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How Poor Sanitation In India Can Contribute To Lasting Gender Barriers

A public latrine in a slum near Bangalore, India.
SuSanA Secretariat
A public latrine in a slum near Bangalore, India.

As of last year, India accounted for around 60 percent of the 2.5 billion people globally without access to a toilet, creating a serious sanitation crisis throughout India.

“What we’re talking about is the spread of disease, but we’re also talking about loss of health. We’re talking about loss of labor time,” said geographer Kathleen O’Reilly.

Despite this, many who do have access to a toilet still choose to practice open defecation. O’Reilly says this is due to wariness about using pit latrines and a preference for “enjoying the fresh air” versus “sitting in a stinky box.”

But the Indian government and international organizations are taking steps to improve sanitation in India via what O’Reilly calls “toilet interventions” – building the toilets and infrastructure necessary for improving sanitation.

O’Reilly says a key part of the success of toilet interventions is social pressure within communities to make the switch to using toilets.

“In a kind of ‘keeping up with the Jonses’ way, families wanted to build latrines because they didn’t want to be the only ones without,” said O’Reilly.

Although toilet interventions are crucial for improving health and sanitation in India, O’Reilly says there are some social concerns of ending open defecation practices, particularly for women.

“In India there are much greater constraints on what spaces women are allowed to occupy… [Ending open defecation could lead to] the disappearance of women from the public sphere … and that is of concern. That’s concerning,” said O’Reilly.

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SUZETTE GRILLOT, HOST: Kathleen O'Reilly, welcome to World Views.

KATHLEEN O'REILLY Thank you very much for having me.

GRILLOT: So, Kathleen, you do work as a geographer on issues of sanitation and clean water practices in urban and rural India. So can we just start with what are we talking about here? We know – and I know you've written about – the notion that there's still a practice of open defecation in India. Can you talk just a little bit about how and why that happens and what some of the consequences of that are before we talk about where you're headed with that kind of study?

O'REILLY: The easiest way to talk about open defecation in India is simply to say most people in India are defecating in the open. You can talk about numbers, but I think "most" says quite a lot. Now, most of those people are living in rural areas. What's concerning is that while the numbers of people in rural India who don't have toilets, who aren't using sanitation, seems to be declining, those numbers are actually going up in urban areas. And in general, we're always concerned about high population densities and open defecation – people and feces on the landscape being more or less in close proximity to each other. So what we're talking about is the spread of disease, particularly diarrheal disease, which can be deadly to children under five. But we're also talking about loss of health; we're talking about loss of labor time. So all of those things, public health in general, make it really important to have sanitation available to people and also to be encouraging them to use it.

GRILLOT: So you mentioned that it's happening more in the urban areas. Is this because of migration perhaps, with people moving from rural areas to urban areas? And so you're seeing an increase in this type of activity there?

O'REILLY: Right. India is a rapidly urbanizing state, and the numbers for urban-dwellers without sanitation is exactly that: people migrating from rural areas into urban areas – often in slums, often on the periphery of cities.

GRILLOT: So you mentioned the health consequences, disease consequences, loss of labor time because of disease and health insecurity, that we need to be concerned about this. But I thought it was interesting that you've demonstrated in your work that even when sanitation is available, we don't necessarily see them taking advantage of it. So talk a little bit about how this is becoming ingrained and perhaps a cultural practice. Is that the case? Or is it a lack of education? Or what is it that, even when they have proper toilets available to them, they still choose not to use them?

O'REILLY: It's a really complicated answer to that question, so let me talk about a few things that I've gotten out of my own work. One of the things is that people enjoy open defecation. If they have a toilet at home, it's the difference between – as they would put it – sitting inside a stinky box compared to being out in the open enjoying the fresh air, having the ability to go for a walk. That kind of enjoyment. I think it's important to think about it as a preference because people are choosing this. And to do so is a daily choice, so that's something else that matters. Those who go for open defecation might find that with one toilet in the family there isn't time to wait if one has to go off to work or something like that. Other things that matter: yes, there seems to be little understanding, especially in rural India, about disease – what it means for feces to actually be on the landscape. So health concerns are not a reason for people to stop going for open defecation. There's also concerns that the toilet they have is not going to enable them to use it indefinitely on into the future, and this is something that I think people in North America can't relate to. We are used to having a sustainable toilet system; we're never going to be able to stop using it. But pit latrines are the norm in rural India, and people have concerns about the pits filling up. So without a way to easily empty those pits, it's another reason to go for open defecation instead.

