Open defecation

Sanitation facilities coverage worldwide from 2000 to 2015 (the orange line is the data for open defecation).[1]

Open defecation is the human practice of defecating outside ("in the open") rather than into a toilet. People may choose fields, bushes, forests, ditches, streets, canals, or other open spaces for defecation. They do so either because they do not have a toilet readily accessible or due to traditional cultural practices.[2] The practice is common where sanitation infrastructure and services are not available. Even if toilets are available, behavior change efforts may still be needed to promote the use of toilets. 'Open defecation free' (ODF) is a term used to describe communities that have shifted to using toilets instead of open defecation. This can happen, for example, after community-led total sanitation programs have been implemented.

Open defecation can pollute the environment and cause health problems and diseases. High levels of open defecation are linked to high child mortality, poor nutrition, poverty, and large disparities between rich and poor.[3]: 11 Ending open defecation is an indicator being used to measure progress towards the Sustainable Development Goal Number 6. Extreme poverty and lack of sanitation are statistically linked. Therefore, eliminating open defecation is thought to be an important part of the effort to eliminate poverty.[4]

As of 2019[update] an estimated 673 million people practice open defecation,[5]: 74 down from about 892 million people (12 percent of the global population) in 2016.[6] In that year, 76 percent (678 million) of the people practicing open defecation in the world lived in just seven countries.[6]

## Contents

* 1 Background
* 2 Terminology
* 2.1 Open defecation free
* 3 Reasons
* 3.1 No toilet
* 3.2 Uncomfortable or unsafe toilet
* 3.3 Unrelated to toilet infrastructure
* 3.4 Public defecation for other reasons
* 4 Prevalence and trends
* 4.1 Countries with high numbers
* 4.2 India
* 4.3 Pakistan
* 4.4 United States
* 5 Impacts
* 5.1 Public health
* 5.2 Safety of women
* 6 Prevention
* 6.1 Integrated initiatives
* 6.2 Simple sanitation technology options
* 6.2.1 Toilet bags
* 6.2.2 Bucket toilets and urine diversion
* 7 Society and culture
* 7.1 Media
* 7.2 Legal status
* 7.3 In popular culture
* 7.4 During outdoor activities
* 8 See also
* 9 References
* 10 External links

## Background[edit | edit source]

In ancient times, there were more open spaces and less population pressure on land. It was believed that defecating in the open causes little harm when done in areas with low population, forests, or camping-type situations. With development and urbanization, open defecating started becoming a challenge and thereby an important public health issue, and an issue of human dignity.[7] With the increase in population in smaller areas, such as cities and towns, more attention was given to hygiene and health. As a result, there was an increase in global attention towards reducing the practice of open defecation.[8]

Open defecation perpetuates the vicious cycle of disease and poverty and is widely regarded as an affront to personal dignity.[3] The countries where open defecation is most widely practiced have the highest numbers of deaths of children under the age of five, as well as high levels of undernutrition, high levels of poverty, and large disparities between the rich and poor.[3]

* Indiscriminate waste dumping and open defecation, Shadda, Cap-Haitien, Haiti

* Open defecation along a riverbank in Bujumbura, Burundi

* Child defecating in the open in a canal in the slum of Gege in the city of Ibadan, Nigeria

* This drain in a community in Bangladesh is used for defecation and urination

## Terminology[edit | edit source]

The term "open defecation" became widely used in the water, sanitation, and hygiene (WASH) sector from about 2008 onwards. This was due to the publications by the Joint Monitoring Programme for Water Supply and Sanitation (JMP) and the UN International Year of Sanitation. The JMP is a joint program by WHO and UNICEF that was earlier tasked to monitor the water and sanitation targets of the Millennium development goals (MDGs); it is now tasked to monitor Sustainable Development Goal Number 6.

For monitoring of the MDG Number 7, two categories were created: 1) improved sanitation and (2) unimproved sanitation. Open defecation falls into the category of unimproved sanitation. This means that people who practice open defecation do not have access to improved sanitation.

