Open defecation

Open defecation in Pandharpur - a pilgrimage town in India

Open defecation is the practice of people defecating outside and not into a designated toilet. The term is widely used in literature about water, sanitation and hygiene (WASH) issues in developing countries. Open defecation causes public health problems in areas where people defecate in fields, urban parks, rivers and open trenches in close proximity to the living space of others.

Eliminating open defecation is the main aim of improving access to sanitation worldwide and is a proposed indicator for the Sustainable Development Goals. Even if toilets are available, people still need to be convinced to refrain from open defecation and use toilets. Therefore, the need for behaviour change is critical in addition to the provision of toilets. A preference for open defecation behavior may be due to traditional cultural practices or lack of access to toilets, or both.[1]

Extreme poverty and lack of sanitation are statistically linked; eliminating open defecation is said to be an important part of development efforts.[2] High levels of open defecation in a country are usually correlated with a high child mortality, as well as high levels of undernutrition, high levels of poverty and large disparities between the rich and poor.[3](p11)

About one billion people, or 15 percent of the global population, practice open defecation.[3] (page v) India has the highest number of people practicing open defecation: around 490 million people, or over a third of the population.[4] Most of it occurs in rural areas, where the prevalence is estimated at 52 percent of the population, as opposed to urban areas, where prevalence is estimated at 7.5 percent.[5] The other countries with the highest number of people openly defecating are Indonesia (54 million people), followed by Pakistan (41 million people), Nigeria (39 million), Ethiopia (34 million), and Sudan (17 million).[3]

Background

Indiscriminate waste dumping and open defecation in the area of Shadda, Cap-Haitien, Haiti
Open defecation in Tirin Kowt bazaar, Afghanistan
Open defecation along a river bank in Bujumbura, Burundi
Child defecating in a canal in the slum of Gege in the city of Ibadan, Nigeria
This drain is used to defecate and urinate in a community in Bangladesh
Open defecation and waste dumping area in Palijat in Gujarat state, India
A dirty pit latrine in Mongolia leading people to choose open defecation instead

Whilst open defecation causes little harm when done in sparsely populated areas, forests or camping type situations; it becomes a significant public health issue - and an issue for human dignity - when it occurs in more densely populated areas.

Open defecation perpetuates the vicious cycle of disease and poverty and is widely regarded as an affront to personal dignity.[3] The countries where open defecation is most widely practised have the highest numbers of deaths of children under the age of five, as well as high levels of undernutrition, high levels of poverty, and large disparities between the rich and poor.[3]

Reasons

There can be many reasons why a person openly defecates, and these may include:

Reasons for people owning a household toilet but still openly defecating may include:[6]

Therefore, the reasons for open defecation are varied, and this activity can indeed be a voluntary or semi-voluntary choice, but in most cases it is due to the fact that the alternatives (i.e. toilets) are not available or not clean, safe, and attractive.

Use of the term

The term "open defecation" became widely used in the Water, Sanitation and Hygiene (WASH) sector from about 2008 onwards when the publications of the Joint Monitoring Programme for Water Supply and Sanitation (JMP) and the UN International Year of Sanitation created more awareness. The JMP is a joint program by WHO and UNICEF to monitor the water and sanitation targets for the Millennium Development Goals (MDGs) - the predecessor to the Sustainable Development Goals from 2016 onwards. For monitoring purposes, two categories were created: improved sanitation and unimproved sanitation. Open defecation falls into the latter category. This means that people practicing open defecation are counted having no access to improved sanitation.

In 2013 World Toilet Day was celebrated as an official UN day for the first time and the term "open defecation" was used in high-level speeches, helping to draw attention to this issue (for example in the "call to action" on sanitation issued by the Deputy Secretary-General of the United Nations in March 2013).[7]

Open defecation free

"Open defecation free" (ODF) is a term first used in Community-Led Total Sanitation (CLTS) programs and has now entered use in other contexts, too. The original meaning was simply that all community members are using sanitation systems rather than practising open defecation. Further more stringent criteria have been added in some countries where CLTS programs exist.[6]

The Indian Ministry of Drinking Water and Sanitation has in mid 2015 defined "open defecation free" as "the termination of fecal-oral transmission, defined by no visible feces found in the environment or village and every household as well as public/community institutions using safe technology option for disposal of feces".[8] This definition is part of the Swachh Bharat Abhiyan (Clean India Campaign).

