research institute for compassionate economics


Open defecation is causing a public health crisis in rural India

Open defecation, the practice of defecating outside without a toilet or latrine, is causing a public health crisis in India.  It spreads bacteria, viruses, and parasites that kill hundreds of thousands of children each year. In addition to causing infant and child death, exposure to environmental germs stunts children’s physical and cognitive growth, leading to a population of adults who are shorter, less healthy and less economically productive than they otherwise would be. The work of r.i.c.e. researchers has helped shed light on the dire consequences of open defecation for infant mortality, malnutrition, cognitive development and economic productivity in India.

Open defecation is particularly harmful to children’s health where population density is high because germs spread from person to person more easily where people live more closely together. r.i.c.e. research suggests that global efforts to reduce open defecation should focus on rural India because in many parts of rural India, both population density and open defecation rates are extremely high, making it one of the worst disease environments in the world for growing children. Indeed, 60% of all people in the world who defecate in the open live in India. In rural India, 70% of households do not own a toilet or latrine, and many people in households that do own a latrine nevertheless defecate in the open.  Further, the density of people who defecate in the open is actually getting worse over time in many places in north India because population growth has outpaced the rate at which households adopt latrines.

Why is open defecation so widespread in India?  

Economic growth had led to improvements in the lives of people in rural India, and yet open defecation remains stubbornly widespread. People in rural India do not build the sorts of inexpensive pit latrines that are used in other countries and that save infant lives and promote child growth. Researchers at r.i.c.e. have conducted original qualitative and quantitative research to explain India’s open defecation puzzle.

We recently conducted a Sanitation Quality, Use, Access, and Trends (SQUAT) survey in Rajasthan, Madhya Pradesh, Haryana, Uttar Pradesh, and Bihar, where fully one-third of the world’s open defecation occurs. Survey teams visited over 3,200 rural households and interviewed them about where they defecate and what they think about it. We also conducted over 100 qualitative interviews with households that own latrines and households that defecate in the open in Haryana, Uttar Pradesh, Gujarat and the terai region of Nepal.

The SQUAT study taught us some surprising facts about open defecation in rural north India:

  • People have a very expensive idea of what constitutes a latrine worth using, and do not build the kinds of simple latrines that save lives and reduce open defecation in other countries.
  • Many people do not use the latrine even if they have one: 40% of households we surveyed that have a working latrine also have at least one person who regularly defecates in the open.
  • Less than half of people living in households in which someone uses a government latrine use it regularly.
  • Many people prefer open defecation to regular latrine use: half of people who defecate in the open say that they do so because it is pleasurable, comfortable and convenient.

The qualitative study helps us understand the findings of the SQUAT study. In the qualitative interviews, we learned that beliefs, values, and norms about purity and pollution as they relate to homes and people mean that open defecation is often preferred to using simple pit latrines. We also learned how the caste system and the practice of untouchability discourage the adoption of simple latrines that are widely used in other developing countries.

What is r.i.c.e. doing now?

Unfortunately, the government’s main sanitation policies have historically, and continue to focus on constructing the kinds of latrines that rural people do not want to use. We hope that by educating people about the most important causes of open defecation in rural India, we can encourage the adoption of sanitation policies that are more likely to speed the reduction of rural open defecation.

r.i.c.e. is working to educate the government, the public and others working in sanitation about the health consequences of open defecation as well as why open defecation is so widespread in rural India. Some of the things we regularly do are write about open defecation for Indian and international newspapers, give presentations about open defecation, and talk with government officials and multilateral organizations about what kinds of programs and policies would be most likely to reduce open defecation in rural India. We also advocate for better monitoring of open defecation and have made recommendations about how to measure open defecation.