Open defecation

From Wikipedia, the free encyclopedia
Open defecation in Pandharpur, a pilgrimage town in India

Open defecation (OD) is the human practice of defecating outside—in the open. In lieu of toilets, people use fields, bushes, forests, open bodies of water or other open space. The practice is common where sanitation infrastructure is not available. About 892 million people, or 12 percent of the global population, practice open defecation.[1]

The term 'open defecation' is used in literature about water, sanitation, and hygiene (WASH). OD can pollute the environment and cause health problems. High levels of open defecation are linked to high child mortality, poor nutrition, poverty, and large disparities between rich and poor.[2](p11)

Ending OD is an indicator being used to measure progress toward the sustainable development goals. Extreme poverty and lack of sanitation are statistically linked. Therefore, eliminating OD is thought to be an important part of the effort to eliminate poverty.[3]

People may prefer open defecation based on traditional cultural practices or lack of access to toilets, or both.[4] Even if toilets are available, behaviour change efforts may still be needed to promote the use of toilets.

Background

Indiscriminate waste dumping and open defecation, Shadda, Cap-Haitien, Haiti
Open defecation, Tirin Kowt bazaar, Afghanistan
Open defecation along a river bank in Bujumbura, Burundi
Child defecating in the open in a canal in the slum of Gege in the city of Ibadan, Nigeria
This drain is used to defecate and urinate in a community in Bangladesh
Open defecation and waste dumping area in Palijat in Gujarat state, India
A dirty pit latrine in Mongolia leading people to choose open defecation instead

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.[5] With the increase in population in smaller areas, such as cities and towns, more attention was given to hygiene and health. As a result, there was an increase in global attention towards reducing the practice of open defecation.[6]

Open defecation perpetuates the vicious cycle of disease and poverty and is widely regarded as an affront to personal dignity.[2] 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.[2]

Use of the term

Open defecation

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).[7]

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 of ODF stated that all community members are using sanitation facilities (such as toilets) instead of going to the open for defecation. This definition was improved and more criteria were added in some countries that have adopted the CLTS approach in their programs to stop the practice of open defecation.[8]

The Indian Ministry of Drinking Water and Sanitation has in mid-2015 defined ODF 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".[9]

Here, 'safe technology option' means toilets that contain feces so that there is no contamination of surface soil, groundwater or surface water; flies or animals do not come in contact with the open feces; no one handles excreta; there is no smell and there or no visible feces around in the environment.[10] This definition is part of the Swachh Bharat Abhiyan (Clean India Campaign).

Reasons

The reasons for open defecation are varied. It can be a voluntary, semi-voluntary or involuntary choice. Most of the time, a lack of access to a toilet is the reason. However, in some places even people with toilets in their houses prefer to defecate in the open.[8]

A few broad factors that result in the practice of open defecation are listed below.

Factors related to not having access to any type of toilet

  • Lack of infrastructure: People often lack toilets in their houses, or in the areas where they live.[1][11]
  • Lack of toilets in other places: Lack of toilets in places away from people's houses, such as in schools or in the farms lead the people to defecate in the open.[11]
  • Use of toilets for other purposes: In some communities, toilets are found to be used for other purposes, such as storing household items, animals, farm products or used as kitchens. In such cases, they often go outside to defecate.[12][13]

Factors related to not having access to a comfortable, safe toilet

  • Poor quality of toilet: Sometimes people have access to a toilet, but the toilet might be broken, or of poor quality - Outdoor toilets (pit latrines in particular) typically are devoid of any type of cleaning and reek of odors. Sometimes, toilets are not well lit, especially in areas that lack electricity. Others lack doors or may not have water. Toilets with maggots or cockroaches are also disliked by people and hence, they go out to defecate.[14][15][16][11]
  • 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.[16][17] Accessing toilets that are not located in the house, might be a problem for disabled people, especially at night.[18]
  • 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.[19][18][11]
  • Lack of water near toilet: Absence of supply of water inside or next to toilets cause people to get water from a distance before using the toilet.[11] This is an additional task and needs extra time.
  • 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 may go outside to defecate instead of waiting. In some cases, people might not be able to wait due to diarrhea (or result of an Irritable Bowel Syndrome emergency).
  • Fear of the pit getting filled: In some places, 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. This is especially true in the case of a pit latrine.[16][18]

