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Where India Goes: Abandoned Toilets, Stunted Development and the Costs of Caste
More than half the people who defecate in the open live in India.
Around the world, people live healthier lives than in centuries past, in part because latrines keep faecal germs away from growing babies. India is an exception. Most Indians do not use toilets or latrines, and so infants in India are more likely to die than in neighbouring poorer countries. Children in India are more likely to be stunted than children in sub-Saharan Africa.Where India Goes demonstrates that open defecation in India is not the result of poverty but a direct consequence of the caste system, untouchability and ritual purity. Coffey and Spears tell an unsanitized story of an unsanitary subject, with characters spanning the worlds of mothers and babies living in villages to local government implementers, senior government policymakers and international development professionals. They write of increased funding and ever more unused latrines.Where India Goes is an important and timely book that calls for the annihilation of caste and attendant prejudices, and a fundamental shift in policy perspectives to effect a crucial, much overdue change.
Around the world, people live healthier lives than in centuries past, in part because latrines keep faecal germs away from growing babies. India is an exception. Most Indians do not use toilets or latrines, and so infants in India are more likely to die than in neighbouring poorer countries. Children in India are more likely to be stunted than children in sub-Saharan Africa.Where India Goes demonstrates that open defecation in India is not the result of poverty but a direct consequence of the caste system, untouchability and ritual purity. Coffey and Spears tell an unsanitized story of an unsanitary subject, with characters spanning the worlds of mothers and babies living in villages to local government implementers, senior government policymakers and international development professionals. They write of increased funding and ever more unused latrines.Where India Goes is an important and timely book that calls for the annihilation of caste and attendant prejudices, and a fundamental shift in policy perspectives to effect a crucial, much overdue change.
311 pages, Kindle Edition
First published August 5, 2017
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December 3, 2019
"People assume that rural Indians defecate in the open because they do not have 'access' to a latrine; if they had 'access' to a latrine, they would use it."
That's a charming but clueless assumption. Using a latrine means having to clean a latrine.
"We cannot empty [the latrine pit] ourselves. We call a Bhangi even if something gets clogged in the latrine...How can we empty it ourselves? It is disgusting so a Bhangi must come to clean it...We are Hindus, so how can we clean it?"
"There are limits to the social and sanitary progress that can be made when higher-caste [sic] people will not remove their own dead animal carcasses, unblock their own drains, cut their own babies' umbilical cords and, most importantly for our puzzle, empty their own latrine pits."
Apparently cleaning a latrine is a much worse fate than having your children's growth stunted or possibly having a child die from an illness that could have been prevented by simple sanitation efforts such as using a latrine.
That's a charming but clueless assumption. Using a latrine means having to clean a latrine.
"We cannot empty [the latrine pit] ourselves. We call a Bhangi even if something gets clogged in the latrine...How can we empty it ourselves? It is disgusting so a Bhangi must come to clean it...We are Hindus, so how can we clean it?"
"There are limits to the social and sanitary progress that can be made when higher-caste [sic] people will not remove their own dead animal carcasses, unblock their own drains, cut their own babies' umbilical cords and, most importantly for our puzzle, empty their own latrine pits."
Apparently cleaning a latrine is a much worse fate than having your children's growth stunted or possibly having a child die from an illness that could have been prevented by simple sanitation efforts such as using a latrine.
August 5, 2022
Recently, I had a discussion with an economics researcher in Germany where we discussed how the cost of racism is quantified in economics. Research outputs from the USA, especially by some of the pioneering Black economists (that's why we need diversity!), have shown the impact of racism on economic growth, innovativeness in society, sustainable growth, the health of the kids (future citizens), etc.
And, it left me wondering whether it's possible to quantify the economic cost of caste.
To quantify the economic cost of caste in India would be a Himalayan task, and it would also be a time-taking one since India does not have a census on the basis of caste post-independence (India took a census with caste data in 2011, and the results of same with details of the backward castes were never published). Of course, there're several other ways to collect caste-based socio-economic data but still to arrive at the economic cost of caste, one must look at every aspect of life affected by caste (meaning, everything an Indian does!).
However, it should be possible to look at the ways how caste does affect the economic aspects of an Indian at places one can follow, identify, and quantify. And, this book exactly does that!
By looking at the problem of open defecation as a case study, the authors explain how social inequality like caste have economic consequences and health inequity in India. India's economic growth in recent decades has been unprecedented but the percentage of open defecation hasn't reduced despite its economic growth. The authors prove that open defecation continues to be a problem in India not because India is poor, or the rural people are not educated (percentage of those with a Bachelors' degree opting for open defecation is around 32%), or that rural India doesn't have access to water or toilets. On the contrary, the open defecation continues only because of the ideas of (ritualistic) purity of caste, a system that affects every single day-to-day choice of an Indian.
It's astonishing to me to realize that more than 65% of Indians consider having a toilet within their homes as 'unclean' or 'impure' while open defecation is considered to be a better option (the authors prove that open defecation causes an outbreak of cholera that results in infant mortality and health inequality).
Some of the results are worth noting:
1. The upper caste people in rural India are more prone to resort to open defecation than the lower castes and Dalits.
2. Although the lower caste people would like to use a toilet at home, they blindly adhere to the practice of open defecation because not following the norms and ritualistic practices of the upper caste would bring the scorn of the society on them.
3. Open defecation continues because the upper caste people consider it an impurity to clean their own toilets with their hands.
4. Hindu population (65%) is more prone to openly defecate than the Muslim population (45%).
5. States like Tamilnadu that are considered to be economically progressive and socially better-off also have a population of around 68% who openly defecate.
6. Lastly, even those with Bachelor's degree open defecate in India (32%), and government built toilets are often used for storage purposes (when they are built as per the plan, without losing money in corruption).
The consequences of the social inequality of caste that result in open defecation (as one of the outcome) results in higher infant mortality rate, gender based health inequities, short-height of Indians (Indians are relatively shorter than sub-Saharan poor), and a wastage of tax-payers money in building toilets that are often siphoned-off due to corruption, or end up in toilets that are not used by the rural Indians.
This book is written in an accessible language that allows anyone interested in the topic to understand (without employing jargons or any economic-technical terms of the academia).
Although, in most other cases, I would be skeptical that it took two white authors to write the underlying problem of the open defecation, it becomes apparent that this was a topic that hasn't been extensively discussed by Indian economists before (bias due to the structure of caste, perhaps!).
This is a wonderful book that would help a researcher in economics to understand how to approach a subject and bring to certain conclusions. Also, this is an excellent read for anyone who wants to understand contemporary India better.
----------------------------
Edit: In a way, the problem of open defecation in India is not only the problem of caste but also a problem of design . If people are against using pit latrines (something they need to clean with their hands), the government could adopt a different, bio-based, latrine system. Seems, that the Indian government wanted to build toilets that are easier to build and then leaving its maintenance to the people (thereby reducing the costs). The only alternative seems to be building proper sewage systems in our rural areas, thereby reducing the dependency on using pit latrines.
And, it left me wondering whether it's possible to quantify the economic cost of caste.
To quantify the economic cost of caste in India would be a Himalayan task, and it would also be a time-taking one since India does not have a census on the basis of caste post-independence (India took a census with caste data in 2011, and the results of same with details of the backward castes were never published). Of course, there're several other ways to collect caste-based socio-economic data but still to arrive at the economic cost of caste, one must look at every aspect of life affected by caste (meaning, everything an Indian does!).
However, it should be possible to look at the ways how caste does affect the economic aspects of an Indian at places one can follow, identify, and quantify. And, this book exactly does that!
By looking at the problem of open defecation as a case study, the authors explain how social inequality like caste have economic consequences and health inequity in India. India's economic growth in recent decades has been unprecedented but the percentage of open defecation hasn't reduced despite its economic growth. The authors prove that open defecation continues to be a problem in India not because India is poor, or the rural people are not educated (percentage of those with a Bachelors' degree opting for open defecation is around 32%), or that rural India doesn't have access to water or toilets. On the contrary, the open defecation continues only because of the ideas of (ritualistic) purity of caste, a system that affects every single day-to-day choice of an Indian.
It's astonishing to me to realize that more than 65% of Indians consider having a toilet within their homes as 'unclean' or 'impure' while open defecation is considered to be a better option (the authors prove that open defecation causes an outbreak of cholera that results in infant mortality and health inequality).
Some of the results are worth noting:
1. The upper caste people in rural India are more prone to resort to open defecation than the lower castes and Dalits.
2. Although the lower caste people would like to use a toilet at home, they blindly adhere to the practice of open defecation because not following the norms and ritualistic practices of the upper caste would bring the scorn of the society on them.
