This refers to the editorial “Shameful neglect” (Dec. 7), highlighting the real and enormous consequences of open defecation in India. The challenge is indeed profound, so we worry that your diagnosis that “in the absence of toilets, more than 620 million people, or over half of India’s population, are forced to practise open defecation” underestimates its complexity. In our ongoing field research across rural north India into sanitation practices in India, we have observed that: although some families are indeed too poor to construct a pucca latrine, people in rural India are also unlikely to make simple but safe and inexpensive toilets — unlike, for example in Bangladesh, where even very poor people manage to make a latrine of some sort. Additionally, many relatively prosperous families have not constructed a toilet, even though they could certainly afford one. Finally, even in many rural households that do own a working latrine, many people continue to defecate in the open.

In many households, only children, the old, and the weak or sick, for whom it is difficult to walk far from the house, use latrines. Others use them to protect the modesty of young women or for the convenience of people who have to get ready quickly in the morning for a job outside the village. However, people who are young and healthy often report preferring to go in the fields or the jungle — in part because of the widespread belief that open defecation is good for health, and that using a latrine is unpleasant or disgusting.

The complexity of sanitation beliefs and practices is easy to overlook, especially when census and survey data only count latrines owned by households, not the behaviour of individuals. But mistaking a problem that is partially about access and affordability for a problem that is only about access and affordability — and thereby overlooking the challenges of changing ideas and changing behaviours — will not eliminate the deadly and enduring consequences of this practice.

Diane Coffey, Aashish Gupta, Nidhi Khurana, Angshuman Phukan, Dean Spears, Nikhil Srivastav, Sangita Vyas, Research Institute for Compassionate Economics

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Shameful neglectDecember 7, 2013

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