This report is being written by Suraya Hayat & Sabreena Hafliz
“Sanitation is more important than independence” – Mahatma Gandhi
Introduction:
Open defecation is defined as ‘the practice of defecating in open fields, waterways and open trenches without any proper disposal of human excreta’. Open defecation is the human practice of defecating outside (in an open environment) rather than into a toilet. People may choose fields, bushes, forests, ditches, streets, canals or other open space for defecation. This practice is common where sanitation infrastructure and services are not available.
Defecating in the open is a very ancient practice. In earlier times, there were more open spaces and less population pressure on land. It was believed that defecating in the open causes little harm when done in areas with low population, forests, or camping type situations. However, with development and urbanization, open defecating started becoming a challenge and thereby an important public health issue and an issue of human dignity. With the increase in population in smaller areas, such as cities and towns, more attention was given to hygiene and health. As a result, there was an increase in global attention towards reducing the practice of open defecation.
Child defecating in the open in a canal in the slum of Gage in the city of Ibadan,
The term “open defecation” is credited to the publications of Joint Monitoring Program (JMP) in 2008, a joint collaboration of World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) to evaluate the global progress on water and sanitation goals. Open defecation is classified as unimproved sanitation.
How is Open defecation a problem?
When a person defecates in the open, the pathogens (disease causing agents) present in the faeces travel from the hand to the mouth.Flies, rainwater, contaminated water, wind, hoofs of domestic animals, shoes, children’s toys, footballs, etc. are different agents or pathways through which faeces can enter one’s home.Faeces (Human Excrement) can get into the mouth via hands and fingernails, flies on food, fruits and vegetables that have been fallen on or been in contact with faeces and have not been washed, utensils washed in contaminated water, dogs licking people, etc.
Facts and figures relating to Open defecation across globe:
The current estimate is that around 673 million people practice open defecation[1]. This is down from about 892 million people, or 12 percent of the global population, who practiced open defecation in 2016. In that year, seventy-six percent (678 million) of the 892 million people practicing open defecation in the world lived in just seven countries. In 2015, 15% of the world’s population was still practicing open defecation.. Regionally, prevalence is highest in South Asia where 36% of the population was practicing open defecation. India in particular still has high rates, at nearly 45%. In Sub-Saharan Africa, this rate was 23%. However, some countries in particular — such as Niger, Chad, South Sudan and Eritrea — still have prevalence between 60 an d 80%. 2.0 billion people still do not have basic sanitation facilities such as toilets or latrines. Of these, 673 million still defecate in the open, for example in street gutters, behind bushes or into open bodies of water.
Open defecation in Cambodia is among the highest in the world. In 2010, 57 percent of Cambodian households still defecate openly, and in rural Cambodia this reached 66 percent.
Reasons for Open defecation:
There are a varied number of reasons for open defecation . It can be a voluntary, semi-voluntary or involuntary choice. Most of the time, a lack of access to a toilet is the reason. However, in some places even people with toilets in their houses prefer to defecate in the open.
A few reason that result in the practice of open defecation are given below:
- No toilet and/or other problems related to toilets:
- Lack of infrastructure: People often lack toilets in their houses, or in the areas where they live.
- Lack of toilets in other places: Lack of toilets in places away from people’s houses, such as in schools or in the farms lead the people to defecate in the open.
- Use of toilets for other purposes: In some rural communities, toilets are used for other purposes, such as storing household items, animals, farms or used as kitchens. In such cases, people go outside to defecate.
- Poor quality of toilet: Sometimes people have access to a toilet, but the toilet might be broken, or of poor quality – Outdoor toilets (pit latrines in particular) typically are devoid of any type of cleaning and reek of odours. Sometimes, toilets are not well lit, especially in areas that lack electricity. Others lack doors or may not have water. Toilets with maggots or cockroaches are also disliked by people and hence, they go out to defecate.
