In January, a group of researchers, coming from a wide variety of academic institutions such as University of Texas at Austin and U C Berkeley, released the end results of their study titled Changes in Open Defecation in Rural North India: 2014-2018. Udit Misra interviewed the lead author of this study, Ashish Gupta of University of Pennsylvania, to understand the policy lessons
Why did you choose North India?
We conducted a study on changes in open defecation in 4 north Indian states: Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh. We revisited 1558 households between September-December 2018 in these states whom we had first interviewed in December 2013 – April 2014. More than 42% of all rural residents in India live in just these four states. In these four states, four-fifths of all rural households did not own a toilet in 2011. Consequently, child health in these states is particularly bad… It is incredibly important to understand the causes and consequences of open defecation in these states.
Did Swachh Bharat Mission and ODF free India help matters? If so, to what extent?
The SBM accelerated the pace of toilet construction in these states. In our study, we found that open defecation declined from approximately 70% of rural people in 2014 to approximately 45% in 2018. This represents an annual rate of decline of about 6 percentage points per year, which is a rapid acceleration in the rate of decline compared to the 2 percentage points per year documented by the 2005 and 2015 National Family Health Surveys (NFHS).
However, this increase came largely from increases in toilet construction, and not from increases in toilet use among households that own toilets. In both the 2014 and 2018 surveys, we found that among households that owned a toilet, 23% of the household members still defecated in the open.
Even more worryingly, we found that coercion and threats have been a central feature in the implementation of the SBM. More than 12% of households in our survey had faced coercion: many had received threats that they would no longer receive public benefits such as subsidised grains from ration shops. Some had even been denied these benefits. Those belonging to disadvantaged social groups, such as Dalits and Adivasis, were more likely to have faced threats and coercion. The SBM, instead of challenging caste and inequality, ended up reinforcing it.
What are the policy lessons?
Going forward, it is essential that there is still a sanitation policy. We have seen that once a state is declared open defecation free, sanitation programs stop. There is no funding available for even toilet construction for people who still do not have one. Additionally, For the next rural sanitation policy, coercive tactics should be stopped, and latrine use should be encouraged. In this, efforts to transform social attitudes related to purity and pollution are essential.
How does India compare with the rest of the world on cleanliness and sanitation? Are there one or two countries that we could learn from?
According the UNICEF and WHO Joint Monitoring Program, Bangladesh had eliminated open defecation in 2017, and just about 0.2% of China’s population defecated in the open. In Sub-Saharan Africa, which is poorer than India, just about twenty percent of the population defecated in the open.
An important reason why open defecation persists in India, compared to other even poorer developing countries in the world, is the persistence of beliefs in caste and untouchability. Because of these beliefs, rural Indians do not want to build and use the kinds of simple pit latrines that are commonly used in other countries because the pits of these latrines require periodic emptying. The findings of our study show that the Swachh Bharat Mission did not adequately address these social attitudes in its activities.