Influencing the beliefs, attitudes, or behaviors of others through research is tough, and often unsuccessful. But this reader’s comment on Diane’s recent article in The Hindu on women eating last inspires us to keep on trying.
Our article on pollution, latrine pits, and untouchability has been published in this week’s EPW! This article discusses the findings of the Switching Study, which we started several years ago. So it’s great to finally see this in print!
India has far higher open defecation rates than other developing regions where people are poorer, literacy rates are lower, and water is relatively more scarce. In practice, government programmes in rural India have paid little attention in understanding why so many rural Indians defecate in the open rather than use affordable pit latrines. Drawing on new data, the article finds that widespread open defecation in rural India is on account of beliefs, values, and norms about purity, pollution, caste, and untouchability that cause people to reject affordable latrines. Future rural sanitation programmes must address villagers’ ideas about pollution, pit-emptying, and untouchability, and should do so in ways that accelerate progress towards social equality for Dalits rather than delay it.
Access the article from EPW’s website here, or download it from our research page.
And congratulations to Avinash, one of our board members, and his colleagues, who also have an article published in this week’s EPW on policy options for making pulses more affordable! See his article here.
The Hindu just ran a four-part series covering the Social Attitudes Research for India (SARI) Survey. SARI uses a sampling frame based on mobile phone subscriptions, random digit dialing, within-household sample selection, and statistical weights to build representative samples of adults 18-65 years old. So far, we’ve interviewed 1,270 adults in Delhi and 1,470 adults in Uttar Pradesh. Through this study, we are trying to learn about people’s perceptions and attitudes towards socially excluded groups, and experiences of discrimination faced by Dalits and Muslims.
In the first op-ed, Diane and Amit discuss perceptions of inter-caste marriage. About 40% of respondents in Delhi and more than 60% in rural Uttar Pradesh said that there should be laws to stop marriages between upper castes and lower castes.
In the second, they discuss how common it is for people to report that their household practices untouchability. Among non-Dalit Hindus in Delhi, a third said that someone in their household practices untouchability. In Uttar Pradesh, half of adults said that someone practices it.
In the third op-ed, Amit discusses the opposition of caste-based reservations, and the reasons people give for their opposition.
In the final op-ed, Diane talks about how common it is for women to eat last. One in three adults in Delhi, and six in ten adults in U.P. said they lived in households where men eat first. Since infants get all of their nutrition in early life from their mothers, moms eating last has important implications for child health.
Today is Gandhi Jayanti, which marks the first anniversary of the Swachh Bharat Mission. r.i.c.e. marked the occasion a few days ago by hosting a Conference on Purity, Untouchability, and Open Defecation: Starting a Conversation for a Swachh Bharat.
At the conference, researchers and policy makers alike agreed that in order to have a chance at eliminating open defecation in India, the SBM must address how beliefs in purity and pollution and the continuing practice of untouchability hinder the use of simple, inexpensive latrines that save infant lives all over the rest of the developing world.
Today, the media agreed too. An editorial in the Indian Express says:
“For it to succeed, Swachh Bharat will also have to account for the culture of purity and pollution rural sanitation is embedded in, and more carefully negotiate issues of caste on the ground. A recent study in the BMC Public Health found that “strongly ingrained beliefs around impurity and pollution and the required rituals for purification and cleansing post-defecation in Indian society may play a big part in the choice to continue defecating in the open”. Modi’s use of his bully pulpit has focused much-needed attention on a dirty reality of Indian society, but a cleansing will take more.”
Anumeha Yadav, in her article in Scroll, also talks about the problems faced when beliefs in purity and pollution are not tackled. She visited an ODF village in Rajasthan in which a number of households were forced to build latrines and took out large loans in order to build latrines with massive pits. Latrines with smaller pits that nevertheless safely confine feces in the ground could be built for much less. She says in her article:
“Till 15 years ago, Dausod had a system of dry latrines which were cleaned manually by dalit communities. With the arrival of flush toilet, the practice ended. But because of the lingering association of latrine cleaning with manual scavenging, wealthier families which constructed toilets first built latrines with large single pits so they can put off emptying them for as long as possible.”
