Translator: Oksana Rotko
India has a lot to be proud of:
its democratic tradition, its diversity,
its contributions in art, architecture, and science, and yoga.
But images like this one
taint India's reputation.
So, why is this image associated with India?
Well, if this circle represents all of the open defecation
that happens in the world,
this is the fraction that happens in India.
And this is the fraction that happens only in rural India.
Sixty-five percent of rural Indians defecate in the open.
So, what that means is
that most of the open defecation that happens in the world
happens in rural India
and most rural Indians defecate in the open.
Every day, 500 million people in villages in India
go in the fields rather than use a toilet or a latrine.
That's bigger than the population of the United States.
And this is a really important issue
because open defecation is really bad for child health.
Every year, hundreds of thousands of children die in India
because of exposure to the bacteria in feces.
And those that survive are physically and cognitively stunted
because of that exposure.
This lives with them for the rest of their lives.
So, why do so many people in India defecate in the open?
If it's such a bad problem,
if it's so widespread and it's so poor for child health,
why does it persist?
That's the question that my colleagues and I sought to answer
when we started our SQUAT survey two years ago,
a survey of sanitation quality, use, access, and trends.
Some of you may be thinking that,
"Well, India's a poor country,
and, you know, maybe people in India just can't afford to build latrines."
I visited a village in Uttar Pradesh last December,
and I was walking around the village,
looking for a household that had a latrine.
So, I was wandering all throughout the village,
and I just couldn't find anyone that had a latrine
until I entered one hamlet,
and I saw all these covered pits all over the place.
I got excited because latrines have pits, and I thought that these were latrines
until I started talking to someone who lived there.
So, I approached a man, and I asked him whether he had a latrine.
He said he didn't.
So, I was a little puzzled, and I asked him,
"Well, if you don't have a latrine,
then what're you using this pit right here that's in front of your house for?"
He said that he and his family had built this pit
so that the water that they use for dishwashing and clothes washing
and bathing
could just flow into the pit and soak into the ground
rather than going into the streets and making the village dirty.
This household could've definitely afforded to build a latrine.
A latrine just has a pit with a slab and a seat on top of it.
They had built most of that infrastructure already.
They just didn't prioritize one.
And in fact, many households in rural India
don't prioritize having a latrine.
So, let's compare India to some other countries in the world.
On the vertical axis of this graph, we have the rate of open defecation
in the country,
and on the horizontal axis, we have GDP per capita.
Each circle on this graph represents a country,
and the size of the circle represents the size of the population.
So, there's a trend line here,
which means that richer countries tend to have lower rates of open defecation
than poorer countries do.
But India is really far from that trend line.
India's an outlier.
Of the 55 countries that are poorer than India on this graph,
46 of them have a lower rate of open defecation.
And these are countries that are poorer than India.
So, let's take Bangladesh as an example.
Bangladesh has a GDP per capita of less than one half of India's.
But in Bangladesh, only four percent of households defecate in the open,
while in India 53% do.
So, the reason why income doesn't really explain open defecation
in India very well
is because simple latrines that safely confine feces in the ground
are actually very inexpensive.
So, in Bangladesh, we'll commonly find latrines that look like this.
And many people use latrines like this all over the country in Bangladesh.
These latrines cost about 50 dollars or 3,000 rupees.
In Kenya, people commonly use latrines that look like this.
And this costs even less than 50 dollars.
These latrines are incredibly simple.
They have a pit which is about 50 cubic feet
or a cylinder in the ground of about three feet by six feet deep.
And on top of that, there's a slab with a seat in it.
Every five years or so, these pits have to be emptied,
and in pretty much every developing country in the world
where latrines like this are used,
they are emptied by hand.
So, the WHO recommends the use of latrines like this
because they reduce the amount of germs in the environment.
And in most developing countries,
latrines like this are commonly found all over the place.
Except in India.
In India, it's more common to find latrines
that have pits that look like this.
And I can promise you, my colleague Nikhil is not a short man.
So, Nikhil and I met this household in Godhra last year,
and we asked them why they were building a pit this large.
They were in the process of constructing it.
This household told us that they wanted to build a pit
that would last them a generation.
So, I asked them, "Why do you need a pit that lasts a generation?
I mean, can't you just build something that's smaller and cheaper
and empty it out periodically?"
They were completely astonished at this question.
How could they empty a latrine pit by hand?
If they did so, they wouldn't be able to go to the temple,
they wouldn't be able to perform their rituals,
they would be completely ostracized from their society.
