In most places around the world, infant mortality is falling quickly, the average height of children is increasing, and increasingly almost everyone uses a safe toilet or latrine. India, where now over one-fifth of babies are born each year, is an exception to each of these.
These exceptions are linked: infant death and open defecation are both more common in India than in many countries with lower GDP per capita and more poverty. This is a puzzle. Why is economic growth not translating into more human development for the sixth of the human population living in India? More broadly, in a world where most lives are improving quickly, can policy and development programs help those special cases that are not?
We have seen that India's exceptionally high rates of open defecation cannot be explained by poverty, nor by illiteracy, nor by lack of water, nor by poor governance.
Here, we turn our investigation to the explanation for enduring open defecation in rural India: casteism and untouchability, two unfortunate consequences of the caste system and the ideas that support it.
Sohni Devi lives with her two small children and her mother-in-law in a Dalit hamlet on the edge of a large village in western Uttar Pradesh. Her husband is a migrant laborer. Sohni Devi told us that her house was built by her mother-in-law and father-in-law. It has two parts, one made out of bricks and the other made out of mud and cow dung. Sohni Devi and her husband did not build the latrine themselves. Instead, the pradhan, an elected village leader, hired workers to build it for them three years ago.
We asked Sohni Devi whether she had ever thought of building a latrine before the pradhan built this one. Sohni Devi explained, "Our house is broken and falling apart, why would we build a latrine?"
She does not even use the latrine she now has. She, her mother-in-law, and her husband all defecate in the open. The two children, aged 7 and 5, use the latrine now, but the family will tear it down when the children are old enough to defecate in the open on their own.
To us, the latrine seemed convenient. And Sohni Devi herself admitted that it saves her the hassle of cleaning up her children's feces. Her children, like those in other families in the village who do not own a latrine, would otherwise defecate in the area in front of the house.
Yet, as the conversation went on, it became increasingly clear that Sohni Devi was annoyed that the pradhan had built a latrine on their land. Exasperated with the village government, she said: "The pradhan made this [latrine]. If we'd made it, we'd have made it the way we wanted. All of this Indira Vikas money has come, so the pradhan has made it. But he only got a very little pit dug. If we made it the way we wanted, then wouldn't we have used a whole room full of bricks? How can a poor man? It costs 20 or 25 thousand rupees to [make a latrine]."
We have seen that India's exceptionally high rates of open defecation cannot be explained by poverty, nor by illiteracy, nor by lack of water, nor by poor governance. The comparison of India's open defecation rates to those of other developing countries presented a puzzle. Although many societies have ideas about what is clean and dirty, rural Indians' ideas about purity and pollution are globally unique (except, of course, for places where Hindus have migrated) and are intimately related to the Hindu caste system.
Rural India's history of untouchability, and the ways in which life is changing for Dalits mean that most households do not see using an affordable pit latrine as a viable option.
Rural India's history of untouchability, and the ways in which life is changing for Dalits mean that most households do not see using an affordable pit latrine as a viable option. As Sohni Devi explained to us, villagers subjectively understand their sanitation options to be two: either build an expensive latrine with a cement-lined tank as large as a small house, or defecate in the open.
The toilets that save lives elsewhere
The latrines that can prevent the spread of infectious diseases are actually quite affordable. Many people in Bangladesh, for instance, build and use latrines that cost as little as two to three thousand rupees. From the health perspective, the most important part of a rural latrine is the underground pit. The World Health Organisation (WHO) promotes the use of inexpensive latrines that have underground pits that are about 50 cubic feet in volume. The WHO recommends that pits be lined with bricks or rocks laid in a "honeycomb" pattern. This pattern allows water to seep out of the pit into the ground. That way, the only thing left to be stored in the pit is decomposing feces, which are also largely water.
The Indian government latrines that are built under the Swachh Bharat Mission are much more expensive than WHO-recommended latrines because they have brick and mortar superstructures above the ground, rather than less expensive superstructures made out of tin, plastic, bamboo, or cloth. However, the latrine pits recommended by the Indian government are similar in size to the ones that the WHO recommends. If they were built and used properly, Indian government latrines would successfully interrupt the transmission of disease, saving lives and promoting child growth.
People in rural India equate manually emptying a latrine pit with the most degrading forms of Dalit labour.
The WHO estimates that when a normal latrine (meaning one with a 50 cubic metre, honeycomb-style pit) is used daily by a family of six, it will fill up after about five years. When the pit fills up, the owners must either empty it or build a new pit. In rural India, as in other parts of the developing world, when honeycomb-style latrine pits are emptied, it is done by hand.
As we explain in the book, biological germs turn out not to be the barrier to pit emptying. People in rural India equate manually emptying a latrine pit with the most degrading forms of Dalit labour. Therefore, the idea of manually emptying a latrine pit is at least as reviled for its social implications as it is for the physically disgusting nature of the work.
The toilets that rural Indians build
Despite the fact that sanitation officials in the Indian government have known for decades that inexpensive latrines with two pits would substantially improve health in villages, and despite the promotion of this technology by some high-profile sanitation NGOs, the adoption of such latrines is extremely limited. Our survey found that only 2.5% of households with a latrine were using a twin-pit model.
[W]hy do rural Indians reject pit latrines? Answering these questions requires an understanding of rural India's history of untouchability, and particularly the practice of manual scavenging.
As Sohni Devi's story suggests, part of the reason why the government fails to get people to use affordable twin-pit latrines is that government latrines are very different from those that rural Indians build for themselves. For one thing, the latrines that people build for themselves are much more expensive. Among survey respondents, we found that the median size of a privately constructed latrine pit was 250 cubic feet —five times as large as the Indian government recommends! In our qualitative research, many people told us that they aspire to owning pits even larger than that.
Missing middle rungs on the sanitation ladder
International sanitation professionals use the analogy of a ladder to explain the different types of latrines in developing countries. Successive rungs on the ladder represent more hygienic options— which can be more expensive, but need not be very much so. The lowest rung represents open defecation. Higher rungs progress to the simplest pit latrines (without a water seal), to pour-flush pit latrines with a water seal, through further improvements, and finally to private toilets that connect to a septic tank or to a sewer. The sanitation ladder in India is missing its middle rungs, with no intermediate steps on which households climb gradually up from open defecation towards flush toilets.
Why do rural Indians want such expensive toilets, sitting atop large pits? Why do they reject the affordable options that are found in other developing countries? In short, why do rural Indians reject pit latrines? Answering these questions requires an understanding of rural India's history of untouchability, and particularly the practice of manual scavenging.
[Edited excerpt from the forthcoming book Where India Goes: Abandoned Toilets, Stunted Development and the Costs of Caste by Diane Coffey and Dean Spears. The book has won the American Institute of Indian Studies' Joseph W. Elder Prize in the Indian Social Sciences.]