Access to sanitation reduces the incidence of diarrhoea–caused by bacterial, viral and parasitic infections, mostly spread by faeces-contaminated water–studies show. Diarrhoea is the leading cause of malnutrition, and is the second leading cause of death in children under five years, as IndiaSpend reported in July 2017.
 
As of January 2018–with a year and a half left to the Swachh Bharat Mission’s target of eradicating open defecation–60 million (76%) rural households and 4.2 million urban households have a toilet, and 11 states, 1,846 cities and 314,824 villages have declared themselves open-defecation-free (ODF), according to data available on the Swachh Bharat Mission (Clean India Mission) website.
 
“The challenge, however, will be in ensuring that ODF villages and cities are firstly, truly ODF, but more crucially that they remain so,” as Avani Kapur, fellow at Accountability Initiative, pointed out in this January 2018 article for Mint.
 
The Centre’s expenditure on information and education–which experts say is the key to solving India’s sanitation problem–continue to remain low.
 
It is in this backdrop that Finance Minister Arun Jaitley is set to present his government’s last full budget ahead of the general elections in 2019.
 
Access to sanitation improves child health, leads to more productive adults
 
Sanitation is crucial for India’s plans to reduce infant mortality. The National Health Policy, released in March 2017, aims to reduce the country’s infant mortality–deaths of children under the age of one–from 41 deaths per 1,000 live births in 2015-16 to 28 in 2019.
 
“If you live next to neighbours who defecate in the open, there are germs on the ground, lot of the people don’t wear shoes, they get their fingers on it [germs], their moms get their fingers on it and then there are flies on it and they get on the food and the entire environment is where is lot of faeces and there is lot of opportunity to get on germs,” Dean Spears, co-founder of the Research Institute for Compassionate Economics, told IndiaSpend in this August 2017 interview.
 
This cascading effect of health hazards is corroborated by data: Diarrhoea, as we said, remains the second leading cause of death in children under five years, killing an estimated 321 children every day in 2015, as we reported in July 2017.
 
Access to sanitation reduces cases of diarrhoea, one of the major causes of malnutrition among children, according to this World Bank study.
 
As many as 50.2% boys and 44.6% of girls with no access to toilets are stunted, compared to 26% boys and 24% girls who live in homes with toilets, according to this September 2017 study released by the National Institute of Nutrition.

Source: National Institute of Nutrition
 
Unsafe water, poor hygiene practices and inadequate sanitation are not only the causes of the continued high incidence of diarrhoeal diseases but a significant contributing factor in under-five mortality caused by pneumonia, neonatal disorders and undernutrition, according to this 2016 report by the United Nations Children’s Fund.
 
Besides, there is also an economic cost to the problem.
 
“If children are healthy when they are babies then they grow up stronger and taller, they are able to concentrate at school and learn more and they have higher achievement,” Spears told us in the above mentioned interview. “We find that adults are paid more and are more productive if they are born in a better disease environment. Their families get to consume more and they pay more taxes and government gets more revenue.”
 
“If you can cause a household to stop defecating in the open, just one household, there would be money in the future but it will be an equivalent of increasing the revenue of India by Rs 20,000 per household. That’s just looking at government’s revenue, but then the family gets to eat more, there is more productivity and they will be healthier and they will be more likely to survive,” Spears added.
 

What Doesn’t Kill You Makes You Poorer: Adult Wages And Early-Life Mortality In India

Source: R.I.C.E
 
Inadequate sanitation–management of human excreta, solid waste, and drainage–costs India Rs 2.4 trillion ($53.8 billion) every year in losses due health, damage to drinking water and tourism costs, according to a January 2011 World Bank study.
 
Allocation to rural sanitation up 33%, but sub-par spending on education hinders toilet use
 
In 2017-18, the Centre allocated Rs 13,948 crore for SBM-G–administered by the ministry of drinking water and sanitation. This was a 33% increase over 2016-17 when Rs 10,500 crore was allocated to the programme.
 
