All posts by Payal Hathi

Breastfeeding promotion in EPW Engage

Check out Nikhil’s article in EPW Engage in which he explores the government’s current pilot program (Mother’s Absolute Affection, or MAA) to improve breastfeeding.  Breastfeeding is known to help children survive, providing vital nutrition and protection from disease.  Nikhil argues that the current funding allocation and design of the MAA program is unlikely to incentivize frontline health workers to carry out the critical task of breastfeeding sensitization.

Through his work on a small pilot project to encourage first time mothers to initiate breastfeeding early and to continue exclusive breastfeeding in a government hospital in UP, Nikhil describes how effective one on one counseling can be:

Of the 1,236 women, who were first-time mothers and who were visited by a lactation consultant, 74% did not have a good latch on the first try, causing delays and hardships for breastfeeding. After one counselling session, almost a third of the women were able to correct the position of the child for a good latch, allowing the newborn to feed and encouraging the mother to continue breastfeeding.

The government’s interest in this important issue is laudable.  But alongside the MAA program, Nikhil advocates for full-time, dedicated breastfeeding and newborn care consultants at each district hospital across the country.   While monetary resources are essential, his recommendation focuses on the close attention that must be paid to the critical work of breastfeeding and newborn care in order to make meaningful headway in improving the lives of many of India’s children.

See the full article here.

Where India Goes makes The Hindu’s Top 10 list!

The Hindu recently compiled its list of top ten non-fiction books of 2017, and Dean and Diane’s Where India Goes made the list!  They write:

Coffey and Spears have come out with a deeply researched and thoughtfully written book about open defecation, the role of caste, and the challenges of implementing policy interventions at this scale. They explain why Indian children are stunted, pointing out that poor nutrition is not the only reason.

See the full list here.


SARI in the news!

We are excited that SARI findings on explicit prejudice, published in EPW last week, have received the following media coverage to date:

  • Seema Chishti’s front page article in the Indian Express – see here
  • Scroll’s coverage – see here
  • NewsClick’s interview with Amit Thorat – see here
  • Kaushik Basu’s tweet – see here
  • Hindi coverage in Aaj Tak – see here

Maternity benefits – not yet universal

At the start of the new year, we were excited to see forward momentum on the national maternity entitlements program: the prime minister announced that the program would be made universal and cover all districts beginning January 1st, 2017 (up from the 52 pilot districts in the current IGMSY pilot program).  Additionally, an expanded budget allocation of 2,700 crore, up from approximately 433 crore last year, was announced a few weeks ago. Even though this amount falls far below what women are actually owed under the law, it was still heartening to see that the government was making plans to reach more women.

However, an Indian Express article last week reported that in the face of insufficient funding, the Ministry of Women and Child Development may limit maternity entitlements to only a woman’s first birth, instead of covering all births, which is what is mandated by law.  Limiting the transfer to the first birth will prevent many children from benefiting from this transfer.  Setting a one-child limit now could set an exclusionary precedent that may be difficult to change later.

In addition to this potential new limit, this article in Scroll yesterday covered many of the other problems with the maternity benefits program, including payment delays which have plagued the program since the beginning.  In the article, Diane is quoted discussing the potential that the benefit can have in improving a mother’s nutrition and birth outcomes if given without delays, and as early in pregnancy as possible: “In order for [the transfer] to have a good effect, it will be essential for the government to give women the first transfer very quickly upon registration of the pregnancy, and to train health workers to educate women that the purpose of the transfer is to promote weight gain in pregnancy.”  Unfortunately, in talking with women in Chhindwara district in Madhya Pradesh, Diane saw that none of the women were receiving any of the money during pregnancy.   Dipa Sinha of the Right to Food Campaign, who has also documented widespread payment delays in other districts and states, further discusses how the new exclusion will likely leave out the women most in need of nutritional support in pregnancy.

The funding shortfall and one-child limits are disheartening. When signs were finally pointing to expansion of the program four years after the law mandating maternity entitlements was passed, it seems that the program may leave out many babies.  We hope that that the government makes a full effort to come into compliance with the law by deciding against limits on the number of children the program can be applied to, allocating additional funds in the near future to truly reach universalization, and addressing the massive delays that plague current implementation.

New paper on the relationship between village conflict and OD

Waterlines recently published Dean, Diane and my paper on the relationship between social fragmentation in villages and the persistence of open defecation in India.  We use quantitative data to show the correlation between perceptions of village conflict, both general and caste-based, and open defecation, and qualitative data to explain how caste hierarchy could be a mechanism linking conflict and open defecation.

