Why Rural Bihar Continues Open Defecation Despite Swachh Bharat's Efforts

A study by Indian researchers found that nearly two-thirds of adults in rural Bihar continue to practice open defecation despite having household toilets, driven by factors like gender, caste, economic status, and inadequate water supply. This underscores the need for a more holistic approach to sanitation efforts.

A recent study conducted by researchers from Vinayaka Mission Medical College and Hospital, AIIMS Patna, and Kasturba Medical College has brought to light the ongoing challenges in eradicating open defecation (OD) in rural Bihar, India, despite the significant investments and efforts under India's Swachh Bharat Mission (SBM). The study, which focused on adults who have access to household toilets, reveals that a substantial portion of the rural population in Patna continues to practice open defecation, pointing to deep-seated cultural and socioeconomic factors that have hindered the success of sanitation initiatives.

The Swachh Bharat Mission’s Shortfall

The Swachh Bharat Mission, launched in 2014, aimed to eliminate open defecation across India by constructing millions of toilets and promoting behavioral change towards hygiene and sanitation. However, this study, which surveyed 609 participants across 30 villages in the Naubatpur block of Patna district, presents a sobering picture of the ground realities. The researchers employed an analytical cross-sectional design, selecting households through a multistage cluster sampling technique to ensure a representative sample. Despite having household toilets, nearly two-thirds (64.2%) of the respondents admitted to continuing the practice of open defecation. This high prevalence highlights the gap between infrastructure development and actual usage, suggesting that the mere availability of toilets is insufficient to alter long-established defecation practices.

Cultural and Economic Barriers Persist

Several factors were identified as contributing to the persistence of open defecation. Gender emerged as a significant determinant, with men being more likely than women to defecate in the open. This finding aligns with broader social patterns where men, who often have more freedom of movement and less concern about privacy, may find it more convenient to defecate outdoors. Additionally, the study found a strong correlation between caste and open defecation practices. Individuals from scheduled caste communities, who often face social and economic marginalization, were more prone to this behavior. The researchers suggest that these communities may lack access to adequate sanitation facilities or may not prioritize toilet use due to deeply ingrained cultural norms.

Economic Constraints and Sanitation

Economic factors also played a crucial role in influencing defecation practices. Families with a gross monthly income of less than Rs. 7770 were significantly more likely to practice open defecation. The study's findings suggest that for these low-income households, the costs associated with maintaining a toilet such as water for flushing and cleaning, or repairs may outweigh the perceived benefits of using it. This economic burden can lead to a preference for the traditional practice of open defecation, which incurs no direct financial cost. Furthermore, the age at which individuals began using toilets was found to be an important factor. Those who started using toilets later in life, particularly after the age of 35, were more likely to continue defecating in the open. This indicates that long-standing habits are difficult to change, and older individuals may be less adaptable to new practices introduced through government programs like the SBM.

Water Availability and Infrastructure Challenges

A critical infrastructural issue identified by the study was the availability of water. The lack of a reliable government-supplied water source was strongly associated with the continued practice of open defecation. Households that relied on less convenient water sources, such as borewells or handpumps located far from the toilet, were less likely to use their toilets consistently. This finding underscores the importance of integrating water supply improvements with sanitation initiatives to ensure that toilets are not only built but are also functional and convenient to use. The study also observed that many government-subsidized toilets were poorly constructed, lacking essential features like a roof, door, or proper ventilation, which further discouraged their use.

Towards a More Holistic Approach

The persistence of open defecation despite the availability of toilets points to the limitations of the Swachh Bharat Mission in addressing the complex social and behavioral factors at play. While the mission has succeeded in increasing the number of toilets, it has not fully succeeded in changing the sanitation practices of the rural population. The study's findings suggest that future efforts should focus not only on building toilets but also on promoting sustained behavioral change through targeted interventions. This could include community-based education programs that address the specific cultural and economic barriers to toilet use, as well as improving the quality and accessibility of sanitation facilities.

The study conducted by Vinayaka Mission Medical College and Hospital, AIIMS Patna, and Kasturba Medical College reveals that open defecation remains a widespread practice in rural Bihar, even among households with access to toilets. The factors associated with this practice gender, caste, economic status, age, and water availability highlight the need for a more nuanced approach to sanitation policy. Addressing these factors will require not just infrastructural investments but also sustained efforts to change deeply rooted behaviors and improve the overall quality of life in rural communities. The researchers emphasize that achieving the goals of the Swachh Bharat Mission will require a more holistic approach that goes beyond toilet construction to include comprehensive support for water supply, education, and community engagement.