3. Open defecation continues because the upper caste people consider it an impurity to clean their own toilets with their hands.
4. Hindu population (65%) is more prone to openly defecate than the Muslim population (45%).
5. States like Tamilnadu that are considered to be economically progressive and socially better-off also have a population of around 68% who openly defecate.
6. Lastly, even those with Bachelor's degree open defecate in India (32%), and government built toilets are often used for storage purposes (when they are built as per the plan, without losing money in corruption).
The consequences of the social inequality of caste that result in open defecation (as one of the outcome) results in higher infant mortality rate, gender based health inequities, short-height of Indians (Indians are relatively shorter than sub-Saharan poor), and a wastage of tax-payers money in building toilets that are often siphoned-off due to corruption, or end up in toilets that are not used by the rural Indians.
This book is written in an accessible language that allows anyone interested in the topic to understand (without employing jargons or any economic-technical terms of the academia).
Although, in most other cases, I would be skeptical that it took two white authors to write the underlying problem of the open defecation, it becomes apparent that this was a topic that hasn't been extensively discussed by Indian economists before (bias due to the structure of caste, perhaps!).
This is a wonderful book that would help a researcher in economics to understand how to approach a subject and bring to certain conclusions. Also, this is an excellent read for anyone who wants to understand contemporary India better.
----------------------------
Edit: In a way, the problem of open defecation in India is not only the problem of caste but also a problem of design . If people are against using pit latrines (something they need to clean with their hands), the government could adopt a different, bio-based, latrine system. Seems, that the Indian government wanted to build toilets that are easier to build and then leaving its maintenance to the people (thereby reducing the costs). The only alternative seems to be building proper sewage systems in our rural areas, thereby reducing the dependency on using pit latrines.
August 12, 2018
If you're up for the subject matter (and don't worry; it's not descriptive), this is a fascinating study on the effects of caste on India and how they've resulted in a higher infant mortality rate than other, poorer countries. The book spends a little too much time summarizing itself (it was probably a report first) but it's otherwise extremely informative on what's probably an extremely taboo subject.
March 28, 2021
A solid book, five stars. Apart from the merit of its contents, it is also a must-read for people in development/social sector - purely to appreciate the multidisciplinary and mixed-method research framework they have employed, and to maybe pick up two cents from their approach.
September 4, 2017
Coffey and Spears establish conclusively that India's high rates of open defecation can only be explained by caste and its attendant notions of ritual purity. They present the horrific health costs and prohibitive economic costs of our slow pace of increase in toilet use (as opposed to toilet construction). They tell us why schemes that focus on toilet construction are doomed to failure (this includes the Swachh Bharat Mission, which basically throws more money at toilet construction), and suggest tentative approaches ("we do not see any magic solutions") to increase toilet use.
A recommended toilet read.
A recommended toilet read.
August 26, 2017
India's journey towards elimination of open defecation has meant different things for different sets of people, contracting opportunities for many, profiteering opportunities for many, research opportunities for some and for some and a very small number, a genuine step towards understanding and addressing the debilitating impact of open defecation.
In this seminal piece and whose book launch I was fortunate to attend, there is a genuine effort to approach open defecation as the reason why indian children are shorter, stunted in their early years, how it impacts their general health and hence their cognitive capacities which impacts the earning potential of these children when they grow up in years to come. The book is well researched and far reaching in its impact. It also debunks and attacks the usual arguments around access, poverty, illiteracy, GDP etc which are convenient reasons proferred to why OD exists in india and takes the focus to one societal aspect which government's ignore and international funding agencies are too scared or distant to talk about....caste and the notions of ritual purity/impurity and their resulting impact on usage of toilets, construction of a certain type of toilet designs etc. This book is a must read for those who want to move beyond the conventional arguments around OD and understand why the SBM is more of what has happened, bigger but under funded and under researched. A must read for students and social workers who have always known this crucial gap but now find solid evidence to design adequate BCC strategies that will help them educate bureaucrats and talk more about the true reasons why OD may be a bigger challenge than what was perceived all along.
In this seminal piece and whose book launch I was fortunate to attend, there is a genuine effort to approach open defecation as the reason why indian children are shorter, stunted in their early years, how it impacts their general health and hence their cognitive capacities which impacts the earning potential of these children when they grow up in years to come. The book is well researched and far reaching in its impact. It also debunks and attacks the usual arguments around access, poverty, illiteracy, GDP etc which are convenient reasons proferred to why OD exists in india and takes the focus to one societal aspect which government's ignore and international funding agencies are too scared or distant to talk about....caste and the notions of ritual purity/impurity and their resulting impact on usage of toilets, construction of a certain type of toilet designs etc. This book is a must read for those who want to move beyond the conventional arguments around OD and understand why the SBM is more of what has happened, bigger but under funded and under researched. A must read for students and social workers who have always known this crucial gap but now find solid evidence to design adequate BCC strategies that will help them educate bureaucrats and talk more about the true reasons why OD may be a bigger challenge than what was perceived all along.
February 27, 2018
This is an important read, not because it highlights an issue that modern India hardly comes across and pays little attention to its gravity. But because it dares to call out the elephant in the room.
There Can Be No Swachh Bharat Without Ending Institutional Discrimination (casteism). How can we eliminate open defecation when higher castes are unwilling to perform traditionally untouchable work. The government expects general public to address the issue of cleanliness but the reality is lower castes primarily continue to work in the profession of sweeping, cleaning and entering dangerous sewer lines, pits and septic tanks.
Where toilets are being built and accepted, household decisions seemed to be more driven by status, convenience and other lifestyle benefits resulting from latrine ownership than by considerations of better health.
The ground reality seems to be that building underground sewage system may be only viable policy option, where people do not want a latrine to be emptied later on. It may seem to be defeating the purpose of inoculating virtues of public sanitation and ending caste discrimination in India. But, if it saves lives of millions of unborn children, then it is a worthy compromise.
There Can Be No Swachh Bharat Without Ending Institutional Discrimination (casteism). How can we eliminate open defecation when higher castes are unwilling to perform traditionally untouchable work. The government expects general public to address the issue of cleanliness but the reality is lower castes primarily continue to work in the profession of sweeping, cleaning and entering dangerous sewer lines, pits and septic tanks.
Where toilets are being built and accepted, household decisions seemed to be more driven by status, convenience and other lifestyle benefits resulting from latrine ownership than by considerations of better health.
The ground reality seems to be that building underground sewage system may be only viable policy option, where people do not want a latrine to be emptied later on. It may seem to be defeating the purpose of inoculating virtues of public sanitation and ending caste discrimination in India. But, if it saves lives of millions of unborn children, then it is a worthy compromise.
March 26, 2019
What is the main focus of Swachh Bharat Mission ?
Looking at the photo-ops of broom wielding ministers, I too thought it was about general cleanliness. Infact >90% Indians too think so.
It actually seeks to end open defaecation problem rampant in India. And ironically it continues policies which have failed earlier.
Open defaecation in India is not about poverty, it is not about awareness, it is not about lack of water, it is not even about governance and corruption ! By comparing with similar developing countries which have far lower rates of the problem, they point to caste, untouchability and notions of ritual purity. And that is based on first-hand research and interactions.
And that is a huge #FacePalm dear fellow Indians and specifically dear co-religionists. How did we get mired in stupid issues like temple and cow when such a major problem inherent in religion that negatively impacts the mental+physical development of children for life remains unsolved ?
Looking at the photo-ops of broom wielding ministers, I too thought it was about general cleanliness. Infact >90% Indians too think so.
It actually seeks to end open defaecation problem rampant in India. And ironically it continues policies which have failed earlier.
Open defaecation in India is not about poverty, it is not about awareness, it is not about lack of water, it is not even about governance and corruption ! By comparing with similar developing countries which have far lower rates of the problem, they point to caste, untouchability and notions of ritual purity. And that is based on first-hand research and interactions.
And that is a huge #FacePalm dear fellow Indians and specifically dear co-religionists. How did we get mired in stupid issues like temple and cow when such a major problem inherent in religion that negatively impacts the mental+physical development of children for life remains unsolved ?
March 4, 2021
"Where India Goes" is an outstanding outsider perspective on internal social issue of open defecation.
