All posts by Diane Coffey

Three recent reviews of Where India Goes

We were very happy to find three reviews of Where India Goes in various corners of the internet and we wanted to share them with you!

The first is by Raghunath Nageswaran at Youth ki Awaas.  It provides a great summary of the book and includes some of our favorite quotations.

The second is by Mangesh Dahiwale at Velivada.  It talks about how sanitation in rural India is related India’s history and ongoing practice of untouchability.  It reminds us that working for social equality will be important for health and economic progress in India.

The third is by Alex Tabarrok at Marginal Revolution.  It talks about how open defecation in India is not about lack of access to latrines but rather about choices not to adopt the sorts of affordable latrines that have pits that need to be emptied by hand.

We are very grateful to Raghunath, Mangesh, and Alex for helping us spread the word about rural open defecation, its causes, and its consequences.  Thank you!

 

Check out Amit’s op-ed in the Hindu!

Today, the Hindu published an op-ed by Amit Thorat and Sonalde Desai that uses India Human Development Survey data to discuss poverty and social safety net programs in India.  Check it out here!

check out this new article on caste & sanitation

Thanks so much to Payal for sharing Nilanjana Sen’s new article at Fair Observer about caste & sanitation in India.  It talks about how India’s history and continuing practice of untouchability makes the adoption of simple latrines a unique challenge.  One of my favorite lines in the piece, which led me to set the village Ambedkar statue from Sitapur as the image for this post is:  “For Ambedkar, the problem of poor sanitation in India was a socio-cultural issue since the scavenger was invariably an Untouchable who was a permanent victim of his hereditary occupation.”

Check out the whole article here!

Nicholas Kristof, Pulitzer prize winning NYT journalist, discusses r.i.c.e. research

Nicholas Kristof, who is visiting rural Uttar Pradesh, wrote about the causes and consequences of India’s malnutrition problems in his NYT column yesterday.  We were thrilled to see that he discussed many ideas that have emerged from r.i.c.e. research.  He talked about poor maternal nutrition and open defecation as reasons for stunting, and pointed out that just because people own toilets doesn’t mean they will use them.  He even gave a shout out to the Muslim mortality paradox.   Do check it out!

Congratulations, Angus!

In celebration of the fact that my PhD advisor, Angus Deaton, has just won the Nobel prize in Economics, I thought I would share one of my favorite of his (many) graphs. The internet is filling up with tributes in various forms – but we thought he might prefer some compelling descriptive statistics.

This graph is figure 2 from his article, “Height, health, and development,” published in the Proceedings of the National Academy of Sciences in 2007. It shows that a country’s economic performance, as measured by GDP per capita, is a poor predictor of women’s heights in developing countries and regions around the world. This is an important finding because women’s heights are a marker of their health in early life, which also shapes their cognitive abilities, and many other factors that influence well-being over the life course.

One particularly striking thing about this graph is that women in South Asia are among the shortest in the world. Understanding why people in South Asia, and particularly in India, are so short, and what might be done about it, has been a big part of what keeps the r.i.c.e. team busy. We have Angus to thank for putting us on to these questions and for giving us so much to think about over the years. Congratulations, Angus!

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Also, if you haven’t read his book, The Great Escape: Health, wealth, and the origins of inequality, here is a link to where you can download three of the chapters, and see options for getting a print copy or an e-book.

Filthy filter

Recently, we at r.i.c.e. have been learning a lot about air pollution — how it is measured, why it is bad for health, where it comes from, who is most at risk, and many other things.  Because Delhi has a very, very serious pollution problem–WHO data suggest that it has worse air quality than any other major capital–we’ve also been learning about ways to protect our own health (albeit to a limited degree).  I thought I would share pictures of one of our air filters.

filter2The bullseye pattern is there because we’d initially had the SmartAir Hepa filter strapped on to a small.  We used it for about a month in a relatively low (for Delhi!) pollution time of year, and only for about 8 hours a day.  Then, we found a larger, quieter fan, and mounted the filter on top of the new fan.  We ran the larger fan for 24 hours a day for about 12 days.

It is extremely worrying to think about the 16 million Deliites who breathe this contaminated air every day.  It is no wonder that study after study has found severe health impacts of Delhi’s air pollution.

