Do you have a toilet in your house?

People feel humiliated when they defecate in the open. For women, it is a constant fear of being molested and raped.

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.