The end of India’s sanitation crisis?

“Sanitation is more important than independence.”  - Mahatma Gandhi 

I started working on addressing India’s sanitation crisis in the summer of 2010. I had just quit my comfortable engineering job and wanted to work on public health and social justice projects in India. At the time, official estimates suggested that 600 million people in India – nearly half the nation’s population – were defecating in the open on a daily basis. Many of the friends I made through my new line of work belonged to the latest generation of impoverished Indians enduring the terrible indignity and deleterious health consequences of not owning a toilet. Unfortunately, ten years later, many of my friends have yet to see improvements in their sanitation conditions.  

That’s why I was utterly shocked when on Oct. 2 of this year, the Prime Minster of India, Narendra Modi, declared the country of India open defecation free (ODF). He attributed this victory to a five-year sanitation campaign called the Clean India Mission, claiming that 110 million toilets were installed for 600 million people across the nation. On the day of this bold announcement – which coincided with Gandhi’s 150^th birth anniversary – I could not help but think about my friends who I know still have no toilet.  

While there is no denying that millions of toilets have been built since the Clean India Mission launched in 2014, I am not the only one who remains incredulous vis-à-vis the validity of Modi’s claims. This is in large part due to the fact that a recent World Health Organization report estimated that in 2017, 520 million people in India were still defecating in the open. Academics, policy makers and journalists wonder how, in just two short years since the report, the government of India could have created toilet access and use for all of those people? This skepticism has been buoyed by first-hand accounts from people who continue defecating in the open because they still do not have a toilet, and by questionable evidence generated from the government’s own National Annual Rural Sanitation Survey. 

If people in India are indeed still living without access to toilets and continue defecating in the open, the question is why? One must look at the theoretical underpinnings of the Clean India Mission, for an answer. It was a sanitation intervention that focused extensively on raising awareness about the benefits of latrine use. The Clean India Mission did so by relying on communication to spur individual-level behavior and demand for toilets. 

Yet public health interventions focused on changing individual-level knowledge, attitudes and beliefs often fail to recognize the social, political, economic and environmental context in which people make decisions. For example, the Sustainable Development Goal for sanitation only counts household-level facilities towards its target. Yet nearly two million people are homeless in India according to a 2011 census. This population does not have access to household toilets and are thus more likely to defecate in the open. In many cases, homelessness is a result of eviction as city governments try to “beautify” their municipalities, the increasing frequency of catastrophic climate events, and rising housing costs. Protections to prevent homelessness are an essential first step to ensuring access to household sanitation, and thus preventing open defecation. 

Additionally, pit latrines – the government’s recommended sanitation technology in rural areas – must be emptied when full. Tankers are cost prohibitive and often infeasible in rural areas that lack good road infrastructure. Furthermore, manual scavenging (cleaning out pits manually) has rightfully been outlawed given the myriad dangers associated with handling human feces, leaving families the only option of doing it themselves. However, social stigma associated with handling human excrement, perpetuated by India’s ancient caste system, deters families from doing so. This causes the pits to fill up, rendering toilets unusable, which leads people to revert to defecating in the open. Thus, waste management services, that absolve individual households from managing their own waste, are essential to promoting toilet ownership and use. 

Gender and household characteristics are other key determinants of toilet ownership and use. For example, women may be keenly aware about the benefits of latrine ownership and use. Yet due to gender inequalities they might not be able to make financial decisions leading to improved household sanitation for their home. Additionally, the average household in rural Bihar (a state in north India) owns 360 square ft of dwelling space. The government’s pit latrine design requires 67 square ft, almost 20 percent of the dwelling space owned by households. Thus, land constraints inhibit a family’s ability to own and therefore use a household latrine. 

Along with homelessness, waste management and gender, I contend that Modi’s declaration in and of itself is a determinant of toilet ownership and use. By claiming that India is now ODF, he has rendered people like my friends invisible. The severity of their situation has been exacerbated by the fact that on paper, India no longer has a sanitation crisis. That is all the more reason people such as my friends will serve as a constant reminder to those of us working in the sanitation space that we must continue struggling for improved sanitation outcomes. We must continue shedding light on the realities faced by those forced to live in the margins. Only then will we be able to ensure that toilets are a right, not just a privilege.  

Anoop Jain is a postdoctoral fellow at the Stanford Program on Water, Health and Development. His research focuses on elucidating the possible social determinants of toilet ownership and use in India. In addition to his academic focus on sanitation issues in India, Anoop is also the founding director of Sanitation and Health Rights in India (SHRI), a non-profit that improves access to toilets and safe drinking water throughout rural India. He received his Doctorate of Public Health from the University of California, Berkeley in 2019.