India, the world’s second-largest country by population, comes out top for the highest number of people without basic sanitation (732 million), according to a new report.
Out Of Order: The State of the World’s Toilets 2017 report by WaterAid says that 355 million women and girls are still waiting for a toilet in India and if they were all to stand in a queue, it would stretch around the Earth more than four times.
China comes second to India despite being the most populous country in the world.
According to government data, the Swachh Bharat Mission built 52 million household toilets between October 2014 and November 2017 and the WaterAid report says that it ranks in the top ten countries for reducing open defecation and improving access to basic sanitation. However, the country still fares poorly in basic sanitation facilities.
Last year, India was the country with the lowest number of urban-dwellers without safe, private toilets.
Globally, the top 10 countries without access to toilets are:
Open Defecation: The lack of toilets in India
The report talks about the country’s progress in reducing open defecation – the proportion of Indians defecating in the open has decreased by 40%, meaning more than 100 million people no longer face this indignity. WaterAid attributes this progress to the Swacch Bharat Mission.
However, a 2016 survey of 7,500 households across India had found that 29% of Swacch Bharat toilets exist only in paper and 36% have been built but are unusable. This year in October, claims that 155 villages in Madhya Pradesh have become open defecation free (ODF) were annulled after verification.
The Indian government has a target of eliminating open defecation by the end of 2019 and 1,171,000 people got decent toilets in the last year with the combined efforts of WaterAid and the government, per the report.
The country ranks sixth among the top ten nations working to reduce open defecation and improving access to basic sanitation.
However, the report adds, “the work is far from done, and the need stretches beyond households to schools and hospitals.”
According to the World Health Organization, two in five health centres lack basic sanitation, putting patients and health workers at risk of infection. 40% of people practise open defecation in India, while 732 million people lack decent toilets, per WaterAid.
60,700 children under five die each year from related diarrhoeal diseases in India
Diarrhoea remains the second leading cause of death in Indian children under five years of age.
Every year, 2,89,000 children under-five die globally due to diarrhoea caused by dirty water and poor toilets and hygiene.
The 2015-16 infant mortality rate (IMR) of India is 41, while the under-five mortality rate is 50. The condition is the worst in Uttar Pradesh where the IMR is 64 deaths per 1,000 live births.
The states with the worst improvement in sanitation are Jharkhand, Bihar, Odisha, Chhattisgarh and Madhya Pradesh. Top five states with access to improved sanitation are Kerala, Sikkim, Mizoram, Punjab and Haryana.
The National Family Health Survey 4 (NFHS 4) also throws light on the poor state of Indian children. Open defecation is a leading contributor of diarrhoea – hookworms, which can be spread by open defecation, cause diarrhoea, anaemia and weight loss in women, and are linked to low birth weight and slow child growth.
The impact of poor sanitation on women and girls
The report by WaterAid points out that female biological needs make a lack of toilets particularly harmful for women and girls, from birth, through childhood, into puberty, throughout adult life, and into old age.
Poor sanitation and hygiene also increase the risk of infection during and after childbirth, with sepsis accounting for 11% of maternal deaths worldwide.
Girls who don’t have decent toilets at school or near home have to defecate in the open or use unsafe, unhygienic toilets, often shared with boys. Aside from the health risks, this is uncomfortable, embarrassing and puts them at risk of verbal and even physical abuse, the report continues.
In June this year, a 55-year old man was lynched to death by civic officials in Rajasthan when he attempted to stop them from taking photographs of women defecating in the open.
When the Swacch Bharat campaign was started by the Modi-led government on 2 October 2014, it encouraged people to photograph those dirtying their surroundings and upload the pictures on Facebook, Twitter and even government websites. The government’s motive was to cause embarrassment and humiliation to offenders, forcing them to change their habit.
When the progress has been sluggish, the solution to preventing open defecation is not public humiliation but actually building usable toilets.
To read the full Out Of Order: The State of the World’s Toilets 2017 report by WaterAid click here.