Prevalence

The prevalence of open defecation as part of voluntary, recreational outdoor activities in remote areas is difficult to estimate but — as mentioned above — is also of very little concern from a public health, environmental resource protection and human dignity perspective.

In developing countries however, the situation is entirely different. Here, open defecation is a practice strongly associated with poverty and exclusion particularly when it comes to less remote and less rural areas, such as urban informal settlements.

Data by Joint Monitoring Programme

The Joint Monitoring Programme for Water Supply and Sanitation (JMP) of UNICEF and WHO has been collecting data regarding open defecation prevalence worldwide. The figures are segregated by rural and urban areas and by wealth quintiles. This program is tasked to monitor progress towards the Millennium Development Goal (MDG) relating to drinking water and sanitation. As open defecation is one example of unimproved sanitation, it is being monitored by JMP for each country and results published on a regular basis.[9] The figures on open defecation used to be lumped together with other figures on unimproved sanitation but are collected separately since 2010.

Over the past 22 years, the number of people practicing open defecation fell by 21%, from 1.3 billion in 1990 to one billion in 2012.< ref name="JMP2014" />(p6) Those one billion people with no sanitation facility whatsoever continue to defecate in gutters, behind bushes or in open water bodies, with no dignity or privacy. Most people (9 out of 10) who practice open defecation live in rural areas, but the number in urban areas is increasing.[3]

82% of the one billion people practicing open defecation in the world live in just 10 countries. India is the country with the highest number of people practicing open defecation: around 600 million people.[3] This is 47 percent of the population (13 percent of urban dwellers and 70 percent of villagers). The other countries with a high number of people openly defecating are Indonesia (54 million people), followed by Pakistan (41 million people), Nigeria (39 million) and Ethiopia (34 million).[3](p19)

Impacts

The health and personal safety impacts due to open defecation are principally the same as those from lack of sanitation.

Health impacts

Open defecation — and lack of sanitation and hygiene in general - is an important factor in causing various diseases, most notably diarrhea and intestinal worm infections but also typhoid, cholera, hepatitis, polio, trachoma and others.[10][11] In 2011, infectious diarrhea resulted in about 0.7 million deaths in children under five years old and 250 million lost school days.[10][12] It can also lead to malnutrition and stunted growth in children.

Certain diseases are grouped together under the name of waterborne diseases, which are diseases transmitted via fecal pathogens in water. Open defecation can lead to water pollution when rain events flush the feces that are dispersed in the environment into surface water or unprotected wells.

Open defecation was found by the WHO in 2014 to be a leading cause of diarrheal death; an average of 2,000 children under the age of five die every day from diarrhea.[13]

Young children are particularly vulnerable to ingesting feces of other people that are lying around after open defecation, because young children crawl on the ground, walk barefoot and put things in their mouths without washing their hands. Feces of farmed animals are equally a cause of concern when children are playing in the yard.

Those countries where open defecation is most widely practiced have the highest numbers of deaths of children under the age of five, as well as high levels of malnourishment (leading to stunted growth in children), high levels of poverty and large disparities between the rich and poor.[3]

Research from India has shown that detrimental health impacts (particularly for early life health) are even more significant from open defecation when the population density is high: "The same amount of open defecation is twice as bad in a place with a high population density average like India versus a low population density average like sub-Saharan Africa."[14]

Safety and gender impacts

There are also strong gender impacts: lack of safe, private toilets makes women and girls vulnerable to violence and is an impediment to girls’ education. Rapes and sexual molestation take place when women search for places for open defecation that are secluded and private, often during hours of darkness.[15][16]