Bus ko rasta do

(Part of the Bus Rapid Transit Corridor in Sheikh Sarai in Delhi.  Photo: RV Moorthy)

If you haven’t already seen it, do check out Aashish and Karthik’s wonder op-ed on public transit in today’s Hindu.  It talks about how lack of willingness on the part of rich Delhites to sacrifice road-space for the convenience for poorer commuters, and for better air quality, rather than any intrinsic problem with BRT technology, gets in the way of a functioning bus rapid transit system in Delhi.  My favorite line in the op-ed is the last one: “Many commentators seem to believe that the involvement of international expertise in the design of Delhi’s BRT will solve its woes, but experts in physical design will have no remedy to offer for this deeper malaise of indifference.”

As with open defecation, the problem here is not with the technology.

 

reflections on the switching study: children would taunt “Bhangi! Bhangi!”

This week I’m in Sitapur, and it’s nice to be back after a long time.   I learn so much here.  Today, I was having a conversation about rural sanitation with Baby, a woman who long-time readers of our blog will already know.  She’s been our research assistant in Sitapur since late 2011.  For those who don’t know Baby, she has worked on a number of projects with us, including a cohort study of infants, a study of the Janani Suraksha Yojana safe motherhood scheme, and now, for over a year, she’s been collecting some original data about birth weight.  Baby is a 30-something Muslim woman who has a 12th grade education, and has traveled once to Delhi, and once to Rajasthan, but has spent most of her life in Sitapur.  I wanted to share our conversation from this afternoon because it highlights that the main findings of the qualitative “switching study” of open defecation that I’ve been working on this year, while certainly new to many of the policy makers we talk to in Delhi, are not new to people living in rural areas.

Lately, we at r.i.c.e. have been saying that sanitation programs should focus on behavior change — basically on convincing people to use simple latrines.  But no one really knows how to do this.  So, we’ve been considering the idea of asking Baby to do some interpersonal communication with villagers in Sitapur and to record the reactions and results that she gets.  To help me introduce this potential project, I got out some of the Hindi language educational materials on sanitation and latrine construction that our friends at the UNICEF office in Lucknow were kind enough to give to us on Friday.  We opened up a laminated flip chart about the construction of simple, honey-comb style pit latrines.   This type of latrine that the Indian government typically provides and is among the latrines recommended by the WHO.  It is inexpensive and safely contains feces.

I started by telling Baby about how in other countries, like Bangladesh, and Cambodia, and countries in sub-Saharan Africa, people make these latrines.  I told her about how using these latrines helps keep children healthy.  I pointed out that the pits of these latrines fill up and need to be cleaned out, or alternated, every 5-10 years.  I further explained that our research had found that people in rural India are resistant to using such latrines because they are concerned about the size of the pit.  Baby replied, “I know, in villages around here, if people build a latrine, they want the pit to last for life.  They don’t want to have to clean it out.”  I stopped, surprised but not too surprised.  Surprised, because here Baby was filling in the details of the results of a study that I hadn’t yet told her much about.  Unsurprised, because the results of the switching study are pretty much common knowledge to rural people, if not to people with decision making authority about sanitation programs.  And, unsurprised because Baby is pretty perceptive  when it comes to how people think, and what we outsiders need to learn — after all, it was she who initially suggested that there are big differences in latrine use between Hindus and Muslims, which helped lead to Dean and Mike’s paper about the Muslim mortality paradox.

Anyway, to get on with the story, I then said, “Yes, we heard that a lot in the interviews — that people want their latrine pits to last for life — they want really big pits that they don’t want to have to clean them out.”  I paused, and then said, “And we think this is because there is caste in India, which doesn’t exist in other countries.  In India, it is the job of “untouchable” (very low caste) people to clean up poop, but in other places, people are not as bothered about the idea of cleaning poop themselves, or of having it cleaned out from their latrines.”  Baby considered my explanation, and replied with a story.  She talked about how when she was growing up, her parents used to ask her and her siblings to clean out the drains (nalis) in front of their house once a week.  This work is often done by untouchables, because they are filled with waste water and sometimes feces.  But Muslims are generally less bothered about caste than are Hindus, and Baby’s family didn’t have much money to pay someone else to do the work.  Baby said that when they were doing this work, other children would come by and taunt them, shouting “Bhangi! Bhangi!”  Bhangi is the name for one of the untouchable castes.  It is also considered to be a bad word, which you would not say, even to a Bhangi, in polite conversation.

