The battle to end open defecation in India needs to be fought on two fronts: on the ground with toilets and sanitation infrastructure, and in the hearts and minds of the people by repositioning toilets so that latrine use becomes the norm.
Until we drive demand for toilets, we will not see the uptake and usage of toilets in India, even as toilets become available.
Of the 1 billion people that still practice open defecation today, almost 600 million, or around 60 percent, reside in India alone. The impacts of open defecation on public health are immense and include the spread of cholera, typhoid, worm infestation and diarrhea, as well as reduced physical growth, undernutrition and impaired cognitive function. Those countries where open defecation is most widely practiced have the highest numbers of deaths of children under the age of 5. And open defecation also impacts on human safety and dignity — in particular women are more vulnerable to gender-based violence and sexual assault when they defecate in the open.
India has launched a massive drive to address toilet infrastructure — 111 million toilets will be built by 2019, that’s more than 60,000 toilets per day, or nearly one toilet every second. Indian Prime Minister Narendra Modi has personally pushed the sanitation agenda in India and is committed to ending the practice of open defecation. However, simply building toilets and sanitation infrastructure will not stop open defecation in India.
Having access to safe and clean toilets is a start, but it does not address long-standing habits or how personal preference affects behaviour with regards to toilet use. We have seen toilets built in India in the past being abandoned, or used as storerooms.
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Over generations in India, open defecation has been the norm. Not only is it the norm, many actually prefer to defecate in the open. According to a recent survey of rural households by SQUAT in several states in north India, many people that own latrines continue to defecate in the open, and 47 percent of people that practice open defecation actually prefer going in the open to using a toilet, and see going out in the open as “pleasurable, comfortable or convenient.” Other perceived benefits of open defecation include social aspects of going out to the fields, getting fresh air, and that it is free.
And toilets have perceived downsides: They are seen as dark, small, enclosed, dirty, they need to be emptied and they cost money. In reality toilets mean health and economic benefits, and improvements to human dignity, but we need the perception of toilets to match this reality.
The aim is to have all 111 million new toilets in India not just built, but used. In order to see this happen and make India open defecation-free, we need to shift the prevailing mindset about toilet use and change behavior by repositioning the toilet — from a dark, dirty and smelly room to a “happy room,” with perceived status, social and convenience benefits.
In the past, the message has always been rational, focused on health impacts and the importance of hygiene: If you don’t use a toilet you will get sick. While this message can be understood rationally, rationality has not yet solved the toilet and sanitation crisis in India.
We need to understand what motivates people, and position toilet use as aspirational, associated with a sense of pride and dignity, in order to encourage toilet use as a personal preference, and drive demand for toilets. By making the toilet an aspirational product, we will be able to realize the full potential and the full benefits of the sanitation drive in India.
Since 2001 and along with our partners, the World Toilet Organization has been tackling the toilet taboo, using humor to raise awareness of the sanitation crisis. Now we are calling on the private sector, the government, corporations, individuals, celebrities and the media to collaborate and work together with us to end open defecation in India.
The private sector is adept at understanding what motivates people and what drives their decision-making, how to position a product as a status symbol, and how to drive demand. By working together with partners in the private sector and enlisting their marketing expertise, we can create a compelling behaviour change campaign. And by partnering with the government and local authorities, celebrities, sports stars and the media, we can disseminate a message to drive a change in behavior from the cities to the villages, to reach every level of society, continuously until people see a toilet as desirable, and eventually as normal.
Together we can work toward 111 million toilets not only built, but being fully utilized as they were intended. Only then will we see an end to open defecation in India, and the dignity, equality and health benefits that come from sustainable sanitation.
Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.