This is outstanding because :
1. WHAT: It utilizes a simple problem of sanitation and correlates the need for sound sanitation policy with infant mortality, health, education, livelihood and lifestyle ( In one word- "Demographic Dividend")
2. WHY: The book break popular myths on why people choose to defecate in fields over toilets (Perception of Ritual Purity over perceived poverty)
3. WHERE: It also highlights where the crux of the issue lies and why it is often ignored; Problem is not in building toilets but sustaining the use of toilets
4. HOW: It provides a perspective on how the issue of rural sanitation can be taken up with a larger focus on behavioral change and breaking popular myths on twin pit toilets
5. WHO: Ultimately, it sums up who the benefactor will be when open defecation can be eliminated, which is the society on whole with multiplier
Despite my appreciation for such a holistic perspective, the book falls short because:
1. Somewhere it assumes "One Size Fits All Approach" by not recognising how diverse India and its problems are
2. Most changes are painstakingly slow and book proposes behavioral change campaigns budget as a measured way forward, which I think is misplaced ( more funds to IEC tools is rendering an arena for more corruption in place of any visible outcome according to most policy makers)
3. The book must appreciate some policy measures taken in recent era: Band Darwaza Campaign, present Direct Benefit Transfer to cut corruption for toilet construction, Sauchalya App that requires people to post photos of the toilet built, inspection process and continuous monitoring duty on District Collectors and External Agency Rankings published quarterly
The books concluding note sets the correct tone where it says,"It is not too late for continuing story of open defecation in India to have a happier ending". For a problem that persisted over centuries, more than a few decades are needed to be completely eliminated and there is hope to accelerate this process in interests of India's growth and inclusive development agenda.
This is outstanding because :
1. WHAT: It utilizes a simple problem of sanitation and correlates the need for sound sanitation policy with infant mortality, health, education, livelihood and lifestyle ( In one word- "Demographic Dividend")
2. WHY: The book break popular myths on why people choose to defecate in fields over toilets (Perception of Ritual Purity over perceived poverty)
3. WHERE: It also highlights where the crux of the issue lies and why it is often ignored; Problem is not in building toilets but sustaining the use of toilets
4. HOW: It provides a perspective on how the issue of rural sanitation can be taken up with a larger focus on behavioral change and breaking popular myths on twin pit toilets
5. WHO: Ultimately, it sums up who the benefactor will be when open defecation can be eliminated, which is the society on whole with multiplier
Despite my appreciation for such a holistic perspective, the book falls short because:
1. Somewhere it assumes "One Size Fits All Approach" by not recognising how diverse India and its problems are
2. Most changes are painstakingly slow and book proposes behavioral change campaigns budget as a measured way forward, which I think is misplaced ( more funds to IEC tools is rendering an arena for more corruption in place of any visible outcome according to most policy makers)
3. The book must appreciate some policy measures taken in recent era: Band Darwaza Campaign, present Direct Benefit Transfer to cut corruption for toilet construction, Sauchalya App that requires people to post photos of the toilet built, inspection process and continuous monitoring duty on District Collectors and External Agency Rankings published quarterly
The books concluding note sets the correct tone where it says,"It is not too late for continuing story of open defecation in India to have a happier ending". For a problem that persisted over centuries, more than a few decades are needed to be completely eliminated and there is hope to accelerate this process in interests of India's growth and inclusive development agenda.
December 16, 2017
Full review at https://booksteaandmorecom.wordpress....
India has the highest rate of open defecation in the world. Open defecation often results in life-threatening diseases, infant mortality and these problems are further compounded in India due to the high population density. As people live in close proximity it increases the chance of getting sick from these fecal germs even if one does not defecate in the open.
With policies like Swach Bharat Abhiyaan and others before it whose focus was on ending open defecation why is that the government has been unable to do so? Is poverty, illiteracy the reasons to be blamed for it? Or are there some deeper innate reasons and behavioral aspects that is causing this?
Poverty, illiteracy, and lack of good governance are chiefly the major factors attributed to open defecation in India. This book shows how countries whose GDP and economic growth are lower than India still have less open defecation than India. It also shows that countries having greater illiteracy and worst governance also fare better in terms of open defecation as compared to India. If these are then the major reason than why does the problem of open defecation still persists in India?
The book shows how it is still the notions of the caste system, untouchability and ritual purity that are acting as major deterrents to the adoption of latrines. It was seen through the studies conducted that often even people who have a toilet in their house went to defecate in the open. The cleaning of toilets and emptying the pits is considered still to be an activity that is filthy and the notion that this should not be done by certain caste and community is still imbibed in some. This results in people preferring to defecate away from home in the open than in the toilets as this gives people a sense of “ritual purity”. Thus this brings out a major point regarding how meer construction of toilets is not the solution to this problem the adoption of these toilets is what is more pertinent. This is where our policymakers are lacking in the fact that they are neglecting the behavioral aspect required to bring the change.
India has the highest rate of open defecation in the world. Open defecation often results in life-threatening diseases, infant mortality and these problems are further compounded in India due to the high population density. As people live in close proximity it increases the chance of getting sick from these fecal germs even if one does not defecate in the open.
With policies like Swach Bharat Abhiyaan and others before it whose focus was on ending open defecation why is that the government has been unable to do so? Is poverty, illiteracy the reasons to be blamed for it? Or are there some deeper innate reasons and behavioral aspects that is causing this?
Poverty, illiteracy, and lack of good governance are chiefly the major factors attributed to open defecation in India. This book shows how countries whose GDP and economic growth are lower than India still have less open defecation than India. It also shows that countries having greater illiteracy and worst governance also fare better in terms of open defecation as compared to India. If these are then the major reason than why does the problem of open defecation still persists in India?
The book shows how it is still the notions of the caste system, untouchability and ritual purity that are acting as major deterrents to the adoption of latrines. It was seen through the studies conducted that often even people who have a toilet in their house went to defecate in the open. The cleaning of toilets and emptying the pits is considered still to be an activity that is filthy and the notion that this should not be done by certain caste and community is still imbibed in some. This results in people preferring to defecate away from home in the open than in the toilets as this gives people a sense of “ritual purity”. Thus this brings out a major point regarding how meer construction of toilets is not the solution to this problem the adoption of these toilets is what is more pertinent. This is where our policymakers are lacking in the fact that they are neglecting the behavioral aspect required to bring the change.
May 2, 2021
This book has been allocated as one of the most excellent non-fictions of the decade. The book associates the pitiable growth of Indian children to hygiene with a huge section of households still devoid of a lavatory. Nobel Prize-winning economist Angus Deaton in his preface to this book writes, “It is hard to think of anything more important than how we treat our children…What happens to children ricochets through their lives, and many of society’s ills could be addressed if we were to take more care of the youngest among us.”
India was not always an outlier in rural hygiene. There was a time when open defecation was the only thing that humans did with their faeces. Not long back, rural open defecation rates would have been high in essentially every country. India stands alone today not because it changed, but because the rest of the world did.
The expanse between the human development that India accomplishes, and the human development that its economic capital forecasts. symbolizes much suffering, many deaths and a disproportionately big fraction of the stunted children and inadequate sanitation found in the world today. So, this fissure is a big deal for anyone, anyplace in the world, who cares about human well-being.
In this book, the authors consider one important piece of the puzzle: sanitation in rural India.
The fact that millions of people defecate in the open every day is a human development tragedy. It is indeed a market breakdown, and it is not being resolved by the Indian state. Both of these facts are important. But neither elucidates why sanitation in rural India is so much worse than in other developing countries. Rather, poor sanitation continues in rural India because of exclusive social forces – especially, caste.
Many people look forward to a modern, prosperous India. But it may not be possible to accelerate India’s future without engaging with the illiberal forces of caste and untouchability that are still part of India’s present.
Open defecation in rural India is an internationally extraordinary case that helps us comprehend how social disparity restrains human growth.
Comparing open defecation in India with sanitation to a different place makes clearly evident the need to keep these questions disconnected.
To answer them, one must distinguish a predicament that is found in a gradually improving place against a record of faster improvement almost worldwide. The effect can conveniently explain what is important.
For instance, sanitation was an unquestionably central part of how mortality declined and health improved in the advanced countries. Differences in sanitation clarify numerous distinctions in outcomes across developing countries today. So, it is no shocker that what today ranks as strangely awful sanitation contributes to pushing India off the global trend of improving health and well-being.
But comparing India with the rest of the developing world also reveals that whatever was accountable for improving sanitation elsewhere either has not been accessible or has not worked the same way in rural India.
Such is the quandary, embedded at the kernel of this book.
In the prologue the authors state: ‘For some readers, this book is about the human development emergency of open defecation in India: a dwindling opportunity to prevent a million or more child deaths before it is too late. For these readers, we are documenting an important case. It was not logically necessary that the ways in which the caste system has adapted and endured in modern rural India would stand against latrine use; that open defecation would be so very bad for child health; and that this would all happen in a densely populated country where over one-fifth of all infant deaths occur. But these did all occur in the same place, in our time. There are reasons to worry about whether the Indian state and international development efforts will supply an effective response. For other readers, less focused on India’s present-day policy challenges, this book is about the paradoxes of development in the early twenty-first century: What scope is there to make life better in an unequal world where conditions are for the most part improving quickly, but in some places and ways, painfully slowly?’
