Bharat isn't as Swachh as the govt claims, but we've made huge strides
There is room for both celebration and humility
In 2019, the Research Institute for Compassionate Economics (R.I.C.E) wrote a paper based on a survey into the sanitation and fuel use habits of rural Indians1. It was a follow-up to their own survey in 20142, interviewing a large section of the same households and trying to gauge the improvements in sanitation in this period.
But this survey must’ve been pretty damn important, because the Indian government issued responses - plural - to it. In January 2019, the government’s press bureau wrote a release3 “cautioning against low-quality surveys”, effectively trying to poke holes in the methodology and coverage of the RICE survey. In October, they released another one4, this time cautioning against an op-ed written by the study authors. This linked press release, by the way, is a work of art. It calls the authors names, and generally tries as hard as possible to deny, attack, and distract from the study without actually engaging with it on any meaningful level. RICE’s - and some media outlets’ subsequently - framing of this doesn’t go far enough to acknowledge the magnitude of what the government has done, in my view. But the government could use a lot more humility about what it’s actually achieved, what remains to be done, and what studies like this actually mean.
Ending open defecation has been a huge public health objective in India for decades. I shouldn’t have to tell you why pooping in the open is bad, but in short, it leads to a host of bad things, including contaminated water bodies, in turn leading to terrible (and preventable) public health and nutrition crises, especially affecting children56. Successive governments have allocated resources towards this goal; many programs have been launched, and a lot of ink spilled.
In October 2014, the Indian government launched the Swachh Bharat Mission (SBM), with ending open defecation and improving solid waste management being a stated goal7. On paper, this has been not only a resounding success but a total victory: on 2nd October 2019, standing in the Sabarmati ashram, the Prime Minister declared India open defecation free8. Around that time, the Ministry of Jal Shakti was writing its report, the NARSS 2017-18, announcing 95.3% access to toilets and 93.4% toilet usage across India. (The same ministry that was supposed to have built all those toilets and provided access to them. The same ministry that was responsible for declaring India 100% open defecation free. The same ministry which wrote those press releases. The very same. Why do you ask?)
The findings of RICE’s (rural) survey suggested that ~71% of respondents had access to a toilet facility, and ~42% of respondents still practiced open defecation - suggesting that there was an overlap of people - about 23% - who had toilets but preferred to poop outside the coop. Given that the government was providing subsidies to build latrines and sometimes penalising those who didn’t build them, I’d be more inclined to expect people to be honest with <researchers clearly saying they’re not from the government> than with <government officials>, just out of incentives.
Now, maybe the study is awful and badly conducted as the government suggests, but 1. A lot of the government’s objections are about treating this study as a representative sample, but the findings remain valid for the thousands of households surveyed, 2. Their methods are transparent and their data is openly available for replication, 3. The government actually engaged with the same researchers in 2014 to understand how their findings could be translated into action9, and
4. Their numbers are actually not that incompatible with the government's own subsequent surveys …so I'm not inclined to believe that.
Three years and a pandemic later, the government’s own data has shown that there is some way to go for actual 100% ODF (open defecation free) status. The NSSO round in 2018 showed that “about 71.3% of the households in the rural and about 96.2% in the urban areas had access to latrine”10. The NFHS-5, 2019-21, said that the share of households practicing open defecation was 19%.11 The department of sanitation in 2019 was, for reasons, exaggerating.
It’s a funny thing. Even without stretching things, the SBM has achieved remarkable things. But the exaggeration means it’s all anyone will talk about.
Let’s keep the politics aside for a minute and look at RICE’s data to understand this a little better.
History and Context
Ending open defecation has been a goal for many decades in India now. Here’s the % of Indian households without access to a toilet over different rounds of the NFHS in the last three decades:
This has been a harder battle to fight for rural areas, and rural rates have historically been significantly higher:
These graphs, and especially the change at the end, represent a huge achievement: at the scale of the Indian population, millions of Indians have access to toilet facilities today who didn’t before. And that’s a great thing!