This interaction was meaningful to me for a couple of reasons.  First, the fact that Baby could so easily relate to the explanations that the switching study advances about why open defecation is exceptionally widespread in rural India suggests to me that our analysis is sound.  Second, it served as a sad reminder of just how pervasive and cruel notions of caste are in rural Uttar Pradesh.  If Muslim children are taunted for cleaning out the drains in front of their house, what indignities are suffered by “Bhangi” children?

100 interviews!

Today, the switching study team finished its final qualitative interview! We have learned a lot about sanitation attitudes and behaviors — from the banks of the Arabian Sea in Gujarat, to the foothills of the Himalayas in the Nepali terai. To tell you the truth, we feel quite humbled, because these interviews have taught us a lot about the precise ways in which it will be difficult to convince people in this region to make the switch to latrines.

We are grateful to all of the families in Gujarat, Haryana, Uttar Pradesh and Nepal who have opened their homes to us and so patiently shared their stories. I think it is fitting, though, that our very last interview was with a Muslim woman who convinced her family to invest in a latrine and valued it highly.

But that’s all I’ll say on our results for today. For now, we’re going to celebrate …

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and take a rest!

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Wise words, part II

I wanted to share Jeff Hammer’s blog post on the World Bank blog about the role of development economists in policy making.

More wise words from Jeff Hammer can be found on a previous blog post on the Indian health care system.

My hang up

Am in the car on the way back from our switching study village and I thought I’d make a quick post about how I’ve been feeling about the project.

When we started the switching study – a qualitative research project on latrine adoption in 4 regions of South Asia – I was pretty nervous. Sangita’s already told you about our lifestyle in the field—lots of people on one floor, cold baths and long lines for the bathroom in the morning. Though I must say having our own cook is pretty posh compared to other data collection projects I’ve worked on. But the thing I was most concerned about was how awkward it was going to be to ask people about where and how they poop. Can you imagine if someone came to your house and started asking you about your toilet habits? I thought I was going to spend weeks, which would add up to months, feeling uncomfortable and making other people feel uncomfortable.

Well, I thought wrong. Sure, people have once in a while laughed at my silly questions about how many times a day they go to the bathroom, but beyond that, they are quite happy to share the details of their defecation habits with me. People are quite comfortable answering questions about where they poop, why they do what they do, and which is better for you. And the things they say go against my intuition and that of many westerners and urban Indians, even those who work in sanitation policy. For instance, in these qualitative interviews, pretty much all of our respondents agree that going in the open is healthier than using a latrine. And it is not really something to be ashamed of – after all, everyone poops – don’t you? Even for women, it is not so much that families want to control who sees their women pooping as they want to control who sees their women at all.

Anyway, I’m getting away from my point – which was that not wanting to talk about poop was my hang up, not the villagers. We urban and westernized sanitation researchers and policy makers should take a hint from the villagers, and get a little more comfortable talking about open defecation in India. The more we do it, and the more comfortable we feel talking about it, the more likely it is that we’ll start talking about solutions, too!

Here are a couple of pictures from yesterday’s and today’s villages, just for fun.

Sahelis

In Hindi, saheli, means “female friend,” and only girls can have sahelis. This post is about two sahelis, Farzana and Suman, who, despite spending years on either side of the same wall, have had very different experiences of motherhood.

Farzana was 20 years old when I met her, and she was pregnant for the first time. She’d been married and living with her husband, his parents and sisters-in-law for five years. Everyone was happy about the pregnancy because they had worried that Farzana could not get pregnant. Farzana once confided in me that she had not even started to have her period yet when she was married, she got it for the first time more than a year after her marriage.

It was a difficult pregnancy: Farzana had trouble eating, she gained very little weight, and she was often sick. There was a time when she wasn’t eating much besides chewing on sugar cane. She went to the hospital to deliver, but her daughter died shortly after birth. Farzana was extremely anemic—she told me that she had had only 2 or 3 mg of hemoglobin per deciliter of blood at the time of delivery—and had nearly died. Instead of getting the blood transfusion that she needed, she was turned out of the government hospital and taken to a private hospital, where they took her money but failed to give her blood.