An article in Hindustan Times echoes the same issues:
“In this hurry to achieve the construction targets, what we are losing sight of is the fact that building toilets is just one part of the challenge. The other objectives of SBM — eradicating manual scavenging, implementing effective scientific municipal waste management, effecting behavioural change among the people, generating awareness on the link that exists between sanitation and health and augmenting the capacity of urban local bodies — are equally important and have to be put in place if India is to achieve the 2019 target. This is because without water supply and safe disposal of faecal matter, toilets would become non-functional.”
You can download the presentations from the conference here.
For those of you haven’t been paying attention to the uproar in India over whether school kids get Christmas off this year, we have one more thing to rejoice today: India’s “commitment towards providing transparent, effective and accountable governance to the people of this country.”
Since today is a day to celebrate governance, I thought I would share a relevant story with you from my recent trip to Sitapur. I spent much of the trip in villages talking to people about pit cleaning, and in the process Nikhil and I ran into a household that uses a dry latrine. Now, it’s no secret that manual scavenging still exists in India. Despite the passage of The Employment of Manual Scavengers and Construction of Dry Latrines Prohibition Act in 1993, the 2011 Census recorded almost 8 lakh dry latrines that are cleaned out by people. After over 20 years since the prohibition of manual scavenging, this degrading and inhumane practice still persists.
What was surprising about this particular family was that the head of the household is an anganwadi worker. So, what’s new? Government employees break the law all the time. But, she thought that we were also from the government, and were there to give away latrines. Despite this belief, she had no qualms about telling us she uses a dry latrine and even allowing us to look at it. Not only does her behaviour suggest that use of dry latrines is socially acceptable, it also suggests that she either has no knowledge of the Act or at least no fear of its enforcement.
Having a place to defecate in the home is pretty important for this anganwadi’s family. Her son had polio when he was a child and now can hardly walk. He is now 21 and gets around on a three-wheeled cycle which he pedals with his arms. He uses the dry latrine because it isn’t easily able to go in the open by himself and it would be difficult for anyone else in the household to pick him up to take him out. The anganwadi worker uses it too because she believes it is inappropriate for women to go in the open. Every few days, a sweeper comes to pick up the poop and throws it out somewhere, and in return he or she gets Rs. 60 per month.
We tried talking with this household about other inexpensive latrine options. They weren’t excited about any of them. It seemed that as long as manual scavengers were available in the village and would do this work, they would keep using the dry latrine, regardless of any law against it.
How can we expect laws to be enforced and social norms to change when the government isn’t even enforcing good behaviour in its own ranks, among the employees who are closest to the ground? So, as we celebrate the path to good governance today, we should keep in mind just how long the road is.
The full dataset from the SQUAT Survey is now available here! You will find the questionnaires and documentation files, also accessible at the same link as above, helpful if you decide to use the data.
We invite you all to play around with the data and do interesting analyses! Get in touch if you have questions, feedback, or things to share.
We just concluded a great week at the Water and Health Conference at UNC! Between the 4 of us attending, we had 6 verbal presentations and 6 poster presentations over the course of the week. We were so thrilled to be able to share so much of our work and to get such great feedback.
The highlight of our week was Tuesday’s side session in which we presented research from the SQUAT Survey and the Switching Study, and heard Tom Clasen’s thoughts on latrine use in India. The session concluded with a panel discussion between Robert Chambers, Oliver Cumming, Barbara Evans, and Eddy Perez, moderated by Jan Willem Rosenboom.
Stay tuned for our presentations, which we’ll put up very shortly.
Now, I don’t really like to talk too much about toilets because it takes away from the conversation on latrine use, but Aashish and I just did some math on missing toilets, and the statistics are pretty stark.
