All posts by Nazar Khalid

Alex Tabarrok reviews AIR: Pollution, Climate Change and India’s Choice Between Policy and Pretense

 Alex Tabarrok, a professor of economics at the George Mason University, recently reviewed Dean’s latest book Air: Pollution, Climate Change and India’s Choice Between Policy and Pretence on his blog Marginal Revolution. He lauds Dean’s efforts in ‘accurately explain[g] academic work’ in a manner which can be understood by everyone, and that by combing the core ideas with ‘on-the-ground reporting’ has rendered this book ‘both informative and full of human interest.’ An excerpt from the review:

“One of the things I like about Air is that it is clear that pollution in India is both a market failure and a government failure. The government has been slow to respond to pollution because much of the public remains unaware of pollution’s true cost and much of the true cost is born by children and future people who have no vote. In the meantime, the government enhances rational ignorance by refusing to fund even the most basic equipment to measure where and when pollution ebbs and flows. Instead the government engages in virtue-politics by banning plastic bags and creating odd-even restrictions on driving in Delhi. These activities are pointless, even counter-productive, but they are well publicized and the appearance of doing something matters more than reality.”

You can order the book on Amazon or Flipkart



Dean’s new book ‘AIR’ reviewed in Hindustan Times

Hindustan Times recently published a review of Dean’s new book AIR: Pollution, Climate Change and India’s Choice Between Policy and Pretense by Sudhirendar Sharma.  Some excerpts from the review:

Air provides a nuanced understanding on air pollution and the country’s deep vulnerability to it in an era of impending climate change. Since policymakers have not invested in monitoring pollution and experts have not developed tools to curb it, this book is directed at enlightened voters who are concerned about the health of our society.”

“Through carefully curated data, Spears provides evidence on how exposure to air pollution not only results in babies born with low height but also, shockingly, leads to higher infant mortality rates. While life expectancy has caught up with the developed world, India continues to have one-quarter of the world’s neonatal deaths.”

“Politics is a difficult way to improve policies, the book asserts, but independent citizens can contribute to democratic accountability by influencing politics. Air pollution is too important to ignore and informed citizens need to track it and influence the state to act for the greater good.”

Read the entire review of AIR here

“Cooking with gas, not wood.” Read Sangita and Aashish’s piece in The Hindu

Sangita and Aashish’s article addresses some popular myths around the use of traditional chulha (earthen/brick stove) and why there is a reluctance to switch over to LPG stoves. This reluctance is observed even when LPG stove protects from several harmful health impacts caused by cooking on traditional chulha using solid fuels.

Based on the findings from a survey of 127 villages across four states-Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, this article highlights a number of policy steps which can provide right incentives and also nudge people’s behaviour in favour of clean fuel use. Broadly, these fall under the following three strategies:

-communicating the harms of solid fuels and the benefits of cleaner fuels

-reducing the cost of LPG cylinder refills in rural areas

– promoting gender equality within households, particularly in cooking and related tasks.

Read the article here 

Aashish’s research on solid fuel use, gender, and adult respiratory health published in Population & Environment

Population and Environment recently published Aashish’s new research titled “Where there is smoke: Solid Fuel externalities, gender, and adult respiratory health in India.” This paper studies the determination of respiratory health in India using data on lung obstruction from the WHO Survey of Global Ageing and Adult Health (WHO-SAGE 2007–2008).  The main findings of the study are:

-Smokers and members of households that use solid fuels (wood, biomass, coal, or dung) for cooking have a higher lung obstruction.

-Even if a respondent’s household uses clean fuels, their lung obstruction is higher if their neighbor’s use solid fuels.

– The influence of determinants is patterned by gender

Read more and download the paper here

Promoting the use of simple pit latrines in rural India: Findings from Bihar, Gujarat, Karnataka and Odisha

For the past three years, r.i.c.e. has been collaborating with 3ie on supporting projects that are testing different strategies for promoting the use of simple pit latrines in rural India. Four teams, comprised of researchers and implementation agencies, came up with different interventions to promote latrine use in rural India, and tested them in four states. Many of these interventions specifically addressed fears surrounding pit emptying that are rooted in ideas of purity and untouchability. There were engaging demonstrations on showing how long it takes for a soak pit to fill and that decomposed sludge looks and feels just like other kinds of fertilizer. They randomly assigned the interventions to be done in some villages and not others. The findings of these studies are now out. You can read the teams’ reports here: Bihar, Gujarat, Karnataka, and Odisha.