Factors that are unrelated to toilet infrastructure

  • Lack of awareness: People in some communities do not know about the benefits of using toilets.[20][21]
  • Lack of behavior change: Some communities have toilets, yet people prefer to defecate in the open.[8] In some cases, these toilets are provided by the government or other organizations and the people do not like them, or do not value them. They continue to defecate in the open. Also, older people are often found to defecate in the open and they are hesitant to change their behavior and go inside a closed toilet.[11]
  • Prefer 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 prefer to be in nature and the fresh air; instead of defecating in a closed space such as a toilet.[3] 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 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 take care of their animals.[11]
  • Social norms: Open defecation is a part of people's life and daily habit in some regions (e.g. in India). It is an ancient practice and is hard for many people to stop practicing. It is a part of a routine or social norm. In some cultures, there may be social taboos where a father-in-law may not use the same toilet as daughter-in-law in the same household.
  • Fecal incontinence: This medical condition can result in abrupt 'emergencies' and not enough time to access a toilet.

Prevalence

In developed countries, open defecation is considered to be a part of voluntary, recreational outdoor activities in remote areas. It is difficult to estimate how many people practice open defecation in these communities. But is also of very little public health, environmental and human dignity concern.[citation needed] The situation is very different in developing and less developed countries and communities, where open defecation is of high public health and development concern. The practice of open defecation is strongly related to poverty and exclusion particularly, in case of rural areas and informal urban settlements.

People practicing open defecation (% of population)[22][23][24]
Country Percentage
India 40
Nigeria 26
Indonesia 12
Ethiopia 27
Pakistan 12
Niger 71
Sudan 27
South Sudan 61
Eriteria 76

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 levels of poverty. 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.[25][1] 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.[1](p34) 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).[1]

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.[1] 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.[1][26]

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),[27] Niger (14 million) and Sudan (11 million).[1][24]

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 that cause various diseases; the most common being diarrhea and intestinal worm infections but also typhoid, cholera, hepatitis, polio, trachoma, and others.[28][29]

In 2011, infectious diarrhea resulted in about 0.7 million deaths in children under five years old and 250 million lost school days.[28][30] It can also lead to malnutrition and stunted growth among children.[31][32]

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.[33]

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.[2]

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."[34]

Safety of women

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.[35][36]

Having to defecate in the open takes its toll on human safety and dignity. The loss of privacy is particularly pointed for women and girls in developing countries. They face the shame of having to defecate in public so often wait until nightfall to relieve themselves. They risk being attacked after dark, though it means painfully holding their bladder and bowels all day.[37][38] Women in developing countries increasingly express fear of assault or rape when having to leave the house after dark. Reports of attacks or harassment near or in toilet facilities, as well as near or in areas where women defecate openly, are common.[37][38]

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.[39][40] The following are some of the key drivers used to fight against open defecation in addition to behavior change:[3]

  • 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.[41]

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."[42]

Simple sanitation technology options

Residents in Mymensingh, Bangladesh participate in a workshop to discover more about mobile sanitation options (MoSan) as an alternative to open defecation

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".[43] This bag is now being used in humanitarian responses, schools, and urban slums in developing countries.[44][45]

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"[46] toilet (used in Kenya) or the urine-diverting dry toilet promoted by SOIL[47] in Haiti.

Country examples

India

India's prime minister Modi launches Swachh Bharat Mission in 2014
  • 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.[48]
  • 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.[49]
  • 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.[50] 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.

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[51][52] and Pakistan.[53][54][55]

Public defecation for other reasons

  • The Mad Pooper is the name given to an unidentified woman who regularly defecated in public places while jogging during summer 2017 in the U.S. city of Colorado Springs

See also

References

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  2. ^ a b c d Progress on drinking water and sanitation, 2014 Update. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP). 2014. ISBN 9789241507240. 
  3. ^ a b c Ahmad,J (30 October 2014). "How to eliminate open defecation by 2030". devex. Retrieved 2 May 2016. 
  4. ^ 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. 
  5. ^ O'Reilly, Kathleen (2016-01-01). "From toilet insecurity to toilet security: creating safe sanitation for women and girls". Wiley Interdisciplinary Reviews: Water. 3 (1): 19–24. doi:10.1002/wat2.1122. ISSN 2049-1948. 
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