Prevention

Key drivers to eradicate open defecation include:[2]

Integrated initiatives

Efforts to reduce open defecation are more or less the same as those to achieve the MDG target on access to sanitation. A key aspect is awareness raising (for example via the UN World Toilet Day at a global level), behaviour change campaigns, increasing political will as well as demand for sanitation. Community-Led Total Sanitation (CLTS) campaigns have placed a particular focus on ending open defecation by "triggering" the communities themselves into action.[17]

As India has such a high number of people practicing open defecation, various Indian government-led initiatives are ongoing to reduce open defecation in that country. It began as the "Total Sanitation Campaign", which was relaunched as Nirmal Bharat Abhiyan in 2012 and integrated into the wider Swachh Bharat Abhiyan (Clean India Mission) in 2014.

Also in 2014, UNICEF began a multimedia campaign against open defecation in India, urging citizens to "take their poo to the loo."[18]

Simple sanitation technology options

Residents in Mymensingh, Bangladesh participate in a workshop to discover more about mobile sanitation options (MoSan) as an alternative to open defecation

There are some simple sanitation technology options available to reduce open defecation prevalence if the open defecation behavior is due to not having toilets in the household and shared toilets being too far or too dangerous to reach, e.g. at night.

Toilet bags

People might already use plastic bags (also called flying toilets) at night to contain their feces, However, a more advanced solution of the plastic toilet bag has been provided by the Swedish company Peepoople who are producing the "Peepoo bag", a "personal, single-use, self-sanitizing, fully biodegradable toilet that prevents feces from contaminating the immediate area as well as the surrounding ecosystem".[19] This bag is now being used in humanitarian responses, schools and urban slums in developing countries.[20][21]

Bucket toilets and urine diversion

Bucket toilets are a simple portable toilet option. They can be upgraded in various ways, one of them being urine diversion which can make them similar to urine-diverting dry toilets. Urine diversion can significantly reduce odors from dry toilets. Examples of using this type of toilet to reduce open defecation are the "MoSan"[22] toilet (used in Kenya) or the urine-diverting dry toilet promoted by SOIL[23] in Haiti.

Society and culture

Affordable household toilets near Jaipur, Rajasthan

Mainstream media

The mainstream media in the countries most affected have recently been picking up on this issue of open defecation, for example in India[24][25] and Pakistan.[26][27][28]