We hope that this paper pushes all of us working on sanitation in India to think beyond traditional approaches to motivating latrine use.  We must seriously question whether popular methods that rely on collaboration can be effective in a context like rural India where deep social divisions continue to govern interactions in daily life.  Experimentation is critical to finding strategies that will work in tackling India’s unique open defecation challenge.

If you have access to Waterlines, you can find the paper here. Otherwise, you can read it here.

30,000 babies in UP


Neonatal mortality is the number of babies, per 1000 live births, that die in the first 28 days of life.  Postneonatal mortality is the number of babies, per 1000 live births, that die between 29 days and a year.  Infant mortality is the sum of these two rates, that is, the number of babies, per 1000 live births, who die in the first year.  These numbers are considered good summary measures of population health.

The graphs below (also shown here) show state level differences in neonatal, postneonatal, and infant mortality from two of India’s most recent datasets – the Annual Health Survey (AHS) and the Sample Registration System (SRS).  The results for most states, and most rates, are quite similar.  The exception is neonatal mortality in Uttar Pradesh.

SRS reports UP’s neonatal mortality rate as 43.9 while the AHS reports it as 50.0.  As stand-alone rates, these numbers do not seem so wildly different, but because Uttar Pradesh has such a large population, the discrepancy in neonatal deaths between the two sources is over 30,000 deaths!  Perhaps another survey is in order.

No matter which of the surveys you use, Uttar Pradesh has one of the highest neonatal mortality (NNM) rates in the country.  That over 200,000 babies die in Uttar Pradesh every year is a tragedy.  These are babies who have been loved by parents and grandparents and siblings and neighbors.

Although the downward sloping lines in these graphs indicate that things are getting better across the eight states, including Uttar Pradesh, improvement is not happening fast enough.  Uttar Pradesh’s especially high rates suggest the need pay more attention to understanding and addressing the causes of NNM there.

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Reflections on the SBM and maternity entitlements

Rahul Jacob wrote a piece today in the Business Standard, highlighting r.i.c.e.’s research and calling on the government to convince people to use latrines if the SBM is to have any impact on public health, rather than simply meeting latrine building targets.  See the article here.

Also, we’ve recently been thinking more about maternity entitlements – check out Diane and my op-ed in the Hindu here.

Diane’s research shows the depth of poor maternal nutrition in India, which leads to low birth weights and high rates of child malnutrition, and poor health, cognition, and productivity later in life.  The 2013 National Food Security Act mandates a maternity entitlement of 6,000 Rs. to pregnant women, which we argue is an important opportunity to improve maternal nutrition.  In reality, however, the benefit has only been implemented as a pilot in very few districts. And rather than being applied universally, as stated in the law, its structure disproportionately leaves out many poor and minority women.  Arguments against universalization are based on misguided concerns that government programs which give cash transfers to mothers will increase fertility, but there is no evidence showing that such small amounts of money will actually motivate a family to have another child.

In response to a Supreme Court notice to the Ministry of Women and Child Development for its non-implementation of maternity entitlements, the MWCD suggests an expansion of the pilot.  But without making improvements in its design, this won’t be enough.  The policy door is already open for maternity entitlements to address India’s maternal nutrition deficits, but in order to do so, they must be funded adequately, applied universally, and used to educate families about the importance of healthy pregnancies.

(Photo source: The Hindu)

How many of us are willing to clean our own toilets?

Sagarika Ghosh’s Times of India blog post this week echoes some of r.i.c.e.’s research findings and addresses a very deep reason why India’s sanitation challenge continues to be so intractable: purity, pollution, and caste discrimination.  You can read the full post here, but here are some excerpts:

“Purity” and “pollution”, said Louis Dumont in his seminal work Homo Hierarchus, are a principal feature of India`s caste system, where the higher you go the “cleaner” or “purer” you become. The lower you are in the caste hierarchy the dirtier or more “impure” you are.

Ghosh goes on to say:

Precisely because cleaning is the duty of the social pariah, cleanliness has become a pariah to our daily lives too. Toilets are “dirty”, to be cleaned by those who do “dirty work”, upper castes are not programmed to clean their own waste because the socially inferior do it for them. We not only need a jhadoo for the street, we need a jhadoo in our minds as well.