However, expenditure on information, education and communication (IEC)–vital for changing personal attitudes and perspectives–has been below par.
 
The programme guidelines recommend that 8% of SBM-G and 12% of SBM-U expenditure be earmarked for IEC. In no year has this target been met.
 
For instance, in 2017-18, only 4% of the allocations to SBM were earmarked for IEC.
 
Consequently, 22.6% Indians who had a toilet at home but did not use one said it was because of “personal preference”, according to the Swachhta Status report 2016.
 
“Lot of families with latrines think that if they use them, it will pollute their home and they will never be able to empty them,” Spears told us in the above mentioned interview. “To avoid all this, it is easier is to defecate in the open. It is going to be a hard problem to solve because it is rooted in these old and strongly held issues of social inequality.”
 
As of January 2018, 11 states and union territories have declared themselves as ODF. However, only six of them have been verified by ministry of drinking water and sanitation.
 
In rural India, 51% of 604,084 villages have been declared ODF. However, only 64% of these had been verified as of January 15, 2018.
 
Since October 2014, 60 million households toilets have been built under SBM-G.
 
Of Rs 13,948 crore ($2.1 billion) allocated to SBM-G in 2017-18, Rs 79 crore ($12.3 million) was for solid- and liquid-waste management. As many as 3.8% rural Indians who chose not to use toilets said broken toilets were the reason they defecated in the open, according to the Swachhta Status report 2016.
 
The urban challenge: 58% cities still report open defecation, only 23% garbage is treated
 
As of December 2017, 1,846 (42%) Indian cities declared themselves ODF, of which 1,337 were verified by the ministry of urban development.
 
As of November 2017, 4.2 million individual household toilets–64% of the 6.6 million targeted–were constructed across Indian cities. Similarly, 92% of the 17,193 targeted community toilets were constructed, data show.
 
Besides eradicating open defecation and constructing household and community toilets, SBM-U also aims to achieve 100% garbage collection and disposal. As of January 10, 2018, 68% of India’s 82,607 wards–urban administrative zones–had achieved this target.
 
Solid waste management, however, remains a challenge. As of November 2017, India generates 145,626 tonnes of solid waste every day; only 23% of this is processed.
 
For SBM-U–administered by the ministry of urban development–the Centre allocated Rs 2,300 crore in 2017-18, the same as 2016-17.
 
Since 2014-15, the Centre earmarked Rs 7,366 crore for improving solid-waste management systems under SBM-U, of which only 29% has been released to states as of January 10, 2018, according to a report by Accountability Initiative.
 
This is the concluding part in our series of eight state-of-the-nation reports ahead of Budget 2018. You can read our report on renewable energy here, on agriculture here, on urban development here, on rural jobs here, on healthcare here, on education here and on defence here.
 
(Salve is an analyst with IndiaSpend.)

Courtesy: India Spend
 

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For people to invest in sanitation, they need to access the kinds of toilets and services that they want to use. One of the benefits of safe sanitation – and one that motivates many to invest in it – is better physical well-being. But messages about preventing disease are often insufficient to change behaviours.
One approach that combines behavioural change with improved access to sanitation products and services is sanitation marketing programmes, defined as:
 

The application of the best social and commercial marketing practices to change behaviour and to scale up the demand and supply for improved sanitation, particularly among the poor.

Toolkits and guides to develop and implement sanitation marketing have been published recently, as have region- and country-specific manuals produced by NGOs and government agencies. There is a growing community working in this area, evidenced by reports and discussions of projects across the globe.

An unsafe toilet next to an informal settlement in Fiji. Author’s own, Author provided
 

Reviewing past outcomes

In most such programmes, an external support agency conducts market research and then assists local entrepreneurs in developing a market in which to sell products and services. These might be toilet slabs and superstructures, pay-per-use toilets or pit emptying for latrine owners. The programmes normally include advertising campaigns to encourage uptake of safe sanitation.

