In March, India was declared polio-free. There is now an even greater scourge that India must battle: Open defecation. It kills more infants each year than those who became sick with polio each year in the 1980s, when polio was much more common. If open defecation is so much worse than polio, why have we not yet had a campaign to address the problem? This is because our leaders mistakenly think that open defecation is a problem of infrastructure — one that can be solved by building toilets.
This is wrong. Most people in India can afford to build latrines — if poorer Bangladeshis and Africans can afford to build and use latrines with no help from the government, so can richer Indians. India’s problems with open defecation fundamentally stem not from a lack of toilet access, but from the fact that too many people in rural India do not want to use toilets.
We are part of a research team that recently surveyed over 3,000 rural households about their sanitation behaviour. In four north Indian states, almost half of households that have a working latrine have at least one person who defecates in the open. Half of people who do so told interviewers that they do so because it is pleasurable, comfortable and convenient.
Just as Pulse Polio workers went door-to-door to convince parents to accept vaccines, the campaign to end open defecation must build a workforce to educate people about the importance of using a toilet. Just as cricketers, celebrities and national leaders used the media to convince people to vaccinate their children against polio, they must reach the masses with the message that open defecation is not acceptable.
Open defecation is killing children, stunting growth, and holding India back from a more developed future. We don’t need the government to build a toilet in every house; what India needs is a ‘toilet use’ revolution. The NDA has declared its goal of eliminating open defecation in India by 2019. But no sooner was the goal announced than a debate began: Will the government be able to achieve it? We are optimistic that it can — if it breaks with old policies, and launches a ‘latrine use’ revolution. If the budget announces a plan to build more latrines without a plan to promote their use, then the government will likely earn praise for appearing to keep its sanitation promise — but it will be falling into the trap that doomed past policies. Nothing short of a campaign to end open defecation — on the scale of Pulse Polio — will reach this urgent goal.
Diane Coffey and Dean Spears are visiting economists at the Centre for Development Economics at the Delhi School of Economics
The views expressed by the authors are personal