It took a few months for Farzana to get better, but when she did, she got pregnant again. A little more than a year after the birth of her first baby, at home, alone, in the middle of the night, without even candle to light the mud and dung room where she lives, Farzana delivered a baby boy. He was light skinned and chubby. He died when he was a week old. It took 8 or 9 days for Farzana’s milk to dry up, and she eventually had to delete the photos of the baby she’d taken on her husband’s mobile because they made her cry too much.

Farzana is expecting her third baby in May.

Each time I visited Farzana during her first pregnancy, her neighbor and friend, Suman, would poke her head over the cement wall that separated her house from Farzana’s, and start to chat. Eventually, Suman would walk around the wall and come to sit with us in Farzana’s family’s small outdoor sitting area, called an angan.

Suman, a high caste young woman, is a daughter of the village where Farzana is a daughter-in-law. Suman was married in July of 2012, and went to live in her husband’s house, closer to the town. Suman’s husband has a government job working on electric lines in another state, and her father-in-law had a government job as well. In contrast, Farzana is Muslim, an oppressed minority group in India, and her husband does informal manual labor work when he finds it. Unlike Farzana’s mud and dung house, Suman’s new house is cement, and unlike Farzana’s family, who often eat only flat bread and onions or chilis, Suman’s family has plenty to eat.

Last month, I visited Suman in her husband’s house. She was holding a chubby three month old baby boy. He’d been born in the end of August, in the same hospital as Farzana’s first. Suman was exclusively breastfeeding him, and when he wasn’t eating, he was constantly passed around and played with by Suman’s four younger sisters in law. When the little boy was two months old, Suman’s husband took her to her village to introduce the baby to family and friends. Farzana called Suman over to her house, and Suman went to introduce the little boy to her friend.

It’s true that life is worse, on average, in some countries than others, and in some districts than others, and even in some villages than in others. But what I learned from Suman and Farzana is that life and death can be very different for moms and babies—and two sahelis—even on two sides of the same wall.

Happy Holidays from rice

Some of you may have already seen this by following the link on our holiday cards (thanks Allie for making our awesome holiday cards!), but I wanted to post this letter on our blog too! Thanks so much for all you do to make rice‘s work possible, and happy holidays!

Dear friends,

Thank you all for everything you have done to make rice’s 2013 a success. As the family portrait above shows, we have grown into a big team. What you cannot see in the picture is what a dedicated and talented group has come together, and how grateful we feel to be working with one another.

As we write, we have surveyors working in Bihar and Haryana, asking people important questions about what they think and feel and want, all on one of the trickiest topics to talk about with strangers. It is a tall order, but our surveyors and team leaders are up to it. By the end of April, we expect they will have spoken with thousands of rural households across eight states of north India. Policy-makers will have more data than ever before about the challenges of ending open defecation in India.

This early start to 2014 caps a 2013 that has seen more advocacy success than we could have predicted a year ago. Our work highlighting the importance of sanitation for child health and growth has appeared in newspapers in Ethiopia, Cambodia, China, and, of course, again and again here in India. We’ve taken our message to central government ministers, local development officers, non-profit partners large and small, newspapers, magazines, and even TV! An active community is growing around commitment to the idea that eliminating open defecation is a priority for human development in India.

India, where one-sixth of all humans live, faces three interlocking challenges. First, the problem is huge: most of the people here do not use toilets, and most of the people in the world who don’t use toilets live here. Second, because of high population density, sanitation especially matters in India: pound-for-pound, reducing open defecation by the same amount in India will have a larger effect on infant mortality and child growth than in most other places in the world. Third, many people here resist switching to safe sanitation; too many people here simply don’t recognize how bad for their children’s health poor sanitation can be. There is no logical reason these had to all happen in the same country, but in fact we all live in a world where they did.

That is why we are so grateful for your help. We could not be growing our team, spreading our message, and reaching across India without the support that all of you provide.

We hope you will click on our “photos” tab to see pictures of rice in action in India, putting your support to good use. Keep in touch in 2014 – watch our blog for more stories, more data, and more pictures!

Happy holidays, and our deepest thanks,

Aashish, Avinash, Dean, Diane, Nikhil, Sangita

No shame in a simple pit latrine

Yesterday was my last day with the team in Rewari, Haryana. Sangita, Nikhil, Nidhi and I had finished up collecting qualitative data to try to understand latrine adoption in the last 10 years. Thanks to our friendly respondents, many of whom were willing to have their interviews recorded, we have lots of interesting findings about latrine adoption and use, and some really fun quotations. But the findings of the “switching study” in Haryana will have to wait for another day.