For the past 15 years, the Total Sanitation Campaign, and then the Nirmal Bharat Abhiyan (NBA), has been building latrines across rural India, but despite these efforts, there has been little reduction in open defecation. In fact, from 2001 to 2011, latrine coverage in rural India increased by about 1 percentage point each year. A total of 5.2 crore rural households, or 31 percent of rural families, had toilets by 2011 in total. The website for the NBA, however, states that it built 8.7 crore toilets between 2001 and 2011
The government’s claims are even more startling when you consider that the Census showed that only about 80 lakh new toilets were built in rural areas over the same period. Let’s make the incorrect assumption that the government was responsible for all of these new toilets. For every toilet that was actually constructed, the government spent money to build 10!
So how many more missing toilets will there be on 31st August, the end of the PMs first 100 days, and the deadline for the construction of 5.2 million toilets? Wouldn’t it be a much better use of funds to instead focus on promoting latrine use, instead of building phantom toilets?
The Prime Minister yesterday gave his Independence Day speech at the Red Fort, and brought up sanitation as an important issue for the next 4 years! He says,
I, therefore, have to launch a “Clean India” campaign from 2nd October this year and carry it forward in 4 years. I want to make a beginning today itself and that is – all schools in the country should have toilets with separate toilets for girls. Only then our daughters will not be compelled to leave schools midway. Our parliamentarians utilising MPLAD fund are there. I appeal to them to spend it for constructing toilets in schools for a year. The government should utilise its budget on providing toilets. I call upon the corporate sector also to give priority to the provision of toilets in schools with your expenditure under Corporate Social Responsibility. This target should be finished within one year with the help of state governments and on the next 15th August, we should be in a firm position to announce that there is no school in India without separate toilets for boys and girls.
While we are very happy to know that Modi continues to prioritize improving sanitation, any successful campaign to eliminate open defecation in India will need to focus on latrine use, not just building latrines. We hope that the designers of the “Clean India” campaign will keep this in mind.
Read the whole speech here.
We often think that education in general, and educating people on how bacteria spread, will get people to use their latrines. In the graph above, we are able to see latrine use by sex and level of education for people who live in households that have a latrine. The data are from the SQUAT Survey of sanitation attitudes and behaviors in the rural parts of 5 north Indian states. What the graph shows is that even among highly educated individuals who have a latrine, a sizeable proportion still defecate in the open.
Of course, more educated people are more likely to use the latrines they have than less educated people, and women are more likely to use their latrines than men at every level of education. But, what is striking is that close to 20% of men who have studied up to the 12th class still defecate in the open even though they have a latrine at home. A larger fraction of men in our sample who are 12th class graduates in households that own latrines defecate in the open than do all people in Ghana, Senegal, and Zambia.
Defecating in the open is very much a part of Indian culture, and is much harder to change than just through education. Just relying on teachers to teach germ-theory in schools may not do the trick.
Bloomberg News came out with a story yesterday on how government latrines are often not used in rural north India because people are often disgusted by them. The journalist quotes Yamini Aiyar, of Accountability Initiative, saying:
Targets for construction of toilets are somewhat irrelevant to resolving the sanitation problem. Building toilets does not mean that people will use them and there seems to be a host of cultural, social and caste-based reasons for that. People need to be taught the value of sanitation.
To continue the trajectory of chart month, I’d like to share some of the data that we collected in the SQUAT Survey on latrine ownership and usage among different religious groups. The SQUAT Survey teams randomly selected and interviewed around 3,200 rural households in over 300 villages in Bihar, Haryana, Madhya Pradesh, Rajasthan, and Uttar Pradesh. For a more detailed explanation of the sampling strategy, see our SQUAT policy brief.
Among SQUAT survey respondents, 52% of Muslim households have latrines, while a smaller 43% of Hindu households do. Moreover, the graph above shows that for every level of wealth, measured using a simple sum of a series of assets, Muslim households are more likely to have a latrine than Hindu households are. These results are similar to what one would see using larger datasets like India’s NFHS and the IHDS.
Now of course, one of the main contributions of the SQUAT survey is that it allows us to look at usage, not just ownership. The following graphs look at usage among people who have latrines and are chock full of interesting stuff. First, they show that for men and women of all ages, Muslims use the latrines they have more often than Hindus do. However, this difference is more prevalent among women than men, suggesting that purdah among Muslim women may be an important factor here.
