The Clean India initiative is one of Indian Prime Minister Narendra Modi’s pet projects. Launched three years ago, it seems to address one of India’s biggest problems — urban sanitation. One figure quoted by The Washington Post as the cost of poor sanitation in India was $106.5 billion in 2015 i.e. over five per cent of the country’s GDP.
Less than half of Indian households have access to a proper toilet and as a consequence many people defecate in public spaces. This means a total of 500 to 600 million people leave their body waste out in the open.
The consequences are quite literally catastrophic: millions of children in India, about 38 per cent of all children, are stunted, shorter than they should be. Studies show that there is a link between open defecation and stunting. Open defecation results in the spread of germs and parasites. Children who are exposed to this environment contract illnesses which can affect the absorption of nutrients that are critical to boosting height and weight. The extent of stunting among Indian children is worse than among the children of sub-Saharan Africa.
In recent months, Mr Modi’s Clean India programme to provide access to sanitation has received international attention and even praise from people like Bill Gates who has commended the fact that the Modi government has said that the problem will not exist by the year 2019. The United States Agency for International Development has pledged millions of dollars, and the World Bank has signed off on a loan of $1.5bn to help speed up the sanitation initiative. Unicef, the UN agency that works for children, is said to be providing training tools and educational material.
The cleaning up of India and the end of open defecation in that country may not be so easy. As researchers Diane Coffey and Dean Spear point out in their recently released book Where India Goes, the issue of why most Indians do not use toilets is less a problem of the unavailability of proper toilets and more to do with social behaviour and religious beliefs.
As Coffey and Spear have pointed out, the caste system that is still prevalent among the majority of the population leads to a situation where no one is willing to clean out the pit latrines that are being built for fear of losing caste. The lower-caste members who would have done the work a long time ago, and who are now beneficiaries of government programmes promoting their uplift, do other things. The result: no one uses the pit latrines and open defecation continues. When everyone goes outside, there is no one to stop them.
Across the border, Pakistan also has a hygiene problem. According to statistics from 2015, Pakistan is number three, after India and Indonesia, in the ranking of countries where people defecate in the open. According to Unicef, 40 to 50 million Pakistanis do not have access to a working toilet. The consequences are the same as in India.
Millions of Pakistanis contract water-borne diseases every year often resulting from their contact with fecal matter. When babies get these infections, they are at high risk of dying — this explains why Pakistan has the second highest child mortality rate in South Asia. The total economic cost of neglecting sanitation in Pakistan is estimated to be $5.7bn annually. The numbers mean that Pakistan is unlikely to realise the Sustainable Development Goal of proper sanitation for all for several years.
The numbers attest to a reality that any Pakistani citizen can attest to. Even large cities like Karachi and Lahore lack public toilet facilities. In situations where such facilities are available, they are in such a state of filth and disrepair that it seems better to forego them. In some cases, excrement can be seen on the floor on or around the latrines instead of inside it. It is nearly impossible to distinguish between water that has been used to clean and liquid excrement.
Women’s restrooms are rare and the stench and state of the few that exist are sickening beyond words. If this is the state of large cities, one can imagine the conditions in smaller ones, not to mention slums and rural areas that have virtually no sanitation.
Unlike India, Pakistan’s condition with regard to the prevalence of open defecation cannot be explained by caste. Moreover, India is at least acknowledging the problem while in Pakistan the issue remains unaddressed, a literal dirty, filthy open secret. Pakistani men in particular seem to have no problem with relieving themselves anywhere and everywhere, just steps from a place of worship, from someone’s home, near a school. While India has embarked on a programme that publicly shames people who engage in open defecation, this method is not in evidence in Pakistan.
If anything, those who defecate in public, using the land of the pure as their personal toilet, seem to feel entitled to do so. All of them seem to believe that no land is really their own unless they can scatter their personal waste all over it.
They have been successful. The stairwells of many public buildings, the boundary walls around many others, all reek of excrement; when there are no toilets the whole country is a toilet. If Pakistanis want a better future for their children, if they want to ensure that so many of them do not perish because of entirely preventable illnesses, this attitude of stubborn denial will have to change. The filth is everywhere; pretending not to see it or smell it or produce it will not make the problem go away.