Today I just want to take a couple of minutes to share a short story about a modest pit latrine. Amit from Arelia (there are two Amits on our team, so we call them Arelia wala Amit and Nalanda wala Amit – Amit from Arelia and Amit from Nalanda) and I were doing an interview for the quantitative survey with an older man in Rewari block. He answered our questions kindly and patiently, but when we got to the section in which Amit was supposed to observe the man’s latrine, the man said it not at the house (it is common in Rewari for people to built latrines on the plot of land where they keep their animals). I told Amit to finish the interview and that we’d fill in that section later. When we finished the interview, we again asked to see the latrine, asking whether there was a child from the house who could take us to the plot. The man looked uncomfortable and said that that would not work. We suggested we could find our way ourselves, and he said no, so we gave up.

Later, when I was reviewing the survey forms in the car, Amit told me that on his way back past the house, the man’s grandson, who was about 20, stopped him. They talked for a bit about the survey, and the grandson asked Amit if he wanted to see the latrine. It turned out that the old man was ashamed of his latrine, which was why he had not wanted to take Amit to see it.

Why would the older man be ashamed of his latrine in a place where so many people practice open defecation? Well, in Haryana, people tend to build extremely fancy latrines, or none at all. The fancy latrines have water seals that prevent bad smells and in many cases flush tanks – we even saw latrines equipped with both a western toilet seat and an Indian one. Here is a photo of one of the fancy latrines from the switching study.

The man who we interviewed had built a perfectly serviceable but, for Haryana, relatively simple pit latrine. It consisted of a hole lined with cement rings, with a cement slab and an Indian seat placed over the hole. He’d built a brick structure, only about 4 feet high, around the seat, and used a plastic tarp as the roof. Though I did not see the latrine myself, from what Amit described it would have looked something like the simple pit latrines we saw all over Bangladesh. I couldn’t find any pictures from Bangladesh with brick superstructures–they tend to use tin–but this will give you an idea of the difference in fanciness between the latrines that the old man may have seen, and the one that he built for his family.

What the old man didn’t know is that I would have been THRILLED to see this simple pit latrine. You see, most people in rural India are not going to be able to afford to build the fancy toilets that you see in the top picture, and that many people in Haryana have been able to build thanks to the state’s incredible recent economic progress. If people in other parts of rural India are going to end the practice of open defecation, they will need more makeshift and lower cost solutions, like the one that this man had built for his family.

And we’re off!

Hello friends!

Sorry for the long break from blogging. We’ve had a whirlwind past 10 days of training for the sanitation survey! We’ve been staying at the Sabhagi Shikshan Kendra’s (SSK) training center on the Sitapur-Lucknow road. In addition to providing more meals of potato, roti, yellow daal and rice than we could count, they also given us a place to sleep, to make friends and to train an amazing group of surveyors on the sanitation survey.

We’ve put together an experienced team of surveyors and team leaders from all over North India, including Bihar, Jharkhand, Rajasthan, Uttar Pradesh, Delhi, and even Assam! They’ve worked on some of our favorite surveys – including the National Family Health Survey, the Annual Status of Education Report and the HUNGaMA project! Here they are on the steps of the SSK.

For the last 10 days, they’ve been mastering rice’s sanitation survey, learning how to delicately ask people about some of the most intimate topics – how do they relieve themselves, why do they do what they do, and how do they think about it? It’s been a ton of work…with in-class training…

…and in-the-field practice and piloting.

Over the next five months, we plan to visit over 3000 households in 16 districts in 8 states of north India. This morning, half the team headed out for rural Bihar, and as I type this, our train is pulling of Lucknow station. We are headed for Harayana, a state that has experienced a more rapid improvement in sanitation in the past 10 years than most other states in India.

Wish us luck as we work to generate the data that will help us answer some of sanitation policy’s most important questions. And stay tuned for lots of stories from the field!

New photos from Sitapur

Check out the new photos of life in rural Sitapur posted on the photos tab! Many thanks to Aashish, who among many others things, takes wonderful pictures for rice! He rode around the villages near our house early one morning to bring us these great shots. This one, of a woman sorting through her grains, is one of my favorites, but there are many great photos to chose from!