Where India Goes

by on August 28, 2017 at 7:25 am in Economics, Medicine | Permalink

Where India Goes, a book about the problem of open defecation in India, is the best social science book I have read in years. Written by Diane Coffey and Dean Spears, Where India Goes, examines an important issue and it does so with a superb combination of human interest storytelling and top-notch empirical research made accessible.

Drawing on the academic literature, Coffey and Spears show that open defecation sickens and kills children, stunts their growth, and lowers their IQ all of which shows up in reduced productivity and wages in adulthood.

The dangers of open defecation are clear. Moreover, Gandhi said that “Sanitation is more important than independence” and Modi said “toilets before temples,” yet in India some half a billion people still do not use latrines. Why not? Jean Dreze and Amartya Sen (2013), offer a typical explanation:

In 2011 half of all Indian households did not have access to toilets, forcing them to resort to open defecation on a daily basis…

The phrasing presents the problem as a lack of access that forces people to resort to open defecation. From this perspective the solution seems obvious, provide access. After all, if you or I had access to latrines we would use them so if someone else isn’t using latrines it must be because they don’t have access. A bit of thought, however, dispels this notion.

Latrines are not expensive. Many people in countries poorer than India build their own latrines. If access is not the problem then building latrines may not be the solution. Indeed, India’s campaign(s) to build latrines have been far less successful than one might imagine based on the access theory. Quite often latrines are built and not used. Sometimes this is due to poor construction or location but often perfectly serviceable latrines are simply not used as latrines. In fact, surveys indicate that 40 per cent of households that have a working latrine also have at least one person who regularly defecates in the open (Coffey and Spears 2017).

For many people in India, open defecation is preferred to latrine use. The reasons relate to issues of ritual purity and caste. Latrines in or near homes are considered polluting, not in a physical so much as a spiritual or ritual sense. Latrine cleaning is also associated with the Dalit (out)-caste, in itself a polluting category (hence untouchable). That is, the impurity of defecation and caste are mutually reinforcing. As a result, using or, even worse, cleaning latrines is considered a ritual impurity. The problem of open defecation is thus intimately tied up with Hindu notions of purity and caste which many do not want to discuss, let alone condemn.

In the villages the idea of open defecation is also associated with clean air, exercise, and health. Thus, in surveys “both men and women speak openly about the benefits of open defecation and even associate it with health and longevity.” Even many women prefer open defecation if only because it gives them a chance to get out of the house and have some freedom of movement.

Eventually, flush toilets and sewage will eliminate the problem of open defecation, but many people will die before sewage comes to rural India. Building latrines is not enough but is there an opportunity for an Indian entrepreneur? If standardized latrines were bundled with service contracts and provided by professional, uniformed workers who emptied the latrines mechanically (and thus had dignity), demand could well be high. A Walmart for latrine construction and management.

Coffey and Spears, however, offer no silver bullets. Problems brought about by belief and behavior are usually more difficult to solve than material problems. Nevertheless, by demonstrating the importance of the problem and by facing the causes squarely, Coffey and Spears have done India a tremendous service.