Open defecation
Open defecation is the human practice of defecating outside rather than into a toilet. People may choose fields, bushes, forests, ditches, streets, canals or other open space for defecation. They do so either because they do not have a toilet readily accessible or due to traditional cultural practices. The practice is common where sanitation infrastructure and services are not available. Even if toilets are available, behavior change efforts may still be needed to promote the use of toilets. 'Open defecation free' is a term used to describe communities that have shifted to using toilets instead of open defecation. This can happen, for example, after community-led total sanitation programs have been implemented.
Open defecation can pollute the environment and cause health problems. High levels of open defecation are linked to high child mortality, poor nutrition, poverty, and large disparities between rich and poor. Ending open defecation is an indicator being used to measure progress towards the Sustainable Development Goal Number 6. Extreme poverty and lack of sanitation are statistically linked. Therefore, eliminating open defecation is thought to be an important part of the effort to eliminate poverty.
an estimated 673 million people practice open defecation, down from about 892 million people in 2016. In that year, 76 percent of the people practicing open defecation in the world lived in just seven countries.
Background
Defecating in the open is a very ancient practice. In ancient times, there were more open spaces and less population pressure on land. It was believed that defecating in the open causes little harm when done in areas with low population, forests, or camping type situations. With development and urbanization, open defecating started becoming a challenge and thereby an important public health issue, and an issue of human dignity. With the increase in population in smaller areas, such as cities and towns, more attention was given to hygiene and health. As a result, there was an increase in global attention towards reducing the practice of open defecation.Open defecation perpetuates the vicious cycle of disease and poverty and is widely regarded as an affront to personal dignity. The countries where open defecation is most widely practised have the highest numbers of deaths of children under the age of five, as well as high levels of undernutrition, high levels of poverty, and large disparities between the rich and poor.
Terminology
The term "open defecation" became widely used in the water, sanitation, and hygiene sector from about 2008 onwards. This was due to the publications by the Joint Monitoring Programme for Water Supply and Sanitation and the UN International Year of Sanitation. The JMP is a joint program by WHO and UNICEF that was earlier tasked to monitor the water and sanitation targets of the Millennium development goals ; it is now tasked to monitor Sustainable Development Goal Number 6.For monitoring of the MDG Number 7, two categories were created: 1) improved sanitation and unimproved sanitation. Open defecation falls into the category of unimproved sanitation. This means that people who practice open defecation do not have access to improved sanitation.
In 2013 World Toilet Day was celebrated as an official UN day for the first time. The term "open defecation" was used in high-level speeches, that helped to draw global attention to this issue.
Open defecation free
"Open defecation free" is a phrase first used in community-led total sanitation programs. ODF has now entered use in other contexts. The original meaning of ODF stated that all community members are using sanitation facilities instead of going to the open for defecation. This definition was improved and more criteria were added in some countries that have adopted the CLTS approach in their programs to stop the practice of open defecation.The Indian Ministry of Drinking Water and Sanitation has in mid-2015 defined ODF as "the termination of fecal-oral transmission, defined by:
- No visible feces found in the environment or village and
- Every household as well as public/community institutions using safe technology option for disposal of feces".
Reasons
The reasons for open defecation are varied. It can be a voluntary, semi-voluntary or involuntary choice. Most of the time, a lack of access to a toilet is the reason. However, in some places even people with toilets in their houses prefer to defecate in the open.A few broad factors that result in the practice of open defecation are listed below.
No toilet
- Lack of infrastructure: People often lack toilets in their houses, or in the areas where they live.
- Lack of toilets in other places: Lack of toilets in places away from people's houses, such as in schools or in the farms lead the people to defecate in the open. Another example is a lack of public toilets in cities, which can be a big problem for homeless people.
- Use of toilets for other purposes: In some rural communities, toilets are used for other purposes, such as storing household items, animals, farm products or used as kitchens. In such cases, people go outside to defecate.
Uncomfortable or unsafe toilet
- Poor quality of toilet: Sometimes people have access to a toilet, but the toilet might be broken, or of poor quality – Outdoor toilets typically are devoid of any type of cleaning and reek of odors. Sometimes, toilets are not well lit at all times, especially in areas that lack electricity. Others lack doors or may not have water. Toilets with maggots or cockroaches are also disliked by people and hence, they go out to defecate.
