Although most people in India defecate in the open without using a latrine, and most people in the world who defecate in the open live in India, the fraction of households in India who defecate in the open decreased between the 2001 and 2011 rounds of the Indian census. However, an active and growing recent literature indicates that exposure to a high density of open defecation — measured as people defecating in the open per square kilometer — may be an especially important threat to early-life health and human capital accumulation. Between the 2001 and 2011 rounds of the Indian census, how did average exposure to open defecation density change? We analyze published district and state level summary statistics from the 2001 and 2011 Indian census.
Most people in India live in a district where the density of open defecation increased from 2001 to 2011. Almost half of people in India live in a state where statewide open defecation density increased; these states are concentrated along the largely rural, impoverished “Hindi Heartland” belt of north India. For the 98.6% of the population which lives outside of the union territory of Delhi, mean exposure to open defecation increased. Decomposition results indicate that the Indian population became more concentrated into states with high open defecation density. In so far as density of open defecation is a relevant exposure to risk, exposure to poor sanitation may have increased for most people in India over the period studied.