..but that’s also the sticky bit. Historically, the success of this objective has focussed on only one measure, the share of households who have access to a toilet. And of course, this precludes everything else - people who have no access to facilities will naturally use the outdoors.
But once you cross a certain threshold of access, you need to fight another battle: that of changing behaviour. Providing access to toilet facilities is in big part a problem of resources, or a problem economics can solve to a large extent.
Let’s look into that. RICE doesn’t capture income as a direct field, but they do ask every household about the different amenities and appliances available in their house - fridges, washing machines, cars and the like. We can bundle these up into an “amenity score” - the more of these you have, the richer you’re likely to be. Here’s the graph of amenity score against toilet usage and access:
Richer people are more likely to both have and use toilets - and this is true almost everywhere. There are two particular problems here. One is the significant lag in adoption in middle quantiles - where the gap between “have toilet” and “use toilet” widens. Two, specific to India, is that this curve has historically not risen fast enough here with income, suggesting that there’s a particular cultural component to it.
Source: Princeton Report12
Let’s track toilet usage with education: Here’s the trend for toilet usage by years of education.
Two things to note again: one is that changes in open defecation outcomes only really start showing with secondary school education, and the second is that, despite all else, there’s a ceiling of ~80% that remains even for graduates and post-graduates.
RICE suggests that this is driven by the ideas about purity in Hinduism: the open defecation (OD) rate among those who thought having a latrine inside the house was “impure” was 68% in 2014. And it seems pretty likely there is a religious/caste angle to it, considering that we’ve historically had higher OD rates than a lot of Asian and African countries despite being richer than them, and considering that Muslims have lower OD rates than Hindus, even in the RICE survey.
But this particular angle - the purity angle - doesn’t seem to be a broadly applicable explanation to me. The high OD rate among the people who had said having a latrine in the house was “impure” was driven by access - 75% of latrine owners who believed they were impure still used them, but a large portion of those who believed latrines were impure didn’t actually have them. Now a lot of them do, and the OD rate among this cohort of people has fallen from 68% to ~41%, about the same as the rest of the survey. This doesn’t feel like a causal factor to me.
But one thing does seem pretty clear: access to toilets is largely an economic problem. Getting people to use toilets is a social problem. And that transition is not straightforward.
Let me make this a little clearer. Since RICE studied a large group of individuals in 2014 and 2018, we can plot this matrix of adopters:
Among people who had always had access to toilets, the rate of open defecation (OD) was 8%. Among the small group of people who backslid - who had latrines in 2014 but somehow didn’t in 2018 - rates of open defecation are still lower than those who haven’t had access to toilets, suggesting some amount of habituation. The people who gained access to latrines - the people SBM really reached - still had OD rates of 44%: they have gained access to toilets, but that hasn’t translated to a change in behaviour.
Providing access to toilets is a huge step, but it’s a first step. How can we take the second?
Let’s come back to the SBM. While behaviour change was an central part of its initial guidelines13, over time its focus shifted almost exclusively to building subsidised toilets and improving access. Personally, I think this kind of thing - optimising for the one quantifiable measure of success of the campaign, slowly to the exclusion of all else - is just a tendency of systems as large and unwieldy as the Indian bureaucracy with top-down projects like this, but there could be other reasons. The SBM spent about ₹530 Cr on promotion, but most of that went towards print, TV and radio advertisements, with no expenditure on grassroots-level awareness campaigns, according to an RTI request14. Instead of the 8% allocated, only about 1.8% had been spent on IEC activities in 2017-1815.
On the other hand - perhaps because of this being a top-down missive and not a bottom-up movement - more than half the respondents reported hearing about some coercion in their village, where people were physically stopped from going to poop in the open, or threatened with a removal of benefits. And predictably, this coercion happened in line with existing social hierarchies, with Adivasi and Dalit households facing a lot more of it than others, even those who owned latrines.