- Risky and unsafe: Some toilets are risky to access. There may be a risk to personal safety due to lack of lights at night, criminals around them, or the presence of animals such as snakes and dogs. Women and children who do not have toilets inside their houses are often found to be scared to access shared or public toilets, especially at night. Accessing toilets that are not located in the house might be a problem for disabled people, especially at night.
- Presence of toilet but not privacy: Some toilets do not have a real door, but have a cloth hung as a door. In some communities, toilets are located in places where women are shy to access them due to the presence of men.
- Lack of water near toilet: Absence of supply of water inside or next to toilets cause people to get water from a distance before using the toilet. This is an additional task and needs extra time.
- Too many people using a toilet: This is especially true in case of shared or public toilets. If too many people want to use a toilet at the same time, then some people may go outside to defecate instead of waiting. In some cases, people might not be able to wait due to diarrhoea.
- Fear of the pit getting filled: In some places, people are scared that their toilet pits will get filled very fast if all family members use it everyday. So they continue to go out to delay the toilet pit filling up. This is especially true in the case of a pit latrine.
Unrelated to toilet infrastructure
- Lack of awareness: People in some communities do not know about the benefits of using toilets.
- Lack of behavior change: Some communities have toilets, yet people prefer to defecate in the open. In some cases, these toilets are provided by the government or other organizations and the people do not like them, or do not value them. They continue to defecate in the open. Also, older people are often found to defecate in the open and they are hesitant to change their behavior and go inside a closed toilet.
- Prefer being in nature: This happens mostly in less populated or rural areas, where people walk outside early in the morning and go to defecate in the fields or bushes. They prefer to be in nature and the fresh air; instead of defecating in a closed space such as a toilet. There may be cultural or habitual preference for defecating "in the open air", beside a local river or stream, or even the bush.
- Combining open defecation with other activities: Some people walk early in the morning to look after their farms. Some consider it as a social activity, especially women who like to take some time to go out of their homes. While on their way to the fields for open defecation they can talk to other women and take care of their animals.
- Social norms: Open defecation is a part of people's life and daily habit in some regions. It is an ancient practice and is hard for many people to stop practicing. It is a part of a routine or social norm. In some cultures, there may be social taboos where a father-in-law may not use the same toilet as daughter-in-law in the same household.
- Social or personal preferences: Open defecation is a preferred practice in some parts of the world, notably in rural India, with many respondents in a survey from 2015 stating that "open defecation was more pleasurable and desirable than latrine use".
- Fecal incontinence: This medical condition can result in abrupt 'emergencies' and not enough time to access a toilet.
Public defecation for other reasons
The Mad Pooper is the name given to an unidentified woman who regularly defecated in public places while jogging during summer 2017 in the U.S. city of Colorado Springs.
Prevalence and trends
Developing countries
The practice of open defecation is strongly related to poverty and exclusion particularly, in case of rural areas and informal urban settlements in developing countries. The Joint Monitoring Programme for Water Supply and Sanitation of UNICEF and WHO has been collecting data regarding open defecation prevalence worldwide. The figures are segregated by rural and urban areas and by levels of poverty. This program is tasked to monitor progress towards the millennium development goal relating to drinking water and sanitation. As open defecation is one example of unimproved sanitation, it is being monitored by JMP for each country and results published on a regular basis. The figures on open defecation used to be lumped together with other figures on unimproved sanitation but are collected separately since 2010.The current estimate is that around 673 million people practice open defecation..
The number of people practicing open defecation fell from 20 percent in 2000 to 12 percent in 2015.. In 2016, the estimate was for 892 million people with no sanitation facility whatsoever and therefore practising open defecation. Most people who practice open defecation live in rural areas, but the vast majority lives in two regions. In 2016, seventy-six percent of the 892 million people practicing open defecation in the world lived in just seven countries.
In India, a campaign to build toilets in urban and rural areas achieved a significant reduction in open defecation between 2014 and 2019, though the data reported by the government is disputed.
