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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 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 behavioural change is critical in addition to the provision of toilets. A preference for open defecation may be due to traditional cultural practices or lack of access to toilets, or both.

Extreme poverty and lack of sanitation are statistically linked. Eliminating open defecation is said to be 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 rich and poor.

About 892 million people, or 12 percent of the global population, practice open defecation. India has the highest number of people practicing open defecation, nearly 525 million people, or over a third of the population. Most of it occurs in rural areas, where the prevalence is estimated at 56 percent of the population, as opposed to urban areas, where prevalence is estimated at 7 percent. The other countries with the highest number of people openly defecating are Nigeria (47 million), followed by Indonesia (31 million), Ethiopia (27 million), Pakistan (23 million), and Niger (14 million).

Background

Defecating in the open is a very ancient practice. In ancient 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. 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, was more attention was given to hygiene and health. As a result, there was increase in global attention towards reducing the practice of open defecation.

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

Use of the term

The term "open defecation" became widely used in the water, sanitation, and hygiene (WASH) sector from about 2008. This was during the publications of the Joint Monitoring Programme for Water Supply and Sanitation (JMP) and the UN International Year of Sanitation. More awareness was generated.

The JMP is a joint program by WHO and UNICEF to monitor the water and sanitation targets for the Millennium Development Goals (MDGs). The MDGs existed from 2000-2015, before the Sustainable Development Goals.

For monitoring purposes, two categories were created: 1) improved sanitation and (2) unimproved sanitation. Open defecation falls into the category of unimproved sanitation. This means that people who practice open defecation do not have access to improved sanitation.

In 2013 World Toilet Day was celebrated as an official UN day for the first time. The term "open defecation" was used in high-level speeches, that helped to draw global 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).

Why do people defecate in the open?

Several scholars have tried to study the reasons why people defecate in the open. In some places even people with toilets in their houses prefer to defecate in the open. A few broad factors that result in the practice of open defecation are listed below:

• Lack of awareness: In places where people do not know about the benefits of using toilets .
• Lack of infrastructure: People often lack latrines or toilets in their houses, or in the areas where they live.
• Poor quality of toilet: Sometimes they have access to a toilet, but the toilet might be broken, or of poor quality such as very dirty and smells bad, not well lit, lack door, or may not have water.Toilets with maggots or cockroaches are also disliked by people and hence they go out to defecate.
• Risky and unsafe: Some toilets are risky to access. There may be a risk to personal safety, such as they may be dangerous to access at night due to lack of lights, criminals around them, the presence of animals such as snakes and dogs. Women and children who do not have toilets inside their houses are often found to be scared to access shared or public toilets, especially at night.
• 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 around
• 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 always prefer going out to defecate instead of waiting for their turn in the shared toilet. Some people might not be able to wait for their turns in public of shared toilet when they have diarrhea (or result of an Irritable Bowel Syndrome emergency).
• Love 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 love being in nature and the fresh air around them, instead of defecating in a closed space such as a toilet - using a hole in the ground, that smells or has flies and lacks light. 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 love to 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 sometimes take care of their animals.
• Use of toilets for other purposes: people often like to use toilets for other purposes, such as storing household items, animals, farm products or even as kitchens. In such cases they prefer to go out to defecate.
• Lack of behavior change: Communities often have toilets, yet people love to defecate in the open. Often these toilets are provided by the government or other organzations and the people do not like them, or do not value them. They continue to defecate in the open. Also, older people ar eoften found to defecate in the open and they are hesitant to change their behaviour and go inside a closed toilet.
• Fear of the pit getting filled: People are scared that their toilet pits will get filled very fast if all family members use it everyday. So they continue to go out to delay the toilet pit filling up, in the case of a pit latrine.
• Lack of toilets in other places: Lack of toilets in places apart from people's houses, such as in schools or in the farms lead the people to defecate in the open.
• Social norms: Open defecation is a part of people's life and daily habit. It is an ancient practice and is hard for many people to stop practicing it. It is a part of a routine or social norm. Also, there may often be social taboos where, a father-in-law may not use the same toilet as daughter-in-law, in the same household.

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.

Open defecation free

"Open defecation free" (ODF) is a phrase first used in community-led total sanitation (CLTS) programs. ODF has now entered use in other contexts. The original meaning simple stated that all community members are using sanitation systems instead of going to the open for defecation. This definition was improved and more criteria were added in some countries that have adopted CLTS programs.