- Presence of toilet but not privacy: Some toilets do not have a real door, but have a cloth hung as a door. In some communities, toilets are located in places where women are shy to access them due to the presence of men.
- Lack of water near the toilet: Absence of supply of water inside or next to toilets cause people to get water from a distance before using the toilet. This is an additional task and needs extra time.
- Too many people using a toilet: This is especially true in case of shared or public toilets. If too many people want to use a toilet at the same time, then some people may go outside to defecate instead of waiting. In some cases, people might not be able to wait due to diarrhea (or result of an Irritable Bowel Syndrome emergency).
2. Unrelated to toilet infrastructure
- Lack of awareness: People in some communities do not know about the benefits of using toilets.
- Lack of behavior change: Some communities have toilets, yet people prefer to defecate in the open. In some cases, these toilets are provided by the government or other organizations and the people do not like them, or do not value them. They continue to defecate in the open. Also, older people are often found to defecate in the open and they are hesitant to change their behavior and go inside a closed toilet.
- Prefer being in nature: This happens mostly in less populated or rural areas, where people walk outside early in the morning and go to defecate in the fields or bushes. They prefer to be in nature and the fresh air; instead of defecating in a closed space such as a toilet. There may be cultural or habitual preference for defecating “in the open air”, beside a local river or stream, or even the bush.
- Combining open defecation with other activities: Some people walk early in the morning to look after their farms. Some consider it as a social activity, especially women who like to take some time to go out of their homes. While on their way to the fields for open defecation they can talk to other women and take care of their animals.
3. Socialization:
- Participants expressed defecation in open fields as an activity undertaken with friends, a common practice by people in the neighborhood that allows socialization.
4. Independent outdoor activity:
- It was reported that open defecation was considered as a personal activity by some respondents that made them feel independent as they could choose different venues, as they wanted on a regular basis. Open defecation was expressed as an activity that is done by active people.
5. Habit:
- Open defecation was perceived to be deeply influenced by the prevailing societal practice since historical times. Participants expressed open defecation as a regular habit for which they had never felt the need for alternatives.
6. Religious beliefs:
- Some participants argued the practice of open defecation continued from the times of god and goddesses. Defecation nearby houses (in latrines) would be against the religious and spiritual norms. The religious book not describing latrines was used to justify that open defecation was in line with the religious norms.
7. Hygiene issues:
- Defecating in a latrine nearby their home was considered a source of disease nearby home. Open defecation was considered better hygiene as the dirt is left far away from home and the nuisance smell would not be found around their home.
Consequences of Open defecation:
- Health related problems:
- Increase in waterborne diseases
Diarrhea and other problems associated with ingesting and exposure to human waste affect children under the age of 5 years the most since they are very susceptible to diseases. This exposure is because most of the open defecation happens next to waterways and rivers.
In urban areas, this can include the drainage systems that are usually meant to traffic rainwater away from urban areas into natural waterways.
Such areas are often preferred because open defecators have a belief that the water washes away their waste. What they seem to forget is that most of such areas are not properly empowered to treat the water to remove human waste and the microbes that move with it.
Such a practice is contrary to proper sewage channels that treat waste black water and channel it into water systems free of any disease-causing germs afterward.
Therefore, the result of open defecation near waterways is that it is carried into the water system minus treatment. As a consequence, the contaminated water ends up in the main water source.
When people in these regions use the water as it for drinking and cooking (since the water is not boiled most of the time because of poverty and lack of education) it results in water-borne diseases such as cholera, typhoid, and trachoma.
- Vector-borne diseases
Apart from water-borne diseases, when human waste collects into heaps, it attracts flies and other insects. These flies then travel around the surrounding areas, carrying defecate matter and disease-causing microbes, where they then land on food and drink that people go ahead and ingest unknowingly. In such cases, the flies act as direct transmitters of diseases such as cholera.
- Compounding the problem of disease exposure
The saddest fact about disease transmission caused by open defecation is the cyclic nature of problems that then begin to manifest. The most common diseases caused by this unsanitary act are increased cases of diarrhea, regular stomach upsets, and poor overall health.
