In mid 2011, Diane Coffey and Dean Spears, both visiting researchers at Economics and Planning Unit of Indian Statistical Institute in Delhi and also assistant professors at the University of Texas at Austin, moved to Sitapur, a district in Uttar Pradesh, to conduct a study on poor early-life health and process of stunting among many Indian children. While Coffey attempted to understand the challenges of raising a baby in the district, Spears compiled government and demographic data to understand the correlation between stunting, cognitive development of Indian children to sanitation. Their findings—that due to poor sanitation, children in rural India die young and those who survive grow up physically and cognitively stunted—raised a further unexplainable question: how is open defecation in rural India different from the rest of developing countries? Coffey and Spears discuss the answer to this question in their book, Where India Goes Abandoned Toilets, Stunted Development and the Costs of Caste. They found that the primary reason for poor sanitation in rural areas is the persistence of caste prejudices or caste hierarchies, which relegate any work involving proximity to human waste to those considered lower-caste, and perpetuate practices such as manual scavenging. (The Caravan published an extract from the book, in which the writers discuss this finding, on its web-exclusives section, Vantage.)
Sagar, a web reporter at The Caravan, spoke to Coffey about the authors’ research and findings. According to Coffey, open defecation in India is a human-development emergency and a dwindling opportunity to prevent a million or more child deaths. Coffey also detailed her experiences speaking to villagers in rural India regarding their outlook towards sanitation, the troubles facing the Swachh Bharat Mission, and why the program is unlikely to achieve its goal of ending open defecation by 2019.
Sagar: You write in the book that, more than bad governance, or the level of poverty, or accessibility to toilets, it has been caste Hindu beliefs in the concepts of purity and untouchability that perpetuated open defecation in rural India. Could you elaborate?
Diane Coffey: One thing we did [during their research] was to look at international data on how things like today’s toilet seats—which are expensive—and governance, poverty, or education, predict using a latrine. These things do predict latrine use for many purposes, but for India, there is a relatively low level of poverty considering the level of open defecation, and governance isn’t that bad, compared to other nations. We came to understand that we were going to need a unique explanation. At the same time, we were working at these international data. We were also doing household surveys: we called it SQUAT—sanitation, quality, use, access and trend. We took the SQUAT survey of several thousand households about where they defecated and why. We partnered that with several hundred qualitative interviews, where I was personally involved with people. Interestingly, that is where we started to understand that the sort of affordable latrines that are promoted by the government and by the WHO [World Health Organisation] are perfectly fine and good from a health perspective, but are not accepted by people in the villages because the pits of those latrines have to be emptied by hand. People link that to manual scavenging, which is associated with Dalit labour and with the social exclusion it comes with, and the caste system, and untouchability. Whereas at other places, where the history of untouchability doesn’t exist, people see it as an unpleasant but necessary job. In India, emptying a latrine is a taboo in a way that it isn’t in other places. Instead of adopting the affordable technology, people either defecated in the open or used expensive technology that can be emptied with a vacuum where nobody has to interact with faeces.
An important point there is that if people were to use the twin-pit latrine [a system in which two pits are constructed, so that when one fills up, it can be covered and allowed to sit for decomposition] in a way that government and international organisations recommend, it would not be an issue of biological danger from the faeces, because they’re supposed to decompose in six months and can be emptied. But of course, there’s not much education on that. People don’t know that latrines can be left to decompose. Even when we explain that to people, they tend to say that what we are saying about the biology of the matter is fine but [that they will] face a lot of social exclusion in my village if [they] work there.
S: Did you compare the sanitation data of other countries to that of India?
DC: We actually looked at data of around 180 countries. India has better governance than so many places that have less open defecation.
S: Could you discuss your visits to these villages and your interactions with their residents, especially upper-caste Hindus? What did they tell you about latrine use?
DC: I remember speaking to a man who had received a government latrine. It was actually very good—there was a superstructure, a latrine fan, it had a door. It was a perfectly useable latrine. But it almost seemed not at all used. He explained that no one in his family lived with him, [he and] his wife have seven sons, and all of those sons were married, and none of these people were using latrines. He had a neighbor who also had a useable latrine. And he explained that they thought that the pit would fill up very quickly, because they were never emptied. So, they thought it was better to go for open defecation than deal with the latrine pit.
S: You also write in the book that, within India, you found that children in Muslim localities were less exposed to diseases than those in Hindu localities, due to better sanitation habits in the former.
DC: It’s not my research specifically, but that of Dean [the co-author of the book] a colleague at the University of Texas, Michael Geruso. It’s long been puzzling to people that Muslims, who are on average poorer than Hindus, are more likely to survive infancy. [The researchers realised that] it’s actually not that Muslims are necessarily more likely to survive infancy—it’s people with Muslim neighbors. Muslims are on an average more likely to use latrines than Hindus, and are also less likely to defecate in the open. So, if your baby is growing up with more people who are using latrines, they are less exposed to diseases and less likely to die, even if you are poor. This research showed the importance of considering the externality of open defecation.
S: What does Swachh Bharat lack?
DC: The main point we make in the book is that Swacch Bharat Mission Grameen [the rural component of the central government’s flagship sanitation programme] is simply a scaled-up sanitation campaign that is very focused on constructing the type of latrines that the villagers are not interested in using. It doesn’t focus on teaching people about twin-pit latrines, why they are useful, how long it takes for it fill up, how can the pits be emptied and on changing people’s mindsets about latrine systems and emptying them. The lack of communication is a really big problem.
S: Did you find evidences of topics such as caste and untouchability in the public awareness materials of the Swachh Bharat Mission?