The book has been divided into three main segments – Causes, Consequences and Responses.
The book sets off with an ‘Introduction’. The fender-bender of technocratic policy with culture, politics and human options is a tale that has been narrated earlier. However, it is significant enough to tell again – this time, against the milieu of a mounting scientific accord about the magnitude of child development and human capital for economic development, and of the interfaces of health and wealth. Each chapter in this book is about open defecation, but it is also about something else.
The opening segment, subheaded as Causes, contains three chapters -
2. The puzzle: Why rural India?
3. Purity, pollution and untouchability and
4. Latrine pits and slow social change
Chapter 2 to 4, asks why open defecation persists in rural India. Chapter 2 poses the conundrum: Why does rural India have such high rates of open defecation when international comparisons suggest that most people could afford to buy, make or use the same latrines that are eliminating open defecation in sub-Saharan Africa and the rest of Asia?
Remarkably, this is often not the primary question that sanitation bureaucrats or development professionals ask. To pose this inquiry requires abandoning the sanitized claim that open defecation in India is all about lack of access to latrines and is no different from what happened in Latin America and South East Asia. It requires recognizing that Indian villagers who discard available, inexpensive sanitation options are the most dominant actors in this book’s story.
Chapters 3 and 4 ask how development is constrained when it runs ahead of social equality and liberalism. In public health, a permanent question is, whether economic inequality makes people sick: Does health in a population become worse, on average, as a result of an increase in income inequality? In the case of open defecation, social discrimination effects poor health for everyone.
Chapters 3 and 4 present a two-part answer to the questions that the authors pose in Chapter 2. In Chapter 3, we hear from villagers who explain that the pit latrines provided by the government are dirty and impure. We consider what this means in a society in which the same system of ritual purity and pollution is applied to objects, such as pit latrines, and to people from certain castes. Many villagers think that having a simple pit latrine is inconsistent with maintaining a home that is ritually pure. Open defecation, in contrast, has no such negative connotations.
Chapter 4 considers the question of why the few latrines that rural Indians have built for themselves are so much more expensive than the latrines that the government builds. At the core: Villagers reject affordable latrines because their pits must eventually be emptied by hand. But disposing of human faeces is the work of Dalits.
Unfortunately, not enough has changed since Dr B.R. Ambedkar observed decades ago that the power and supposed superiority of the higher castes are tied to avoiding untouchable work. Even today, more than sixty-six years after the Indian Constitution declared people from all castes equal under the law, the vast majority of higher-caste people still find the idea of emptying their own latrine pits unacceptably degrading.
And, as in Ambedkar’s time, avoiding untouchable labour continues to be a way for Dalits to resist an oppressive social order and, in some cases, to improve their lives. Even where pit-emptying work is profitable, many Dalits would prefer to avoid the humiliation and social exclusion that accompany this work.
These add up to compelling reasons for rural Indians to reject the types of latrines that save lives elsewhere. If the prospect of full latrine pits threatens to continue Dalit oppression because someone will have to empty them, and if many people in rural India do not mind defecating in the open, you might ask whether it should really be a policy priority to end open defecation.
The second segment of this book is titled as Consequences, and has the following three chapters:
5. Health: Surviving and growing in childhood
6. Economics: Children’s human capital, adults’ wages
7. Dignity: The people who want latrines
Chapters 5 and 6 cover the reasons as to why reducing open defecation is so important for India’s future. They build on a growing consensus among economists that two important dimensions of well-being – wealth and health – cannot be fully understood alone.
Chapter 5 reviews evidence for the considerable effects of open defecation on multiple dimensions of children’s health. Researchers have found effects of open defecation on mortality, on anaemia and even on the sizes of children’s bodies. Reaching this understanding has required the sustained work of epidemiologists, demographers and economists, collaborating across decades and centuries. By focusing on the puzzle of why Indian children are so much shorter than children elsewhere, we emphasize the importance of infectious disease to nutritional outcomes, such as height, which are more commonly associated with food. Humanity’s Great Escape from infectious disease remains incomplete.
Chapter 6 explores the economic consequences of India’s widespread open defecation. Development in a child’s earliest years shapes his economic productivity as an adult. One way that open defecation negatively impacts India’s economy is by stunting the cognitive development of future workers. The same diseases that make children short also make it more difficult for them to learn. The result is another generation that grows up to be less productive workers than they could be, who earns less money and pays less in taxes. This research shows that open defecation is not only in the portfolio of the health ministry: The finance minister has good reasons to care about this problem too.
Chapter 7 is about a different type of consequence of open defecation: the loss of dignity experienced by those who would like to use a latrine, but who do not have that option. For a small fraction – but large number – of people in rural India who are very old or disabled, walking to the fields to defecate is difficult, painful or impossible. For those elderly and disabled who are lucky enough to get a latrine, they must live with the burden of having caused their families to make a large expenditure. These are real costs of the fact that, in rural India, open defecation is perfectly normal.
The concluding segment of the book, titled as ‘Responses’, contains the following chapters –
Responses
8. Policy: Politics, development and latrine construction
9. Conclusion: The next rural sanitation policy
The two concluding chapters focus on policy responses to open defecation: What do the Indian state and international development do, what they claim to control, and what do we hope they will do?
Chapter 8 turns to the sanitation programmes and policies of Indian governments, past and present. Elected governments come and go, but rural sanitation policy remains little more than publicly funded latrine construction. The Swachh Bharat Mission has a bigger budget than earlier sanitation programmes, but it is not importantly different. Unfortunately, there is little democratic pressure to change where a half-a-billion rural Indians defecate.
Finally, in Chapter 9 the authors inquire: What strategies might speed up the decline of open defecation in rural India from its hoary rate of one percentage point a year? The authors offer some timid ideas of their own, talk about some common proposals they believe will not work and ask what it means to endorse well-being through development policy in a world that is speedily becoming richer and healthier, with vital exceptions.
As a reader you would be enlightened and enriched by this book indubitably. The book is both genuinely researched plus solicitously penned. Aside from being a book open defecation, the function of caste, and the challenges of employing policy interventions at this scale, the authors also reflect upon the thorny road of growth shed off from clichés and technocratic resolutions.
Grab a copy if you choose.
India was not always an outlier in rural hygiene. There was a time when open defecation was the only thing that humans did with their faeces. Not long back, rural open defecation rates would have been high in essentially every country. India stands alone today not because it changed, but because the rest of the world did.
The expanse between the human development that India accomplishes, and the human development that its economic capital forecasts. symbolizes much suffering, many deaths and a disproportionately big fraction of the stunted children and inadequate sanitation found in the world today. So, this fissure is a big deal for anyone, anyplace in the world, who cares about human well-being.
In this book, the authors consider one important piece of the puzzle: sanitation in rural India.
The fact that millions of people defecate in the open every day is a human development tragedy. It is indeed a market breakdown, and it is not being resolved by the Indian state. Both of these facts are important. But neither elucidates why sanitation in rural India is so much worse than in other developing countries. Rather, poor sanitation continues in rural India because of exclusive social forces – especially, caste.
Many people look forward to a modern, prosperous India. But it may not be possible to accelerate India’s future without engaging with the illiberal forces of caste and untouchability that are still part of India’s present.
Open defecation in rural India is an internationally extraordinary case that helps us comprehend how social disparity restrains human growth.
Comparing open defecation in India with sanitation to a different place makes clearly evident the need to keep these questions disconnected.
To answer them, one must distinguish a predicament that is found in a gradually improving place against a record of faster improvement almost worldwide. The effect can conveniently explain what is important.
For instance, sanitation was an unquestionably central part of how mortality declined and health improved in the advanced countries. Differences in sanitation clarify numerous distinctions in outcomes across developing countries today. So, it is no shocker that what today ranks as strangely awful sanitation contributes to pushing India off the global trend of improving health and well-being.
But comparing India with the rest of the developing world also reveals that whatever was accountable for improving sanitation elsewhere either has not been accessible or has not worked the same way in rural India.
Such is the quandary, embedded at the kernel of this book.
In the prologue the authors state: ‘For some readers, this book is about the human development emergency of open defecation in India: a dwindling opportunity to prevent a million or more child deaths before it is too late. For these readers, we are documenting an important case. It was not logically necessary that the ways in which the caste system has adapted and endured in modern rural India would stand against latrine use; that open defecation would be so very bad for child health; and that this would all happen in a densely populated country where over one-fifth of all infant deaths occur. But these did all occur in the same place, in our time. There are reasons to worry about whether the Indian state and international development efforts will supply an effective response. For other readers, less focused on India’s present-day policy challenges, this book is about the paradoxes of development in the early twenty-first century: What scope is there to make life better in an unequal world where conditions are for the most part improving quickly, but in some places and ways, painfully slowly?’
