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.

Switching study presentation at IGC at 3pm on Friday (today)!

Written by on July 18th, 2014

Today at 3pm, in a presentation called “Culture and the health transition: the case of sanitation in rural north India” Diane will be presenting findings from the Switching Study, a qualitative companion study to the SQUAT survey, at the IGC-ISI India Development Policy Conference.

This qualitative study seeks to understand households’ and individuals’ motivations for constructing and using a latrine using in-depth, semi-structured interviews with 99 households in Haryana, Uttar Pradesh, Gujarat, and the Nepali terai.  In the presentation, Diane will explore how cultural understandings of a wholesome rural life and the impurity of affordable latrines lead to the persistence of open defecation and to a rejection of latrine use in India.  These attitudes, while widespread, continue to go unaddressed by government policy and practice.

The conference is happening at the Le Meridien hotel in Delhi.  We hope you can join us today!

Bending the curve from business as usual

Written by on July 18th, 2014

I’m just writing to flag a useful recent blog post by Eddy Perez of WSP: How and Why Countries are Changing to Reach Universal Access in Rural Sanitation by 2030.  Eddy’s main examples are from other countries, but I think there are at least two important messages for those of us working on rural sanitation in India.

The first is the importance of evaluating programs and policies at scale.  The challenges and constraints are importantly different for Uttar Pradesh and for a small, careful pilot.  We do learn important social science from tightly controlled studies, but that can’t be enough.  Luckily, I think this point is increasingly well understood: at the first day of yesterday’s IGC-ISI conference, for example, we saw several statewide or larger scale studies of programs and policies.

The second is the inadequacy of business as usual for ending open defecation.  Sure, if we all keep doing what we’re doing open defecation will go away… in at least 50 years.  Open defecation in India has been going down at one percentage point a year for a long, long time.  If that continues, we have 53 years to wait.  Ending open defecation won’t be easy, and is not a solved problem.

Oops! We didn’t realise. The Economist used our map as a daily chart too!

Written by on July 17th, 2014

 

The Economist also agrees with rice on sanitation

Written by on July 17th, 2014

The Economist wrote a rather brilliant article on sanitation in India, quoting a whole lot of rice research and the squat survey. It also used our map, but made it much nicer (see below). We thank them for writing this article, and request you to share it.

Click here to read it!

 

Many people don’t know that latrine use is good for health

Written by on July 16th, 2014

In light of the recent New York Times article highlighting r.i.c.e.’s research on the importance of sanitation for health, quite a few people have asked me how this can be considered an emerging issue.  While it may seem obvious to many of us that open defecation must be bad for health, especially the health of children, what we found in the SQUAT data is that this connection is not at all obvious to many people living in rural north India.

In the spirit of chart month, below are a few pie charts that demonstrate this point quite clearly.  In the SQUAT survey, we read a list of several changes to respondents, and asked them to tell us if they thought those changes would improve health or not as a result.

Over 97% of respondents in our survey believe that having a hospital nearby would improve health.  In terms of personal behaviors, over 98% believe that a person’s health would be improved if they stop chewing tobacco, stop smoking, or stop consuming alcohol.  Messages about the detrimental impacts of these behaviors seem to have been successfully communicated, and thus their connection to health is widely known.  On the other hand, less than 70% of individuals believe that defecating in a latrine would improve health.

hospital2

tobacco

cigarettes

alcohol

latrine

In fact, when asked directly about which is better for health, 43% of all respondents stated that open defecation is no worse for child health than latrine use.  Even worse in terms of the challenge that lies ahead, 51% of respondents who defecate in the open report that defecating in the open would be at least as good for child health as everyone in the village using a latrine.

Part of the problem is that there is insufficient communication around latrines generally, as many people don’t remember hearing or seeing messages about latrine use: only 31% of respondents said that they had seen a poster, wall-painting, pamphlet, street play, or film about using latrines.  Plus, communication that has occurred, at least in terms of the health impacts of open defecation, does not appear to be very effective: when asked why children get diarrhea, only 26% of respondents answered in a way that reflects an understanding of how it may be caused through infection, bacteria, not washing hands, or defecating in the open.  Given that diarrhea is a very visible outcome, it’s even less likely that people understand the longer-term impacts of open defecation in terms of physical and cognitive stunting, poorer school outcomes, diminished adult productivity, and higher risk of infection and mortality.

It’s clear that people are just not used to thinking about toilets in terms of health.  While we don’t know exactly which messages will motivate people to want to use latrines, this lack of awareness that open defecation is a threat to health is just one of the many reasons that latrine use is not a priority to many people in rural India.

How can we move the latrine use pie chart to be all blue like the rest?  We’re advocating for all hands on deck – every individual throughout India needs to know how deeply harmful open defecation is for their own health and the health of those around them.

 

More Maps: Did open defecation really decline in India between 2001 and 2011?

Written by on July 15th, 2014

Its still chart month on rice blog, and here are some new maps.

