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Open defecation is the practice of defecating outside and not into a designated toilet. It is especially problematic in areas where people defecate in fields, urban parks, rivers and open trenches in close proximity to the living space of others. This behavior may be result of cultural practices, the lack of access to toilets, or both.

Eliminating open defecation is the main aim of improving access to sanitation worldwide, as it can have a significant impact on public health if a large proportion of the population openly defecates. 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.

Extreme poverty and lack of sanitation are closely linked, so eliminating open defecation is an important part of development efforts. 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.

About one billion people in the developing world, or 15 percent of the global population, practice open defecation. India is the country with the highest number of people practicing open defecation: around 600 million people - most of it occurs in rural areas where the prevalance is estimated at 65 percent of the population. 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) and Ethiopia (34 million).

Background

Open defecation is practiced all over the world in nature or camping type situations and represents no health and environmental problems 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 use this option. It is often the method of choice for hikers and campers in remote areas.

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.

Open defecation is known to perpetuate the vicious cycle of disease and poverty and is widely regarded as an affront to personal dignity. 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.

Use of the term

The term "open defecation" became widely used in the WASH sector in 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 having no access to improved sanitation.

The term "open defecation" has also become more popular due to the success of the Community-Led Total Sanitation (CLTS) programs. In the CLTS concept, a village can be declared "open defecation free" (ODF) if all villagers are using toilets.

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).

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

Data exists for open defecation figures for each country of the world, segregated by rural and urban areas thanks to the Joint Monitoring Programme for Water Supply and Sanitation (JMP) of UNICEF and WHO. 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. 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. 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.

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. 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).

Reasons

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

• Lack of other choices, i.e. no toilet available
• Toilets are available but are filthy, dark, malodorous, or unattractive (often the case for shared or public toilets)
• Toilets are available but there is a risk of personal safety, e.g. if the toilets are public or shared and criminals are known to gather at those toilets to wait for possible victims
• Toilets are not available as part of the household but only at some distance and it may be dangerous to get there at night
• Diarrhoea attack may mean there is not enough time to go to the shared toilet which may be at some distance
• Cultural or habitual preference for going to the toilet "in the open air"; Using a local river or stream, or even the bush, may feel better than using a hole in the ground that smells or has flies and lacks light.

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

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 — or lack of sanitation - is a major factor in causing various diseases, most notably diarrhea and intestinal worm infections but also typhoid, cholera, hepatitis, polio, trachoma and others. For example, infectious diarrhea resulted in about 0.7 million deaths in children under five years old in 2011 and 250 million lost school days. It can also lead to malnutrition and stunted growth in children. Open defecation is 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 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.

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."

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.

Prevention

Key drivers to eradicate open defecation include:

• Political will
• A focus on behavior change
• Sanitation solutions that offer a better value than open defecation
• Stronger public sector local service delivery systems
• Creation of the right incentive structures

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.

As the highest number (in absolute terms) of people practicing open defecation live in India, various Indian government-led initiatives are ongoing to reduce open defecation in that country. One of them was called the "Total Sanitation Campaign" but as it was not very successful it has now become more similar to Community-Led Total Sanitation (CLTS) under the new name of Nirmal Bharat Abhiyan. In 2014, Unicef began a multimedia campaign against open defecation in India, urging citizens to "take poo to the loo."

Short-term technologies

Long-term sustainable solutions are very important, but there are also technological possibilities that can reduce that proportion of open defecation which is due to not having toilets in the household and the shared toilets being too far or too dangerous to reach at night.

Whilst people might already use plastic bags (also called flying toilets) at night, a more advanced solution 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". This bag is now being used in humanitarian responses, schools and urban slums in developing countries.

A vast improvement on a conventional bucket (historically called chamber pot) are modern plastic urine-diverting dry toilets which can be operated odor-free in the household, used at night or during the day by people with disabilities and emptied for example on a daily basis. Due to the urine diversion, there is nearly no odor. Examples of this design are the MoSan toilet (currently on trial in Kenya), the urine-diverting dry toilet promoted by SOIL in Haiti or the urine-diverting dry toilet promoted by the Clean Team in Ghana.

Society and culture

India and Pakistan

The general media in the countries most affected have recently been picking up on this issue of open defecation, for example in India and Pakistan.

References

1. ^ Ahmad, Junaid (30 October 2014). "How to eliminate open defecation by 2030". devex. Retrieved 1 November 2014.
2. ^ JMP (2014). Progress on drinking water and sanitation, 2014 Update. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), ISBN 978 92 4 150724 0, page 11.
3. ^ JMP (2014). Progress on drinking water and sanitation, 2014 Update. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), ISBN 978 92 4 150724 0 - Summary, page v
4. ^ JMP (2014). Progress on drinking water and sanitation, 2014 Update. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), ISBN 978 92 4 150724 0, page 19.
5. JMP (2014). Progress on drinking water and sanitation, 2014 Update. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), ISBN 978 92 4 150724 0, Annex 3: Country, area or territory estimates on sanitation and drinking water
6. "Call to action on UN website" (PDF). Retrieved 19 October 2014.
7. "Data and estimates". JMP - WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation. WHO/UNICEF. Retrieved 12 March 2015.
8. ^ JMP (2014). Progress on drinking water and sanitation, 2014 Update. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), ISBN 978 92 4 150724 0, page 6
9. ^ "Call to action on sanitation" (PDF). United Nations. Retrieved 15 August 2014.
10. "Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts". Plos One. Retrieved 2014-03-10.
11. 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.
12. "WHO | Diarrhoeal disease". Who.int. Retrieved 2014-03-10.
13. Vyas, S. et al. (2014). Population density and the effect of sanitation on early-life health, slide 19 (presentation at UNC conference in Oct. 2014) Research Institute for Compassionate Economics, project SQUAT (Sanitation Quality, Use, Access, and Trends): Evidence based sanitation advocacy for India (r.i.c.e.), USA
14. 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
15. 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.
16. "Field Notes: UNICEF Policy and Programming in Practice" (PDF). UNICEF. Retrieved 10 March 2015.
17. "Why take poo to the loo". Poo2Loo. Retrieved 2015-03-10.
18. 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
19. Russel, K. (2013). Mobile sanitation services for dense urban slums - Various documents on results from research grant. Stanford University, USA
20. "BBC News - Why India's sanitation crisis needs more than toilets". Bbc.com. Retrieved 2015-03-10.
21. "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.
22. "More than 40m Pakistanis defecate openly: Unicef - Pakistan". Dawn.Com. Retrieved 2015-03-10.
23. Desk, Web (2012-03-13). "Lack of toilets tied to stunted growth in Pakistan: UNICEF – The Express Tribune". Tribune.com.pk. Retrieved 2015-03-10. {{cite web}}: |last= has generic name (help)
24. "Over 43 million people in Pakistan defecate in the open". thenews.com.pk. Retrieved 2015-03-10.

External links

• UN Call to action to end open defecation
• Documents about open defecation in library of Sustainable Sanitation Alliance

• Public health
• Sanitation