This may seem like a sensible approach, but we and our colleagues suspected that some of these programmes use practices that adversely affect some people. In a new paper, we review 33 sanitation marketing programmes to understand what practices are used and the outcomes reported. Four of the 33 programmes reviewed reported the following adverse effects:
 

• The death or injury of someone falling into a badly constructed latrine pit;
• Social unrest where entrepreneurs were viewed as being subsidised and not passing on the benefits;
• Negative impacts on social cohesion due to conspicuous consumption, where customers are encouraged to purchase items so as to enhance their social status;
• The shock, shame and disgust of intended beneficiaries when practices criticised their personal sanitation behaviours.

We were particularly interested in conspicuous consumption and the criticism of personal sanitation behaviours, because these were common in the 33 cases we reviewed. Sixteen included practices which promoted conspicuous consumption and ten included practices which criticised individuals who did not use a safe toilet.

Use of status and shame

Conspicuous consumption occurs when improving status is emphasised in promoting products and services. In this case, that means attempting to convince potential buyers that investing in sanitation will enhance their standing compared to those around them. This is achieved, for example, through promoting toilets as a status symbol, and invoking peer pressure to increase sales. The idea of “Keeping up with the Joneses”, a worldwide phenomenon whereby people purchase goods and services so as to socially and financially keep up with, or outdo, their neighbours, is very much at work here.

Some sanitation marketing programmes set out to make people feel disgusted by their sanitation behaviour to encourage them to invest in the product or service on offer. One example in Indonesia portrayed a character who defecates in the open, Lik Telek (“Uncle Shit”), as a threat to his community. One of the programme’s posters portrayed Lik Telek being driven out of his village for not investing in sanitation, reading:
 

My village is clean and healthy. No stench, no flies, and no more Lik Telek. The whole village is more dignified.

Although many of the programmes we looked at which employed such tactics evaluated their impact in terms of whether toilets were purchased or used, few evaluated their impacts on well-being. But personal dignity is a human right that can be or is eroded by these practices. Reduced dignity is associated with poor physical and psychosocial well-being in the form of depression, social anxiety and alienation.

A banner in a Nepali village promoting safe sanitation, as open defecation is ‘only for cows’. Author’s own
 

Adverse effects

Safe sanitation protects and improves physical well-being for those who acquire and use it, and for those around them. One person using a toilet reduces the amount of excreta entering the environment, with benefits community-wide for those who use toilets and those who do not. It has been argued that temporary loss of dignity leading to the adoption of behaviours that are beneficial to both the individual and community is tolerable.

This argument is only sound so long as the remedy – safe sanitation – is universally achievable. But there are often disadvantaged people who are unable to invest in safe sanitation (for financial reasons, perhaps, or because they are physically unable to contribute to construction). Many sanitation marketing programmes do not provide subsidies or other pro-poor strategies which may assist because such practices are considered to “distort the market”. Individuals who do not acquire safe sanitation are particularly susceptible to reduced well-being, and they will be unable to remedy this.

During the design and implementation phases of sanitation marketing programmes, external support agencies need to understand sanitation marketing’s potential to reduce well-being. If practices that erode dignity are used, then such agencies must consider how the programme will eventually restore it.

During the design and implementation phases of sanitation marketing programmes, external support agencies need to understand sanitation marketing’s potential to reduce well-being. If practices that erode dignity are used, then such agencies must consider how the programme will eventually restore it.

Dani J Barrington, Lecturer in Water, Sanitation and Health, University of Leeds and Jamie Bartram, Director of the Water Institute, University of North Carolina – Chapel Hill

This article was originally published on The Conversation. Read the original article.

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“When I got pregnant, it was hard to walk to the field to defecate as the path was not safe. My mother-in-law used to accompany me because I needed help sitting down and getting up.”–Maheshwari (25), Raichur, India. India has the highest number of people, 732 million, with no access to toilets and women and girls are among the worst affected.
 
The report by WaterAid, titled Out Of Order:The State of the World’s Toilets 2017, further stated that 355 million women and girls lack access to a toilet. If they were to stand in a line, the queue could circle the Earth more than four times.

