Do you have a toilet in your house?

Published: April 23, 2014
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Talking about toilets isn’t glamorous. In fact, toilet talk is often associated with germs, disgust and revulsion. PHOTO: FILE

Almost two and a half billion people in the world do not have toilets in their homes or lack access to proper sanitation facilities. South Asia makes a significant contribution to these staggering numbers – 65% in India, 53% in Pakistan and 45% in Bangladesh.

Not only does this result in adverse health-related problems, like malnutrition and diarrhoea, it also severely affects the economy. On an average, countries in South Asia lose 6% of their Gross Domestic Product (GDP) because of poor sanitation.

Though many people in the region consider this lack of proper washrooms a major problem, it is not the health-related issues that worry them. For them, this is a crisis because it compromises their convenience, privacy, safety and social prestige; this is especially true for women and children who are disproportionately affected.

In areas where public defecation is the norm, women have to wait till after sunset or before sunrise to go out into the fields for such needs. This means that they often need to limit their food and water intake during the day, causing innumerable health problems alongside physical and psychological distress. The problem is further exacerbated for menstruating and pregnant women. Public defecation also puts women at a risk of harassment, molestation and rape.

I met a woman in a slum area who had taken a loan for building a toilet in her house. Considering that several generations of her family had defecated in the open, I was curious to find out what had driven her to impose such an onerous financial burden on herself for constructing a facility that her family had lived without for years. Her answer was simple,

“No girl from the community wants to marry my son because I don’t have a toilet in my house”.

Another woman, Fatima, told me that her little boy was run over by a train when he had gone to defecate on the railway track near her slum dwelling.

However, constructing more toilets is not the answer. I believe that addressing this enormous challenge requires a multi-pronged strategy.

First, it is crucial to understand why people want toilets. Historically, programmes launched by governments and NGOs aimed at increasing sanitation coverage have focused on health and hygiene benefits. And this is perhaps why a large number of constructed toilets have slowly fallen into disrepair or are being used as storage spaces. They haven’t invested enough time to understand the real challenges faced by people or what their needs, preferences and aspirations are.

For most of the women I have spoken to, it is not preventing diarrhoea that motivates them to build, maintain and use a toilet. It is the indignity they suffer as a result of defecating in the open. It is the constant fear of being molested and raped. And until we appreciate these fundamental human desires and motivations, we will never succeed. It is crucial to not impose textbook solutions on local communities and instead, develop programmes in collaboration with them.

Second, identifying those who are worst affected – usually women and children – is vital, as they can bring about substantial change and champion the cause of sanitation.

It is difficult to imagine how something as basic as a toilet is not a priority for everyone. However, come to think of it, when you live in an overcrowded slum settlement with as many as 10 people sharing one small room, sanitation might not be your biggest worry. A number of slums I visited did not even have adequate space for walking, let alone laying pipelines or building toilets.

Third, there are thousands of community toilets that are either dysfunctional or completely unusable. As a woman, I have often dreaded the very thought of having to use a public washroom. Instead of merely building new toilets, it is important that equal attention is paid to repairing and maintaining existing infrastructure. This is especially important in public places like markets and parks as well as space-constrained slum environments where it is often simply impossible to provide a toilet for every family.

One strategy that can be used is encouraging local entrepreneurs to maintain toilets and in turn earn a livelihood by charging a reasonable fee from communities. Additionally, given the implementation constraints faced by governments, private operators can be engaged on a contract basis for operation and maintenance of public toilets. While cleaning toilets might not seem like the most coveted job at first, there is a growing realisation that, apart from impacting lives positively, it can also prove to be a viable business opportunity.

Talking about toilets isn’t glamorous. In fact, toilet talk is often associated with germs, disgust and revulsion. I have found that people are often very reluctant to talk about the subject and prefer to swiftly change the topic. However, not having a toilet affects billions of lives in unimaginable ways.

Beyond the health statistics, the personal stories associated with inadequate sanitation are heart wrenching. It is up to us to collectively prioritise the issue, develop locally adapted solutions and ensure that tragedies such as the one suffered by Fatima are not repeated.

Urvashi Prasad

Urvashi Prasad

A public health professional with experience in urban slums. A postgraduate from the University of Cambridge, UK and is currently pursuing a masters degree in public health at the London School of Hygiene & Tropical Medicine, UK.