The book has been divided into three main segments – Causes, Consequences and Responses.
The book sets off with an ‘Introduction’. The fender-bender of technocratic policy with culture, politics and human options is a tale that has been narrated earlier. However, it is significant enough to tell again – this time, against the milieu of a mounting scientific accord about the magnitude of child development and human capital for economic development, and of the interfaces of health and wealth. Each chapter in this book is about open defecation, but it is also about something else.
The opening segment, subheaded as Causes, contains three chapters -
2. The puzzle: Why rural India?
3. Purity, pollution and untouchability and
4. Latrine pits and slow social change
Chapter 2 to 4, asks why open defecation persists in rural India. Chapter 2 poses the conundrum: Why does rural India have such high rates of open defecation when international comparisons suggest that most people could afford to buy, make or use the same latrines that are eliminating open defecation in sub-Saharan Africa and the rest of Asia?
Remarkably, this is often not the primary question that sanitation bureaucrats or development professionals ask. To pose this inquiry requires abandoning the sanitized claim that open defecation in India is all about lack of access to latrines and is no different from what happened in Latin America and South East Asia. It requires recognizing that Indian villagers who discard available, inexpensive sanitation options are the most dominant actors in this book’s story.
Chapters 3 and 4 ask how development is constrained when it runs ahead of social equality and liberalism. In public health, a permanent question is, whether economic inequality makes people sick: Does health in a population become worse, on average, as a result of an increase in income inequality? In the case of open defecation, social discrimination effects poor health for everyone.
Chapters 3 and 4 present a two-part answer to the questions that the authors pose in Chapter 2. In Chapter 3, we hear from villagers who explain that the pit latrines provided by the government are dirty and impure. We consider what this means in a society in which the same system of ritual purity and pollution is applied to objects, such as pit latrines, and to people from certain castes. Many villagers think that having a simple pit latrine is inconsistent with maintaining a home that is ritually pure. Open defecation, in contrast, has no such negative connotations.
Chapter 4 considers the question of why the few latrines that rural Indians have built for themselves are so much more expensive than the latrines that the government builds. At the core: Villagers reject affordable latrines because their pits must eventually be emptied by hand. But disposing of human faeces is the work of Dalits.
Unfortunately, not enough has changed since Dr B.R. Ambedkar observed decades ago that the power and supposed superiority of the higher castes are tied to avoiding untouchable work. Even today, more than sixty-six years after the Indian Constitution declared people from all castes equal under the law, the vast majority of higher-caste people still find the idea of emptying their own latrine pits unacceptably degrading.
And, as in Ambedkar’s time, avoiding untouchable labour continues to be a way for Dalits to resist an oppressive social order and, in some cases, to improve their lives. Even where pit-emptying work is profitable, many Dalits would prefer to avoid the humiliation and social exclusion that accompany this work.
These add up to compelling reasons for rural Indians to reject the types of latrines that save lives elsewhere. If the prospect of full latrine pits threatens to continue Dalit oppression because someone will have to empty them, and if many people in rural India do not mind defecating in the open, you might ask whether it should really be a policy priority to end open defecation.
The second segment of this book is titled as Consequences, and has the following three chapters:
5. Health: Surviving and growing in childhood
6. Economics: Children’s human capital, adults’ wages
7. Dignity: The people who want latrines
Chapters 5 and 6 cover the reasons as to why reducing open defecation is so important for India’s future. They build on a growing consensus among economists that two important dimensions of well-being – wealth and health – cannot be fully understood alone.
Chapter 5 reviews evidence for the considerable effects of open defecation on multiple dimensions of children’s health. Researchers have found effects of open defecation on mortality, on anaemia and even on the sizes of children’s bodies. Reaching this understanding has required the sustained work of epidemiologists, demographers and economists, collaborating across decades and centuries. By focusing on the puzzle of why Indian children are so much shorter than children elsewhere, we emphasize the importance of infectious disease to nutritional outcomes, such as height, which are more commonly associated with food. Humanity’s Great Escape from infectious disease remains incomplete.
Chapter 6 explores the economic consequences of India’s widespread open defecation. Development in a child’s earliest years shapes his economic productivity as an adult. One way that open defecation negatively impacts India’s economy is by stunting the cognitive development of future workers. The same diseases that make children short also make it more difficult for them to learn. The result is another generation that grows up to be less productive workers than they could be, who earns less money and pays less in taxes. This research shows that open defecation is not only in the portfolio of the health ministry: The finance minister has good reasons to care about this problem too.
Chapter 7 is about a different type of consequence of open defecation: the loss of dignity experienced by those who would like to use a latrine, but who do not have that option. For a small fraction – but large number – of people in rural India who are very old or disabled, walking to the fields to defecate is difficult, painful or impossible. For those elderly and disabled who are lucky enough to get a latrine, they must live with the burden of having caused their families to make a large expenditure. These are real costs of the fact that, in rural India, open defecation is perfectly normal.
The concluding segment of the book, titled as ‘Responses’, contains the following chapters –
Responses
8. Policy: Politics, development and latrine construction
9. Conclusion: The next rural sanitation policy
The two concluding chapters focus on policy responses to open defecation: What do the Indian state and international development do, what they claim to control, and what do we hope they will do?
Chapter 8 turns to the sanitation programmes and policies of Indian governments, past and present. Elected governments come and go, but rural sanitation policy remains little more than publicly funded latrine construction. The Swachh Bharat Mission has a bigger budget than earlier sanitation programmes, but it is not importantly different. Unfortunately, there is little democratic pressure to change where a half-a-billion rural Indians defecate.
Finally, in Chapter 9 the authors inquire: What strategies might speed up the decline of open defecation in rural India from its hoary rate of one percentage point a year? The authors offer some timid ideas of their own, talk about some common proposals they believe will not work and ask what it means to endorse well-being through development policy in a world that is speedily becoming richer and healthier, with vital exceptions.
As a reader you would be enlightened and enriched by this book indubitably. The book is both genuinely researched plus solicitously penned. Aside from being a book open defecation, the function of caste, and the challenges of employing policy interventions at this scale, the authors also reflect upon the thorny road of growth shed off from clichés and technocratic resolutions.
Grab a copy if you choose.
August 23, 2021
This is an interesting book on developmental economics and policy focusing on open defecation in India. Like many others, I believed largely prevalent open defecation in rural was because of poverty and lack of access. This book is based on years of detailed research done by the authors. They explain why the govt programs have failed, why much poorer Bangladesh has almost eliminated open defecation while richer India hasn’t, why Muslim kids have much lower infant mortality rate than Hindu babies being on average poorer, the true economic costs of this problem and suggestions for the govt’s.
I was not surprised that casteism and untouchability was one of the reasons behind open defecation but not that it would be one of the biggest reasons why this problem continues to persist.
I found the book very interesting and well written.
I was not surprised that casteism and untouchability was one of the reasons behind open defecation but not that it would be one of the biggest reasons why this problem continues to persist.
I found the book very interesting and well written.
January 2, 2018
Excellent. Should be read by everyone working in development in India or development/sanitation more generally.
Also just a good read in general.
Also just a good read in general.
January 26, 2025
(4.5 rounded up to 5)
A well crafted account of how open defecation is a complex problem in India and goes beyond the standard rhetoric of availability of sanitation facilities The book delves into how social customs, ideas of ritual pollution, caste and misplaced ideas create a noxious environment that prevents adaptation of latrines. The most shocking part was the health (especially child mortality), developmental and social/economic impacts of open defecation - which was well presented with statistics and how india is an outlier even among developing countries in accepting latrines and reducing open defecation.
A well crafted account of how open defecation is a complex problem in India and goes beyond the standard rhetoric of availability of sanitation facilities The book delves into how social customs, ideas of ritual pollution, caste and misplaced ideas create a noxious environment that prevents adaptation of latrines. The most shocking part was the health (especially child mortality), developmental and social/economic impacts of open defecation - which was well presented with statistics and how india is an outlier even among developing countries in accepting latrines and reducing open defecation.
February 6, 2018
“Open defecation is not concentrated among the world’s poorest people.” Summarizes my surprise, even though I’m working in this sector (although not familiar with Indian context). So after all, behavior change is the key to stop open defecation, and we kind of all knew that already, but what to do? Especially in India with this much social/ cultural deeply rooted beliefs? I found this book very interesting and informative, academic research but good for general read!
October 16, 2022
Very informative book. Based on big data collected on this topic and anthropology research. Enjoyed listening.