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:

1. No visible feces found in the environment or village and
2. Every household as well as public/community institutions using safe technology option for disposal of feces".

Safe technology option means no contamination of surface soil, groundwater or surface water’ excreta is not accessible to flies or animals; no handling of fresh excreta; and freedom from odor and unsightly conditions. 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 is also of very little concern from public health, environmental, and human dignity perspectives.

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. The figures on open defecation used to be lumped together with other figures on unimproved sanitation but are collected separately since 2010.

In recent years, the number of people practicing open defecation fell from 20 percent in 2000 to 12 percent in 2015. Those 892 million 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 of 10) who practice open defecation live in rural areas, but the vast majority lives in two regions (Central Asia and South Asia).

Seventy-six percent (678 million) of the 892 million people practicing open defecation in the world live in just seven countries. India is the country with the highest number of people practicing open defecation, around 525 million people. This makes 40 percent of the total Indian population including 7 percent of urban dwellers and 56 percent of villagers. About 59 percent of people in the world practicing open defecation live in India.

Further countries with a high number of people openly defecating are Nigeria (47 million), followed by Indonesia (31 million), Ethiopia (27 million), Pakistan (23 million), Niger (14 million) and Sudan (11 million).

Impacts

Public health

The negative public health impacts of open defecation are the same as those described when there is no access to sanitation at all.

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. In 2011, infectious diarrhea resulted in about 0.7 million deaths in children under five years old and 250 million lost school days. 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 flushes 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.

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 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

There are also strong gender impacts: the lack of safe, private toilets makes women and girls vulnerable to violence and is an impediment to girls' education. Women are at risk of sexual molestation and rape as they search for places for open defecation that are secluded and private, often during hours of darkness.

Prevention

There are several drivers used to eradicate open defecation, one of which is behaviour change. SaniFOAM (Focus on Opportunity, Ability and Motivation) is a conceptual framework which was developed specifically to address issues of sanitation and hygiene. Using focus, opportunity, ability and motivation as categories of determinants, SaniFOAM model identifies barriers to latrine adoption while simultaneously serving as a tool for designing, monitoring and evaluating sanitation interventions. The following are some of the key drivers used to fight against open defecation in addition to behavior change:

• Political will
• 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 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."

Simple sanitation technology options

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". This bag is now being used in humanitarian responses, schools, and urban slums in developing countries.

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" toilet (used in Kenya) or the urine-diverting dry toilet promoted by SOIL in Haiti.

Society and culture

Media

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

Examples

India

• In an attempt to stop city residents from urinating and defecating in public, a city council in western India is planning to pay residents to use public toilets. In 2015, the Ahmedabad Municipal Corporation announced it will give residents one rupee a visit in a bid to draw them into its 300 public toilets and away from open areas and public walls, which often reek of urine.
• In India, the State of Rajasthan became the first state in the country to make a "functional toilet" mandatory in the house of a contestant for contesting elections to Panchayati Raj institutions. The post of village head is called "sarpanch" in Rajasthan, India. A person cannot contest for the post of sarpanch unless they have a functional toilet at their residence.
• The Government of India has taken up an initiative called Swachh Bharat Mission wherein a large scale drive has been initiated to construct toilets on mass level. Government has increased subsidy on toilet construction to INR 12,000. A number of industries in India are manufacturing affordable toilet rooms using pre-fabrication techniques to meet high demand of toilets created after this new legislation. As of October 2017 2.5 lakh villages,207 districts and 5 states in India where declared open defection free areas in India after the launch of Swachh Bharath mission in 2014 the household with toilets rose from 38.7% in 2014 to 69.04% in October 2017 and schools with separate toilet for girls rose from 0.4 million to one million (91%) to attain a open defection free country Indian government should build 12 million toilets. ]

See also

• Indian states and union territories ranked by prevalence of open defecation
• List of abbreviations used in sanitation
• Swachh Bharat Abhiyan