The views expressed by the writer and the reader comments do not necessarily reflect the views and policies of The Express Tribune.

  • Safwan

    53%. . . .The military needs to understand the situation of this country and that we must invest on our people. They should get out of their mentality of competing with India, enough funds should be provided to them to fight terrorism and safeguard our borders. I am quite sure with these new objectives as sole objectives of the army, we can almost halve our defence budget (and build those damn toilets!)Recommend

  • Sami

    I really believe Many newspapers of Pakistan are working on the agenda of our neighboring country where they devise ways and means to bash Pakistan army time and again. Why so many Indian trolls and Impostors try to bring in Army in every discussion.? The figure of 65 % and 45% is also there but you specifically talked only about 53 % of the figure?.

    Your comment is not relevant to the above topic but since it is Army Bashing so it is approved. Also 53 percent figure is utterly wrong in my view. It is developed by some NGO to get some more funding and nothing else.

    Pakistani Newspapers should not fall prey to the Social Sabotage and Political Warfare efforts of another country. ET kindly approve the relevant comments only and Army bashing should have some limits. Off topic comments must not be approved in any case.Recommend

  • Waqar Qureshi

    Awesome article. Desi Liberals / Tribune bloggers of Pakistan should learn from you how to write on small yet so important topics and still make sense. Hats off!Recommend

  • DeptofSS&PW

    Not too mention that 100% of the army has toilets so they are not at issue here.Recommend

  • Col (Retd) Imtiaz Alam

    We should follow sunnah of our Prophet (Pbuh) and Ummahat ul Momineen in this case. There were no toilets in arabia that time.Recommend

  • Lalit

    you are right ….actually it was 5.3%.a point here or there can cause serious problems for your ego you know…not to worry..next time i hope it will be .53%.Recommend

  • BlackJack

    Quote: Also 53 percent figure is utterly wrong in my view.
    Answer: Genius! How did you figure that out? Do you go from house to house counting toilets? Even if the number were only 15% for India it would be depressing – and we have so far to go if 638 M people are defecating in the open in India today. But in Pakistan, it is a conspiracy against the army! Funny people.Recommend

  • Amer

    I do agree that sanitation is a very important issue but I totally dispute the 53% figure given in this article. Where do you get such figures from? We have lived in this country all our lives, traveled far and wide but 53% don’t have a toilet, give me a break! These surveys should not include the Afghan refugees living in slums or camps etc since they should be the responsibility of the UN and not the Pakistani government.Recommend

  • Alam

    I would love to agree with you because I would love to see my army being strong and steadfast against its enemies. The reason some people criticise army is due to the fact that they are a major force in the country (militarily and politicaly) and we all wish that our Army use that strength to push for positive agenda. Since they can (and do) interfere in civilian agendas, we urge them to interfere to ask for 6% gdp for education and same or more for health/basic facilities.Recommend

  • Dante

    Lol I liked this comment “Desi Liberals” :)Recommend

  • Amar Ali Khan

    Heartening to see you writing on such an issue which most of Pakistanis doesn’t considers as an issue. The main problem is what you mentioned in your last paragraph that “No body wants to talk about this topic” , but it is a fact and we have to talk and work out plans for overcoming this serious shortage.

    To me the solution according to the local needs is to dig the grounds to several feets like 15-20 feets and use these for toilet purposes , this has two benefits ,one is that it doesn’t requires sanitation and the 2nd is that a lot of water is saved. In many old villages such a toilet is commonly found in every 2nd home. But the need is to provide such infrastructure to the slums and the poor, it doesn’t cost a lot, you have just to dig a well like hole and that’s it.

    Appreciating you once again for taking a bold step and writing on such a topic, one has to realize it’s importance, whether it is hygiene related or other related issues which you raised in your’s article.Recommend

  • Necromancer

    any references for this, I really doubt about 53% people not having toilets in PakistanRecommend

  • thinktank

    we need education more than providing them with toilets all you need is to do dig a big hole in the fields a really deep one and cover it up with some tin walls or something and put a toilet over it and wolla a rural instant toilet for the next 2 yearsRecommend

  • thinktank

    there were no computers eitherRecommend

  • محب اللہ کراچوی

    There were also no piped water, food inspectors, sewage system and trash collection services etc. but we need all those things in order to survive in a dense urban environment.Recommend

