Ideas for India and Live Mint do sanitation series

Written by on August 18th, 2014

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Ideas for India and Live Mint are publishing a series on sanitation and r.i.c.e. work.  You can see Diane’s piece on the conclusions from the SQUAT and qualitative “switching” study about why so many people in India defecate in the open here in Ideas for India, and here in Mint.  You can see Michael Geruso’s piece on the effects of sanitation on child mortality here in Ideas for India and here in Mint.  Dean’s pieces on the unique challenges for sanitation policy in India are coming out tomorrow.

I used a picture of a latrine pit for this post because it reminds us that when we’re thinking about rural sanitation solutions for north India, we need to remember that the pit is the part of the latrine that is most important to people in villages!

Sanitation is a core message in PMs Independence Day speech!

Written by on August 16th, 2014

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.

Does the IEC messaging on sanitation needs to change?

Written by on August 15th, 2014

The government of India over the years has focused on latrine construction and its spending on behavioral change in the form of Information and Educations Campaigns (IEC) has been minuscule. Infact, the IEC spending between financial year 2013-14 were just 209 cr in comparison to 2518 cr spent on construction.

Figure 1

chart 4

The results of this lack of IEC spending and its non effectiveness can be seen clearly in the SQUAT data. In the SQUAT Survey, we asked people if they have ever heard or seen any messages on sanitation (in the form of wall paintings, street plays, fliers, posters, short films, etc). In figure 1, among all the people who participated in our survey, only 32% of the respondents had seen some form of sanitation message, and a majority of respondents (68%) had never seen one.

Figure 2

chart 5

Among the people who had seen IEC messages, we asked about the content of the message and.43% of the respondents (G+H) either said they remember it being some slogan or photo but do not remember what the slogan/photo was about or they do not remember the content at all. Another 25% (D+E) said that the message promoted latrines as enabling women’s modesty or as being beneficial to woman in some form. Only 12% of the respondents in the survey had been exposure to a correct message on the health benefits of latrine use.

These graphs not only point to the importance of increasing IEC spending on sanitation, they also highlight an important issue regarding the content of these messages. It’s important for the government to think seriously about what these messages contain because promoting some themes may actually do more harm than good. For instance, the IEC message focusing on women re-enforces gender inequality, endorses restricted mobility of woman in rural areas, and also distracts from the important message that everyone needs to use a latrine. The answer may not just be to advertise the health benefits of latrine use and so we need to do lots of experimentation.

Lots of educated men who have toilets still defecate in the open

Written by on August 13th, 2014

Education

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 also finds unused government latrines

Written by on August 5th, 2014
Photographer: Kartikay Mehrotra/Bloomberg

Photographer: Kartikay Mehrotra/Bloomberg

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.

He also cites some research from the SQUAT Study! Check the full story out here!

Purity, latrine use, and religion

Written by on July 31st, 2014

From the SQUAT Survey, we found that many people prefer open defecation to latrine use, and that latrines are often seen as dirty and unpleasant.  Through our conversations with people in rural India, it seems that part of this distaste is rooted in notions of purity and pollution: many expect latrines to emit foul smells, which are often seen as unhealthy and disease-inducing, and are averse to the periodic cleaning that pits require.

We asked our respondents what they thought about latrines and open defecation in terms of purity.  We asked whether they thought defecating in the open near or far from the house was pure or impure, and whether they thought a latrine constructed near or far from the house was pure or impure.  This post focuses on impurity, since it is the perception of impurity that seems to be holding people back from latrine use.

For respondents overall,  defecating in the open near the house is considered the most impure out of all defecation practices listed (a full 91% say it’s impure), while latrine construction far from the house is considered to be the least impure (only 4% say it’s impure).

It is between latrine construction near the house and defecating in the open far from the house where there are differing opinions.  The graph below shows the percentage of people who report each of these options as “impure” for respondents overall, just for toilet owners, and just for toilet users.

