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Open defecation is the practice of defecating outside and in public, in and around the local community, as a result of ingrained cultural patterns or having no access to toilets, latrines or any kind of improved sanitation. It currently affects one billion people in the developing world, or 15% of the global population. It is a practice widely considered to be at the heart of issues around sanitation worldwide.

Open defecation in developing countries perpetuates the vicious cycle of disease and poverty and is an affront to personal dignity.

Practice

Open defecation is practised all over the world in nature or camping type situations and represents no health and environmental problems at all when done in sparsely populated settlements and when the "cat method" is used, i.e. covering the feces with some soil, leaves or sand. During war times, soldiers may also revert to this option. It is often the method of choice for hikers and campers in remote areas.

However, open defecation becomes a significant health problem and an issue for human dignity when it occurs in more densely populated areas, such as in larger villages or in urban informal settlements in developing countries. Here, the practise is usually associated with poverty and exclusion.

Use of the term

The term "open defecation" has become more widely used in the WASH sector since about 2008 when the publications of the Joint Monitoring Programme for Water Supply and Sanitation (JMP) started having an impact during the UN International Year of Sanitation. The JMP is a joint program by WHO and UNICEF to monitor the water and sanitation targets for the Millennium Development Goals (MDGs). 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 as not having access to improved sanitation.

The term "open defecation" has also become more popular due to the successes of the Community-Led Total Sanitation (CLTS) programmes which have shown promising results in many countries after starting in Bangladesh by Dr. Kamal Kar. In the CLTS concept, a village can be declared "open defecation free" (ODF) if all villagers are using toilets (the toilets should normally have a water seal to prevent access by flies).

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

Prevalence

Open defecation is a practice strongly associated with poverty and exclusion. The good news is that over the past 22 years, the number of people practising open defecation fell by a remarkable 21%, from 1.3 billion in 1990 to one billion in 2012.Cite error: A <ref> tag is missing the closing </ref> (see the help page). 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. Nine out of 10 people who practise open defecation live in rural areas, but the number in urban areas is gradually increasing.

82% of the one billion people practising open defecation in the world live in just 10 countries. Globally, India continues to be the country with the highest number of people (597 million people) practising open defecation according to the latest estimate from 2012. Other countries in the Top-10 list of countries with the highest number of people practising open defecation (in absolute terms) are Indonesia, Pakistan, Nigeria, Ethiopia, Sudan, Niger, Nepal, China and Mozambique.

Health impacts

A single gram of human faeces contains as much as 10,000,000 viruses, 1,000,000 bacteria, 1,000 parasite cysts and 100 parasite eggs. When ingested it can therefore lead to typhoid, cholera, hepatitis, polio, pneumonia, fatal worm infestation, trachoma, stunted physical development and impaired cognitive function. It makes open defecation a leading cause of diarrheal death; 2,000 children under the age of five die every day, one every 40 seconds, from diarrhea.

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 mouthes 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 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.

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 are taking place when women are searching for places for open defecation that are secluded and private, often during hours of darkness.

Prevention

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) and increasing political will as well as demand for sanitation. Community-Led Total Sanitation (CLTS) campaigns have placed a particular focus on ending open defecation.

As the highest number (in absolute terms) of people practising open defecation live in India, various Indian government-led initiatives are ongoing to reduce open defecation in this country. One of them was called the "Total Sanitation Campaign" but as it was not very successful is has now become more similar to Community-Led Total Sanitation (CLTS) under the new name of Nirmal Bharat Abhiyan.

See also

• Sanitation
• Diarrhea
• Manual scavenging
• Trachoma
• Poverty
• Environmental health
• Public health
• Nirmal Bharat Abhiyan

References

1. "OpenDefecation.org". 2014-05-28. Retrieved 2014-05-28.
2. "Website of Joint Monitoring Programme (JMP) of WHO and UNICEF". Retrieved 19 October 2014.
3. ^ Cite error: The named reference :0 was invoked but never defined (see the help page).
4. "Call to action on UN website" (PDF). Retrieved 19 October 2014.
5. "Toilets - The Facts - New Internationalist". Newint.org. Retrieved 2014-03-10.
6. "Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts". Plos One. Retrieved 2014-03-10.
7. "WHO | Diarrhoeal disease". Who.int. Retrieved 2014-03-10.
8. 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
9. 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.

External links

• Website of the UN Call to action to end open defecation

• Public health
• Sanitation