In 2013 World Toilet Day was celebrated as an official UN day for the first time. The term "open defecation" was used in high-level speeches, that helped to draw global attention to this issue (for example, in the "call to action" on sanitation issued by the Deputy Secretary-General of the United Nations in March 2013).[9]

### Open defecation free[edit | edit source]

"Open defecation free" (ODF) is a phrase first used in community-led total sanitation (CLTS) programs. ODF has now entered use in other contexts. The original meaning of ODF stated that all community members are using sanitation facilities (such as toilets) instead of going to the open for defecation. This definition was improved and more criteria were added in some countries that have adopted the CLTS approach in their programs to stop the practice of open defecation.[10]

The Indian Ministry of Drinking Water and Sanitation in mid-2015 defined ODF as "the termination of fecal-oral transmission, defined by:

1. No visible feces found in the environment or village and
2. Every household as well as public/community institutions using safe technology option for disposal of feces".[11]

Here, a "safe technology option" means a toilet that contains feces so that there is no contamination of surface soil, groundwater or surface water; flies or animals do not come in contact with the open feces; no one handles excreta; there is no smell and there are no visible feces around in the environment.[12] This definition is part of the Swachh Bharat Abhiyan (Clean India Campaign).

## Reasons[edit | edit source]

The reasons for open defecation are varied. It can be a voluntary, semi-voluntary or involuntary choice. Most of the time, a lack of access to a toilet is the reason. However, in some places even people with toilets in their houses prefer to defecate in the open.[10]

A few broad factors that result in the practice of open defecation are listed below.

### No toilet[edit | edit source]

* Lack of infrastructure: People often lack toilets in their houses, or in the areas where they live.[5][13]
* Lack of toilets in other places: Lack of toilets in places away from people's houses, such as in schools or in the farms leads the people to defecate in the open.[13] Another example is a lack of public toilets in cities, whether by a reluctance among businesses to allow patrons to use their toilets or limited hours (e.g. if there are no 24-hour businesses in town and someone needs to use the toilet after regular business hours), which can be a big problem for homeless people.[14]
* Use of toilets for other purposes: In some rural communities, toilets are used for other purposes, such as storing household items, animals, farm products or used as kitchens. In such cases, people go outside to defecate.[15][16]

### Uncomfortable or unsafe toilet[edit | edit source]

A pit latrine with failing superstructure in Zambia.

* Poor quality of toilet: Sometimes people have access to a toilet, but the toilet might be broken, or of poor quality – outdoor toilets (pit latrines in particular) typically are devoid of any type of cleaning and reek of odors. Sometimes, toilets are not well lit at all times, especially in areas that lack electricity. Others lack doors or may not have water. Toilets with maggots or cockroaches are also disliked by people and hence, they go out to defecate.[17][18][19][13]
* Risky and unsafe: Some toilets are risky to access. There may be a risk to personal safety due to lack of lights at night, criminals around them, or the presence of animals such as snakes and dogs. Women and children who do not have toilets inside their houses are often found to be scared to access shared or public toilets, especially at night.[19][20] Accessing toilets that are not located in the house might be a problem for disabled people, especially at night.[21] In some parts of the world, Zambia for example, very young children are discouraged from using pit latines due to the risk of them falling through the open drop-hole. In such cases when there is no other available sanitation facility, children are encouraged to practice open defecation.[22]
* Presence of toilet but not privacy: Some toilets do not have a real door, but have a cloth hung as a door. In some communities, toilets are located in places where women are shy to access them due to the presence of men.[23][21][13]
* Lack of water near toilet: Absence of supply of water inside or next to toilets cause people to get water from a distance before using the toilet.[13] This is an additional task and needs extra time.
* Too many people using a toilet: This is especially true in the case of shared or public toilets. If too many people want to use a toilet at the same time, then some people may go outside to defecate instead of waiting. In some cases, people might not be able to wait due to diarrhea (or the result of an Inflammatory Bowel Disease emergency).
* Fear of the pit getting filled: In some places, people are scared that their toilet pits will get filled very fast if all family members use them every day. So they continue to go out to delay the toilet pit filling up. This is especially true in the case of a pit latrine.[19][21]

