India spent $30 billion to fix its broken sanitation. It ended up with more problems

This story is part of A Dirty Job, CNET’s look at the toilets and tech saving lives in India.

Urmila is a housemaid living in a South Delhi slum. Today she has a toilet at home thanks to the Indian government’s massive sanitation program called Swachh Bharat. She’s grateful for not having to use a public toilet, though she admits that many prefer not using any toilet at all. 

Meanwhile, Meera, who lives in a slum in New Delhi, prefers to defecate in the open, at nightfall. 

India has a problem with toilets. It doesn’t have enough of them.

That means hundreds of millions of people in the country end up defecating outside, which can spread diseases including cholera, typhoid and COVID-19. Poor sanitation in India leads to over 126,000 deaths every year from diarrheal diseases.

Prime Minister Narendra Modi has sought to fix this longstanding issue through the Swachh Bharat, or Clean India, mission. A centerpiece program for his government, it started in 2014 as an effort to stop open defecation through promotion of better hygiene practices and the construction of millions of toilets.

While Modi essentially declared victory against open defecation in October 2019 to coincide with Mahatma Gandhi’s 150th birthday, the work of this program is far from over, particularly as the coronavirus pandemic rages in the country.

Swachh Bharat has made huge gains so far, but many challenges remain. Let’s run through them.

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How does open defecation harm people’s health?

Fresh feces is filled with viruses and bacteria, able to transmit ailments including diarrhea, cholera, dysentery, hepatitis A, typhoid and polio. Transmission occurs when flying insects land on deposits and carry the viruses elsewhere or when excrement contaminates water supplies in groundwater or wells. Poor hygiene practices, like not washing hands after defecating, are common in poor and rural communities, making these areas especially susceptible to diseases.

«Kids are particularly vulnerable,» said Tom Slaymaker, a data specialist for UNICEF, who tracks sanitation and hygiene globally. He added that pathogens in fresh excrement are the biggest cause of diarrhea, and diarrhea is the biggest cause of death in children under the age of five globally.

Is the problem of open defecation getting better in India?

Yes, it is, but there’s still a very long way to go. 

India is the No. 1 country in the world for open defecation, with over 344 million people without regular access to toilets in the country, according to 2017 statistics from the World Health Organization and UNICEF. If you add up Nos. 2 to 10, it still wouldn’t come close to India’s number, showing just how big the problem is there.

Huge strides have been made to reduce that figure through Swachh Bharat and other sanitation efforts. WHO and UNICEF report the number of people practicing open defecation was twice as high in 2000, at 764 million. 

«There’s evidence to suggest they’ve dramatically reduced open defecation, especially in rural areas,» Slaymaker said.

How did India become the No. 1 country for open defecation in the first place?

Overpopulation and a lack of sanitation infrastructure have contributed to this health crisis. Additionally, India has often failed to properly maintain public toilets after the’re built.

Cultural behaviors play a big role too. Purity is an inherent part of toilet etiquette in India. According to common customs, toilets are often built outside the home and deemed unclean. That means many people in India still see open defecation as a more sanitary option than using a bathroom in or near the home. Because of this, even after the government builds new toilets for people, they will go unused, instead functioning as storage rooms.

«In order to change that you need to change people’s behavior, and that can take quite a long time,» Slaymaker added.

Layered atop this cultural issue is a societal one. Lower castes for years had been tasked with cleaning latrines in India. While the caste system doesn’t hold the same sway it once did in the country, perceptions about lower castes being connected to toilets has put a negative light on sanitation.

How has Swachh Bharat worked to counteract these problems?

The central government has spent over $30 billion over the past seven years to improve sanitation across a country of 1.3 billion people. A primary part of this work has been building over 100 million toilets, especially in rural areas where open defecation has been much more widespread.

While past sanitation efforts in India have focused mostly on building toilets, Swachh Bharat has included a much larger component of promotional campaigning, bringing in celebrities for ads and putting Swachh Bharat posters around the country. The government is also providing educational material to stigmatize open defecation and change people’s behaviors so they use the new toilets.

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