 
Source: WaterAid
Note: Data as of 2015
 
India’s low ranking on the sanitation index is despite the changes brought by the government’s Swachh Bharat (Clean India) Mission. Launched in October 2014, it increased the country’s sanitation coverage from 39% to 65% by November 2017, according to government data. In this period, 52 million household toilets were built in rural India.
 
The cleanliness campaign has reduced the proportion of people defecating in the open by 40%, meaning more than 100 million people now use toilets, according to the WaterAid report.
 
India also ranks sixth among the top ten nations working to reduce open defecation and improving access to basic sanitation. The percentage of population without access to at least basic sanitation fell from 78.3% in 2000 to 56% in 2015, according to the report.
 
Diarrhoeal diseases kill 60,700 Indian children each year
 
Each year, 60,700 children under five years die from diarrhoeal diseases, the WaterAid report said.
 
Diarrhoea remains the second leading cause of death in Indian children under five years, killing an estimated 321 children every day in 2015, as IndiaSpend reported on July 29, 2017, based on a World Health Organization factsheet.
 
Hookworms, which can spread through open defecation, cause diarrhoea, anaemia and weight loss in women, according to the report. These problems are linked to low birth weight and slow child growth–38% of children in India under five are stunted, according to the National Family Health Survey, 2015-16, (NFHS-4) data.
 
Indian states with poor access to sanitation report high incidence of diarrhoeal diseases. Uttar Pradesh, Bihar, Madhya Pradesh, Assam and Chhattisgarh had the highest rate of mortality among children under five years of age, higher stunting (low height-for-age) rates and higher prevalence of diarrhoea due to poor sanitation, as IndiaSpend reported on April 26, 2017, based on NFHS-4.
 

States With Higher Access To Improved Sanitation
Had Lower Prevalence Of Anaemia, Diarrhoea

Source: National Family Health Survey 2015-16
*reported in two weeks preceding the survey **Among women aged 15-49 years
 
The tables above show the top five and bottom five states based on the percentage of households with improved sanitation, according to NFHS-4. States with higher percentage of improved sanitation have lower levels of anaemia among women (both pregnant and non-pregnant). These states also reported fewer cases of diarrhoea than the national average.
 
For example, Kerala, which had the highest percentage of households with improved sanitation (98.1%)–the national average was 48.4%–also had the lowest prevalence of diarrhoea (3.4%) and the lowest percentage of women with anaemia (22.6%).
 
Bihar, with only 25% households using improved sanitation, had the highest prevalence of diarrhoea (10.2%) and the highest percentage of anaemic pregnant women (58.3%).
 
For women, high risk of illiteracy, harassment
 
Apart from poor health, lack of toilets means that more than 1.1 billion women and girls globally get limited education and face harassment. In rural India, high dropout rates and non-enrolment among girls can be attributed to absence of toilet facilities, as IndiaSpend reported on July 19, 2017.
 
In rural India, 23% of girls have listed menstruation as the chief reason for dropping out of school. As many as 28% of them said they do not go to school during their period because they lack clean and affordable protection, as IndiaSpend reported on June 19, 2017.
 
Sanitation policies should cover the needs of those who are vulnerable, said Raman VR, head of policy at WaterAid India.
 
“Adolescent girls and women want facilities in which they can manage their periods safely and hygienically,” he said, “Pregnant women need easily accessible and usable toilets, and the elderly or people with disability require toilets with design features that help overcome the physical constraints they typically face.”
 
(Salve is an analyst at IndiaSpend.)

Courtesy: India Spend
 

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These are the conclusions of an IndiaSpend analysis–of government data–of the Swachh Bharat Abhiyan (Clean India Mission), which was inaugurated by Prime Minister Narendra Modi on October 2, 2014, with the aim to make India free of open defecation by October 2, 2019.
 
The World Bank has termed the scheme’s implementation as ‘moderately unsatisfactory’. However, a August 2017 survey conducted by an autonomous government body–Swacch Sarvekshan 2017–found that nine in 10 (91.29%) rural households having access to a toilet are using it.
 
