In India, one in two people defecate in the open, making India a country with the dubious distinction of having the largest number of people defecate in the open in the world, at more than 564 million (UNICEF report). The rural-urban divide is most pronounced in this case with about 65 per cent of rural India with no access to toilets (as opposed to 12 per cent of urban India). This is an issue that brings out the inequities most prominently: the coverage is lowest in the poorest sections of the population.
With the lack of toilets and their low usage proper disposal of faeces remains a problem, with as high as 44 per cent families disposing children’s faeces in the open. This poses a serious health risk particularly in the form of diarrhoea (of which India reports highest number of deaths in the world) and other water borne infectious diseases, opportunistic infections or worm infestations. Frequent bouts of such illnesses lead to malnutrition compromising physical and cognitive development in early childhood.
This particularly affects the health of women and girls. In rural areas and urban slums, women forced to defecate in the open, often far removed from their households become vulnerable to sexual assaults and harassment. Frequently women have reported the practice of limiting food and water intake all day to avoid the need to defecate. Lack of toilets in schools affects girls the most with many dropping out early on and many when they hit puberty. Moreover, there is fear of snake bites, water logging during monsoons leading to injuries and infections besides the risk to their safety and security.
Toilet construction and usage remains low in India as toilet construction is seen as a low priority issue especially in poor households. Moreover since the discourse around toilets is still dominated by ideas of purity and pollution many do not consider building a toilet inside the compound even if there is space for the same. Even when there are toilets inside the house, they often remain unused either because of norms and attitudes or due to poor quality, poor maintenance, and lack of proper water supply.
Since women are the most vulnerable section affected by lack of toilets and as use of toilets depends on behaviours around usage, an intervention in rural Uttar Pradesh tested whether women collectives can impact sanitation. This was based on the theory that women collectives will be better able to articulate their needs and generate demand. Moreover women groups will have greater agency to change behaviours and norms and create awareness towards toilet construction and usage.
Demand generation by women becomes especially important since it was observed that the process of toilet construction did not engage with women at the level of decision making or planning. As one woman noted that while toilets remained priority for women, the decision to actually construct it rested on the man and even if a low cost kutcha toilet was constructed, the responsibility of cleaning and maintaining it wholly fell on the woman. Another woman noted that often toilets were constructed through middlemen who were corrupt and most toilets remained non functional often being used for storage. Even when women were aware of the implications of open defecation, they reported having little agency in this regard because the elders and men of their family preferred fields for defecation. Thus, it was important to see how collectives could help individual women articulate their demand and take part in decision making process on the strength of the group.
These women collectives were in the form of all women self help groups (SHGs) organised by a non-profit, Rajiv Gandhi Mahila Vikas Pariyojana, working in rural Uttar Pradesh. They partnered with Bill & Melinda Gates Foundation, International Centre for Research on Women and Shramik Bharti to train the women in the SHGs on WASH (water, sanitation and hygiene) activities.
The first step of this intervention was to strengthen and increase the self help groups and introduce WASH component in these groups. These community organisations are linked to micro credit. But the regular meetings do more than facilitate savings and loans. These serve as platforms where development interventions, knowledge sharing, and interactions among members to discuss common concerns can be facilitated. The members are drawn from the community, leaders are from the same group and all the development programmes are owned and managed by the same women. These platforms aid in building social capital in the village, empower women to articulate their needs and issues and embolden them to demand their rights and entitlements. This leads to challenge of regressive societal norms and demand driven social development.
Second step was to involve key government functionaries like the Accredited Social Health Activists (ASHAs), Anganwadis, Auxiliary Nursing mid wives (ANMs), village pradhans etc. as well as SHG leaders and members, their internal social capital in the form of swasthya sakhis (village health workers) and community health trainers (CHTs). They were encouraged to increase their reach and generate awareness on toilets, infectious diseases and hand washing after use of toilets. Members of the SHGs were made aware of the role of these key functionaries as well a key government schemes and policies around sanitation and encouraged to demand their services.
Third step was to engage and sensitise the community through interesting practices like puppet shows, movie screenings, videos on WASH, open defecation, menstrual hygiene management and hand washing, followed by community discussions, campaigns and rallies, general body meetings and night meetings with equal participation of men, women and adolescents.
The results were positive. The study showed increase in the construction as well as use of toilets led by community. The SHG women members actively involved men and elderly of the village in this process since they were seen as primary decision makers around the same. Increased awareness in the community and open and frank discussion around the health and safety concerns around open defecation led to change in behaviours and practices. This further generated demand for toilets that were usable and well maintained.
Ending the practice of open defecation in India will have to be a community led effort. It will be a cyclical process: awareness generation regarding spread of infections and safety issues will lead to increase in demand for toilets; demand will generate supply of proper water linked toilets which in turn will increase usage and gradually impact behaviours; better behavioural practices will further challenge antiquated norms around purity and pollution.
Moreover bridging of gender gap in priorities is needed. Women led SHGs can play a role in this, enabling women in articulating their demands strongly, and involving men in the community in the process of toilet construction and maintenance. During the awareness generation campaigns there were instances of young women who refused to marry into households without a working toilet or young brides who refused to go to their new house unless one was constructed. This is a positive trend and shows how prioritising the discourse around women health and safety can be the best solution for ending open defecation and promoting safe sanitation in India.
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