DC: There is not lot of attention to this issue in terms of information, education and communication. Recently, a very nice thing has happened where the secretary of ministry of water and sanitation has done a pit-emptying demonstration and encouraged other people to do [the same]. I think that’s useful, in showing people that emptying the pit is not the same thing as doing manual scavenging. That said, I think it’s going to take a lot more awareness-raising. I think it’s an uncomfortable issue for particularly local implementers. People might find it far more strenuous in villages. And then of course, there’s the issue of how [in the mission] the focus is on constructing latrines and not on encouraging people to use them and to educate them. Many people could afford [these] latrines, but don’t want to use them.
S: Do you believe Indian policymakers have been unaware of the cost of caste in sanitation programmes?
DC: In chapter 9 [of the book], we talk about how difficult it is for the government to spread this message [of the cost of caste] because so many of the local implementers would be uncomfortable with spreading this message. We get specifics from other studies about how many people from higher caste are in government and I think we have some specifics about teachers who are often the people who are called upon to spread the government’s message. And possibly there has been the question of how difficult it would be for the government to take this up, and we hope that they can do more on it, but I think we also need to be modest about what we can expect, given the statistics available.
S: What do you think is the role of international agencies that are funding India’s sanitation issue? Many agencies put their money into these programs without acknowledging these basic questions.
DC: Some people feel it as a controversial issue, but when we speak to Indian officials, it’s not seen as that controversial. Indian officials who have been working on sanitation for many years will tell us, “Yes, it’s something we have always known about, but just haven’t articulated in that manner.” International organisations, I think, don’t know how to negotiate these issues. I am hoping that [this will go the way], for example, that we see of conversations around say, gender [taking place]—it was less politically correct to be talking about that [earlier]. I hope that people from India and the government and international organisations will feel more comfortable talking about what is it that caste has to do with development.
S: You say in the book that India hasn’t conducted its demography and health survey since 2005. During the same period, our neighbor Bangladesh has conducted a similar survey thrice. The book says that the time that the Prime Minister Narendra Modi launched the Swachh Bharat Mission in 2014, we didn’t have data for how many individuals defecated in the open in 2014, 2015 and 2016.
DC: We have to remember that the demographics and the house surveys don’t only collect data on open defecation but also about nutrition, about vaccination. When we are missing out on data on open defecation we’re also missing out on data on a pool of other health indicators.
S: In your book, you recount your visits to government offices responsible for sanitation, and find them short-staffed, or the staff ill equipped and untrained. Could you talk about this?
DC: The important thing to know, about the sanitation programme is that there is very low ground-level staff. So there’s been talk in the SBM of hiring workers [who would train and educate about latrine use]. It happens slowly, in different stages and different ways of training. In many places, they [sanitation workers] are unpaid. We saw the example of [workers being hired with] NREGA, or when the government wanted to get more women to go to health centres—it’s not been the same with sanitation, there are no ground-level staff who are paid and are responsible. So, one of the things we have written about is that it would be a useful thing for the government to do. The response we tend to get is: this is a short-term, we will build latrines and then these people won’t have a job. I think it’s probably not true. In India, it still takes quite a bit effort to convince people. So it’s a worthwhile thing that’s not being done.
S: There is however, a provision for a sanitation army under Swachh Bharat.
DC: Yes, there is. But in most places, they are not actually paid. If there is no provision for payment, they are not going to do very much.
S: The book predicts that SBM will not end open defecation by 2019. Could you tell us the reasoning behind the prediction?
DC: A major message of the book, that the people do have the means to stop defecating in the open right now. They don’t need the government’s help just to build and use latrines that cost Rs 3000 or Rs 5000.
I think what we want people to take away from the book is that if people were to stop defecating in the open, it would be about the way that they think and their own choices and what they feel is acceptable technology and an acceptable place to defecate. And that’s not necessarily very expensive or has a large construction price.
S: Wouldn’t that be like putting blame on people themselves for open defecation without providing them infrastructure and technical help?
DC: I think that’s sort of the point of the book—[in that] I think people shy away from the explanation of latrine and of untouchability because that is like blaming people. But it’s kind of like how the United States has a history of slavery, and as a white American I behave in certain ways because of that history. If people are really not adopting affordable latrines in a way that is connected to the history of untouchability, we can still understand that they have the option to build the inexpensive latrine and empty the pit. We write in the book that there are still victims of open defecation we don’t talk much about—the babies who die early [due to diseases resulting from poor sanitation], children who get stunted and of course, disabled and elderly people who would really like to use a latrine but their families feel like having an affordable latrine would be too much trouble so they have to suffer the indignity of defecating in the fields. I think we have a different idea of who are the victims in this than [that of] people in urban India.
S: You write that both the left and the right in India have failed to design a sanitation policy around the constraints on affordable latrine adoption imposed by caste, untouchability and social attitudes over the past three decades, because in their ideologies caste doesn’t exist. For the right, it’s an issue of national shame and for the left, it is only the class difference that exists.
DC: I think that’s the whole argument. You pretty much summed it up.
S: The book draws from newspapers reports that till date, there has been no conviction under the Prohibition of Employment as Manual Scavengers and their Rehabilitation Act 2013. How important do you think it is for India to punish the violators of the act if it wants to achieve total sanitation?
DC: The fact that there has been no conviction under the Manual Scavenging Act really highlights the ways in which the government has failed to give attention to the issue of manual scavenging, to the problems of the people do the cleaning work face. I think a commitment to a number of things around manual scavenging [is needed]. One would be enforcing the act. Quite another would be that the government begins to comply with the act—in many circumstances, people who work for government organisations don’t comply. Following and implementing that law would be an important signal of what the government’s priorities are. And when I don’t see that happening, it makes you wonder the extent to which the government is willing to take up the issue of pit-emptying and try to deal with the caste issues around that.
This interview has been edited and condensed.