From our qualitative study, this same sentiment came through in many of the interviews we conducted.  People feel intense disgust towards the idea of dealing with feces and cleaning latrine pits because feces are considered “unclean” and “impure.”  By extension, those responsible for cleaning feces are considered polluting.  Given enduring caste hierarchies, Dalits, who are called upon to handle human waste, are considered polluted because of this work, and people in higher castes consider contact with them to be polluting as well.

What does this all have to do with latrines and latrine use?  Simple latrines, common in most developing countries, are difficult to find in India because they are considered unacceptable, in part because latrine use means accumulating pollution and impurity near the home.  Pit emptying in India presents a deeper challenge than in most societies because of these concepts of purity and pollution and because of caste and untouchability.  Deeply internalized casteism means that most people are unwilling to empty their own or others’ latrine pits.

One way that people try to get around the problem of pit emptying is by constructing enormous pits, which are essentially underground rooms to collect feces.  Large pits allow people to feel that they’ll almost never have to deal with the feces, escaping the possibility of pollution.  These unnecessarily large pits appear to be the social norm in rural areas, making it socially unacceptable for the less wealthy to build and use simpler latrines that they can actually afford.  Instead, they continue to defecate in the open.

The solution is not for everyone to make latrines with larger and larger pits.  As Ms. Ghosh points out, what is needed is a change in mindsets, to transform what is culturally acceptable and make the use of simple latrines the aspiration of every individual in rural India.

The true cost of sanitation

Written by  on October 22nd, 2014

In Rohini Nilekani’s recent LiveMint piece, she argues that before we “rush out to build toilets everywhere” it is important to understand both the costs of poor sanitation, and the complexities in overcoming the challenge.

Ms. Nilekani quotes our work in talking about some of the hidden, and difficult to measure, costs of poor sanitation:

The work of economist Dean Spears and the Research Institute for Compassionate Economics, or R.I.C.E., shows us that this true cost of not completing the sanitation loop is also reflected in millions of stunted or malnourished children, and in high maternal and infant mortality rates.

Ms. Nilekani also importantly points out that access alone is not the issue.  Getting people to actually use their latrines is not a simple thing to do in rural India, and creating demand takes time, manpower, and resources:

What is important to accept is that even when people have access to toilets, many prefer to use the outdoors.  Over the past two decades, the experience of many organizations working on rural sanitation has yielded some explanations. People behave perfectly rationally when they prefer an open-air space to a small, smelly loo. They are worried that the small underground pits which collect the waste from the toilets will fill up quickly and that it will require money and added work to empty them. Hence, many men think they are being considerate when they desist from using the toilet, in favour of the women of the house.

We need to carefully understand the situation, the emotions and the rationales of people in order to understand what it will cost to improve sanitation facilities in the country…

First, there is the question of proper demand generation. People have to clearly see the connection between their family’s health and their sanitation habits. And they need sustained help to break old habits and make the appropriate change in behaviour. We can now leverage the work of many agencies that have successfully designed and delivered scientific and effective communication. But this comes at a price. To use an example from the work of my foundation, Arghyam in Davangere district in Karnataka, the communication campaign cost was around Rs.1,000 per toilet. Gramalaya, an NGO believes it takes as much as Rs.2,500 per toilet over several months on behaviour-change communication so as to achieve sustainable sanitation outcomes.

It is absolutely true that the costs of poor sanitation are far too high and that we can no longer afford failure in addressing the challenge.  Many more players are needed to learn how to motivate people to change their behavior if we are to prevent these costs from rising even further.

The Hindu covers Aashish’s research on the underreporting of violence against women in India

Rukmini S. of The Hindu published an article today about Aashish’s new studyon how so few violent crimes against women are actually reported to the police in India.  Part of the article is below, but read the full text here.

Husbands commit a majority of acts of sexual violence in India, and just one per cent of marital rapes and six per cent of rapes by men other than husbands are reported to the police, new estimates show.

In keeping with the widely held belief among women’s rights activists in India that sexual violence is grossly under-reported, social scientist Aashish Gupta with the Research Institute for Compassionate Economics compared National Crime Records Bureau (NCRB) statistics on officially reported cases of violence against women with data from the National Family Health Survey (NFHS), which asked women respondents whether they had faced any sexual or physical violence.

Since the most recent round of the NFHS was conducted in 2005, Mr. Gupta compared the NCRB statistics for that year with the extent of violence that women had admitted to in the NFHS survey.