‘Toilets for the dignity of our mothers and sisters’
 
It was on August 15, 2014, during his Independence Day speech, that Prime Minister Narendra Modi launched the Swachh Bharat Mission (SBM), with these words: “Brother and Sisters, we are living in 21st century. Has it ever pained us that our mothers and sisters have to defecate in open? Whether dignity of women is not our collective responsibility? The poor womenfolk of the village wait for the night; until darkness descends, they can’t go out to defecate. What bodily torture they must be feeling, how many diseases that act might engender. Can’t we just make arrangements for toilets for the dignity of our mothers and sisters?”
 

 
The mission is divided into two components: Gramin (rural) and urban
 
Swacch Bharat Mission (Gramin)
 
 

• 38.7% of rural households had individual household latrines (IHHL) on October 2, 2014, the day SBM was launched; 

• 249,811 villages were open-defecation free (ODF) in 2017, of which 63% (157,935) were verified officially; 

• 207 districts are ODF, of which 62% (127) were verified officially.

Note: Data not available for Delhi and Lakshadweep.
 
Villages are considered ‘open defecation-free’ when “no faeces are visible and every household and public/community institution uses safe technology to dispose of faeces in such a way that there is no contamination of surface soil, groundwater or surface water; excreta is inaccessible to flies or animals, with no manual handling of fresh excreta; and there are no odour and unsightly conditions”, as the ministry of drinking water & sanitation ( MoDWS) website explains.
 
As of 2016, 36.7% of rural households used “improved sanitation facilities”, according to data from the National Family Health Survey 4, conducted between January 2015 and December 2016. A majority (51.6%) did not, IndiaSpend reported on May 24, 2017.
 
“The current statistics on the construction of toilets, ODF villages and districts and states are indeed a positive development. I believe that even if we do not achieve the target of 100% toilet coverage and usage by October 2, 2019, and have 70-80% full coverage and usage compliance, that would be a big achievement in itself,” said Avinash Kumar,  director- policy & programmes at WaterAid India, an advocacy. “Construction of toilets, however, needs to be context specific. For instance, in several villages, the faulty design of toilets leads to contamination of groundwater.”
 

Behind the government’s data, unverified details
 
While the government’s data reveal substantial progress over three years, experts pointed out much of these claims were not verified.
 
“It is important to remember that ODF declarations are self-reported,” said Avani Kapur, fellow, Centre for Policy Research (CPR), a think tank, and director of the Accountability Initiative, a CPR programme. “If we look at the numbers, as of today (September 29, 2017), while 252,430 villages have been declared ODF, only 1.5 lakh have been verified meaning that nearly 40% have not been verified as yet.”
 
States are allowed to define their own verification process, Kapur said, which does not help standardised verification.
 
“Ideally, there should be regular, third party evaluations which conduct their own independent surveys to ensure actual ODF,” said Kapur. “What we have seen on the ground is that declarations often follow presence of toilets rather than actual ODF. Worryingly still, once a village has been declared as ODF, most monitoring efforts come to a stop and there isn’t a concerted effort to maintain the ODF status.”
 
The World Bank, which had promised a loan of $1.5 billion (Rs 10,500 crore) for SBM-Gramin, did not release the first instalment due in July 2016 because India did not fulfill a condition of conducting and announcing results of an independent verification survey, The Economic Times reported in January 2017.
 
The World Bank’s current ranking of the overall implementation progress of the project is ‘moderately unsatisfactory’.
 
Swacch Bharat Mission (Urban)
 
As on September 29, 2017, this is what data from the ministry of drinking water and sanitation show:
 

• 44,650 wards (of 82,725) have 100% door-to-door waste collection;
• 12,526 community toilets built in three years;
• 11,806 public toilets constructed.