Read
November 3, 2022A good book with solid data points but too stretched.
May 3, 2021
This is a fascinating, focused, rigorous book about a very interesting puzzle in rural India : open defecation. It starts off by showing that, for some reason, India is lagging behind even poorer countries in reducing open defecation despite having enacted several large scale government programs to tackle it. The following quote, in my view, captures the puzzling situation very well :
"[Sohni] does not use the latrine she has. She, her mother-in-law and her husband all defecate in the open. The two children, aged seven and five, 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."
This is incredibly counterintuitive behaviour. The reasons for this are very well explained in the book. The role that concepts of purity and caste play here is argued convincingly. Following a thorough explanation of the causes, the authors write to persuade, even the most utilitarian among us, that open defecation needs to be dealt with. They finish by showing why past and present government programs are failing and provide possible avenues for addressing the issue.
I loved this book for teaching me that the world is a weird place, that things that make sense don't translate to reality, that technocratic solutions can miss the mark, that a problem that is in absolutely everybody's interest to solve, can end up stuck because of social and political dynamics. I appreciated the provision of carefully collected quantitative arguments to back most claims, and how well the authors presented the limitations of their analyses. This book ranks very high in my list of non fiction books despite its dry academic writing style.
"[Sohni] does not use the latrine she has. She, her mother-in-law and her husband all defecate in the open. The two children, aged seven and five, 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."
This is incredibly counterintuitive behaviour. The reasons for this are very well explained in the book. The role that concepts of purity and caste play here is argued convincingly. Following a thorough explanation of the causes, the authors write to persuade, even the most utilitarian among us, that open defecation needs to be dealt with. They finish by showing why past and present government programs are failing and provide possible avenues for addressing the issue.
I loved this book for teaching me that the world is a weird place, that things that make sense don't translate to reality, that technocratic solutions can miss the mark, that a problem that is in absolutely everybody's interest to solve, can end up stuck because of social and political dynamics. I appreciated the provision of carefully collected quantitative arguments to back most claims, and how well the authors presented the limitations of their analyses. This book ranks very high in my list of non fiction books despite its dry academic writing style.
August 25, 2021
Treating the symptoms rather than the cause with respect to open defecation is highlighted in this book. Understanding culture, history and politics is necessary to tackle behavioral patterns. Quite useful to anyone who wants to know rural India.
Excellent use of data to qualitatively and quantitatively measure significant factors affecting population behaviour.
Excellent use of data to qualitatively and quantitatively measure significant factors affecting population behaviour.
February 15, 2020
A very well written book that not only throws light on the subject (sanitation particularly toilet usage mainly in rural India) but also on research methods... A must read for anybody interested in social research, both qualitative and quantitative. I felt each chapter (each concept) delved into began with wonderfully framed research questions followed by how it was studied and finally the answer to the research question.
Really loved the compassion and passion the authors have for the subject and for addressing undernutrition and ill health in India's rural children. The urgency for action is visible.
As I finish the book, my mind is full of further questions and a thirst for finding more relevant answers to this and various other related wicked problem haunting India.
Really loved the compassion and passion the authors have for the subject and for addressing undernutrition and ill health in India's rural children. The urgency for action is visible.
As I finish the book, my mind is full of further questions and a thirst for finding more relevant answers to this and various other related wicked problem haunting India.
October 10, 2020
In 2014, in his first Independence Day speech, Prime Minister Narendra Modi said that, by 2nd October, 2019 India would be open defecation free. As planned, PM Narendra Modi, on the occasion of Gandhiji’s 150th birthday declared that India is free from open defecation, having little idea that, as per the 2011 census, 12.3 crore Indians household reported lacking of toilet or latrine. Declaring India as open defecation free amounted to building 67,000 new latrine per day over a period of five years. Unfortunately, there are only 86,400 seconds in a day. It is daunting to know that 70 per cent of the rural population in India, predominantly one in eight human beings in the state of Uttar Pradesh, defecate in open.
This book is a well-constructed thesis with painstaking research on India’s incurable menace of open defecation. It is a commonly held belief that the case of open defecation is a result of extreme poverty, lack of accessibility to toilets and water, illiteracy and fragile governance. It is easy for the urban elites, bureaucrats and the politicians to blame the rural population for this menace. In this book, authors Diane Coffey and Dean Spears argues that the India’s high rates of open defecation is not due to the poverty, access to water or the educational levels or even the governance, but due to the prevalence of societal order in form of caste. The researchers after much case studies found that the rural population in India continues to defecate in open rather than opting for affordable latrines for simpler yet strong reasons related to beliefs, values and norms about spiritual purity, pollution and untouchability. The experimental data and experience reports presented in this book also hold true to their claim that open defecation in rural India is rooted in the social forces of caste and untouchability and it cannot be solved solely by distributing toilets.
In one of the most intriguing chapter, the authors have uncovered the commonly held misconception about the Indian enigma, that Indians are genetically predisposed to be shorter compared to the rest of world’s population. Scientific consensus is that an adult’s health, growth and productivity are shaped by his childhood’s environment. For this reason, the externality of open defecation during infancy which exposes them to germs (bacteria and parasites), majorly lead to the prevalence of lower cognitive development and growth among Indian children as per the ASER and NFHS data. As various studies have shown the effect of parasitic and bacterial infections on deterring growth and malabsorption of nutrients in children, the oral infestation of faecal coliforms among children pose as an urgent public health concern for India. The oral infestation of faecal coliforms, leading to cholera and infant dysentery are the same reason why the infant mortality and under five mortality rates of India are miserably high and on par with Sub-Saharan African countries. Open defecation also contributed to the high rates of anaemia in India. Though supplementation of iron has been the response of government to it, the overlooked scientific fact is that body needs folate and vitamin B6 and B12 to produce haemoglobin. Frequent diarrhoea and parasitic infections among children exposed to faecal microorganisms, make them unable to absorb the above nutrients to synthesis haemoglobin, making them anaemic.
After conducting multiple longitudinal and cross sectional studies across the rural villages of India with high open defecation rates, the researchers noted that many villagers believed that having a simple pit latrine would make their home ritually impure and also rejected the free government latrines because their pits must eventually be emptied by hands, which is considered to be the work of the Dalits. The cost of caste on India’s development and its role in stymieing the Sustainable Development Goals (SDGs) are well discussed in this book, with much emphasis on manual scavenging. Though legally criminalized and prohibited, the continuing existence of manual scavenging hinders the upward mobility of the lowest strata of Indian society. As long as the upper strata of rural India consider cleaning their own toilet or septic tank as an act of indignity and shame, no number of sanitation policies without prioritizing such behavioural change would make any difference in the open defecation rates. The urban elites who often draft sanitation policies fail to acknowledge such societal barriers in implementation. Consequently, it is always easy to believe that all public problems are ultimately management problems, rather than social problems.
This book is a well-constructed thesis with painstaking research on India’s incurable menace of open defecation. It is a commonly held belief that the case of open defecation is a result of extreme poverty, lack of accessibility to toilets and water, illiteracy and fragile governance. It is easy for the urban elites, bureaucrats and the politicians to blame the rural population for this menace. In this book, authors Diane Coffey and Dean Spears argues that the India’s high rates of open defecation is not due to the poverty, access to water or the educational levels or even the governance, but due to the prevalence of societal order in form of caste. The researchers after much case studies found that the rural population in India continues to defecate in open rather than opting for affordable latrines for simpler yet strong reasons related to beliefs, values and norms about spiritual purity, pollution and untouchability. The experimental data and experience reports presented in this book also hold true to their claim that open defecation in rural India is rooted in the social forces of caste and untouchability and it cannot be solved solely by distributing toilets.
In one of the most intriguing chapter, the authors have uncovered the commonly held misconception about the Indian enigma, that Indians are genetically predisposed to be shorter compared to the rest of world’s population. Scientific consensus is that an adult’s health, growth and productivity are shaped by his childhood’s environment. For this reason, the externality of open defecation during infancy which exposes them to germs (bacteria and parasites), majorly lead to the prevalence of lower cognitive development and growth among Indian children as per the ASER and NFHS data. As various studies have shown the effect of parasitic and bacterial infections on deterring growth and malabsorption of nutrients in children, the oral infestation of faecal coliforms among children pose as an urgent public health concern for India. The oral infestation of faecal coliforms, leading to cholera and infant dysentery are the same reason why the infant mortality and under five mortality rates of India are miserably high and on par with Sub-Saharan African countries. Open defecation also contributed to the high rates of anaemia in India. Though supplementation of iron has been the response of government to it, the overlooked scientific fact is that body needs folate and vitamin B6 and B12 to produce haemoglobin. Frequent diarrhoea and parasitic infections among children exposed to faecal microorganisms, make them unable to absorb the above nutrients to synthesis haemoglobin, making them anaemic.