With diarrhea, for instance, it means that people cannot make their way to distant places due to the urgency of their calls of nature, so they pass waste close to where they have their bowel attacks.
It simply ends up creating more of the same problems that started the disease in the first place and in turn, leads to more people catching diseases and fewer people using the facilities. The result of this is more sick people and more opportunities for the disease to spread.
- Malnutrition in children
Malnutrition in children is another health problem associated with open defecation. Once a child is a victim of one of the diseases passed on due to the lack of proper sanitation and hygiene, they begin to lose a lot of fluids and lack of appetite for food. As a result, it gives rise to many cases of malnutrition in children.
Also, the situation is worsened by intestinal worm attacks passed through human refuse. Altogether, these problems lead to stunted growth and weakened immune system that makes the child more susceptible to other diseases such as pneumonia and tuberculosis.
- Harmful Effects of Open Defecation on the Environment:
- Contamination via microbes
The environment also suffers as a result of open defecation because it introduces toxins and bacteria into the ecosystem in amounts that it cannot handle or break down at a time. This leads to the build-up of filth. Also, the load of microbes can become so great that in the end, they end up in aquatic systems thereby causing harm to aquatic life.
At the same time, it can contribute to eutrophication or the formation of algal blooms that form disgusting scum on the surface of the waterways which disturb aquatic life underneath the water by preventing oxygen and light diffusion into the water.
- Visual and olfactory pollution
Heaps of humans or just the sight of it cause an eyesore and nauseate anyone who is close. The stink emanating from the refuse is also highly unappealing and pollutes the surrounding air. Such places also attract large swarms that make the area completely unattractive for the eye.
For all those unfortunate to see the regions affected, it creates a sorry sight and reduces the dignity of all those living in the squalor of those regions. The smells augment the problem by disgusting those who live within the affected regions making life awful.
- Open defecation leads to sexual violence:
Finally, there is violence against women and girls, which is often life-threatening. Violence against women and girls of all ages. Physical violence, which may include murder, rape, stabbing and other bodily harm, is a not uncommon experience for women and girls as they journey to a place of OD, especially at night (Gómez et al. 2008). Bhalla (2014) reported the occurrence of two ‘open-defecation murders’ in rural India:
‘The two [girl] cousins, who were from a low-caste Dalit community and aged 14 and 15, went missing from their village home in Uttar Pradesh’s Budaun district when they went out to go to the toilet [in a neighbouring field]. The following morning, villagers found the bodies of the two teenagers hanging from a mango tree in a nearby orchard.’It transpired that the two girls had been attacked and gang-raped by five local men before they were hanged. Unfortunately, such incidents are not at all uncommon: Gosling et al. (2015) reported that many women in Bhopal and Delhi, India, and Kampala, Uganda
experienced violence and harassment on a daily basis. Such violence may often induce longer-term psychological damage.
World towards ending open defecation:
- Policy taken to eradicate open defecation:
The Millennium Development Goals (MDGs) sought to halve the proportion of the population globally without access to an improved sanitation facility (designed to hygienically separate excreta from human contact). Despite progress, this global target was missed by nearly 700 million people. The SDG(Sustainable development goals) 6.2 target is far more ambitious than previous MDG targets. It calls for access to adequate and equitable sanitation and hygiene for all and to end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.
The world is currently off-track to eliminate open defecation by 2030. Between 2000 and 2015, 337 million people stopped practicing open defecation about 22 million a year. To successfully end open defecation, at least 60 million people need to stop the practice each year between 2015 and 2030. Of the 62 countries where at least five per cent of the population practiced open defecation in 2015, only 18 countries are on track to eliminate open defecation by 2030. Globally, three times the current progress is needed to end open defecation by 2030.