 
This is “slow” progress, said Kapur of CPR. No more than 53% of wards have 100% door-to- door collection of garbage, and only 23% of trash is processed. “Until the solid waste management issue is resolved, even achieving 100% ODF declarations will do nothing for our public health crisis and could, in fact, worsen it,” said Kapur.
 
Six states and union territories, including Gujarat, Assam and Kerala, had not received funds  for solid waste management since the programme started on October 2, 2014, according to this January 2017 brief from the Accountability Initiative, which Kapur co-authored.
 
The central government had also not released 46% of funds set aside to build toilets under the Swachh Bharat Mission (Urban), according to this reply to the Lok Sabha (lower house of Parliament) on July 26, 2017, as IndiaSpend reported.
 
Is constructing toilets = using toilets?
 
The SBM rhetoric has moved from constructing toilets to using them, as it should.
 
“At every level–state, district, block or even gram panchayat (village council)–the common phrases you will hear are “triggering”, “demand driven” and “behavior change,” said Kapur. “Unfortunately, I don’t think the actions follow the language.
 
In 2016, the budget for “information, education and communication (IEC)” indicates that no more than 10% of the money set aside to change behaviour was spent. Till January 2017, no more than 12% of the IEC budget was spent.
 
“The argument now seems to be ‘build toilets first and then people will use them’, which is the exact opposite of the community-led sanitation (CLTS) model and what SBM itself had envisaged in its guidelines,” said Kapur.
 
However, the CLTS model may not be effective in India due to the prevalence of casteism, according to American scholars Dean Spears and Diane Coffey, sanitation researchers and authors of the 2017 book, ‘Where India Goes: Abandoned Toilets, Stunted Development, and the Costs of Caste’.
 
Once the pits fill, likely Dalits will have to empty them
 
“In CLTS, people are supposed to come together as a community against open defecation. In most places, community means local area, my town or my village but in India, it means religion or caste,” Spears and Coffey told IndiaSpend in an interview on August 13, 2017. “The whole idea of CLTS is to get the whole village to cooperate, but people in villages in India unfortunately don’t cooperate, especially ones where open defecation is common.  Exactly the places where casteism is important, those are the places where open defecation is common and those are the places where there is a lot of conflict among castes.”
 
“Imagine if SBM was successful and magically everyone is using the latrines. In a few years, they are going to fill up and who is going to empty them? It is going to set back progress in social liberalism because, one way of the other, Dalits will be the people who have to empty the latrine pits. I don’t think there is a solution to the problem and I think it is problem that we should all be thinking about.”
 
The SBM targets appear to be in conflict with the imperative of behaviour change: Government officials have little choice but to focus on deadlines.
 
“This means that every stakeholder, especially government officials, is under pressure to achieve targets,” said Kumar of WaterAid, an advocacy. “This leads them to use questionable tactics such as public shaming and taking away public welfare services.”
 
He cited the example of Uttar Pradesh, which accounts for a fourth of open defecation in India. UP has set a goal to be ODF by December 2018. He said “A state, which has limited resources and capacity, will then use questionable tactics to achieve their targets,”Kumar said.
 
Coercion has been reported in Rajasthan, where the poorest people in a village were threatened with withdrawal of public services, and in Jharkhand, where officials confiscated lungis from violators.
 
From the government, empirical evidence that toilets are being used
 
The Swachh Survekshan Gramin 2017 survey–covering 140,000 households and 700 districts–conducted by the Quality Control of India (QCI), an autonomous government body, is more optimistic than those who have watched the SBM unfold.
 
“In the criticism of the Swachh Bharat Mission, many have cited anecdotal evidence about toilets being used to store grains, but there is empirical evidence of a dramatic improvement in both coverage and usage of toilets,” wrote Adil Zainulbhai, Chairman, QCI, in an op-ed for Indian Express on September 28, 2017. “Three years after the launch of the mission, a behavioural change is discernible, especially in rural India.”
 
More than nine in 10 (91.29%) rural households with access to a toilet use it, said the QCI survey. The results are similar for urban areas. Of 73 cities that participated in Swachh Survekshan 2016, 54 cities have improved their score in overall municipal solid waste management in 2017.
 
