If the central message of the need for more toilets to stop open defecation in India got lost in the “more toilets than temples” controversy last year, the joint estimate for the year 2011 by the World Health Organization and UNICEF of the number of people who defecate in the open is yet another reminder of why the country has to address this issue on a war-footing. In the absence of toilets, more than 620 million people, or over half of India’s population, are forced to practise open defecation. This is yet another development index where India’s extremely poor performance has ‘helped’ it retain the dubious distinction of having the most people in the world defecating in the open. That Bihar alone has a higher rate than any other country in the world to continue this practice speaks volumes of how much the country lags behind. While the government’s mission to rid the country of this practice by 2022 and 50 per cent of all gram panchayats by 2017 is laudable, it is an ambitious goal. For instance, if nearly 74 per cent did not have access to toilets in 1990, the figure declined to only about 50 per cent in 2011. Besides other countries, Bangladesh, Pakistan and Nepal have achieved the most improvement during 1990-2011. By reducing it from 32 per cent to 4 per cent during 1990-2011, Bangladesh has fared extremely well. The reduction has been about 50 per cent in the case of Nepal (84 to 43 per cent) and Pakistan (52 to 23 per cent) during the same period. But the rate of decline may accelerate in the years to come with the government increasing last year the amount to be spent for household toilets in rural areas from Rs.4,600 to Rs.10,000.

Financial incentives alone cannot end or drastically reduce the percentage of people continuing with this practice. If other countries have achieved it, there is no reason why India cannot do it. The need to aggressively address the issue cannot be overemphasised as open defecation affects children, especially those below five, the most. This practice causes diarrhoea, one of the most common communicable diseases in India and a number one killer of young children. Frequent diarrhoeal events result in under-nutrition. That explains why nearly 50 per cent of under-five children in rural areas are stunted, wasted and underweight. Children weakened by this disease are in turn more prone to opportunistic infections such as pneumonia. Now, a World Bank report released recently goes beyond the well known physical impact. It found a link between open defecation and reduced cognitive achievements.

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