As we move from the overall sample, to those who own latrines, to those who actually use latrines, we see that more respondents report that open defecation far from the house is impure (from 42% to 51% to 59%), and fewer respondents report that latrine construction near the house is impure (42% to 39% to 37%). Of course we can’t know with our data which comes first – the ownership and use of the latrine, or changing beliefs around open defecation – but it is certainly interesting to see the connection between perceptions of purity and latrine practices in these trends.

 latrines impurity graph.png

So where might these ideas of purity come from?  If ideas of purity are associated with latrines, we wanted to explore how religion may or may not influence these perceptions.  What we find is that Muslims are less likely than Hindus to say that a latrine constructed near the house is impure.  In the graph below, the bottom segment (dark red) shows the percentage of Hindu and Muslim respondents who reported that a latrine near the house is “pure” and the middle section (lighter red) shows the percentage of respondents who said that having a latrine near the house is “not pure.”  In both segments we see that Muslims are less averse to having a latrine near the house.

In the context of knowing that Muslims are much more likely to both own and use a latrine, we see a clear possibility.  Ideas of purity and the cleanliness of latrines are cultural notions that appear to be holding back progress in eliminating open defecation for a majority of rural Indians.

hindu muslim purity graph.png

These graphs tell us that it is going to be important both to convince people of the detrimental impacts of open defecation, and that there is nothing bad or dirty about latrines.  How cultural perceptions shape these beliefs is something we need to examine more deeply.  If indeed cultural forces are influencing sanitation outcomes, we need to develop a better understanding of them so that they can be fully incorporated in the design of government sanitation policy.

Do religious leaders talk about defecation in India?

Written by on July 30th, 2014

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.

Figure 1

char 1

We asked people if their religious leaders have ever told them where they should defecate or where they should not. Among all respondents, both those who have a working latrine or those who do not, 47% of Muslim respondents and only 29% of Hindus said that their religious leaders have told them something about where they should or should not defecate. This trend does not change if we look at the subset of people who own government latrines or even for those who built their latrine spending their personal money.

Figure 2

chart 2

Another interesting finding (Figure 2) from the SQUAT data comes from when we asked people what specific messages on defecation they had heard from their religious leaders, if they had heard one at all. More Muslim respondents said that their religious leaders ask them to use a latrine than Hindu respondents. We also found the opposite: more Hindu respondents than Muslim respondents said that their religious leaders ask them to defecate in open. There was not much difference between Hindu and Muslim respondents in terms of religious leaders asking them to go far from their house for defecation.

Researches in the past have shown difference in latrine access between hindus and muslims. And if we account the negative externality of open defecation on India’s children it is worth exploring as to why the difference exists. These may be preliminary finding but they certainly point towards a direction where much more can be explored.

What do the SQUAT data say about latrine usage and religion?

Written by on July 29th, 2014

Hindu Muslim ownership

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.

Hindu Muslim use combined

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.

V.S. Naipaul understood the culture of open defecation way back in 1964!

Written by on July 25th, 2014

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.

Behavior change order to states from the MoDWS!

Written by on July 23rd, 2014

Toilet promotion in Madhya Pradesh: Love your toilets, they prevent disease

Just 12 days after the order to states to construct over 5 million toilets by the end of August, the Ministry of Drinking Water and Sanitation issued another order, addressing the need to “sensitize the rural population on sanitation,” by educating about and encouraging the building and use of toilets.  The order accurately points out that:

One of the biggest challenges in making the country ODF is triggering behavioural change in the population to accept the need for building and using toilets.  A large number of people amongst the Indian population are still unconvinced of the need to build toilets in their homes. In this connection, coordinated effort by all the Departments of the State Government that have interface with rural populations is required.

It is heartening to see the new government directly acknowledging the lack of demand for toilets, and talking about the need for behavior change.  In asking several ministries (Education, Health, Panchayati Raj, Women and Child Development) for their participation, and encouraging “functionaries at all levels to help India become ODF by 2019,” we’re cautiously optimistic that this is just the beginning of a larger plan to launch a latrine use revolution in India.

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