Some important lessons we learned from these projects include:
– Research shaped around informing policy is challenging, and difficult to do usefully! These projects got started at a time when the SBM became very active in villages throughout India. What this means is that reported open defecation decreased substantially in many of the study areas, in both places that were randomly assigned to get interventions and those that weren’t. We don’t know whether the reported declines after the SBM reflect real behavior change or whether people simply reported less open defecation because the government had been discouraging it. But, they make it difficult to understand how well the interventions themselves worked.
– It is very difficult to change deeply rooted beliefs around purity and untouchability. The Bihar team implemented several demonstrations to educate on pit emptying, and how it is ok for someone in the household to do it. However, in the follow-up survey, most households still reported that pit emptying was “inconvenient,” and they would hire someone else to empty a decomposed pit. These beliefs are unlikely to be changed just by informational campaigns targeted at pit emptying, and may require broader change in beliefs around purity and untouchability.
– We learned a lot about measuring latrine use! A survey experiment found higher rates of reported open defecation from an individual-level question that asks about open defecation or latrine use for every household member, compared to a household-level question that asks about the behavior of everyone in the household in one question. The Gujarat team also developed another tool for measuring latrine use: a physical activity questionnaire that asked how many minutes a person walked to defecate in the fields, among a series of other physical activity questions. This tool was designed to try to hide the open defecation question, to try to minimize social desirability bias. It found slightly less open defecation than the individual questionnaire. See their report for more on this.


Sangita awarded Parker Frisbie Publication Award for her paper on coal and child height.

Sangita is among the two winners of the Parker Frisbie Publications Award for this year.  The award committee had following to say about her paper:

“Her impressive paper, “The child health impacts of coal: evidence from India’s coal expansion,” examines the child health impacts associated with a large coal plant expansion in India. Using a rich collection of space-time matched data sources including India’s Demographic and Health Survey (DHS), the Central Electricity Authority of India’s CO2 Baseline Database for the Indian Power Sector, and satellite data from the Multiangle Imaging SpecroRadiometer, she shows that coal plant exposure at birth predicts decreased height and that the result is likely due to air pollution. The effects, moreover, do not differ by socioeconomic background and are robust to a variety of alternative specifications and explanations. This paper highlights an important health burden to India’s young that could increase unless appropriate policy action is taken to either curtail coal plant expansions, or mitigate emissions from them, because coal plants are projected to continue to expand in India in the near future.”

Congratulations Sangita! r.i.c.e is proud of you.


Dean, Diane, Sangita and Nikhil feature in a video made to honour Dr Babasaheb Ambedkar

Dean, Diane, Sangita and Nikhil feature in a video project by Chandrakant Agame at Dr Babasaheb Ambedkar Technological University, Lonere, as part of his work as the Literature Secretary of Dr Babasaheb Ambedkar Anniversary Committee.

In this video celebrating the birth anniversary of Dr Ambedkar, they talk briefly about his work on Indian society and caste, and how that has influenced r.i.c.e’s research in understanding the health and wellbeing of children in rural India.

Watch the entire video which features several prominent scholars and activists from various fields here.


Willingness to sacrifice for Climate mitigation: r.i.c.e’s new research now available

A new research paper by Diane, Payal and Dean that studies people’s willingness to sacrifice to achieve climate mitigation is out now!

Using representative data from round 2 of the Social Attitudes Research, India (SARI), this paper finds that people are willing to accept some electricity cuts to prevent climate damages and the demand curve slopes down, meaning that fewer respondents are willing to accept larger costs of mitigation. Moreover, people who reported that temperatures are increasing and that this is bad were more likely to report being willing to accept electricity cuts for mitigation than those who either did not report that temperatures are increasing or did not report that this is bad.

Find more about the paper and a downloadable link here

N-ISSUP publishes a short article on Diane’s research on neonatal mortality and facility birth in India

N-ISSUP, the online magazine of the International Union for the Scientific Study of Population, published a short article based on Diane’s paper “The association between neonatal death and facility birth in regions of India” published in the Demographic Research.

The article summarizes the main finding of the paper that there is important heterogeneity in the association between neonatal death (NNM) and hospital birth across regions in India. The country contributes more NNM to the global NNM than any other country in the world, yet the NNM of 30 per 1000 births masks wide spatial variations. For example, among states with more than 25 million people, Uttar Pradesh had the highest NNM at 45 per 1000, and Kerala had the lowest at 4 per 1000.

