Shitting Outside a Big Problem in India Despite $30 Billion Spent on Clean India

India spent $30 billion to fix its broken sanitation. It has reportedly ended up with more problems.

Map showing forecast prevalence of open defecation in rural areas by end 2017, South Asia

The Swachh Bharat mission, launched in 2014, was an ambitious effort to stop open defecation. It’s far from reaching that goal. There’s not enough of toilets.

That means hundreds of millions of people in the country of 1.3 billion population end up defecating outside, which can spread diseases including cholera, typhoid and COVID-19. Poor sanitation in India leads to over 126,000 deaths every year from diarrheal diseases.

Prime Minister Narendra Modi has sought to fix this longstanding issue through the Swachh Bharat, or Clean India, mission. A centerpiece program for his government, it started in 2014 as an effort to stop open defecation through promotion of better hygiene practices and the construction of millions of toilets.

While Modi essentially declared victory against open defecation in October 2019, the work of this program is far from over, particularly as the coronavirus pandemic rages in the country –the daily surge is now hovering around 20,000 cases.

According to 2017 statistics from the World Health Organization and UNICEF, India is the No. 1 country in the world for open defecation, with over 344 million people without regular access to toilets in the country. If you add up Nos. 2 to 10, it still wouldn’t come close to India’s number, showing just how big the problem is there.

WHO and UNICEF report that the number of people practicing open defecation was twice as high in 2000, at 764 million despite huge strides having been made to reduce that figure through Swachh Bharat and other sanitation efforts.

How did India become the No. 1 country for open defecation in the first place?

Overpopulation and a lack of sanitation infrastructure have contributed to this health crisis. Additionally, India has often failed to properly maintain public toilets after the’re built.

Cultural behaviors play a big role too. Purity is an inherent part of toilet etiquette in India. According to common customs, toilets are often built outside the home and deemed unclean. That means many people in India still see open defecation as a more sanitary option than using a bathroom in or near the home. Because of this, even after the government builds new toilets for people, they will go unused, instead functioning as storage rooms.

“In order to change that you need to change people’s behavior, and that can take quite a long time,” said Tom Slaymaker, a data specialist for UNICEF, who tracks sanitation and hygiene globally.

How does open defecation harm people’s health?

Fresh feces is filled with viruses and bacteria, able to transmit ailments including diarrhea, cholera, dysentery, hepatitis A, typhoid and polio. Transmission occurs when flying insects land on deposits and carry the viruses elsewhere or when excrement contaminates water supplies in groundwater or wells. Poor hygiene practices, like not washing hands after defecating, are common in poor and rural communities, making these areas especially susceptible to diseases.

“Kids are particularly vulnerable,” Slaymaker added.