Open defecation is the human practice of defecating outside; in the open environment rather than into a toilet. People may choose fields, bushes, forests, ditches, streets, canals or other open space for defecation. They do so because either they do not have a toilet readily accessible or due to traditional cultural practices. The practice is common where sanitation infrastructure and services are not available. Even if toilets are available, behavior change efforts may still be needed to promote the use of toilets.
About 892 million people practiced open defecation in 2016 according to reports. 678 million of the 892 million people practicing open defecation in the world live in just seven countries.
Open defecation 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. Therefore, eliminating open defecation is thought to be an important part of the effort to eliminate poverty.
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, 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.
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 under-nutrition, high levels of poverty, and large disparities between the rich and poor.
The term “open defecation” became widely used in the water, sanitation, and hygiene (WASH) sector from about 2008 onwards. This was due to the publications by the Joint Monitoring Programme for Water Supply and Sanitation (JMP) and the UN International Year of Sanitation. The JMP is a joint program by WHO and UNICEF to monitor the water and sanitation targets of the Sustainable Development Goal Number 6.
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 United Nations 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.
Open Defecation Free
Open defecation free is a phrase first used in community-led total sanitation programs. Open defecation free has now entered use in other contexts. The original meaning of Open defecation free 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.
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.
A few broad factors that result in the practice of open defecation are listed below.
No toilet
• Lack of infrastructure: People often lack toilets in their houses, or in the areas where they live.
• 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.
• Use of toilets for other purposes: In some rural communities, toilets are used for other purposes, such as storing household items, animals, farm products or used as kitchens. In such cases, people go outside to defecate. Another example is a lack of public toilets in cities which can be a big problem for homeless people.
Uncomfortable or unsafe 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.
• Risky and unsafe: Some toilets are risky to access. There may be a risk to personal safety due to lack of lights at night, criminals around them, or 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. Accessing toilets that are not located in the house might be a problem for disabled people, 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.
• 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. 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 toilets pits will get filled very fast if all family members use it every day. So they continue to go out to delay the toilet pit filling up. This is especially true in the case of a pit latrine.
Unrelated to toilet infrastructure
• Lack of awareness: People in some communities do not know about the benefits of using toilets.
• Lack of behavior change: Some communities have toilets, yet people prefer to defecate in the open. 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.
• 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. 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.
• Social norms: Open defecation is a part of people’s life and daily habit in some regions. 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.
Prevalence and trends
The practice of open defecation is strongly related to poverty and exclusion particularly, in case of rural areas and informal urban settlements in developing countries. 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.[23][2] 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. 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.
In 2015, India was reported to be the country with the highest number of people practicing open defecation: 524 million people or 40% of the total population. These numbers have since then been reduced significantly due to the efforts of the Indian government’s Clean India Mission. However, some of the government data may reflect only the availability of toilets but not the actual daily use of toilets.
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.
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 among 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 dies 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.
Prevention
Make toilets a status symbol
We have to make toilets sexy so that people want to have them. When you say “toilet” people often think of dark, dirty and smelly places. Instead, we need them to think of toilets as rooms of happiness – clean, colourful and not smelly. Rational approaches have limited impact on behaviour change. Although they can serve as justification for choice, people primarily make decisions based on aspirations and justify their decisions rationally afterwards.
Change the vocabulary
Let’s make the conversation more accessible by saying what we mean. Even among those working in the field, we constantly hide behind clean-sounding words like sanitation, latrine, Wash [Water Sanitation and Hygiene], open defecation. These words don’t mean anything to the masses, so how can we drive action if we can’t even talk about what we are doing? Let’s replace words like sanitation and open defecation with toilets and shitting outside.
Start with health
Disease transmission and other risks are associated with open defecation. People need to understand the worth of investing in toilets in terms of the health benefits. This is not feasible without supportive policies and a market environment and cannot increase demand for sanitation alone. That requires a combination of factors.
Try a community-led approach
It is not a silver bullet, but some of our country programmes have had success in applying the community-led total sanitation (CLTS) approach. As far as we can see, the key is to ensure it is really community-driven, which can be tricky when CLTS becomes government policy. Governments might feel pressured to push communities into being Open Defecation-Free (ODF), rather than it being a real journey of community learning
Don’t count the loos
There are pockets of changes in some States such as Cross Rivers where they have realised that the focus should be on counting open defecation-free communities, and not toilets. The previous supply-driven approach has resulted in graveyards of toilets, where they are used as storage
Make the case to governments
The best way to encourage governments is when populations demand it. Somehow this creates a vicious cycle, but one that could be made virtuous. In the shorter term, if sanitation becomes a priority for donors, development banks and NGOs, it will also influence government priorities. We need to be better at making the case that it’s a great investment, with tremendous return; five to one, due to the impacts on public health, education, gender, and dignity. For local governments, it is key they see that delivering on sanitation might help them win their next elections.
Encourage hand-washing
We see hygiene and sanitation messages as linked, especially the need for systematic hand-washing with soap or ash. Not defecating in the open, keeping toilets fly-proof, and washing hands after using the toilet and before preparing food are the three key indicators for declaring a community ODF. But systematic hand washing is a more difficult habit to create, and we’re working with the London School of Hygiene and Tropical Medicine in Nigeria to test the addition of emotional triggers to the normal CLTS approach.
Support sustainable programmes
People start asking DfID and other donors about how they are supporting the sustainability of these programmes, they might change their reporting rather than just focus on toilet building. I have noticed that Oxfam have added “fix a well” to their list of gifts this year, which is great, but I wait for the day when I can gift “empty a pit latrine” to my family.
Don’t rely on business
Pit-emptying and sludge transportation are the two links in the sanitation chain with the most business potential for the private sector, but there is no single case of profit-driven sanitation success at scale, not even in developed countries. If markets have not delivered sanitation in the past, that is for a reason. While the private sector and markets have a big role to play, we need to be very clear: sanitation is profitable from a public health and dignity perspective, and it requires public investment.
Teach poo as a resource
If you do CLTS first, you teach disgust of the shit and I don’t think you can unteach it, so then there are problems with using biogas and other things that come from it. If you teach poo as a resource first you can motivate people to bring their shit to you and then teach hygiene later. This is highly culture-specific but open defecation is not just about desirable toilets. We need to support sanitation chains to make shit valuable enough for someone to come and collect it. Until we can empty them, toilets won’t be sustainable and people will keep using open defecation rather than a full-pit latrine
Adewole Kehinde is the Publisher of an Online Media; Swift Reporters based in Abuja. Additional information to the write up was culled from Wikipedia. [email protected]
