- Topics: Sanitation
In India, health improvements have not kept up with economic growth, in considerable part due to the country’s exceptionally poor sanitation. In densely populated rural north India, over 70% of households defecate in the open, spreading infectious diseases that contribute to child mortality and stunting. Because one-fifth of all births occur in India, and because most people who defecate in the open worldwide live there, open defecation in India is a top global human development challenge. Yet, Indian open defecation presents a unique puzzle to scholars of development: India has far higher open defecation rates than other regions where people are poorer, literacy rates are lower, and drinking water is scarcer. This paper draws on complementary qualitative and quantitative data sources, newly collected by the authors, to present social and cultural explanations for India’s uniquely widespread open defecation. We find that beliefs, values, and norms about purity and pollution of private spaces and of bodies contribute to the ubiquity and social acceptability of open defecation, and that renegotiation of caste and untouchability retard and complicate the adoption of inexpensive latrine technologies that improve health in other developing regions. Open defecation in rural India is unlikely to be ended by government latrine construction programs that are not designed around the beliefs and social norms that we document.