Open defecation

Background

Whilst open defecation causes little harm when done in sparsely populated areas, forests, or camping type situations, it becomes a significant public health issue—and an issue of human dignity—when it occurs in more densely populated areas.

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.

Reasons

There can be many reasons why a person openly defecates, and these may include:

Reasons for people owning a household toilet but still openly defecating may include:

Therefore, the reasons for open defecation are varied, and this activity can indeed be a voluntary or semi-voluntary choice, but in most cases it is due to the fact that the alternatives (i.e., toilets) are not available or not clean, safe, and attractive.

Use of the term

The term "open defecation" became widely used in the water, sanitation, and hygiene (WASH) sector from about 2008 when the publications of the Joint Monitoring Programme for Water Supply and Sanitation (JMP) and the UN International Year of Sanitation created more awareness. The JMP is a joint program by WHO and UNICEF to monitor the water and sanitation targets for the Millennium Development Goals (MDGs)—the predecessor of the Sustainable Development Goals from 2016 onwards. For monitoring purposes, two categories were created: improved sanitation and unimproved sanitation. Open defecation falls into the latter category. This means that people practicing open defecation are counted having no access to improved sanitation.

In 2013 World Toilet Day was celebrated as an official UN day for the first time and the term "open defecation" was used in high-level speeches, helping to draw attention to this issue (for example, in the "call to action" on sanitation issued by the Deputy Secretary-General of the United Nations in March 2013).

Open defecation free

"Open defecation free" (ODF) is a phrase first used in community-led total sanitation (CLTS) programs and has now entered use in other contexts. The original meaning was simply that all community members are using sanitation systems rather than practising open defecation. Further more stringent criteria have been added in some countries where CLTS programs exist.

The Indian Ministry of Drinking Water and Sanitation has in mid-2015 defined "open defecation free" 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". This definition is part of the Swachh Bharat Abhiyan (Clean India Campaign).

Prevalence

The prevalence of open defecation as part of voluntary, recreational outdoor activities in remote areas is difficult to estimate, but is also of very little concern from public health, environmental, and human dignity perspectives.

In developing countries however, the situation is entirely different. Here, open defecation is a practice strongly associated with poverty and exclusion particularly when it comes to less remote and less rural areas, such as urban informal settlements.

Data by Joint Monitoring Programme

The Joint Monitoring Programme for Water Supply and Sanitation (JMP) of UNICEF and WHO has been collecting data regarding open defecation prevalence worldwide. The figures are segregated by rural and urban areas and by wealth quintiles. This program is tasked to monitor progress towards the millennium development goal (MDG) relating to drinking water and sanitation. As open defecation is one example of unimproved sanitation, it is being monitored by JMP for each country and results published on a regular basis. The figures on open defecation used to be lumped together with other figures on unimproved sanitation but are collected separately since 2010.

Over the past 22 years, the number of people practicing open defecation fell by 21 percent, from 1.3 billion in 1990 to one billion in 2012. Those one billion people with no sanitation facility whatsoever continue to defecate in gutters, behind bushes, or in open water bodies, with no dignity or privacy. Most people (9 of 10) who practice open defecation live in rural areas, but the number in urban areas is increasing.

Eighty-two percent of the one billion people practicing open defecation in the world live in just 10 countries. India is the country with the highest number of people practicing open defecation, around 490 million people. This is 47 percent of the population (13 percent of urban dwellers and 70 percent of villagers).

Further countries with a high number of people openly defecating are Indonesia (54 million people), followed by Pakistan (41 million people), Nigeria (39 million) and Ethiopia (34 million).

Impacts

The health and personal safety impacts due to open defecation are principally the same as those from lack of sanitation.

Health impacts

Open defecation—and lack of sanitation and hygiene in general—is an important factor in causing various diseases, most notably diarrhea and intestinal worm infections but also typhoid, cholera, hepatitis, polio, trachoma, and others. In 2011, infectious diarrhea resulted in about 0.7 million deaths in children under five years old and 250 million lost school days. It can also lead to malnutrition and stunted growth in children.

Certain diseases are grouped together under the name of waterborne diseases, which are diseases transmitted via fecal pathogens in water. Open defecation can lead to water pollution when rain flushes feces that are dispersed in the environment into surface water or unprotected wells.

Open defecation was found by the WHO in 2014 to be a leading cause of diarrheal death. An average of 2,000 children under the age of five die every day from diarrhea.

Young children are particularly vulnerable to ingesting feces of other people that are lying around after open defecation, because young children crawl on the ground, walk barefoot, and put things in their mouths without washing their hands. Feces of farmed animals are equally a cause of concern when children are playing in the yard.

Those countries where open defecation is most widely practiced have the highest numbers of deaths of children under the age of five, as well as high levels of malnourishment (leading to stunted growth in children), high levels of poverty and large disparities between rich and poor.

Research from India has shown that detrimental health impacts (particularly for early life health) 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 and gender impacts

There are also strong gender impacts: 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.

Prevention

Key drivers to eradicate open defecation include:

Integrated initiatives

Efforts to reduce open defecation are more or less the same as those to achieve the MDG target on access to sanitation. A key aspect is awareness raising (for example via the UN World Toilet Day at a global level), behaviour change campaigns, increasing political will as well as demand for sanitation. Community-Led Total Sanitation (CLTS) campaigns have placed a particular focus on ending open defecation by "triggering" the communities themselves into action.

As India has such a high number of people practicing open defecation, various Indian government-led initiatives are ongoing to reduce open defecation in that country. It began as the "Total Sanitation Campaign", which was relaunched as Nirmal Bharat Abhiyan in 2012 and integrated into the wider Swachh Bharat Abhiyan (Clean India Mission) in 2014.

Also in 2014, UNICEF began a multimedia campaign against open defecation in India, urging citizens to "take their poo to the loo."

Simple sanitation technology options

There are some simple sanitation technology options available to reduce open defecation prevalence if the open defecation behavior is due to not having toilets in the household and shared toilets being too far or too dangerous to reach, e.g., at night.

Toilet bags

People might already use plastic bags (also called flying toilets) at night to contain their feces, However, a more advanced solution of the plastic toilet bag has been provided by the Swedish company Peepoople who are producing the "Peepoo bag", a "personal, single-use, self-sanitizing, fully biodegradable toilet that prevents feces from contaminating the immediate area as well as the surrounding ecosystem". This bag is now being used in humanitarian responses, schools, and urban slums in developing countries.

Bucket toilets and urine diversion

Bucket toilets are a simple portable toilet option. They can be upgraded in various ways, one of them being urine diversion which can make them similar to urine-diverting dry toilets. Urine diversion can significantly reduce odors from dry toilets. Examples of using this type of toilet to reduce open defecation are the "MoSan" toilet (used in Kenya) or the urine-diverting dry toilet promoted by SOIL in Haiti.

Media

The mainstream media in the countries most affected have recently been picking up on this issue of open defecation, for example, in India and Pakistan.

India