Sustainable Development Goal 3 aims to reduce global neonatal mortality (NNM) to 12 deaths per 1,000 births by 2030. Reducing NNM in India is critical to this goal because it accounts for 27% of global neonatal deaths. Diane suggests that it would be worthwhile for future research to compare how delivery and postpartum care practices differ across different regions in India.

Find more on this and a downloadable link of the original paper from our earlier blog post. You can also download the paper directly from the Demographic Research website.

The Wire bulletin covers r.i.c.e’s research on the solid fuel use and LPG ownership.

The Wire covered r.i.c.e’s new research on the persistence of solid fuel use despite increases in LPG ownership[report runs from 00 to 4:30 mins]. Here are some points covered in the bulletin:

The Pradhanmantri Ujjawal Yojna is often presented as a grand success, particularly in the ongoing election season. Most beneficiaries under the scheme, however, are forced to use traditional chulha for cooking.

A new research study by r.i.c.e finds that over 85 per cent of Ujjawala beneficiaries’ resort to using the traditional chulha because of the financial burden involved in refilling the gas cylinder.

The study conducted in the second half of 2018 in Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh visited over 1550 households to understand more about the impact of Ujjawal scheme. These four states account for about 40 per cent of the total rural population of India.

Launched in 2016, the government provides a gas cylinder, regulator, and pipe for free, and gives loans to households for the stove and the gas in the first cylinder under the Ujjawala scheme. According to the central government, over 60 million families have benefitted from it; the current study found that 76 per cent of households in these parts of rural India have benefitted from this scheme. Yet, close to 98 per cent of households continue to keep both traditional chulha and gas stove.

The study asked households about what they(fuel source) used for cooking food items such as rice, roti(chapati), dal(pulses), vegetables, tea and [boiling] milk the day before the survey. Among the surveyed households, around 27 per cent reported to have used gas stove exclusively, 37 per cent reported using both gas stove and traditional chulha, and 36 per cent reported using the traditional chulha. Moreover, among Ujjawala beneficiaries, 53 per cent households reported using only traditional chulha, while 32 per cent used both chulha and gas stove.

Ujjawala beneficiary households are poorer, on average, compared to those who got (LPG) gas connection own their own. As a result, refilling the cylinder constitutes a greater fraction of their monthly consumption, thus making them less likely to do so. The study found that about 70 per cent of families spends nothing on solid fuels; even with the subsidy, the money spent on the gas cylinder is much higher compared to that on solid fuels.

Gender disparity plays an important role too. The work of cooking with solid fuels is performed by women, and they also play a major role in collecting/making solid fuels. Moreover, women’s task is usually seen to have a lower opportunity cost. Add to this the fact that women also have low status and are typically not economic decision-makers in the household. These factors likely contribute to the use of solid fuels, even among households that own LPG.

Check out our new research study on the persistence of soild fuel use despite increases in LPG ownership!

Exposure to air pollution has important consequences for public health. Several studies have held that a major source of air pollution exposure in rural India is the use of solid fuels, such as dung cakes and wood, for cooking and heating. High levels of indoor air pollution can kill infants, get in the way of healthy child development, and contribute to heart and lung disease.

In May 2016, the Indian government launched the Pradhan Mantri Ujjwala Yojana, which aims to promote the use of clean cooking fuel in rural India. Reducing the use of solid fuels is an important public health goal because it would reduce exposure to harmful indoor air pollution.  The central government claimed that by December 2018, 6 crore households had received access to LPG through the Ujjwala Yojana, and that 90% of all Indian households owned an LPG cylinder and stove.

An important question to be asking is how successful have these government initiatives been in reducing solid fuel use in rural India? This article addresses this question using data from a 2018 survey on fuel use which revisited households originally visited in 2014 in rural Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh.

We find that that Ujjwala has led to a substantial increase in LPG ownership among rural households in the sample states. About three-quarters of households reported owning LPG at the time of the survey, up from about one-third in 2014. This is an important improvement. However, we also find that many LPG owners, and particularly those that received cylinders through Ujjwala, still use solid fuels to cook. Most LPG owners also own a stove that uses solid fuel, and among households owning both, about three-quarters of households used solid fuels the day before the survey. 37% used both LPG and solid fuels, and 36% cooked everything using solid fuels.