Examples

India

See also

Notes

    References

    1. ↑ Clasen,T; Boisson,S; Routray,P; Torondel,B; et al. (2014). "Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial". The Lancet Global Health 2 (11): e645–e653. doi:10.1016/S2214-109X(14)70307-9. ISSN 2214-109X.
    2. 1 2 3 Ahmad,J (30 October 2014). "How to eliminate open defecation by 2030". devex. Retrieved 2 May 2016.
    3. 1 2 3 4 5 6 7 8 9 Progress on drinking water and sanitation, 2014 Update. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP). 2014. ISBN 9789241507240.
    4. ↑ "Table 16 R/U: Percentage of persons in respective age categories going for open defecation". Swachhta Status Report 2016 (PDF). Ministry of Statistics and Programme Implementation, Government of India. 2016. pp. 69–70. Retrieved 2 May 2016.
    5. ↑ "Rural population (% of total population)". World Bank. 2016. Retrieved 2 May 2016.
    6. 1 2 Cavill, S; Chambers, R; Vernon, N (2015). Sustainability and CLTS: Taking Stock Frontiers of CLTS: Innovations and Insights Issue 4. IDS. p. 18. ISBN 978-1-78118-222-2.
    7. ↑ "United Nations Deputy Secretary-General's Call to Action on Sanitation" (PDF). United Nations. 2013. Retrieved 19 October 2014.
    8. ↑ "Guidelines for ODF Verification" (PDF). Indian Ministry of Drinking Water and Sanitation. 2015.
    9. ↑ "Data and estimates". JMP - WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation. WHO/UNICEF. Retrieved 12 March 2015.
    10. 1 2 "Call to action on sanitation" (PDF). United Nations. Retrieved 15 August 2014.
    11. ↑ Chaturvedi, Vishnu; Spears, Dean; Ghosh, Arabinda; Cumming, Oliver (2013). "Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts". PLoS ONE 8 (9): e73784. doi:10.1371/journal.pone.0073784. ISSN 1932-6203.
    12. ↑ Walker, CL; Rudan, I; Liu, L; Nair, H; Theodoratou, E; Bhutta, ZA; O'Brien, KL; Campbell, H; Black, RE (Apr 20, 2013). "Global burden of childhood pneumonia and diarrhoea". Lancet 381 (9875): 1405–16. doi:10.1016/S0140-6736(13)60222-6. PMID 23582727.
    13. ↑ "WHO | Diarrhoeal disease". World Health Organization. 2013. Retrieved 2014-03-10.
    14. ↑ Vyas (2014). Population density and the effect of sanitation on early-life health], slide 19 (presentation at UNC conference in Oct. 2014) (PDF). Research Institute for Compassionate Economics, project (r.i.c.e.).
    15. ↑ Lennon, S. (2011). Fear and anger: Perceptions of risks related to sexual violence against women linked to water and sanitation in Delhi, India - Briefing Note. SHARE (Sanitation and Hygiene Applied Research for Equity) and WaterAid, UK
    16. ↑ House, Sarah, Suzanne Ferron, Marni Sommer and Sue Cavill (2014) Violence, Gender & WASH: A Practitioner’s Toolkit – Making water, sanitation and hygiene safer through improved programming and services. London, UK: WaterAid/SHARE.
    17. ↑ "Field Notes: UNICEF Policy and Programming in Practice" (PDF). UNICEF. Retrieved 10 March 2015.
    18. ↑ "Why take poo to the loo". Poo2Loo. Retrieved 2015-03-10.
    19. ↑ Wheaton, A. (2009). Results of a medium-scale trial of single-use, self-sanitising toilet bags in poor urban settlements in Bangladesh. Deutsche Gesellschaft für Technische Zusammenarbeit GmbH (GTZ), Dhaka, Bangladesh
    20. ↑ Owako, E. (2012). Nyando peepoo trial project report. Kenya Red Cross, Kenya
    21. ↑ Naeem, K., Berndtsson, M. (2011). Peepoo Try Pakistan - Sindh Floods, November 2011. UN-HABITAT, Pakistan
    22. ↑ Mijthab M., Woods E., Lokey H., Foote A., Rieck. C (2013). Sanivation and MoSan Toilet - 4 week Service Pilot in Karagita Naivasha, Kenya. GIZ and Sanivation
    23. ↑ Russel, K. (2013). Mobile sanitation services for dense urban slums - Various documents on results from research grant. Stanford University, U.S.
    24. ↑ "BBC News - Why India's sanitation crisis needs more than toilets". Bbc.com. Retrieved 2015-03-10.
    25. ↑ "India has highest number of people practicing open defecation | Latest News & Updates at Daily News & Analysis". Dnaindia.com. 2014-11-19. Retrieved 2015-03-10.
    26. ↑ "More than 40m Pakistanis defecate openly: Unicef - Pakistan". Dawn.Com. Retrieved 2015-03-10.
    27. ↑ "Lack of toilets tied to stunted growth in Pakistan: UNICEF – The Express Tribune". Tribune.com.pk. 2012-03-13. Retrieved 2015-03-10.
    28. ↑ "Over 43 million people in Pakistan defecate in the open". thenews.com.pk. Retrieved 2015-03-10.
    29. ↑ "Indian city to pay residents to use public toilets". Retrieved 9 June 2015.
    30. ↑ Aarti Dhar. "Rajasthan passes bill on eligibility for panchayat polls". The Hindu.
    31. ↑ Staff Reporter. "Subsidy for toilet construction". The Hindu.

    External links

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