### Unrelated to toilet infrastructure[edit | edit source]

* Lack of awareness: People in some communities do not know about the benefits of using toilets.[24][25]
* Lack of behavior change: Some communities have toilets, yet people prefer to defecate in the open.[10] In some cases, these toilets are provided by the government or other organizations and the people do not like them, or do not value them. They continue to defecate in the open. Also, older people are often found to defecate in the open and they are hesitant to change their behavior and go inside a closed toilet.[13]
* Prefer being in nature: This happens mostly in less populated or rural areas, where people walk outside early in the morning and go to defecate in the fields or bushes. They prefer to be in nature and the fresh air; instead of defecating in a closed space such as a toilet.[4] There may be a cultural or habitual preference for defecating "in the open air", beside a local river or stream, or even the bush.
* Combining open defecation with other activities: Some people walk early in the morning to look after their farms. Some consider it a social activity, especially women who like to take some time to go out of their homes. While on their way to the fields for open defecation they can talk to other women and take care of their animals.[13]
* Social norms: Open defecation is a part of people's life and daily habits in some regions. For instance, a 2011 survey in rural East Java, Indonesia, found that many men considered the practice ‘normal’, and having distinct benefits such as social interaction and physical comfort.[26] In some cultures, there may be social taboos where a father-in-law may not use the same toilet as a daughter-in-law in the same household.[citation needed]
* Social or personal preferences: Open defecation is a preferred practice in some parts of the world, , with many respondents in a survey from 2015 stating that "open defecation was more pleasurable and desirable than latrine use".[26]
* Fecal incontinence: This medical condition can result in abrupt 'emergencies' and not enough time to access a toilet.

### Public defecation for other reasons[edit | edit source]

In developed countries, open defecation is either due to homelessness, or considered to be a part of voluntary, recreational outdoor activities such as camping in remote areas. It is difficult to estimate how many people practice open defecation in these communities.

## Prevalence and trends[edit | edit source]

### Countries with high numbers[edit | edit source]

The practice of open defecation is strongly related to poverty and exclusion particularly, in the case of rural areas and informal urban settlements in developing countries. The Joint Monitoring Programme for Water Supply and Sanitation (JMP) of UNICEF and WHO has been collecting data regarding open defecation prevalence worldwide. The figures are segregated by rural and urban areas and by levels of poverty. This program is tasked to monitor progress towards the millennium development goal (MDG) relating to drinking water and sanitation. As open defecation is one example of unimproved sanitation, it is being monitored by JMP for each country, and results are published on a regular basis.[27][6] The figures on open defecation used to be lumped together with other figures on unimproved sanitation but are collected separately since 2010.

The current estimate is that around 673 million people practice open defecation.[5]: 74

The number of people practicing open defecation fell from 20 percent in 2000 to 12 percent in 2015.[6]: 34 In 2016, the estimate was for 892 million people with no sanitation facility whatsoever and therefore practicing open defecation (in gutters, behind bushes, in open water bodies, etc.). Most people (9 of 10) who practice open defecation live in rural areas, but the vast majority lives in two regions (Central Asia and South Asia).[6] In 2016, seventy-six percent (678 million) of the 892 million people practicing open defecation in the world lived in just seven countries.[6]

Some countries with large numbers of people who openly defecate are listed in the table below.

People practicing open defecation by country – in alphabetical order (use up and down arrows to order by numbers).  Country  | Total population  | Percentage and Number of people who defecate in the open  | Other estimates (based on government-provided data or other sources)

|
|
|

Cambodia  | 16,949,415  | 17% or 2.8 million (2021)[28] |
Chad | 16,244,513  | 69% or 11 million (2018)[29] |
China  | 1,411,778,724  | 1% or ~13 million (2018)  |
Eritrea | 5,228,000  | 76% or 4 million (2017)  |
Ethiopia  | 117,876,227  | 18% or 20.1 million (2020)[30] |
India  | 1,352,642,280  | <2% or 50 million [31] [32] [33] |

The National Annual Rural Sanitation Survey of India reported that 96.5% of rural households in India had toilets. The Indian government's own estimate in January 2019 was 1.4% or 19 million.[34][35][36][37]