These findings have shortcomings, according to this August 10, 2017, analysis of the QCI survey by Down To Earth, a environment magazine.
 
“Though 34.6% villages in India have declared themselves ODF, but factors like availability of water, sensitisation, long-term affordability (based on soil type and groundwater level), cleanliness and maintenance may deter toilet usage,” said the analysis. “The Swachh Survekshan Gramin ignores employed toilet technology, solid and liquid waste management, adaptability and acceptance by villagers in its method of study. QCI surveyed 1.4 lakh rural households from 4,626 villages, a miniscule 0.72% of the total villages in India.”
 
(Saha is an MA Gender and Development student at Institute of Development Studies, University of Sussex.)

Courtesy: http://factchecker.in
 

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Akshay Kumar’s movie Toilet: Ek Prem Katha (A love story), releasing on August 11, 2017 tells the story of a young bride who walks out of her marriage when discovers that her in-law’s home does not have a toilet. The satire deals with open defecation and Kumar calls it his “contribution” to the Swachh Bharat Mission spearheaded by Prime Minister Narendra Modi.

Source: YouTube/Viacom18 Motion Pictures
 
The prime minister responded with words of appreciation for the film.

 
In the film, the young woman’s revolt leads to social change, but in real India, women do not appear to be a position to rebel–even if they are educated.
 
Women have limited decision-making powers in the construction of toilets in homes, according to a 2016 study conducted in Puri, a coastal Odisha district, by researchers at the London School of Hygiene and Tropical Medicine.
 
Women and girls are most vulnerable to problems associated with open defecation.
 
In 80% of households, decisions on the construction of sanitation facilities were made exclusively by men, the study found. In 11%, the decision was made by men in consultation with their wives, and in no more than 9% was the decision made by women.
 
These findings are relevant because only 37% of households in Puri district have improved sanitation, according to the National Family Health Survey 2015-16 (NFHS-4). However, this is higher than rural Odisha’s average of 23% and state average of 29.4% of households with toilets.
 
Improved sanitation facilities include the following: Flush to piped sewer system, flush to septic tank, flush to pit latrine, ventilated improved pit (VIP)/biogas latrine, pit latrine with slab, and twin pit/composting toilet, which is not shared with any other household.
 
The study sampled 475 households, of which 217 had no latrine, 211 had a functional one and 47 had one that didn’t work.
 
Only 42% of households in rural Odisha have individual household latrines (IHHL) under the Swachh Bharat Abhiyan (Clean India campaign), third lowest among states, according to government data.
 

 
Compared to households without latrines, households with functional latrines had more educated men and women, larger family sizes and higher incomes.
 
Households with latrines more often owned agricultural land (85%) and a tubewell (83%) and were less likely to be employed as share croppers or labourers, the study found.
 
‘Husband is the head of the family’: how social norms trump female literacy
 
Gender inequities within the family influenced decisions on sanitation too, interviews conducted during the study revealed. “After all, the husband is the head of the family, he is elder in age and in relationship and he will spend for the latrine, therefore, the decision making power lies with him,” said a 52-year-old woman.
 
Confined to the home and village, women also seemed to have little confidence in their decision-making skills, interviews showed. “We females don’t know anything. All things beyond my house boundaries are done by my husband, so they [husband and other males] can decide for the family’s welfare, not we,” said a 42-year old woman.
 
This is despite the fact that in rural Puri, 83% of women — and 92% of men – are literate, according to the NFHS-4 data. This is higher than the state average of 67.4% and 84.3% respectively.
 
A woman’s power to make decisions about marriage or visits to a healthcare centre are not necessarily strengthened by a high literacy rate or a better sex ratio at the state-level, IndiaSpend reported on February 13, 2017. This suggested the overpowering role of social norms that differ across India.
 
The IndiaSpend report, based on data from the Indian Human Development Survey 2012, showed that almost 80% of Indian women said they had to seek a family member’s permission to visit a health centre. Of these women, 80% said they permission from their husband, 79.89% from a senior male family member, and 79.94% from a senior female family member.
 
