Curbing Open Defecation in India for Positive Health and Human Rights

Over 600 million people in India—53 percent of the country’s population—defecate in the open, without using a toilet or a latrine.

More than 600 million people in India—53 percent of the country’s population—defecate in the open, without using a toilet or a latrine. The effects of this action are numerous, including but not limited to: increased transmission of water-borne diseases resulting in mortality, limited cognitive capacity particularly for youth, environmental contamination of soil, water, and crops, a decrease in tourism, and a tarnished international image.

Resulting nationwide consequences also include higher government and individual spending for those pursuing disease treatment, of access time such as school and work absences due to inadequate toilets for women and girls, as well as a loss in tourism revenue due to foreign perception and contraction of gastrointestinal illnesses. In purchasing power parity (PPP) terms, the adverse economic impact of inadequate sanitation in India was about $161 billion or $144 per person, in 2006.

These numbers however, given the aforementioned subsets, differ between India’s northern and southern regions (with worse public hygiene in the north), between urban and rural contexts, as well as between individual and family income levels. Because the consequences of inadequate countrywide sanitation affect several interdependent factors of social welfare, and is a matter of basic human rights and dignity, international and internal efforts must be channeled towards not only curbing open defecation, but also encouraging the prevalence and usage of toilets and latrines.

Health as a Human Right

In 2010, the United Nations General Assembly and the Human Rights Council recognized access to clean drinking water and safe sanitation methods to be basic and essential human rights. Sanitation is, therefore, an entitlement, rather than a commodity, mandating that efforts focus on those vulnerable populations hardest to reach. This often involves empowering communities through education and engagement in the decision-making processes, using the United Nations’ mechanisms to monitor their progress and hold governments accountable.

As Catarina de Albuquerque, the first UN Special Rapporteur on the right to safe drinking water and sanitation, has said: “Dignity closely relates to self-respect, which is difficult to maintain when being forced to squat down in the open, with no respect for privacy, not having the opportunity to clean oneself after defecating, and facing the constant threat of assault in such a vulnerable moment.”

Open defecation further repudiates the right to well-being, as stipulated by Article 25 of the Universal Declaration of Human Rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

Without using a toilet or latrine accompanied by proper washing mechanisms, a multitude of diseases are easily communicable, such as typhoid, diarrhea, intestinal worms, trachoma, polio, encephalitis, dysentery, and hepatitis. More than 800,000 children under age 5 die each year due to diarrheal diseases, caused when pathogens present in feces end up in stomachs, from either not washing hands when using a latrine or toilet or from contaminated food, water, soil, animals, and flies. Cholera is also a pressing problem in many Asian and African countries, with more than 830,000 cases reported by the World Health Organization in a four-year period.

More appallingly, an estimated 400 million school-aged children in the developing world contract intestinal worms, from inadvertently ingesting human feces or food contaminated with feces. Chronic hookworm infections reduce physical growth and impair intellectual development, especially during early stages of childhood, leading to intense whipworm infections that cause children to miss twice as many school days as those worm-free. The takeaway, then, is that stopping open defecation and improving sanitation methods are key to lowering mortality rates, improving nutrition and reducing stunting rates, as well as increasing retention rates among school children and their cognitive abilities.

The Remedy

Public sector challenges, such as open defecation, often result from insufficiencies across various entities: government operation, policy makers, geographical locations and environmental pressures, quality education and guidance, access to healthcare, and material resources—to name a few. While institutional and academic studies of the composition of informative manuals can be helpful, it is more effective to specifically target the individuals who partake in open defecation through local educative methods for self-sustainability and practical change. Thus, solutions should be divided into prevention and treatment, in an effort to combat the overlap of these shortcomings.

Many stakeholders would need to commit and cooperate, involving government officials, private companies, NGOs, and those who defecate in the open, themselves. This requires incentivizing each stakeholder through components and categories that affect them the most. Given the Indian government, officials may deem best to spend national monetary resources towards other areas, for example, in the realm of defense or security.

But if they were instead presented with the appropriate, already conducted research on how open defecation is a national health and image issue, this may convince them that through solving open defecation, overall government expenditure on healthcare, for example, would decrease. The issue can be further remedied by pairing government accountability with NGO operations, via community outreach and educative campaigns (potential “market” for NGOs)—such as the UN’s “World Toilet Day.”

Furthermore, appealing to private companies, such as those for construction and waste management, would allow for more manpower and funding, while incentivizing them to be sole partners in the business aspect of this cause and, therefore, advertising for their services.

Lastly and most importantly, there should be a focus on sustainability—more specifically, self-sustainability. What goes to say that these partnerships between local organizations and communities will not fall apart? In building such ties, local NGO representatives and community activists should be trained, so as to be able to answer questions accurately regarding what open defecation is, why it is a problem given its health consequences, and sample solutions to combat this “norm.”

So What?

Protecting and advocating for positive health and well-being are duties inextricably linked to promoting human rights. While open defecation may not be a health concern that easily comes to mind, such as HIV/AIDS or maternal mortality, its health consequences are undoubtedly just as widespread. Similar to other public health epidemics, its preventative measures lie at the hands of policy makers, advocacy organizations, research centers, businesses, and vulnerable communities themselves—working in conjunction to ensure success, safety, and dignity as inalienable pursuits for all human beings.