Some countries with large numbers of people who openly defecate are listed in the table below.
| Country | Total country population in 2015 as reported in 2017 by JMP | Percentage of people who defecate in the open and absolute numbers | More recent estimates |
| Chad | 14,037 | 68% or 10 million | |
| China | 1,376,049 | 2% or 28 million | |
| Eritrea | 5,228 | 76% or 4 million | |
| Ethiopia | 99,391 | 27% or 27 million | |
| India | 1,311,051 | 40% or 524 million |
|
| Indonesia | 257,564 | 12% or 31 million | |
| Niger | 19,899 | 71% or 14 million | |
| Nigeria | 182,202 | 26% or 47 million | |
| Pakistan | 188,925 | 12% or 23 million | 41 million people in Pakistan do not have access to adequate toilet infrastructure as per UNICEF |
| South Sudan | 12,340 | 61% or 8 million | |
| Sudan | 40,235 | 27% or 11 million |
India
Open defecation is a large problem in India, affecting about 50 million people. Many factors contribute to this, ranging from poverty to and government corruption. Domestic and foreign agencies have studied these factors in order to better figure out how to deal with these problems and tackle the root causes that hamper progress in sanitation. About 550 million people were affected by lack of access to adequate toilets in 2014 but, since then, through Swachh Bharat, a program managed by the Indian government in conjunction with UNICEF, India has reduced the number of people without access to toilets to about 50 million.Other countries
In San Francisco, open defecation complaints for street feces increased fivefold from 2011 to 2018, with 28,084 cases reported. This was mainly due to the rising amount of homelessness in the city.Impacts
Public health
The negative public health impacts of open defecation are the same as those described when there is no access to sanitation at all. Open defecation—and lack of sanitation and hygiene in general—is an important factor that cause various diseases; the most common being diarrhea and intestinal worm infections but also typhoid, cholera, hepatitis, polio, trachoma, and others.Adverse health effects of open defecation occur because open defecation results in fecal contamination of the local environment. Consequently, open defecators are repeatedly exposed to faecal bacteria and faecal pathogens, and this is particularly serious for young children whose immune systems and brains are not yet fully developed.
Certain diseases are grouped together under the name of waterborne diseases, which are diseases transmitted via fecal pathogens in water. Open defecation can lead to water pollution when rain flushes feces that are dispersed in the environment into surface water or unprotected wells.
Open defecation was found by the WHO in 2014 to be a leading cause of diarrheal death. In 2013, about 2,000 children under the age of five died every day from diarrhea.
Young children are particularly vulnerable to ingesting feces of other people that are lying around after open defecation, because young children crawl on the ground, walk barefoot, and put things in their mouths without washing their hands. Feces of farm animals are equally a cause of concern when children are playing in the yard.
Those countries where open defecation is most widely practiced have the highest numbers of deaths of children under the age of five, as well as high levels of malnourishment, high levels of poverty and large disparities between rich and poor.
Research from India has shown that detrimental health impacts are even more significant from open defecation when the population density is high: "The same amount of open defecation is twice as bad in a place with a high population density average like India versus a low population density average like sub-Saharan Africa."
Safety of women
There are strong gender impacts connected with open defecation. The lack of safe, private toilets makes women and girls vulnerable to violence and is an impediment to girls' education. Women are at risk of sexual molestation and rape as they search for places for open defecation that are secluded and private, often during hours of darkness.Lack of privacy has an especially large effect on the safety and sense of dignity of women and girls in developing countries. They face the shame of having to defecate in public so often wait until nightfall to relieve themselves. They risk being attacked after dark, though it means painfully holding their bladder and bowels all day. Women in developing countries increasingly express fear of assault or rape when having to leave the house after dark. Reports of attacks or harassment near or in toilet facilities, as well as near or in areas where women defecate openly, are common.
Prevention
The following joint strategies can enable communities, both rural and peri-urban, to become completely open defecation free and remain so: Sanitation marketing, behavior change communication, and ‘enhanced’ community-led total sanitation, supplemented by ‘nudging’.There are several drivers used to eradicate open defecation, one of which is behaviour change. SaniFOAM is a conceptual framework which was developed specifically to address issues of sanitation and hygiene. Using focus, opportunity, ability and motivation as categories of determinants, SaniFOAM model identifies barriers to latrine adoption while simultaneously serving as a tool for designing, monitoring and evaluating sanitation interventions. The following are some of the key drivers used to fight against open defecation in addition to behavior change:
- Political will
- Sanitation solutions that offer a better value than open defecation
- Stronger public sector local service delivery systems
- Creation of the right incentive structures
Integrated initiatives
Also in 2014, UNICEF began a multimedia campaign against open defecation in India, urging citizens to "take their poo to the loo."