The other interesting thing about these graphs is how usage changes among different age groups. Now remember, this data is cross-sectional, so it doesn’t show how usage changes over time for individuals, but how usage is different right now among different age groups. Young children often defecate in the open. As they get older, both women and men tend to use their latrines more, although women of childbearing age are more likely to use than men of the same age. Older people are more likely to defecate in the open, most likely because it is their habit. It’s what they have been doing since they were children. Finally, there is an uptick in usage among the very old, probably because ailing health makes it difficult for them to walk out to the fields.
The story that these graphs tell is that in the rural areas we visited in north India, just as in larger nationally representative datasets, Muslims are more likely to own latrines than Hindus. Moreover, among those households who have latrines, Muslims are also more likely to use it. Given the consistency between different datasets, both nationally representative and focused on rural areas where the sanitation problem is concentrated, and the consistency between ownership and usage, I’m pretty convinced that this story is real.
I recently picked up V.S. Naipaul’s book An Area of Darkness, a chronicle of his first trip to India published in 1964. Although some view the book as overly pessimistic and scathing, his portrayal of India’s culture of open defecation is uncannily accurate.
Shankaracharya Hill, overlooking the Dal Lake, is one of the beauty spots of Srinagar. It has to be climbed with care, for large areas of its lower slopes are used as latrines by Indian tourists. If you surprise a group of three women, companionably defecating, they will giggle: the shame is yours, for exposing yourself to such a scene.
In Madras the bus station near the High Court is one of the more popular latrines. The traveller arrives; to pass the time he raises his dhoti, defecates in the gutter. The bus arrives; he boards it; the woman sweeper cleans up after him.
In Goa, you might think of taking an early morning walk along the balustrade avenue that runs beside the Mandovi River. Six feet below, on the water’s edge, and as far as you can see, there is a line, like a wavering tidewrack, of squatters. For the people of Goa, as for those of Imperial Rome, defecating is a social activity; they squat close to one another; they chatter. When they are done they advance, trousers still down, backsides bare, into the water to wash themselves.
Indians defecate everywhere. They defecate, mostly, beside the railway tracks. But they also defecate on the beaches; they defecate on the hills; they defecate on the river banks; they defecate on the streets; they never look for cover.
A handsome young Muslim boy, a student at a laughable institute of education in an Uttar Pradesh weaving town, elegantly dressed in the style of Mr. Nehru, even down to the buttonhole, had another explanation. Indians were a poetic people, he said. He himself always sought the open because he was a poet, a lover of Nature, which was the matter of his Urdu verses; and nothing was as poetic as squatting on a river bank at dawn.
He eloquently describes in these vignettes what we have found 50 years later in the SQUAT and Switching Studies: that defecating in the open is the social norm. It is considered to be a part of the wholesome, rural life, in which one takes a walk outside in nature, socializes with friends, and avoids polluting oneself and one’s home.
Clever title aside, Victoria Fan and Rifaiyat Mahbub of the Centre for Global Development discuss the overlaps between an older paper by Shroff et al and a more recent one by Arabinda Ghosh and r.i.c.e researchers, both explaining the differences in health outcomes between West Bengal and Bangladesh.
Fan and Mahbub end with:
And yet both our study and this newer study seem to be deficient and complement each other. Our study did not account for the nutritional status of women or the problem of open defecation in trying to understand differences in health indicators across West Bengal and Bangladesh. Meanwhile, the recent study stopped short of disentangling oral rehydration therapy and immunization.
More research that increases the scope of these two studies and examines the combination of the factors explored in two works discussed needs to be undertaken. Drawing on these natural experiments is also a fruitful area for research – the Two Bengals, Two Punjabs, two Germanys, two Koreas, two Chinas, etc. Any takers, public health students?
We are all for more research on this topic, and we are definitely all for taking advantage of more natural experiments!
Julie McCarthy of National Public Radio covers the recent incident of sexual and caste violence in Badaun and open defecation. She rightly highlights the importance of shifting social norms in order to eliminate open defecation, and even uses some statistics from the SQUAT survey!