Bangladesh, in a similar position as India in the 2000s, nearly eliminated open defecation in the last decade16 by going the exact opposite route: not through a top-down, subsidy-driven construction approach, but a bottom-up, grassroots-level social attitude approach called Community Led Total Sanitation, or CLTS17. One of the major features of CLTS was the focus on social belief change, for example through demonstrations of flies going from shit to food and back - provoking disgust about open defecation, and trying to change social norms through that disgust.
In RICE’s 2018 survey, among latrine owners who responded to the question, the OD (open defecation) rate among those who hadn’t watched a movie/TV show about latrines was 26%, compared to 13% for those who had, a statistically significant difference. (For overall respondents this was 70% vs 47%). Perhaps trying to change social narratives and norms is the way to go.
What’s a little victory lap among friends?
And that brings us back to the study, and the Indian government’s reaction to it.
When the ministry for water and sanitation is able to provide access to toilets for millions of Indians, changing their and their children’s lives materially for the better right now, that is a great thing which deserves to be acknowledged, regardless of what else the government does. At the same time, it doesn’t yet mean that the mission is accomplished. And that’s okay! When a study points out that people haven’t yet started to use toilets as much as is claimed, it deserves to be engaged with. When the ministry tries to instead to attack and discredit the study because it wants to take a victory lap, that is not realpolitik - that is bullshit.
The last few years have created a huge expansion in what can be considered to be a political game, in part because this government has talent and creativity in creating political games.
But in general, declaring a mission successful paints you into a corner, where there is no room to pivot approaches and where any change to your stance will be taken as failure, by you and by others. We have seen this happen with multiple policies (farm laws? covid? anyone?). Engaging with reality and being flexible to change approach where necessary is good!
But I want to suggest to you, dear Bracket reader, that political games are not just acrimonious and divisive and bitter - they’re boring. In so many cases, as in this case, when we go beyond them, when we don’t treat toilets as yet another team sport, the reality is so much more fun.
And yeah, don’t shit outside the pit.
Footnotes
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3323179
https://fr.ircwash.org/sites/default/files/coffey_et_al_2014_revealed_preference_for_open_defecation_evidence_from_a_new_survey_in_rural_north_india_squat_working_paper_no._1.pdf
https://pib.gov.in/PressReleseDetail.aspx?PRID=1559229
https://pib.gov.in/PressReleasePage.aspx?PRID=1588317
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3774764/
https://documents1.worldbank.org/curated/en/503721468050049986/pdf/WPS6659.pdf
https://en.wikipedia.org/wiki/Swachh_Bharat_Mission
https://www.thehindu.com/news/national/india-open-defecation-free-says-narendra-modi/article29576776.ece
https://jalshakti-ddws.gov.in/sites/default/files/SQUAT_Survey.pdf
https://pib.gov.in/Pressreleaseshare.aspx?PRID=1593252
https://www.telegraphindia.com/india/nearly-one-in-five-households-in-india-practise-open-defecation-survey/cid/1863938
https://spia.princeton.edu/sites/default/files/content/India%20Workshop%20Report_FINAL_2.25.2016.pdf
https://swachhbharatmission.gov.in/sbmcms/writereaddata/images/pdf/Guidelines/Complete-set-guidelines.pdf
https://scroll.in/article/857030/centre-spent-rs-530-crores-in-3-years-on-swachh-bharat-publicity-but-has-little-to-show-for-it
https://swachhindia.ndtv.com/reduction-in-overall-allocation-for-swachh-bharat-abhiyan-in-budget2018-may-hinder-the-missions-progress-feel-experts-17167/
https://www.thehindu.com/news/international/Bangladesh-stops-open-defecation-to-a-large-extent-in-just-over-a-decade/article60462918.ece
https://en.wikipedia.org/wiki/Community-led_total_sanitation