After conducting multiple longitudinal and cross sectional studies across the rural villages of India with high open defecation rates, the researchers noted that many villagers believed that having a simple pit latrine would make their home ritually impure and also rejected the free government latrines because their pits must eventually be emptied by hands, which is considered to be the work of the Dalits. The cost of caste on India’s development and its role in stymieing the Sustainable Development Goals (SDGs) are well discussed in this book, with much emphasis on manual scavenging. Though legally criminalized and prohibited, the continuing existence of manual scavenging hinders the upward mobility of the lowest strata of Indian society. As long as the upper strata of rural India consider cleaning their own toilet or septic tank as an act of indignity and shame, no number of sanitation policies without prioritizing such behavioural change would make any difference in the open defecation rates. The urban elites who often draft sanitation policies fail to acknowledge such societal barriers in implementation. Consequently, it is always easy to believe that all public problems are ultimately management problems, rather than social problems.
October 27, 2017
Many things I appreciated about this book.
First, the authors are measured and rigorous in tone. They go deep on the topic of sanitation in India, and have clearly spent a lot of time reflecting on both topics (sanitation and India). The research is used together well to make compelling circumstantial assertions, while also being transparent about the limitations of each individual data point.
Second, the topic is surprisingly interesting. Initially, because the reality of the situation is intuitive, but non-obvious (to borrow a phrase from a colleague): giving people more latrines will not reduce open defecation, because many people view using and maintaining a latrine as a dirtier / degrading than defecating outside. Second, because the implications of open defecation on public health are stunning. Lastly, because as an Indian American, I was fascinated to learn about some of the key voices in India on caste and casteism, over time.
In terms of style, I ultimately did not mind the delivery of the messages in the book, because I came to respect the authors in their voice as researchers and people who genuinely care about the community. They were also very good about reminding readers of the core structure / assertions of each sections.
Two criticisms:
1. This is a book that some people will not make it through. The authors have to remind us about the book's outline because, admist all the wonkiness, the assertions don't follow the order I'd expect. Perhaps the core audience of this book is not laypeople like myself. They begin the book by talking about a puzzling research phenomenon (why India's open defecation rates are so high), before spending any time really explaining why somebody should spend a few hours of their life reading a book about open defecation at all. Here is the question that comes on p97 that I wished had come earlier: "Why, then, should development policy bother to try to change rural sanitation at all? If people are happy with what they are doing, what is the policy challenge? A large majority of people in rural India think that open defecation is not a public policy issue at all. Are they right?"
2. Relatedly, the authors make some very provocative claims about the implications of the current, faulty strategy in India. This part of the book is gripping. But I couldn't quite gauge how confident they were in the implications section (and how confidently the research supported it), given how far they buried the lead and the (mostly) modest language they use. I would have walked away a more ardent advocate, if I understood this.
First, the authors are measured and rigorous in tone. They go deep on the topic of sanitation in India, and have clearly spent a lot of time reflecting on both topics (sanitation and India). The research is used together well to make compelling circumstantial assertions, while also being transparent about the limitations of each individual data point.
Second, the topic is surprisingly interesting. Initially, because the reality of the situation is intuitive, but non-obvious (to borrow a phrase from a colleague): giving people more latrines will not reduce open defecation, because many people view using and maintaining a latrine as a dirtier / degrading than defecating outside. Second, because the implications of open defecation on public health are stunning. Lastly, because as an Indian American, I was fascinated to learn about some of the key voices in India on caste and casteism, over time.
In terms of style, I ultimately did not mind the delivery of the messages in the book, because I came to respect the authors in their voice as researchers and people who genuinely care about the community. They were also very good about reminding readers of the core structure / assertions of each sections.
Two criticisms:
1. This is a book that some people will not make it through. The authors have to remind us about the book's outline because, admist all the wonkiness, the assertions don't follow the order I'd expect. Perhaps the core audience of this book is not laypeople like myself. They begin the book by talking about a puzzling research phenomenon (why India's open defecation rates are so high), before spending any time really explaining why somebody should spend a few hours of their life reading a book about open defecation at all. Here is the question that comes on p97 that I wished had come earlier: "Why, then, should development policy bother to try to change rural sanitation at all? If people are happy with what they are doing, what is the policy challenge? A large majority of people in rural India think that open defecation is not a public policy issue at all. Are they right?"
2. Relatedly, the authors make some very provocative claims about the implications of the current, faulty strategy in India. This part of the book is gripping. But I couldn't quite gauge how confident they were in the implications section (and how confidently the research supported it), given how far they buried the lead and the (mostly) modest language they use. I would have walked away a more ardent advocate, if I understood this.
August 5, 2023
I don't exactly remember why and when I picked this book up but I wasn't too glad when I finished the first chapter. I then trudged through it little by little but eventually picked up the pace along the third chapter, I think. This book quite literally explains why India, among other developing and poor nations, has the highest rates of open defecation. Time and again, we hear of new programs which aim to tackle open defecation in rural India but that's the end of it, no follow-ups.
But the underlying reason why India, of all the poor nations, cannot rid herself of open defecation is not that they don't have access to latrines, which a lot of people come to accept, including me hitherto. It's the undying caste system. And the moment I read this sentence, this quote from Annihilation Of Caste came to mind:
"Caste is not merely a division of labour, it's a division of labourers."
And I somehow knew the rest of the story. It's baffling that in this day and age, a stark fraction of people still believe in untouchability, to the point of defiantly admitting it in surveys, as shown in the book. The researchers/authors present data as to how people who defecate in the open, affect you and others around them. How infants who grow up in an environment where there's open defecation--if they indeed survive--grow up to be adults who perform lower in various metrics including, but not limited to, health and career.
It's sobering and I don't think I ever looked at open defecation through any other lens than that of cleanliness, let alone untouchability. But here we are, the caste system affecting yet another aspect of lives in rural India. An eye-opener of a book.
But the underlying reason why India, of all the poor nations, cannot rid herself of open defecation is not that they don't have access to latrines, which a lot of people come to accept, including me hitherto. It's the undying caste system. And the moment I read this sentence, this quote from Annihilation Of Caste came to mind:
"Caste is not merely a division of labour, it's a division of labourers."
And I somehow knew the rest of the story. It's baffling that in this day and age, a stark fraction of people still believe in untouchability, to the point of defiantly admitting it in surveys, as shown in the book. The researchers/authors present data as to how people who defecate in the open, affect you and others around them. How infants who grow up in an environment where there's open defecation--if they indeed survive--grow up to be adults who perform lower in various metrics including, but not limited to, health and career.
It's sobering and I don't think I ever looked at open defecation through any other lens than that of cleanliness, let alone untouchability. But here we are, the caste system affecting yet another aspect of lives in rural India. An eye-opener of a book.
March 28, 2018
Ever wondered why our roads are so dirty? We always curse a lack of civic sense in India, but have youe ever questioned why? The answer, believe it or not, lies not in "culture" or something, but India's pernicious caste system, a malaise that just refuses to leave.
The lowest rungs of Indian society (certain subcastes among Dalits) are delegated to a life of manual scavenging, cleaning etc. as it is considered their "duty" for just being born Dalit. When a certain class of society will always be there for cleaning after everyone else, the entitlement to throw garbage starts making more sense. "Koi utha lega" or "someone else will pick it up" is how we sub-consciously assign this duty to a few.
While improved civic sense can make a change, of what use is anything when three-quarters of the rural populations "goes out" in the open? This book brings an improtant policy perspective to a country where missions like "Swach Bharat" are pushed with no sense of irony, without so much as countering the caste system. This book was enlightening in many respects. It brings a much needed Ambedkarite/anti-caste analysis to one of the most massive ills plaguing Indian society.
While the book was slightly repititive, and the data is not cited well in places, it also draws correlations to pervasive problems such as "The Indian Enigma" (lower average heights in Indians), malnutrition and the sheer lack of cleanliness in India. For sheltered urbanites, this book will be a wake-up call to how caste actually functions beyond an abstract concept, and for confused westerners, a perspective of why the whole "street shitting" meme exists.
The lowest rungs of Indian society (certain subcastes among Dalits) are delegated to a life of manual scavenging, cleaning etc. as it is considered their "duty" for just being born Dalit. When a certain class of society will always be there for cleaning after everyone else, the entitlement to throw garbage starts making more sense. "Koi utha lega" or "someone else will pick it up" is how we sub-consciously assign this duty to a few.