Mr. Gupta found that while 157 per 1,00,000 women reported to NFHS surveyors that they had experienced rape by men other than their husbands in the past 12 years, 6,590 — or nearly two of every three women — said their husbands had physically forced them to have sexual intercourse against their will. This meant that just 2.3 per cent of all rapes experienced by women were by men other than their husbands.

For both marital and non-marital rapes, however, the officially reported figures were extremely low, Mr. Gupta said in a working paper he shared with The Hindu. Comparing the NCRB and NFHS data in 2005, just 5.8 per cent of rapes by men other than the woman’s husband were reported to the police, and just 0.6 per cent of rapes by the husband. Since marital rape was not recognised as a crime in India, it was probably reported as “cruelty,” Mr. Gupta found.

 Check out our UNC posters and presentations

As Sangita posted a few days back, we had a great week at the UNC Health and Water Conference last week.  I’m posting our presentations and posters here, in case anyone wants to take a closer look at the research that we shared:


Confronting the challenge: Sanitation behavior change in rural north India:

Population density and the effect of sanitation on early-life health


Please do let us know what you think – we’d love to hear your feedback!

A look at the plans for the “new” Swacch Bharat Mission

The government has announced that the Swacch Bharat Mission is to be a mass movement to make India open defecation free in five years. By spending one lakh thirty four thousand crore rupees for the construction of about 11 crore 11 lakh toilets in the country, “the pet project of the Prime Minister will be executed on a war footing with the involvement of every gram panchayat, panchayat samiti and Zila Parishad in the country, besides roping in large sections of rural population and school teachers and students in this endeavor.”

While it is commendable that the government has set high ambitions for making India free of the practice of open defecation, it is worth exploring the way in which they are planning on reaching this goal.  Unfortunately, plans for the new Swacch Bharat Mission (SBM) don’t look very different from the current Nirmal Bharat Abhiyan (NBA).  The priority is still on construction, perhaps even more so than before, and so does not appear to be as significant a break from the past as hoped.

One important change in the new SBM is its increased budget.  11 crore is the number of households that have no toilet facilities, so much of the enlarged budget will go towards building a new toilet for every household in India without one.  This may seem like a good idea to those who argue that havinga latrine is a prerequisite to using one, but we at r.i.c.e. would argue that there’s something that needs to happen even before that. We know from our recent SQUAT survey that many people in households with working latrines choose to defecate in the open anyway.  To reach these people, we need to create a desire in them to actually have and use a toilet, even before they physically get or make one.  Access to toilets alone will not solve the problem of open defecation when many people simply prefer to defecate in the open.  Is the government really prepared to waste away the resources it is gearing up to spend?

Not only are more toilets to be built, but at 12,000 INR each, they cost 2,000 INR more than each latrine under the current NBA.  As a simple exercise, we calculated that if the government hired one dedicated behavior change staff member for each of 700,000 villages, five staff members in each block office, and one staff member in each district, for five years, it would cost less than one-fifth of what it would cost to build a 12,000 INR toilet for every household without one in India. Not only does it make practical sense to focus on changing people’s minds, it makes financial sense too.

Rather than motivating people to want and use their latrines, the SBM is actually worse than the NBA in terms of behavior change because the IEC allocation has decreased from 15% of the budget to just 8%.  While it may be true that this is a larger monetary amount than previously allocated (because the entire budget of the SBM is much larger than that of the NBA), the reduction is symbolic in terms of the importance given to changing people’s minds and sanitation practices versus construction.  The language of the new policy indicates that “behaviour change and usage of toilets shall be given top priority to ensure increased demand,” but given budgetary allocations, this seems even less possible now than it was under the NBA.

It is useful to reflect on just how much money has actually been allocated, only for the construction of new toilets.  Per year, the projected construction allocation under the SBM is more than 9 times the 2013-14 NBA expenditure, almost equal in size to the NREGA budget, and a full 2% of the entire 2013-14 Union budget. These numbers are enormous.  And still, the question remains whether the government will actually be able to spend whatever money ultimately gets allocated.  Of the cumulative funds allocated to the NBA and its predecessor, the TSC, till date, the government was able to spend only 80% of funds allocated for household construction and 40% of funds allocated to IEC.  Without hiring more ground staff to increase what the government has the capacity to spend, it is unlikely that the SBM will be able to make faster progress than previous sanitation efforts.

