More Indians than ever before now have access to a toilet, but little attention to education and changing attitudes means that at least 522 million Indians still defecate in the open, leaving many millions susceptible to disease and poverty.
Access to sanitation reduces the incidence of diarrhoea–caused by bacterial, viral and parasitic infections, mostly spread by faeces-contaminated water–studies show. Diarrhoea is the leading cause of malnutrition, and is the second leading cause of death in children under five years, as IndiaSpend reported in July 2017.
As of January 2018–with a year and a half left to the Swachh Bharat Mission’s target of eradicating open defecation–60 million (76%) rural households and 4.2 million urban households have a toilet, and 11 states, 1,846 cities and 314,824 villages have declared themselves open-defecation-free (ODF), according to data available on the Swachh Bharat Mission (Clean India Mission) website.
“The challenge, however, will be in ensuring that ODF villages and cities are firstly, truly ODF, but more crucially that they remain so,” as Avani Kapur, fellow at Accountability Initiative, pointed out in this January 2018 article for Mint.
The Centre’s expenditure on information and education–which experts say is the key to solving India’s sanitation problem–continue to remain low.
It is against this backdrop that Finance Minister Arun Jaitley presented his government’s last full budget ahead of the general elections in 2019.
Access to sanitation improves child health
Sanitation is crucial for India’s plans to reduce infant mortality. The National Health Policy, released in March 2017, aims to reduce the country’s infant mortality–deaths of children under the age of one–from 41 deaths per 1,000 live births in 2015-16 to 28 in 2019.
“If you live next to neighbours who defecate in the open, there are germs on the ground, lot of the people don’t wear shoes, they get their fingers on it [germs], their moms get their fingers on it and then there are flies on it and they get on the food and the entire environment is where is lot of faeces and there is lot of opportunity to get on germs,” Dean Spears, co-founder of the Research Institute for Compassionate Economics, told IndiaSpend in this August 2017 interview.
This cascading effect of health hazards is corroborated by data: Diarrhoea, as we said, remains the second leading cause of death in children under five years, killing an estimated 321 children every day in 2015, as we reported in July 2017.
Access to sanitation reduces cases of diarrhoea, one of the major causes of malnutrition among children, according to this World Bank study.
As many as 50.2 per cent boys and 44.6 per cent of girls with no access to toilets are stunted, compared to 26 per cent boys and 24 per cent girls who live in homes with toilets, according to this September 2017 study released by the National Institute of Nutrition.
Unsafe water, poor hygiene practices and inadequate sanitation are not only the causes of the continued high incidence of diarrhoeal diseases but a significant contributing factor in under-five mortality caused by pneumonia, neonatal disorders and undernutrition, according to this 2016 report by the United Nations Children’s Fund.
Besides, there is also an economic cost to the problem.
“If children are healthy when they are babies then they grow up stronger and taller, they are able to concentrate at school and learn more and they have higher achievement,” Spears told us in the above mentioned interview. “We find that adults are paid more and are more productive if they are born in a better disease environment. Their families get to consume more and they pay more taxes and government gets more revenue.”
“If you can cause a household to stop defecating in the open, just one household, there would be money in the future but it will be an equivalent of increasing the revenue of India by Rs 20,000 per household. That’s just looking at government’s revenue, but then the family gets to eat more, there is more productivity and they will be healthier and they will be more likely to survive,” Spears added.
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