While improved civic sense can make a change, of what use is anything when three-quarters of the rural populations "goes out" in the open? This book brings an improtant policy perspective to a country where missions like "Swach Bharat" are pushed with no sense of irony, without so much as countering the caste system. This book was enlightening in many respects. It brings a much needed Ambedkarite/anti-caste analysis to one of the most massive ills plaguing Indian society.
While the book was slightly repititive, and the data is not cited well in places, it also draws correlations to pervasive problems such as "The Indian Enigma" (lower average heights in Indians), malnutrition and the sheer lack of cleanliness in India. For sheltered urbanites, this book will be a wake-up call to how caste actually functions beyond an abstract concept, and for confused westerners, a perspective of why the whole "street shitting" meme exists.
September 20, 2017
The authors discovered a very important problem and what seems to be its root cause. Did you know 6,000,000 Indians (at a rate of 200,000 per year) will die due to open defecation? Their discovery is shocking, profound, and deserves a lot of attention.
That being said, this book has a few issues.
1) There is no data! I'm supposed to just take the authors word for their arguments, which isn't inherently objectionable, but disappointing.
2) The book is badly overwritten. On one hand, I'm glad this book is only 230 pages, as some academics could have taken the same content and made it into 500 words. However, this book really should be much more condensed.
3) No discussion of possible ways to mitigate the malnutrition caused by open defecation. For example, diarrhea kills 100,000's of Indians, and there are ways to mitigate this. Obviously there is a connection between malnutrition from open defecation and the problems of babies suffering diarrhea, but the book doesn't discuss this at all.
3) The book overstates the connection between height and malnutrition while understating the correlation between genes and height.
4) The book fails to discuss why Indians don't view open defecation as being dirty/gross, which seems to be pretty widely accepted in the rest of the world, and worthy of analysis.
For anyone interested in this book, I highly recommend you read this summary first (and possibly instead), which will give you a good overview of 90% of what you'll learn from the book: marginalrevolution.com/marginalrevolu...
That being said, this book has a few issues.
1) There is no data! I'm supposed to just take the authors word for their arguments, which isn't inherently objectionable, but disappointing.
2) The book is badly overwritten. On one hand, I'm glad this book is only 230 pages, as some academics could have taken the same content and made it into 500 words. However, this book really should be much more condensed.
3) No discussion of possible ways to mitigate the malnutrition caused by open defecation. For example, diarrhea kills 100,000's of Indians, and there are ways to mitigate this. Obviously there is a connection between malnutrition from open defecation and the problems of babies suffering diarrhea, but the book doesn't discuss this at all.
3) The book overstates the connection between height and malnutrition while understating the correlation between genes and height.
4) The book fails to discuss why Indians don't view open defecation as being dirty/gross, which seems to be pretty widely accepted in the rest of the world, and worthy of analysis.
For anyone interested in this book, I highly recommend you read this summary first (and possibly instead), which will give you a good overview of 90% of what you'll learn from the book: marginalrevolution.com/marginalrevolu...
November 1, 2017
In Malad, the fastest growing suburb and home to some of the best shopping malls and complexes, which is situated in Mumbai, an alpha world city- I see small children dotting the roads, defecating in the open - everyday; the Sulabh Sauchalaya or Public Toilet is a mere 100 meters away. If you ever take the Mumbai Local Trains, seeing adults and kids openly defecate is as as common as spotting the house crows! You cannot un-see them!! This is a huge wake up call...
The Swachh Bharat Mission (SBM) aims to obliterate open defecation in India by 2019. This book elucidates why it is almost impossible to achieve this. It disqualifies the intuitive but incorrect hypothesis we hold - Poverty, education, water shortages, access to latrines as reasons to the slow rate of latrine adoption in India, proving that caste and notions of ritual purity are the culprit, at least in rural India. It further goes on to enumerate the impact of open defecation on the physical and mental well-being of children- How our children are worse off than children in Bangladesh and even Sub -Saharan Africa. SBM has had its share of predecessors - Nirmal Bharat Abhiyan & Total Sanitation Campaign - which have been unsuccessful - so what and why should SBM do to be differentiated that it is not doing? Also, how are we measuring success? Someone one said, "Torture the data and it will confess to anything".
September 17, 2020
“Where India Goes” by Diane Coffey and Dean Spears is an excellent book.
First, I will congratulate them for staying in Sitapur during their research. Most Indians would shy away from this.
The book confirms some impressions I had — that to reduce open defecation, education is essential.
I have read Mulk Raj Anand’s book, “Untouchable”, which sensitized me to the caste bias regarding the role of Dalits in clearing excrement.
The book contains a few surprises for me. I did not realize that many people in rural India consider open defecation to be healthy.
Neither did I realize that some women prefer to defecate in the open. It provides them with a chance to socialize with other women.
Building expensive toilets and latrines is not a solution for India. This is clear.
Diane stresses the need to build inexpensive toilets.
She emphasizes the need to educate people.
Finally, she recognizes the social prejudices that exist in India.
The recommendations at the end of the book enhance its value.
Open defecation is a problem, one that will take years of sustained effort to tackle.
First, I will congratulate them for staying in Sitapur during their research. Most Indians would shy away from this.
The book confirms some impressions I had — that to reduce open defecation, education is essential.
I have read Mulk Raj Anand’s book, “Untouchable”, which sensitized me to the caste bias regarding the role of Dalits in clearing excrement.
The book contains a few surprises for me. I did not realize that many people in rural India consider open defecation to be healthy.
Neither did I realize that some women prefer to defecate in the open. It provides them with a chance to socialize with other women.
Building expensive toilets and latrines is not a solution for India. This is clear.
Diane stresses the need to build inexpensive toilets.
She emphasizes the need to educate people.
Finally, she recognizes the social prejudices that exist in India.
The recommendations at the end of the book enhance its value.
Open defecation is a problem, one that will take years of sustained effort to tackle.
January 27, 2018
An in-depth survey of sanitation practices (mainly targeting open defecation) across the country and how it affects child development and the potential human capital. It addresses questions like
Why people prefer open defecation?
How are commonly believed causes of open defecation like poverty, water availability or education are not really the cause?
Why hasn't government programs of building toilets worked?
How do caste and common beliefs (about purity, pollution & rituals) effect sanitation practices?
An excerpt just made me wonder how fortunate I am to be born in a clean and healthy environment.
"In densely populated India, widespread open defecation is especially disastrous. This coincidence appears to be a horrible accident of demography. It is humanity's bad luck that one-fifth of all births are in the country with most of the world's open defecation, which just so happens to be a country with very high population density."
Why people prefer open defecation?
How are commonly believed causes of open defecation like poverty, water availability or education are not really the cause?
Why hasn't government programs of building toilets worked?
How do caste and common beliefs (about purity, pollution & rituals) effect sanitation practices?
An excerpt just made me wonder how fortunate I am to be born in a clean and healthy environment.
"In densely populated India, widespread open defecation is especially disastrous. This coincidence appears to be a horrible accident of demography. It is humanity's bad luck that one-fifth of all births are in the country with most of the world's open defecation, which just so happens to be a country with very high population density."
January 12, 2020
The book highlights the causes and effects of open defecation in India, especially villages and especially villages in north India, inspite of owning a pit latrine. It does fairly good job at dealing with these though it does get repetitive as if feeding the story to a two year old kid at which the book becomes lightly dragged. It offers on plate the mindset of caste-divided villagers and their surprising reasons for supporting open defecation without shying away from conveying the reality.
The book also highlights why swachh bharat abhiyan is such a scam and what the government could have rather done to set and achieve a more realistic target to counter the problem of open defecation.
Though our prime minister has declared India ODF (Open defecation free), the reality is far away from it.
For a fact - Infant mortality in India is 20% higher than the international trend predicts for a country with India’s GDP per capita.
The book also highlights why swachh bharat abhiyan is such a scam and what the government could have rather done to set and achieve a more realistic target to counter the problem of open defecation.
Though our prime minister has declared India ODF (Open defecation free), the reality is far away from it.
For a fact - Infant mortality in India is 20% higher than the international trend predicts for a country with India’s GDP per capita.
April 14, 2024
One of the most important sociology and economic books on India. In Telugu public culture and discourse, open defecation is a subject of joke. Something to jeer at rural India about and its precarious condition. The authors and the whole team of researchers behind them, and their initiative r.i.c.e expose how open defecation may very well be the most threatening fact about India, and rural India in particular with no close parallels anywhere in the world, not in less educated countries, poorer countries, or with nations that either leave much to the market or allow the state to take over social reform. India is singularly hit by the evil of not having effective toilets at home and worse, refusing to use toilets made for them, in their houses! The reason is a fine logic and the book firmly places caste as the culprit. A very very very important book.
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