That's why they wanted to build a pit this big.
And this household isn't unique in feeling that way.
In fact, many households in rural India feel the same way.
And while the WHO recommends
pits of about 50 cubic feet in size,
what we found in the SQUAT survey is that people tend to build pits
that are five times the recommended WHO pit size.
And when we asked households what they would ideally like to build,
they told us that they wanted to build pits that were 20 times that size.
And you can imagine pits this large are quite expensive to build,
so latrines that people use in India are much more expensive
than the kinds of latrines that are commonly used
in most other developing countries in the world.
So, what's the big deal with emptying a pit latrine?
I mean, in pretty much most other countries in the world
while emptying a pit latrine by hand isn't the most fun thing to do,
people still do it.
But here in India, handling feces carries a stigma.
India's unique from other developing countries in the world
because of its history of caste.
I'm sure most of you in this room know what caste you are.
While the influence of caste is slowly declining in India,
most people in India are still very conscious of it.
And unfortunately, most people still think
that higher-caste people are purer than lower-caste people.
Caste has a lot to do with sanitation
because people from the lowest caste
have been historically responsible for doing manual scavenging
or the daily cleaning of feces from dry toilets by hand.
We heard a lot about manual scavenging earlier this morning from Mr. Shaikh.
People from the lowest caste are considered permanently polluted.
And because caste is still so important in Indian society even today,
people from the lowest caste
are often very socially marginalized and oppressed.
People from higher castes try to often avoid contact
with people from lower castes and their work
because they believe if they come into contact with them,
they will also become polluted.
So, this has a lot to do with latrine use in India
because people associate emptying a pit latrine
with manual scavenging.
And what that means is that people from middle and upper castes
would find it inconceivable to empty a pit latrine by hand themselves.
At the same time, people from lower castes
tend to avoid doing such work, understandably,
because it's associated with their past and continuing oppression.
So, the market for pit emptying in India has completely broken down.
And that's why people want huge pits.
So, while many rural Indians think of this when they think of using a latrine,
many people think open defecation looks like this.
So, I visited a retired army officer in Haryana last year.
And he had a big family.
His four sons and their wives and children all lived with him.
This family had a latrine, and it had a very large pit.
They had probably spent 60,000 rupees or 1,000 dollars on building this latrine.
Only the children used this latrine.
Everyone else in the family went in the open,
even the young daughters-in-law.
So, I asked this retired army officer, "Why do you go in the open
instead of using your very nice latrine that you have right here at home?"
And he told me that going in the open allows him to exercise his body.
(Laughter)
It allows him to get the impurities out.
And in fact, if he used the latrine, he probably wouldn't live as long:
"That's why people in cities only live to 60 or 70 years,
while people in villages live for 100 years."
So, this gentleman thought that defecating in the open
was actually better for health than using a latrine.
And what we found in the SQUAT survey is that many households feel that way.
In fact, most people who defecate in the open
that we talked to in our SQUAT survey
thought that going in the open was just as good for child health
as using a latrine.
But let's remember here.
Even though we may imagine this beautiful field
when we think of defecating in the open,
going in the open is really bad for child health
and kills hundreds of thousands of children each year in India.
So, who's working on this issue?
We heard just earlier about Gram Vikas.
And fortunately, we also don't have to prove to the government
that sanitation is a worthy topic to be working on.
In fact, the government has been building latrines in India
for the past 15 years now.
But many of these latrines
are the kinds of latrines that the WHO promotes.
So, it's really no wonder that many of them end up looking like this.
They're used for storerooms.
They're left to become dilapidated.
So, if constructing toilets isn't going to work,
what can we do?
What can the government do?
What can you and I do?
You know, I get this question all the time,
and I really wished that I had a good answer.
One thing that we could do is just wait, wait for rural Indians
to get rich enough to build the kinds of latrines that have big pits.
But I don't think we want to wait that long.
I don't think we want to lose that many children to open defecation.
What we need to do is start having frank conversations
about caste and about what caste has to do with sanitation.
And we need to be experimenting like crazy
with solutions that address people's real concerns about pit emptying.
You know, you and I,
and other elite Indians who live in cities,
we get to avoid talking about caste and open defecation
because they're messy and uncomfortable topics.
But India's growing children don't have that same luxury
of avoiding the germs, death, and disease spread by open defecation.
If we care about giving these children a chance
to live a happy, long, and healthy life,
we need to start having those conversations right now.
Thank you.
(Applause)