UNICEF’s commitment and ambition to meet this challenge are stronger than ever. Goal of UNICEF is that by 2021, 1. 250 million fewer people will be practicing open defecation; 2.30 million additional people will be living in certified open defecation free communities as a direct result of UNICEF programming support; 3. 60 million additional people will be accessing basic sanitation services as a direct result of UNICEF programming support; and in 26 game plan countries, governments will be routinely analyzing trends (including equity analysis) and reporting on progress towards the fulfillment of SDG 6.2, with a specific focus on reducing open defecation.
- Geographic focus: the 26 game plan countries:
UNICEF is currently implementing WASH program in over 100 countries, and will continue to do so based on regional and country contexts and their respective priorities. There will be a special focus on sanitation programming in the 26 ‘high burden’ countries. These either have more than five million people defecating in the open or more than 50 per cent of the population defecating in the open. These are UNICEF’s ‘game plan countries’; together, the 26 game plan countries represent over 90 per cent of the global burden of open defecation. UNICEF’s game plan to end open defecation will specifically target these 26 countries for additional support over the next four years, to accelerate or sustain the annual reduction rate in open defecation. The 26 game plan countries represent a broad range of contexts. They include 13 low-income countries and 13 middle-income countries. Nine of the countries are characterized as ‘fragile states’. This highlights the very different backgrounds against which ending open defecation programs need to be developed. Of the 26 game plan countries:
• Only five are on track for eliminating open defecation by 2030;
• Seventeen are making progress but at too slow a rate; and
• In four countries, the share of people practicing open defecation is actually increasing.
All program approaches must of course be context specific. Each country is at a different stage and country offices are designing their own set of activities towards successfully eliminating open defecation, built on UNICEF’s long experience and comparative advantage in the sector. UNICEF will ensure that resources target the communities in greatest need and look for intervention models that can be sustained and scaled up within the capabilities of government and partners. What constitutes a successful approach will be different in each country. By working with government and partners to map the national and sub-national contexts, UNICEF can identify what approaches, skills and resources are appropriate and most likely – to maximize and sustain results. UNICEF’s sanitation programs are a blend of three main elements, with the emphasis on each element differing according to country contexts. These elements are:
- Creating demand through institutionalizing community approaches to total sanitation, addressing behavioral barriers, and creating a sustained social norm of not practicing open defecation at scale.
- Strengthening supply chains and markets so that they meet the demand for quality sanitation goods and services that are affordable to all – including to the lowest quintile and otherwise marginalized communities and individuals. This will allow households to move progressively up the sanitation ladder.
- Strengthening of the enabling environment and national systems to deliver sustainable sanitation services with an equity focus. This includes support for bottleneck analyses, policy development, including financing of sanitation in sector plans, promoting sustainability checks, coordination, and monitoring.
A focus of UNICEF’s support to governments is improving monitoring systems at the national and sub-national level, in close coordination with ongoing efforts of other UN agencies on SDG monitoring. Improved monitoring systems provide information that supports decision-making and enhances sustainability and equity of the sanitation program.
- Progress towards goal of open defecation free:
“Open defecation free” (ODF) is a phrase first used in community-led total sanitation (CLTS) programs. The original meaning of ODF stated that all community members are using sanitation facilities (such as toilets) instead of going to the open for defecation. This definition was improved and more criteria were added in some countries that have adopted the CLTS approach in their programs to stop the practice of open defecation.
The Indian Ministry of Drinking Water and Sanitation has in mid-2015 defined ODF 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”.