It is disappointing that the government has not taken a fundamentally new approach to the challenge of ending open defecation.  Still, we sincerely hope that the government will commit to increasing its capacity to carry out this ambitious mission.  We are committed to helping learn more about which messages will work in motivating people to use latrines, and to promoting behavior change as the first priority.  While construction seems to have trumped behavior change thus far, we hope that the Swacch Bharat Mission can still ensure that what has been allocated to behavior change is spent and that the only toilets that are constructed are those that will be used.

Public service announcement: Ending open defecation is in our hands!

Check out this public service announcement, called “Ending open defecation is in our hands,” made by WASH United. It calls upon us all to join in and help: “India is ready for another epic achievement – ending open defecation…It is in our hands.” Plans are set for the government to start using this soon too, which we’re very excited about!

Showing low-cost latrines at the end of the video, the message is clear that we can change India’s national shame into another major public health success (much like the recent eradication of polio). Although we can’t give out Oscar or Emmy awards, if we could, the r.i.c.e. team would love to create the “Shitty Awards” for efforts that have the potential to motivate each one of us to get involved in a much-needed national scale movement to end open defecation – WASH United’s PSA would surely be a winner!

Purity, latrine use, and religion

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.

Behavior change order to states from the MoDWS!

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)!

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!

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

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.






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.


Another misguided toilet building target

Earlier this month, the Ministry of Drinking Water and Sanitation (MDWS) issued an order to all states saying that they must construct over 5.2 million toilets by August 31st, the 100th day of the new government’s term. That’s just 58 days from the date of the original order. We very much appreciate Down to Earth’s response, which calculates just how unrealistic this target is: in order to meet their goal, the government would have to build one toilet every second from now until the end of August.

Even more important than the impracticality of the target is the unfortunate fact that this strategy continues the same construction-focused ideas of the past, which clearly have not worked in the Indian context. From our SQUAT survey, we know that most people who own a government-constructed latrine defecate in the open anyway.

Further, the MDWS order says nothing about changing the behavior or attitudes of the many people who prefer not to use a latrine, so if the goal is to end open defecation, this massive construction plan is very likely headed for failure. Using a simple model, we also found that if the government did actually construct a latrine for every household in our survey that did not have one, without doing anything to change preferences about open defecation, more than half of people in our focus-state sample would still defecate in the open.

It is indeed sad to see that when given the opportunity to take meaningful action towards ending open defecation, the government has yet again chosen to ignore the challenge of motivating people to use latrines, and instead decided to implement more of the same flawed policies of the past. In addition to changing people’s minds to want to use a latrine, we also need to convince policymakers that current and future policy must increasingly focus on toilet use, not just construction.

More media using SQUAT to push for attitude change

Two new articles came out this week, both urging the government to focus on the right problem – the one of changing attitudes to eliminate open defecation in India.

Using data from the SQUAT survey, Yamini Aiyer and Avani Kapur of the Accountability Initiative push the new government to focus on behavior change and motivating toilet use, rather than merely increasing construction. Check the Live Mint piece out here. They explore some of the steps the government can take starting now:

So how can the new government avoid the mistakes of the past? There is little argument that total sanitation can only be achieved through collective behaviour change. But engineering shifts in social behaviour is not something that governments, even efficient ones, are good at. Doing this right would require a nuanced approach—one that understands the reasons behind user preferences, and develops awareness campaigns and solutions linked to that. This is something that advertising firms might be better at than bureaucrats trained to move files.

Even as India’s policymakers grapple with finding the best solution, there are a few small steps that the new government must take. First, start measuring the right problem. Appropriate measurement will serve two purposes.

One, it will send a clear message that the goal of sanitation policy is “usage” and not construction. Two, if done innovatively by reaching out to communities to get involved in data collection, it can also be an awareness creation strategy.

Second, incentivize innovation and experimentation. Rather than developing a tightly controlled, Delhi-centric scheme, the Swachh Bharat Mission should be designed as an innovation fund, which allows states and local governments to develop appropriate strategies. Funds to states should be tied to cost of state-specific innovations and achievements against outcome indicators. A message from the Prime Minister that the goal is to promote toilet usage and not toilet construction will ensure that this fund doesn’t fall into the NGP construction trap.

Also, in a Millennium Post article, KV Venkatasubramanian writes about the growing urgency around addressing problems of sanitation in India. He highlights many of the issues that r.i.c.e. has researched, including the negative impacts of open defecation on health, cognition, and adult productivity. Further, he uses SQUAT data to argue that latrine ownership does not necessarily translate into latrine usage, and quotes Diane about the need to address beliefs and norms around latrine use. See the piece here.