We shall not defeat any of the infectious diseases that plague the developing world until we have also won the battle for safe drinking water, sanitation and basic health care.
– Kofi Annan
Globally, 494 million people still practise open defecation. In India itself as of 2020, 22.4 percent of rural population and 1.0 percent urban population practiced open defecation. This is despite the remarkable performance of Swachh Bharat Abhiyan, under which around 1071 lakhs toilets have been built since 2014.
The importance of proper hygiene and sanitation cannot be stressed enough. Besides health, they are prerequisites for human capital development too. Improper sanitation affects the productivity and health of people, results in loss of educational opportunities and adversely effects the economic activity and income of households. Thus, improper sanitation also has an economic cost. In 2018 NSS survey revealed that despite having access to toilet facilities, around 3.5 percent of rural population and 1.75 percent of urban population have never used it. Besides the rural-urban difference, usage of toilet varies amongst states and union territories as shown in figures 1 and 2.

Source: Author’s calculation from Unit level data of NSS

Source: Author’s calculation from Unit level data of NSS
The above graphs depict interstate disparities in the lack of usage of latrines. In terms of rural population, Jharkhand and Odisha lead the list with about 10 percent of their populations never using latrines. The proportion is lowest in Sikkim. On the urban front, Meghalaya, Jharkhand and Bihar have the largest proportions of populations never using latrines, between 3 and 4 percent. Only Daman & Diu has 100 percent of its population using latrines.
Lack of cleanliness/unavailability of sufficient water is the leading reason why people, both urban and rural, don’t use toilets. Personal preference is also a strong factor in both areas, while in urban settings, affordability of paid facilities is also an issue. It is worth noticing that 1.4 percent of rural population and 0.7 percent of urban population mentioned that the built latrine is used for other purposes. This points out to the fact that merely building of toilets is not enough to achieve the dream of ‘open-defecation free’ India. Beside provision of water facility to encourage use of latrines, behavioural changes are also required.


In this respect, the focus of the Swachh Bharat Mission on prioritizing behavioural change is laudable. The demand-driven and community leadership approach of the mission has resulted in about 60 crore people changing their sanitation habits. As a result, households are able to save INR 8,024 per year due to reduce medical expenses. Also, owing to the time saved from seeking place to defecate and resultant sickness, households have gained additional benefits worth INR 24,646 per year.
Further, sanitation facilities lead to better health and proper menstrual hygiene management for women. This improves educational outcomes for girls. Additionally, investing in sanitation and easy access to clean water reduces the burden of unpaid work on women and girls and enhances their participation in education and employment activities. Hence, Swatch Bharat Mission also plays a significant role in empowering women.
Seeing the progress of the mission, that it is a success is beyond doubt. However, a lot still needs to be done as changing age-old perceptions and behaviours is not an easy task.
It is recurringly observed that the major factor impeding adoption of toilets has been the non-availability of water. It creates an extra burden on people to fetch water before using toilets and thus reduces the ease and motivation in using them. As usually women are considered to be the providers of water in Indian households, this results in a lot of effort and waste of time for women. Not to mention, the additional burden of fetching water for toilets also undermines the effort of the Swachh Bharat Mission to empower women. With climate change and increasing water woes, this is slated to become one of the prominent challenges in the near future. More research and practical solutions are required to address this issue.

Suchitra Pandey
The views and opinions expressed in the above article belong to the author(s) and do not necessarily represent the official opinion, policy or position of Lokmaanya.