Since 2000, the global rate of open defecation has decreased from 21% to 9% (0.7 percentage points per year). Between 2000 and 2017, the number of countries where at least 1% of the population practiced open defecation from 108 to 81, while the number of ‘high burden countries with rates of more than 5% decreased from 79 to 61. In 2017, these 61 ‘high burden’ countries were home to a combined population of 3.2 billion. Between 2000 and 2017, open defecation rates declined in all SDG regions except Oceania. While Europe and North America and Australia and New Zealand have already achieved ‘near elimination’ (<1%), in all other SDG regions at least 1% of the population still practiced open defecation in 2017. The largest reductions in each SDG region were recorded by Ethiopia, Nepal, Cambodia, Sudan, Kiribati and the Plurinational State of Bolivia. Countries that already reduced open defecation below 25% by 2000 generally progressed more slowly, , reflecting the challenges associated with fully realizing the target of “elimination”,a total of 16 countries reduced open defecation by over 20 percentage points, including five countries by over 33 percentage points, and two countries by over 50 percentage points. Since 2000, one third of the population of Nepal and the Lao People’s Democratic Republic, over half of the population of Cambodia and Ethiopia, and nearly half of the population of India have stopped practicing open defecation. This not only represents a significant reduction in inequality but also a transformational shift in social norms and public health in those countries. Between 2000 and 2017, 91 countries reduced open defecation by a combined total of 696 million people with Central and Southern Asia accounted for three quarters of this reduction.
In 2017, 45% of the global population (3.4 billion people) used a safely managed sanitation service. 31% of the global population (2.4 billion people) used private sanitation facilities connected to sewers from which wastewater was treated. 14% of the global population (1.0 billion people) used toilets or latrines where excreta were disposed of in situ. However during the same period open defecation was still practiced by 18% of the rural population and 1% of the urban population. Nine out of ten open defecators lived in rural areas, and poorer people were much more likely to practise open defecation. Assuming current rates of progress continue, less than half are on track to achieve ‘near elimination’ of open defecation (<1%) nationally by 2030. Even fewer countries are on track in rural areas, and just one in five are on track to eliminate open defecation among the poorest rural wealth quintile. Efforts to end open defecation by 2030 will therefore need to be targeted primarily at rural populations and particularly at the rural poor. Nepal is one of the few countries which is on track to achieve ‘near elimination’ among the poorest in rural areas where open defecation has been reduced by 4.6 percentage points per year since 2000.
India and Open defecation:
To accelerate the efforts to achieve universal sanitation coverage and to put the focus on sanitation, the Prime Minister of India had launched the Swachh Bharat Mission (SBMG) on 2nd October 2014. Under the mission, all villages, Gram Panchayats, Districts, States and Union Territories in India declared themselves “open-defecation free” (ODF) by 2 October 2019, the 150th birth anniversary of Mahatma Gandhi, by constructing over 100 million toilets in rural India. To ensure that the open defecation free behaviours are sustained, no one is left behind, and that solid and liquid waste management facilities are accessible, the Mission is moving towards the next Phase II of SBMG i.e ODF-Plus. ODF Plus activities under Phase II of Swachh Bharat Mission (Grameen) will reinforce ODF behaviours and focus on providing interventions for the safe management of solid and liquid waste in villages.
Since 2014, the Government of India, in partnership with UNICEF, has made remarkable strides in reaching the Open Defecation Free targets. 36 states and union territories, 706 districts and over 603,175 villages have been declared open defecation free as of Jan 2020.
Conclusion:
The significance of sanitation to safeguard human health is irrefutable and has important public health dimensions. Access to sanitation has been essential for human dignity, health and well-being.
Along with the obvious health benefits of ending open defecation, countries that have rid themselves of the practice have also enjoyed a huge transformation in social norms and a noticeable reduction in inequality.
Reference:
Saleem, M., Burdett, T. & Heaslip, V. Health and social impacts of open defecation on women: a systematic review. BMC Public Health 19, 158 (2019). https://doi.org/10.1186/s12889-019-6423-z ( accessed on 16-06-2020)
https://en.wikipedia.org/wiki/Open_defecation#Reasons (accessed on 16-06-2020)
Policy Brief for Parliamentarians Open Defecation: This is also your business.
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Scaling Up Rural SanitationInvesting in the Next Generation:Growing Tall and Smart with Toilets Stopping Open Defecation Improves Children’s Height in Cambodia
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