The IHDS survey in 2012 covered over 34,000 urban and rural women between the ages of 15 and 81, in 34 Indian states and union territories.“The bias against daughters can only end if women’s education is accompanied by social and economic empowerment,” concluded a study conducted over 30 years in Gove, Maharashtra, by Carol Vlassoff, a professor at the University of Ottawa, as IndiaSpend, reported in December 2016.
 
No jobs, limited bargaining power
 
Financial constraint was commonly cited as the reason for not building latrines or keeping them functional. The perception was that latrine installation is expensive, so men who controlled the household budget were not keen to build one. Those who had some money were reluctant to invest in latrines as they had other priorities.
 
The study found that women see latrine construction as a “big decision” that men could take. Women relied on their husbands even for small purchases: “I alone cannot decide, we depend on them [husband] for every penny. Even for small things like purchasing bangles, saree for ourselves, we ask them for money.”
 
Even in other decisions involving money, women had limited bargaining power. For instance, in 91% households, only men took decisions on determining healthcare expenses for women. And 85% of women respondents were housewives, which probably limited their bargaining power. Puri district’s female work participation rate is 7.5%, third lowest among all districts in Odisha, according to the 2011 census.
 

NGOs focused on toilet building targets perpetuate gender inequality
 
The study found that even NGOs involved in latrine construction perpetrated these inequalities. They were given targets for latrine construction and field workers mostly approached men for faster permission to construct.
 
Women complained about this. “The NGO person looked for the males. They had meetings with them [husband and other males], and told us to dig a pit and keep it ready. One day, they came with a mason, and started constructing the latrine. He was the only mason to construct all the latrines in the village, so, due to his unavailability, he left the structure unfinished,” said a 65-year-old female respondent.
 
Image courtesy: Viacom18 Motion Pictures
 
(Saha is an MA Gender and Development student at Institute of Development Studies, University of Sussex.)

Courtesy: India Spend
 
 

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Representational picture. Credit: vidushisandhir/wordpress.com

A report called Swachhata Status Report ­ 2016 by ministry of drinking water and sanitation tabled before the Lok Sabha, showed that as of July 18, 2016, nearly 17 lakh households in rural Gujarat did not have toilets ­ which is almost 24.17% of houses in Gujarat according to Times of India.
 
Interestingly, Gujarat was one of the first states in India to declare its urban areas (180 cities and towns) open-defecation free last month. According to the news reports, on October 2 – on the 2nd anniversary of the Swachh Bharat Mission, union urban development minister Venkaiah Naidu complimented Gujarat chief minister Vijay Rupani saying, “Gujarat is the torchbearer and has set an example for others in swachhta (cleanliness).“
 
The report published by National Sample Survey Organisation (NSSO) also shows that 37% of villages from the state lack sewerage systems.
  
According to the TOI report, Centre's Census 2011 report says that out of the 1.22 crore households, including urban and rural areas in Gujarat, 47.25% do not have toilets.
 
The state, however, has claimed to have constructed 1.55 lakh toilets in 2013-14 and, 3.35 lakh in 2014-15, 9.22 lakh in 2015-16, and 2.08 lakh till July this year in 2016-17. Though no one questions why the construction of toilets dropped so drastically as against last year, on the face of it, both the Centre and the state government continue to praise each other about their achievements in taking the SBM forward, reported TOI.
 
Apart from lack of toilets, proper drainage or sewage systems are absent from 6,714 of the nearly 18,000 villages in Gujarat, claims the government report on swachhta, as the SBM promotes construction of soak-pit toilets in rural areas.
 
A social rights activist, Bharatsinh Jhala, who has been fighting for rights of homeless people, said that it is the government's duty to identify the people in need.
 
“Rather than making false propaganda in the name of Mahatma Gandhi, the Centre and the state government should sincerely provide better sanitation to the people of this country,” Jhala told TOI.
 
 

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