Although the Ujjwala Yojana has substantially increased access to LPG, many households that have LPG continue to use solid fuels, and these household behaviours have important implications for the potential health impacts of Ujjwala. Households that continue to use solid fuels continue to expose themselves and their neighbours to harmful air pollution. Discouraging the use of solid fuels and promoting exclusive LPG use will be essential to realizing the full health benefits of the expansion in LPG ownership brought about by Ujjwala.

Read the paper here.

Coercion, Construction, and ‘ODF Paper pe’ : Swachha Bharat According to Local Officials published in The India Forum

The India Foruma Journal Magazine on Contemporary Issues published our article “ Coercion, Construction, and ‘ODF Paper pe’: Swachha Bharat According to Local Officials.” This article is based on extensive qualitative interviews with government officials at the village and block levels across 11 districts in the states of Madhya Pradesh, Uttar Pradesh, Rajasthan and Bihar. These local officials were entrusted with the implementation of the Swachha Bharat Mission at their Panchayat/blocks.

The paper sheds light on how the SBM is implemented on the ground. As the title of the paper suggests, there is widespread use of threats and coercion for latrine construction. Not only the villagers, the officials at villages and blocks were also under a lot of pressure to meet their construction targets, often in a limited time period, or else they would lose their job. The government’s impatience in declaring villages, blocks, districts and, eventually states, and the entire country ODF (Open Defecation Free) meant that the focus was mostly on the latrine construction and not on its usage. However, we found that many places that had been declared ODF still had significant levels of open defecation- they were declared ODF only on paper.

Read The India Forum paper here. Read findings from our quantitative survey which accompanied the qualitative research here.


Survey of Rural Sanitation and Solid Fuel Use, 2018, is publicly available now!

We are excited to announce that the data from our new survey on the status of rural sanitation and solid fuel use is publicly available now. The survey visited rural parts of Rajasthan, Madhya Pradesh, Uttar Pradesh and Bihar in September-December 2018 and collected data on 9,812 individuals living in over 1500 households. It covered rural sanitation behaviour, the Swachh Bharat Abhiyaan, cooking fuel use, the Ujjawala Scheme, and several other topics.

This is an important region to be thinking about because it represents about 40 per cent of India’s rural population and home to 45 per cent of households without a toilet or latrine.  A significant fraction of all people worldwide who defecate in the open live in these four Indian states.   Our results, therefore, are relevant not merely to sanitation policy in India, but also to addressing the global sanitation challenge.

Growing up in India we all had heard about the famous saying, “gaon ki hawa aur shahar ki dawa ”  (roughly translated as [fresh] air of villages and [better] medicines in cities) can cure all illness. However, that is no longer the case as air in villages are getting increasingly polluted.  A major source of air pollution in rural India is the use of solid fuels for cooking and heating. There is increased awareness now about the fact that exposure to air pollution has important consequences for public health. High levels of air pollution can kill infants and older people, get in the way of healthy child development, and contribute to heart and lung disease. Our dataset provides useful information on the source and extent of the solid fuel use and practices of rural households that can help us gain useful insights on the matter.

To download and know more about other features of the dataset, please visit here




Reducing open defecation in rural India is an important human development goal, but at what cost? Read Sangita’s piece in Hindustan Times

Sangita’s article in Hindustan Times raises some pertinent questions about the ways in which the Swachh Bharat Mission has been implemented. She draws attention to the fact that the Mission’s success in getting latrines constructed and the subsequent decline in the practice of open defecation has come about through the use of threats and coercion.
In a survey of four north Indian states, every second person had heard of fines, denial of government benefits, and being stopped from defecating in the open, being used as tools to compel latrine construction and use in their own village. Some people were denied their rations, pensions, and other government benefits. Moreover, the survey finds that the use of force had a visible caste angle to it: Dalits were twice as likely while Adivasis were thrice as likely to be at the receiving end of threats and coercion.
The implementation of the SBM has come at a cost to certain fundamental rights. She argues, “[T]he tactics employed by the SBM present important trade-offs that require public debate. Evaluating these trade-offs will at the very least require understanding how many people have been hurt because of the SBM, and how much it has accelerated the decline in open defecation. Reducing open defecation in rural India is an important human development goal, but at what cost?” Read more

Dainik Bhaskar, a prominent Hindi newspaper, reports on our new research on changes in open defecation in India: 2014-2018.