References

1. Clasen; Boisson; Routray; Torondel; 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. PMID 25442689.
2. ^ Ahmad,J (30 October 2014). "How to eliminate open defecation by 2030". devex. Retrieved 2 May 2016.
3. ^ Progress on drinking water and sanitation, 2014 Update. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP). 2014. ISBN 9789241507240.
4. ^ WHO and UNICEF (2017) Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines. Geneva: World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), 2017
5. "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.
6. "Rural population (% of total population)". World Bank. 2016. Retrieved 2 May 2016.
7. ^ "UNICEF: Without toilets, childhood is even riskier due to malnutrition". UNICEF. Retrieved 22 August 2017. The fact remains that in Pakistan, 25 million people (or 13 percent of the population) practice open defecation.
8. "Nearly a Billion People Still Defecate Outdoors. Here's Why". 25 July 2017. Retrieved 4 October 2017.
9. "United Nations Deputy Secretary-General's Call to Action on Sanitation" (PDF). United Nations. 2013. Retrieved 19 October 2014.
10. ^ Cavill; Chambers; Vernon (2015). Sustainability and CLTS: Taking Stock Frontiers of CLTS: Innovations and Insights Issue 4. IDS. p. 18. ISBN 978-1-78118-222-2.
11. In 2016, Kunwar Bai Yadav, a woman claiming to be 105 years old, said she had never heard about a toilet until that year, and had always gone into the nearby woods to defecate. Only when she learned about them, did she have one built in her community. Source: BBC News (India): "How a 105-year-old ended open defecation in her village, November 1, 2016
12. "Guidelines for ODF Verification" (PDF). Indian Ministry of Drinking Water and Sanitation. 2015.
13. "Definition of ODF – Open Defecation Free (Indian government publication)". 18 June 2015. Retrieved 5 October 2017.
14. "Progress on Sanitation and Drinking Water 2015 Assessement and MDG update" (PDF). UNICEF. Retrieved 22 August 2017.
15. "People practicing open defecation (% of population)". data.worldbank.org. Retrieved 22 August 2017.
16. ^ "Progress on Drinking Water, Sanitation and Hygiene - 2017". www.washdata.org. World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). Retrieved 26 September 2017.
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19. ^ "Call to action on sanitation" (PDF). United Nations. Retrieved 15 August 2014.
20. 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. PMC 3774764. PMID 24066070.{{cite journal}}: CS1 maint: unflagged free DOI (link)
21. Walker, CL; Rudan, I; Liu, L; Nair, H; Theodoratou, E; Bhutta, ZA; O'Brien, KL; Campbell, H; Black, RE (20 April 2013). "Global burden of childhood pneumonia and diarrhoea". Lancet. 381 (9875): 1405–16. doi:10.1016/S0140-6736(13)60222-6. PMID 23582727.
22. Mara, Duncan (1 March 2017). "The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals". Journal of Water Sanitation and Hygiene for Development. 7 (1): 1–12. doi:10.2166/washdev.2017.027. ISSN 2043-9083.
23. "WHO | Diarrhoeal disease". World Health Organization. 2013. Retrieved 10 March 2014.
24. 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.).
25. 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
26. 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.
27. Devine, J (2009). Introducing Sanifoam: A Framework to Analyze Sanitation Behaviors to Design Effective Sanitation Programs. Washington, DC, USA: World Bank.
28. Devine, J (2010). "Beyond tippt-taps: The role of enabling products in scaling up and sustaining handwashing". Waterlines. 29: 304–314. doi:10.3362/1756-3488.2010.033.
29. "Field Notes: UNICEF Policy and Programming in Practice" (PDF). UNICEF. Retrieved 10 March 2015.
30. "Why take poo to the loo". Poo2Loo. Retrieved 10 March 2015.
31. 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
32. Owako, E. (2012). Nyando peepoo trial project report. Kenya Red Cross, Kenya
33. Naeem, K., Berndtsson, M. (2011). Peepoo Try Pakistan - Sindh Floods, November 2011. UN-HABITAT, Pakistan
34. 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
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38. "More than 40m Pakistanis defecate openly: Unicef - Pakistan". Dawn (newspaper). Retrieved 10 March 2015.
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40. "Over 43 million people in Pakistan defecate in the open". The News International. Retrieved 10 March 2015.
41. "Indian city to pay residents to use public toilets". Dawn (newspaper). Retrieved 9 June 2015.
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43. Staff Reporter (15 April 2015). "Subsidy for toilet construction". The Hindu.

External links

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

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