to the fields at night to relieve themselves, as their homes did not have toilets. The next morning, their bodies were found hanging from a tree – they had been gang-raped and murdered. This is just one of many brutal incidents, and highlights why open defecation is a security issue.

A baby receives treatment at the SOS medical centre in Kaolack, Senegal
Every 20 seconds, a child dies as a result of poor sanitation. Diseases range from
diarrhoea and hepatitis to worm infestation.

UNICEF points out that that a single gram of human waste can contain up to 10 million viruses, 1 million bacteria, 1,000 parasite cysts, and 100 parasite eggs. This is an alarming statistic, particularly in light of another claim made by the UN: that a child dies as a result of poor sanitation every 20 seconds. Diseases resulting from open defecation include diarrhoea, hepatitis, and worm infestation. Some of these illnesses kill people, others leave them physical stunted or mentally impaired.

Open defecation is also an environmental hazard, contributing to ground and air pollution. During my time in New Delhi, my asthma symptoms considerably worsened due to the air pollution, which is exacerbated by open defecation. I was told that Indian lungs are accustomed to the toxic fumes. This is not the same for foreigners; defecation is a visual deterrent for many tourists, but more so is the threat of infection. This jeopardises the tourism industry, which in turn affects the economy. According to WHO, inadequate sanitation amounted to a 6.4% loss of India’s GDP.

An attitude adjustment?

Poverty and lack of lavatories are the most commonly cited reasons for open defecation. However, there’s more to it than that. Millions of toilet facilities have been built by the Indian government, but many of them lie abandoned or are even turned into storerooms. So why would citizens refuse to use them, despite the problems related to open defecation, including the lack of privacy and dignity?

After interviewing over 3,000 households in various Indian states, a sanitation quality, use, access, & trends (SQUAT) survey pinpointed some surprising views. “Half of people who defecate in the open say that they do so because it is pleasurable, comfortable and convenient,” was a prominent finding. Respondents explained that it is a healthy, wholesome way of life. And more than 10% of them say it is a habit or tradition. Other factors come into play, such as opinions on latrine costs and the quality of government-provided latrines (which are actually pits). However, let’s start by addressing this fundamental issue: that open defecation is a social norm for several populations.

Displaced Syrian families must share facilities, like this basement toilet in Damascus
In India, many people see toilets are dirty and enclosed spaces, and perceive a toilet
in the house as being unclean

In a BBC article, Sue Coates, Chief of WASH at UNICEF India, says: “Just building toilets is not going to solve the problem, because open defecation is a practice acquired from the time you learn how to walk. When you grow up in an environment where everyone does it, even if later in life you have access to proper sanitation, you will revert back to it.”

Sanitation solutions

Numerous people – including those from middle and high-income households – believe that having toilets facilities in their house is unclean. Yet they do not perceive open defecation as a problem, and open defecation is not recognised as a health threat. Toilets are often viewed as dirty and enclosed spaces. This outlook has to change, because much of the money currently spent on building these facilities is going to waste.

The SQUAT report notes that respondents with higher educational attainment tend to have more accurate beliefs about sanitation. This is why awareness initiatives are vital, informing individuals exactly how health and sanitation are linked. Since celebrities can be highly influential, such initiatives could include campaigns featuring Bollywood and sports personalities, which may encourage people to adopt healthier sanitation practices. Priority should be given to educating children, as it is easier to change their perceptions than those of adults. We should also help parents to understand the implications for their daughters’ safety and their children’s health.

Ultimately, it’s about shifting mindsets; transforming the idea of a toilet from a small, dark room to a symbol of health and convenience, as well as a mark of social status. Otherwise the many available toilets will remain unused, while outside, human waste accumulates, aggravating pollution and exacerbating health risks.

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