When the results of the houselisting operations of the 2011 Indian census came out, most newspapers published articles comparing mobile and toilet ownership (here is a sample). Even when the situation was bad, commentators were of the opinion that at least there has been some progress on sanitation coverage, even if slow. Indeed, the proportion of population with a toilet increased in this period, as the district-wise maps below, created using the same method we have used in the past to create world open defecation maps, show.

Picture1

Picture2

You can see that the map below is less red/brown than the map above (the white blank spaces are due to unavailability of data). Of course, this map has been done better by others, such as by the very cool blog datastories.in, which did these maps at the block level in two different ways.

But, as we explained in the our previous map post,

Rice’s research shows that “Open defecation is particularly harmful to children’s health where population density is high”. Indeed, even intuitive reasoning would lead to the conclusion that for a kid, what matters is not the proportion of people defecating in the open in a country, but the number of people defecating in the open around his or her surroundings. A way to measure that is to measure number of people defecating in the open per square kilometer.

So here is a third way of doing this map, apart from the two presented by datastories: at the district level, but showing the number of people defecating in the open per square kilometer in that district. The two maps below, for 2001 and 2011, do exactly that.


picture 4

 

Picture3

The differences between these two maps seem a bit more difficult to see. While there seem to be districts of India where open defecation per square kilometer decreased, such as cities of Delhi or the state of Kerala, there seems to be many places, particularly in the Hindi-Heartland, where open defecation per square kilometer has actually increased. These two charts paint a different story from the story of overall improvement in every district in open defecation as shown by maps that show the proportion of families who own a toilet. To make it easier for you, we post a map that shows the change in number of people defecating in the open per square kilometer in the following map.

The areas in shades of red are where open defecation per square kilometer has increased, and the areas in the shades of blue are where open defecation per square kilometer has declined. The darker the shade, the more the decline or the increase.

picture 5

 

You can see that things got a lot worse in many districts, while they improved in some others. In particular, Uttar Pradesh, Bihar, Jharkhand, Madhya Pradesh, Orissa and Rajasthan are the places where things got worse, while they seem to have improved in coastal areas of India (particularly Kerala) and up north in Himchal Pradesh, Uttaranchal and Punjab. However, it is important to realise that an awful lot of people live in these states where open defecation per square kilometer got worse, which means that the disease environment and child health got worse, too, despite other improvements, such as in government programmes, literacy, or income.

In a new working paper, Dean argues,

most people in India live in a district where their exposure to density of open defecation increased from the 2001 census to the 2011 census. This is especially true outside of a few highly densely populated and relatively highly developed metropolises. If exposure to open defecation density is indeed a relevant risk factor for early life health and human capital accumulation – as an active and growing literature indicates – then there is little evidence that sanitation in India has been improving; indeed the average sanitation exposure in India arguably worsened from 2001 to 2011.

The same map can be done as district-wise percentage change in open defecation per square kilometer, and it does end up looking more dramatic if we do that. Here we can see that its not just Bihar or Uttar Pradesh that performed worse on our indicator for disease environment – open defecation per square kilometer – other rural areas in north India, such as Rajasthan and Madhya Pradesh are also pretty bad, they are just less densely populated than Bihar.

picture 6

With that depressing map, we leave you, dear reader of rice. Do keep in mind the health emergency that lots of Indian districts face when it comes to open defecation, and if you can contribute to the cause of changing sanitation policy in India to encourage behavior change, do try to do that. Also, when someone, particularly in the government says to you that look, open defecation is on the decline in India and we are working hard, tell them that no, open defecation per square kilometer is what matters, and its increasing in India. Thank you.

Welcome new readers from the New York Times!

Written by on July 14th, 2014

r.i.c.e. is a non-profit economic and demographic research organization working in India, and concentrating on child health and early-life human development. Many new readers are finding us from Gardiner Harris’s New York Times article, Poor Sanitation in India May Afflict Well-Fed Children with Malnutrition.

 

Indian children -- the three large circles in the bottom corner -- face the double threat of exceptionally high open defecation amidst high population density.

Indian children — the three large circles in the bottom corner — face the double threat of exceptionally high open defecation amidst high population density.

 

Indeed, widespread open defecation in India is a human development tragedy of enormous scale.  That’s why we research it, and why we are hopeful for policy action that focuses on promoting toilet and latrine use, not just more construction projects.  But sanitation is not the only thing we study: recent r.i.c.e. research has also focused on child nutrition and women’s status, child height and cognition, maternal healthcare, and the link between women’s status and clean cooking fuel use.

For more on r.i.c.e.’s sanitation research:

  • This paper details our finding highlighted in the article that open defecation is an important part of what makes Indian children so short.
  • This website presents findings from our recent SQUAT survey in rural north India, highlighting the behavioral and social challenges entailed in reducing open defecation.

Sanitation article featuring rice research is among most tweeted and most emailed at nyt

Written by on July 14th, 2014

Gardiner Harris‘ article on sanitation for the New York Times featuring tonnes of rice research has received a tremendous response. Apart from having as many as 151 comments, it also features in the list of the most emailed and the most tweeted articles.

See for yourself these screenshots from the nytimes website.

most emailed

 

 

most tweeted - no. 7 on the list

 

If you still have not read it yet, please do. Its here.

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