The Gates Foundation’s Brian Arbogast says even affordable innovations won’t alone solve India’s sanitation problems. He says India needs to shift the mindset that open defecation is ‘natural and normal’ to ‘it is not healthy.’
‘You teach them that their children and their families are suffering a lot of sickness because of basically fecal matter being transmitted by flies or other ways to the food they eat,’ Arbogast says. ‘And once people really realize that, that can really be a triggering event for a community.’
Diane Coffey, an economist and Ph.D. candidate with Princeton’s Woodrow Wilson School says simply providing latrines is no guarantee that people will actually use them. She studied five northern Indian states and found that 19 percent of women with access to a latrine still preferred to defecate in the open.
‘They’re used to it, for one,’ Coffey says. And she says the research is clear that ‘building toilets without addressing common norms, attitudes and beliefs around latrine use is unlikely to reduce open defecation in rural India.’
And she’s very right about Indians’ expectations of Modi. He better make good on his recent election campaign promise: “toilets first, temples later.”
Check out her article and radio segment here.
Today we have a blog post by Nidhi Khurana, our wonderful SQUAT survey team leader. She has been traveling around with our SQUAT team for the past 3.5 months, and she is finally sharing some of her experiences with you all today! We will hopefully have many more of these before the survey ends.
“We have got 450 latrines built for our villagers. 650 more applications have been received and we seek to provide them soon to everyone.”
Last month, I visited a village with the SQUAT team in Tonk, Rajasthan, that had started its own local sanitation campaign. The figures mentioned above are the number of latrines that were given to the beneficiaries in this village, impressive given what the NBA and IAY normally cover in a year.
As usual, after sending all the surveyors in their assigned directions, I went to talk to the Sarpanch. I reached the Sarpanch’s house and asked for him/er. Somebody escorted me to the back courtyard without asking my purpose for meeting the Sarpanch. Thinking this was a normal Gram Panchayat meeting, I took a seat and started listening to the conversation. At first, I was a little baffled because they were speaking in English! This was quite strange for a GP meeting. Then, a lady who was so well-dressed I thought she could be a TV reporter started introducing her colleagues to the others at the meeting. This lady turned out to be the Sarpanch. And she was introducing her team to some visitors from a large international NGO. This wasn’t a normal GP meeting at all!
And then everyone’s eyes reached me as if they expected me to introduce myself. I began to speak and told them that I am from Delhi University, here with 4 other people, hoping to get permission to conduct interviews with a few households. Without much trouble, the Sarpanch gave me permission after I gave everything to her in writing. I completed all the formalities and went out.
On my way back I saw many latrines outside people’s houses. All of these latrines looked the same, and all of them had the Sarpanch’s name written on them. I found Rajkumar, one of our surveyors, and sat down to accompany him while he did his interview. The household had one of these latrines, but when we asked about the household’s defecation practices, the respondent said that everybody goes out in the fields, including his younger sister and the old dadi. For the next two interviews I sat through, we got the same response. Nobody seemed to be using these latrines, even though they looked decent and had everything that a normal latrine would have!
I also managed to interview the Secretary of the NGO which was instrumental in getting these latrines built. The man told me that they are relying on CSR funds for the latrine construction and the Sarpanch was helping them a lot in fetching these sponsors. I quite liked the approach that the Sarpanch was using but I also wondered if it was a sustainable way of making an open defecation free country, or village to say the least. An English speaking Sarpanch can easily attract the corporates. But the question is how many Sarpanch’s in India can do that?
The Sarpanch surely had a potential to change the face of her village. In fact, the village did look better and cleaner than many other villages, convincingly a Nirmal Gram in the making. However, I hardly found any incentive that was promoting the use of the latrines that were being built. None of the respondents in that village said that they had seen an advertisement or street play on latrines. The latrines with the Sarpanch’s name written on them seemed more like a superficial exhibition of her power and influence.
The Sarpanch needs to realize that a culture which has been practicing open defecation for so long cannot embrace latrines without having a need for them. Emotional motivators can be very effective. Information and Education Campaign (IEC) and Behavoiral Change Communication (BCC) techniques can spur action but subsidies without an associated motivational campaign is indeed good for nothing.