Indonesia  | 270,203,917  | 9% or 25 million (2020)[citation needed]}[38] |
Nepal  | 28,095,714  | <1 or 2.8 million (2019)[39] |
Niger  | 24,112,753  | 68% or 14 million (2017)  |
Nigeria  | 211,400,708  | 24% or 48 million (2021)[40] |
Pakistan  | 225,199,937  | 7% or 15 million (2020)[41] |
Philippines  | 106,651,394  | 4% or 4 million (2020)[42] |
South Sudan | 12,778,250  | 63% or 6 million (2019)  |
Sudan  | 44,909,353  | 27% or 11 million (2017)  |
Vietnam  | 96,208,984  | 4% or 3.7 million (2017)  |

### India[edit | edit source]

Further information: Swachh Bharat Mission

Open defecation has been an issue in India. A report published by WaterAid stated that India had the highest number of people without access to basic sanitation despite efforts made by the Government of India under the Swachh Bharat Mission.[43][44] About 522 million people practiced open defecation in India in 2014, despite having access to a toilet.[45][46] Many factors contributed to this, ranging from poverty to government corruption.[47]

Since then, through Swachh Bharat, a two-phase program managed by the Indian government, India has constructed around 100 million additional household toilets which would benefit 500 million people in India according to the statistics provided by Indian government (Phase 1: 2014–2019, Phase 2: 2020 to 2025).[48] A campaign to build toilets in urban and rural areas achieved a significant reduction in open defecation between 2014 and 2019. In September 2019, the Bill & Melinda Gates Foundation awarded Indian leader Narendra Modi for his efforts in improving sanitation in the country.[49] According to UNICEF The number of people without a toilet reduced from 550 million to 50 million.[50][51] There have also been reports of people not using the toilets despite having one, although according to the world bank 96% of Indians used the toilets they had.[52][53] In October 2019, Modi declared India to be "open defecation free", though this announcement was met with skepticism by experts who cited slowly changing behaviors, maintenance issues, and water access issues as obstacles that continued to block India's goal of being 100% open defecation free.[54][55]

Although open defecation still continues, it has been reduced by a large amount. With the success of the Swachh Bharat Mission, Modi has to launch Phase 2 from 2020 to 2025.[56] During phase 2 the government will focus on segregation of waste and further eliminating open defecation in the country.[57]

### Pakistan[edit | edit source]

In 2017, WaterAid report revealed that 79 million people in Pakistan lacked access to a decent toilet in the country.[58][59] In 2018, 10% or 22 million people in Pakistan practiced open defecation according to the figures provided by the UNICEF.[60][61] According to the latest UNICEF report as of 2020, 7% or 15 million people in Pakistan practice open defecation.[41]

### United States[edit | edit source]

In San Francisco (United States), open defecation complaints for street feces increased fivefold from 2011 to 2018, with 28,084 cases reported. This was mainly due to the rising amount of homelessness in the city.[62] Similar problems were reported in Los Angeles[63] and Miami.[64]

The Mad Pooper was the name given to an unidentified woman who regularly defecated in public places while jogging during summer 2017 in the U.S. city of Colorado Springs.[65]

## Impacts[edit | edit source]

A dirty pit latrine in Mongolia leading people to choose open defecation instead

### Public health[edit | edit source]

Further information: WASH § Health aspects

The negative public health impacts of open defecation are the same as those described when there is no access to sanitation at all. Open defecation—and lack of sanitation and hygiene in general—is an important factor that cause various diseases; the most common being diarrhea and intestinal worm infections but also typhoid, cholera, hepatitis, polio, trachoma, and others.[66][67]

Adverse health effects of open defecation occur because open defecation results in fecal contamination of the local environment. Consequently, open defecators are repeatedly exposed to many kinds of fecal bacteria like gram-positive Staphylococcus aureus and other fecal pathogens, and this is particularly serious for young children whose immune systems and brains are not yet fully developed.[26]

Certain diseases are grouped together under the name of waterborne diseases, which are diseases transmitted via fecal pathogens in water. Open defecation can lead to water pollution when rain flushes feces that are dispersed in the environment into surface water or unprotected wells.