The Dainik Bhaskar (DB), a prominent Hindi language newspaper, published a comprehensive report on r.i.c.e and Accountability Initiative of Centre for Policy Research’s (CPR) new research on changes in open defecation in India: 2014-2018. We were thrilled that the DB helped us share this research with millions of readers by carrying this report in several editions across India.  Here is the photo of the article. You can also find it here

For our non-Hindi readers, here are the main points covered in the DB report:

44 % people in Madhya Pradesh (MP), Uttar Pradesh (UP), Rajasthan and Bihar continue to defecate in the open, although this is an improvement of 26 per cent from what it was in 2014. This proportion remains despite MP and Rajasthan being declared open defecation free (ODF), and Bihar and Rajasthan are soon to be declared one!

The research survey visited 120 villages and covered about ten thousand people. Of the households that didn’t own a latrine in 2014, 57 % of them have a toilet now. However, the survey found the use of coercive tactics and force by the government machinery. People were threatened with the ration cuts or fines and were forced to build latrines; compared to General caste people, Dalits were twice as likely, and Adivasis were thrice as likely to face coercion.

The paper carried excerpts from their interview with Aashish: Caste system and untouchability are key reasons why open defecation exists in India. People believe that the task of cleaning toilets is reserved for those belonging to a specific caste. Therefore, these notions need to be tackled first.

Coercion is common; 56 per cent people in our survey admitted knowing about the threats and coercive tactics. In Bihar, one person was jailed for fifteen days, and his family had to pay a tip of 10000 to seek his release. In MP police visited those families who had refused to construct latrines. In Rajasthan, people were told that if they fail to build latrines then not only will their rations, pensions and other government benefits be stopped, their children’s names will also be taken out from the school registers. In UP there were orders by the district magistrate (DM) to stop people’s rations, and use other means to frighten people into constructing latrines.

The paper also reports that 23 % people (20 % women and 25 % men) defecate in the open despite owning a latrine. Overall, 39 % in UP, 60 % in Bihar, 25 % in MP and 53 % in Rajasthan defecate in the open, thus taking the total average to 44.

Open Defecation is responsible for the deaths of about two lakh children, every year, even before they reach their fifth birthday. It is the reason why the average height of Indian children is shorter compared to those of the poorer countries. Dean’s research shows that bacteria in the faecal matter hinder not only the physical but cognitive health of children as well. There is abundant research that shows that shorter people earn less than their taller counterparts.

The report also includes excerpts from Nazar’s interview: Government has shown haste in declaring the states as ODF. Post this declaration, the programs which are directed at motivating people to adopt toilets stop; MP and Rajasthan are clear examples of this, where such programs are no longer active. In such a situation, many more children would continue to see death.

Release of r.i.c.e and Accountability Initiative’s research study “Changes in open defecation in rural north India: 2014-2018.”


r.i.c.e is delighted to share that the release of the new research study on “Changes in open defecation in rural north India: 2014-2018” was held at India Habitat Centre (IHC) on the 9th January 2018.

The study, which was conducted in collaboration with the Accountability Initiative (AI) of the Centre for Policy Research (CPR), reports on the findings from the two surveys.  The first survey visited rural Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh in late 2018, and collected data on 9,812 people and interviewed 156 local government officials. The second survey, in Udaipur district, visited 505 households in 19 villages and 60 households in 2 census towns.   This new study sheds light on what the Swachh Bharat Mission did and on changes in open defecation since 2014. It is informative about changes because researchers revisited families who participated in a 2014 survey.

Sangita presented the main findings from the research.  Broadly, these are:

  • the Swachh Bharat Mission has built a lot of latrines: 57% of   households without a latrine in 2014 had one by 2018;
  • this has reduced open defecation more quickly than before but open defecation is by no means eliminated: 44 %of rural people over two years old in rural Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh defecate in the open;
  • and reductions may not be sustained, as it happened through threats and coercion: people being stopped while defecating in the open, government benefits being threatened, and fines. Among households that own a latrine, Dalits are over twice as likely to report experiencing one of these three forms of coercion. Adivasis were almost three times as likely.

Find Sangita’s presentation slides here. The working paper on the study is available here.

It was amazing to see a large turnout for the event and lively post-presentation discussions.

The study has been covered in The Hindu, Livemint, Firstpost, IndiaSpend, Swarajya, The Wire, Scroll, BloombergQuint, Dainik Bhaskar and Navbharat Times among others.  We’ll be updating the “News” section of the website as more articles come out!