We talk about what we learned in Bangladesh, and what India can learn from Bangladesh. Check it out here.
And here’s a little spoiler, a nice infographic from the article.
Lant Pritchett wrote a blog for the Center for Global Development website last week on how development, including the decade-long RCT movement, is a faith-based activity. He says, “The delightfully quirky aspect of the success of the randomista movement is that it was, and remains, entirely faith-based. That is, the central claim of the movement was not just that more inputs(intellectual and monetary) into RCTs would write better (and more publishable) papers, which is, in a development logframe sense, just an output. The claim that attracted resources and support from development organizations and attention from the press was the claim that “rigorous” evidence from these RCTs could, should, and would produce better development projects and policies and, hence, ultimately better outcomes for human beings…But there was never any theory or evidence that a key, or even important, constraint on development practice was the lack of rigorous evidence about causal impacts, or that the production of such evidence would change practices. This was to be taken on faith.”
So his answer to the question posed in the title: none, really. And indeed, this comment doesn’t just apply to RCTs but to all kinds of development research in general (including what we here at rice do), if the goal of that research is to affect policy. So should we just give up? Well, probably not. But there are things that we can do to enhance the likelihood that our research is relevant for the people who do make decisions.
Our friends Heather Lanthorn and Suvojit Chattopadhyay recently wrote a related World Bank blog that talks about how we can do more formative work in the beginning to better design research questions, the answers of which will more likely be used by policy makers afterwards. They conclude with, “In sum, we think that careful formative and needs-assessment work on what decision-makers (and potential implementers) want to see to be convinced and what types of evidence will inform decision-making may lead to the generation of evidence that is not only policy-related but genuinely policy-relevant.”
A few days ago I went with our SQUAT survey team to a village in Tonk, Rajasthan. While walking into the village, I saw a girl of around 8 walking out into the fields off the side of the road with an old plastic bottle filled with water. She was going to defecate in the open. And after spending the whole morning there, I noticed she was not the only one. In short, to me the village seemed like it was like many others that we had already visited in the district.
But when I met Aashish for lunch, he told me that the village was in fact not like the others that we had already visited, that it was open defecation free! Or at least was ODF in the eyes of the government at one point in time.
Aashish can do many things that I can’t do very well, and one of them is reading Hindi quickly. While he was walking around the village accompanying our surveyors on interviews, he noticed wall-paintings like the one above saying that the village had won the Nirmal Gram Puruskar (NGP), a monetary prize awarded to GPs that have eliminated open defecation.
However, the village was clearly not open defecation free. Of the nine randomly selected households with which our team conducted interviews, only four had latrines. Of these four, all of the members of two households still defecated in the open despite saying they had a latrine. So of the households we visited, only two had latrines that were used, but not by everyone; some of those still reported going in the open regularly.
In one of the households that I visited with Laxmi, one of our surveyors, our respondent told us that her household had a latrine and that the sarpanch had built it for them. But when we went to the latrine to complete the observation section, we realized that although it had been a latrine at one point in time, the household had removed the seat and filled in the pit with cement. There was no roof or door, and it looked to me like they used it to urinate and/or wash clothes. Our respondent told us that they had filled in the pit because there was so much space to go in the open. Indeed, they lived on the edge of the village and could easily go in the fields next to their house. I also suspect that the respondent thought that the latrine was too close to their living quarters, in fact it was right next to the one kaccha room in the house. Many people in north India believe that it is impure to have a latrine close to the living quarters, and in fact our respondent believed so as well. She believed that latrines should be built far from the house, and anywhere closer is impure.
There had clearly been a sanitation campaign in the village; some of the poorer households (the one we visited was quite poor) had gotten latrines from the sarpanch. And there were old slogans written on the walls throughout the village. However, the messages written on the walls clearly did not sink in and the latrines built were clearly not always used.
This just shows how important the behavioral component of this problem is, and how difficult it is to change. Building latrines alone will not solve the problem. The NGP has the right goal in mind, incentivizing the use of latrines, but this only has the potential to work as an incentive if it is awarded to villages that really do sustainably eliminate open defecation.