  • Anushe Noor Faheem

    If they are Desi, it is hard for them being Liberals……Recommend

  • Anushe Noor Faheem

    We all need to understand the need of proper infrastructure and help these people out this crisis. I appreciate the writer fir putting forward this issue as I can’t even think of it as an issue. Glad to read it. :)Recommend

  • Anushe Noor Faheem

    would it help raise your literacy rate?Recommend

  • Humza

    I think some of the Indian bloggers here forget that India is the largest buyer of arms in the world and that India is responsible for creating the nuclear arms race in South Asia. Imagine instead if India stopped wasting billions on weapons and instead used it on improving basic living conditions for its own people. This article comments that over 65 % of Indians have no access to toilets compared to over 50 % for Pakistanis. It’s bad for poor people in both countries but I am sure Pakistan will redirect resources better sanity prevails in the region.Recommend

  • unbelievable

    Nice blog. In general Pakistan has made great progress in reducing open defecation – used to be around 53% in 1990 and down to 23% by 2011 — different issue than “in home” toilets but probably more relevant when it comes to health. Men who rape women are cowards with no moral compass. http://apps.who.int/iris/bitstream/10665/81245/1/9789241505390_eng.pdfRecommend

  • Urvashi Prasad

    Since a lot of people are sceptical about the 53% figure for Pakistan I want to mention that these numbers are from credible NGO and other sources (like WaterAid, World Bank and the UN). These numbers have been reported elsewhere as well – http://www.balochistanexpressquetta.com/2014/03/21/enough-water-and-sanitation-aid-not-reaching-pakistan-water-aid-report/
    The issue is that merely having the physical infrastructure of a toilet is not enough. It needs to be functional (have proper water and sewage) and usable (not dirty). It is important to realise that whatever the numbers are they are huge and they need collective action especially from South Asian countries instead of being defensive.Recommend

  • gp65

    Generaly speaking a well written article. But as per the 2011 census 47% Indians had toilets which means 53% did not – pretty much the same as Pakistan.
    Incidentally, the problem is well recognized in India and there are projects both in the private and public sector to address the issue.
    One of our ministers went as far to say that there is a greter need for building toilets than for building temples. No one accused him of blasphemy.
    It is only recently however that the problem is being discussed in Pakistan and even now awareness is low as can be seen by the frequent references to Indians without toilets coming on blogs that have little to do with the subject without realizing that Pakistan has a similar situation.
    I agee this is a big problem and the important point is to acknowledge the problem first. Only the can you find a solution.Recommend

  • gp65

    Young lady, that is a huge stereotype. Cannot say about people in Pakistan but I know plenty of liberal Indians – especially in urban India.Recommend

  • gp65

    http://defence.pk/threads/less-than-half-of-pakistanis-have-access-to-sanitation-says-wb.307583/
    This report quotes a World Bank source that says 47% Pakistanis have access to toilets – which means 53% do not.Recommend

  • gp65
  • Jack Sim

    Thanks Urvashi for the very good article. If we solve the Toilet Problems of India and Pakistan, the global sanitation crisis becomes a much smaller scale problem. The solution needs a Cultural Revolution. When the Toilet enters the Mind of the People in the same Priority Level as a Cellphone, the Demand will Drive the Supply.
    So much government subsidy for toilets will only be effective if toilets become a status symbol and object of desire.Recommend

  • Kulwnt Singh

    Col. Sahib there were no cars,no computers,no cycles. etc etc but now these are the need of the hour.Recommend

  • Anushe Noor Faheem

    Well every society has two different groups of thinkers, yet talking about Pakistan if DESI then they are not LIBERALS.Recommend

  • Shanawer

    I’ve worked with USaid in pakistan on this particular issue & there figure was 19% Pakistanis dont have access to toilets and proper sanitary facilities so i know that ur 53% figure about pakistan is totally invalid.Recommend

  • Ajnabi Sheher

    Unfortunately you are right. Our desi liberals understand true Liberalism as much as our religious fanatics understand true meaning of Islam.Recommend

  • Necromancer

    Well now I have read the whole report of World Bank it doesn’t say anywhere about this claim, please read before commenting and plus defence.pk is not a very good source either…..cheersRecommend

  • Malik Abdul Rehman

    one does not simply come across a toilet bowl close up on a Pakistani websiteRecommend