Swachh Bharat Mission Grameen releases a commendable ad to promote twin pit latrines!

The Swacch Bharat Mission Grameen recently launched an advertisement campaign video with Hindi movie stars Bhumi Pednekar and Akshay Kumar. In the video the actors educate viewers about how twin pit latrines work. The ad also teaches viewers how the decomposed feces can be used for greater farming benefits and prosperity.
An important feature of the ad which distinctly stands out is that Akshay Kumar touches the decomposed feces with his own hands. We know from years of field research that misplaced beliefs and untouchability-related barriers around handling of feces is one important reason why such a high fraction of the Indian population still defecates in the open. The message of this advertisement is therefore really important, and its makers should be commended.

For the readers who don’t understand Hindi, here is a translation of the dialogues from the video.
Mishra [M]: [In an astonished tone] So many varieties of flowers and fruits…this is incredible!
Akshay Kumar [AK]: It’s all because of the latrine Mishra.
M: [surprised and with a disgusted look on his face] LATRINE?
Bhumi Pednekar [BP]: [disapproving of Mishra’s tone and disgusted face] Yes, the latrine..and that also with two pits.
BP: I had made it clear to him at the time of our marriage, seven years ago, that if there is no toilet in the house then I wouldn’t marry him.
AK: And what did I say then? If I get a toilet, it must be one with the twin pits.
M: [surprised] Two pits…why?
AK: One pit will get filled in five years with regular use. After that, start using the other pit by changing the lever.
M: What is the need to do all this…why not empty the filled pit itself and then start using again? They are just feces.
AK: These are not just feces…these are gold!
M: [Disgusted facial gesture] chhee chhee (eww)
AK: If this pit is closed and left for a year…this will turn into gold.
BP: [with a tray of decomposed feces] That is, sonkhaad (gold in the form of manure).
AK: [lifts the decomposed feces by his hands from the tray] Spread this sonkhad in your field and then experience the blessings of the latrine.
M [convinced and excited] Even I am going to build a latrine with two pits.
BP: [handing Mishra a tray full of fruits and vegetables] Give this to your wife as gift from us.
AK: This is a gift from the land, Mishra.
AK and BP [together]: The best latrine is one that has two pits.

Hunger and health: Royal Economic Society video highlights prize-winning r.i.c.e. research

In last few decades, India has seen a declining household per capita average calorie consumption. This throws a puzzle, as over the same time people in India have gotten richer. Dean and Josephine investigate how India’s improving disease environment can explain part of the calorie decline.
Their research matches data on infant mortality rates (IMR) and open defecation with survey data on per capita calorie consumption. They find that between 1988 and 2004-05, districts that had a larger decline in IMR saw a larger decline in household per capita calorie consumption. Also, those households that live in villages where more of their neighbours defecate in open are also the ones that eat more calories on average.
An implication of this research is that as more households use toilets, then the food that government provides to them can be used more efficiently and there could even be cost savings. Not only will children be healthier and more likely to survive, they will also have better nutritional outcomes. Additionally, the money that the government spends on food subsidies can also be put to better use. Access this article here 

Dean talks to the Institute of Development Studies on what motivated ‘Where India Goes?’

In this short interview, Dean talks to the IDS about what motivated him and Diane to write their book “Where India Goes: Abandoned toilets, stunted development, and the cost of caste.” While the book addresses the puzzle of widespread open defecation in rural India, originally, they were interested in a different puzzle- the puzzle concerning child health and well-being in India.  The statistical data, for example, revealed that India had a higher neonatal mortality and shorter children compared to many other developing countries with lower per capita incomes. In their effort to learn about child health they stumbled at the puzzle of open defecation in rural India.

There is a number of things that make situation tough for children in India. The lower status of women, for instance, means that young mothers do not eat a lot which shows in the health of their babies. Another important reason for this is sanitation and disease environment. India is a place with a very high density of population on one hand and a lot of open defecation on the other hand. Together, they create an environment, especially in rural parts of the northern states, where an awful lot of children are exposed to their neighbor’s open defection and their germs.

Where India goes is, in part, an attempt to share what they learned about open defecation and how important it is for children’s health and development, and for the population that they grow into. There is another important motivation for writing it: to share what they learned about why there is open defecation in rural India. The ideas of purity and pollution in the caste system and how people think about latrine pits filling up and needing to be emptied influence people’s behavior on the use of pit latrines that many are happy to use in other developing countries.