GRILLOT:  So as far as moving people in that direction – and I don't know if education is the right word to use in terms of making sure that people are aware of the fact that there are health and disease and other consequences to open defection. You talk about in some of your work, the use of social pressure and how once some people are converted to using proper sanitation practices that it's more likely, then, to spread. Can you talk a little bit about how that works? And this is a matter, I guess, of socialization?

O'REILLY: Sure. One of the things that I've learned from my work in west Bengal and Himachal Pradesh, where toilet interventions, toilet building interventions, were successful, was that, in a kind of "keeping up with the Jonses" way, families wanted to build latrines because they didn't want to be the only ones without. And neighbors would pressure other neighbors to build toilets and then to use them. Almost like a tipping point, families were ready to talk to their neighbors about having a toilet and using it because of not necessarily the health effects – although these communities were aware of those things, so education does matter – but also for the aesthetics of it. "Most of us are using toilets. You should too."

GRILLOT: In some of your work you've focused on women in particular and how women are affected by this. So can you tell us a little bit about how this is a women's issue? Is it a gendered issue? Obviously we all go to the toilet – men and women. So how does this issue affect women more so than men? Or does it?

O'REILLY: Well men are the least likely to use toilets even if they have one at home. Women's concerns are both individual and social. And of course those two things overlap. In India there are much greater constraints on what spaces women are allowed to occupy; there are greater pressures about modestly in public. And then of course there's the threat of physical violence.

GRILLOT: I was going to ask if this was also a safety and security issue for women.

O'REILLY: Mmm-hmm. Yes. Most definitely. So women are more likely to use toilets if they have access to them because of these privacy, convenience, and safety issues. Their work is mostly inside the household. I'm not saying that women don't work outside the house, but one of the things we heard often from women was, "I like having the toilet because it means that I can be cooking, and if I need to go, I can just go and come right back. If I have childcare responsibilities, I'm not gone for long or it's not necessary to take the children out for open defecation and then come back." Those types of timesaving measures. But the gendered aspect is most definitely about women's position in society, which is subordinate to men. They do not have the same freedoms of movement, and they certainly don't have the same kinds of physical security that men do. On the other hand, I am concerned about toilet building for women, and there have certainly been movements to target women as the reason to build a toilet at home. Those may be effective, but my concern is for the disappearance of women from the public sphere – that while going for open defecation is a small part of how a woman might be seen in public, might have some mobility out of the house. To build a toilet, particularly in the study area in Rajasthan, building a toilet meant that women really never had a reason to leave the house. And that is of concern. That's concerning.

GRILLOT: It's interesting to think of the negative social consequences, as you're pointing out, of limiting women's access to the public, even if we are talking about to get out to use the toilet. It's really remarkable to think about it along those lines. Well you've also spent a lot of time in India working with nongovernmental organizations and others who – I loved how you put it earlier, you talked about "toilet intervention" and trying to encourage people – men and women, I presume – to use toilets as opposed to open defecation. But how supportive is the Indian government? And how involved are they in providing the resources and the services, the sewer lines, the ability to even have toilet capability or the pit latrines or what have you? How involved is the Indian government in this?

O'REILLY: Well the Indian government has run a total sanitation campaign for India at large for decades. Narendra Modi since he's been in power as the prime minister has stated many times publically that this is a focus for him. However, it takes many layers of government to make a toilet intervention work. Not only to build the kinds of toilets that people want to use, but also to get the word out in terms of education, widening social pressure, so that people will use these facilities. And in urban India there is a real tension between what municipal governments want – which is not necessarily to have slums – that's held in tensions with holding back services from those slums in anticipation that those slums will eventually be torn down and the people living in them will be relocated. So by withholding services like water provision or putting sewer pipes and things like that, it means that the government has not committed itself to that slum being a permanent fixture, and that creates a lot of uncertainty for the people who live there. It certainly creates the kind of landscape that neither slum-dwellers nor elites or middle class citizens in the city want to deal with.

GRILLOT: So I know we've been talking about India and that you're an expert in India and spent most of your time there. But is this a larger issue that goes beyond India? Do you see these same types of practices and concerns in other areas that might even just make this a larger global development issue?

O'REILLY: It's definitely a global development issue. India usually pointed out as the state with the worst problems, but there are places around the world that have issues with open defecation both in cities and in rural areas. It is most definitely a global problem, and I think the community of scholars, activists, and policy makers working on this topic are all hoping that this body of knowledge can come together and be globally applicable. Context is always important, but I think we're all working toward some general solutions.

GRILLOT: Well, Kathleen, I know this a difficult subject often to talk about and a little sensitive, perhaps, to talk about the toilet, but it's something very important, and I appreciate you sharing that with us so that we can understand more about some of these important global development issues. Thank you.

O'REILLY: Thanks for having me. I appreciate it.

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