Open defecation was found by the WHO in 2014 to be a leading cause of diarrheal death. In 2013, about 2,000 children under the age of five died every day from diarrhea.[68]

Young children are particularly vulnerable to ingesting feces of other people that are lying around after open defecation, because young children crawl on the ground, walk barefoot, and put things in their mouths without washing their hands. Feces of farm animals are equally a cause of concern when children are playing in the yard.

Those countries where open defecation is most widely practiced have the highest numbers of deaths of children under the age of five, as well as high levels of malnourishment (leading to stunted growth in children), high levels of poverty, and large disparities between rich and poor.[3]

Research from India has shown that detrimental health impacts (particularly for early life health) are even more significant from open defecation when the population density is high: "The same amount of open defecation is twice as bad in a place with a high population density average like India versus a low population density average like sub-Saharan Africa."[69]

Open defecation is also badly affecting the health of children and their life quality as it creates health and psychological issues.[70]

### Safety of women[edit | edit source]

There are strong gender impacts connected with a lack of adequate sanitation. In addition to the universal problems associated with open defecation, having to urinate in the open can also be problematic for females. The lack of safe, private toilets makes women and girls vulnerable to violence and is an impediment to girls' education.[71] Women are at risk of sexual molestation and rape as they search for places to urinate or defecate that are secluded and private, often during hours of darkness.[72][71]

Lack of privacy has an especially large effect on the safety and sense of dignity of women and girls in developing countries. They face the shame of having to urinate or defecate in public so often wait until nightfall to relieve themselves. They risk being attacked after dark, though it means painfully holding their bladder and bowels all day.[73][74] Women in developing countries increasingly express fear of assault or rape when having to leave the house after dark. Reports of attacks or harassment near or in toilet facilities, as well as near or in areas where women urinate or defecate openly, are common.[73][74]

## Prevention[edit | edit source]

The following joint strategies can enable communities, both rural and peri-urban, to become completely open defecation free and remain so: Sanitation marketing, behavior change communication, and 'enhanced' community-led total sanitation ('CLTS + ’), supplemented by 'nudging'.[26]

There are several drivers used to eradicate open defecation, one of which is behavior change. SaniFOAM (Focus on Opportunity, Ability, and Motivation) is a conceptual framework that was developed specifically to address issues of sanitation and hygiene. Using focus, opportunity, ability and motivation as categories of determinants, SaniFOAM model identifies barriers to latrine adoption while simultaneously serving as a tool for designing, monitoring and evaluating sanitation interventions.[75][76] The following are some of the key drivers used to fight against open defecation in addition to behavior change:[4]

* Political will
* Sanitation solutions that offer a better value than open defecation
* Stronger public sector local service delivery systems
* Creation of the right incentive structures

### Integrated initiatives[edit | edit source]

Efforts to reduce open defecation are more or less the same as those to achieve the MDG target on access to sanitation. A key aspect is awareness-raising (for example via the UN World Toilet Day at a global level), behavior change campaigns, increasing political will as well as demand for sanitation. Community-Led Total Sanitation (CLTS) campaigns have placed a particular focus on ending open defecation by "triggering" the communities themselves into action.[77]

### Simple sanitation technology options[edit | edit source]

Residents in Mymensingh, Bangladesh participate in a workshop to discover more about mobile sanitation options (MoSan) as an alternative to open defecation

There are some simple sanitation technology options available to reduce open defecation prevalence if the open defecation behavior is due to not having toilets in the household and shared toilets being too far or too dangerous to reach, e.g., at night.

#### Toilet bags[edit | edit source]

People might already use plastic bags (also called flying toilets) at night to contain their feces. However, a more advanced solution of the plastic toilet bag has been provided by the Swedish company People who are producing the "Peepoo bag", a "personal, single-use, self-sanitizing, fully biodegradable toilet that prevents feces from contaminating the immediate area as well as the surrounding ecosystem".[78] This bag is now being used in humanitarian responses, schools, and urban slums in developing countries.[79][80]

#### Bucket toilets and urine diversion[edit | edit source]

Bucket toilets are a simple portable toilet option. They can be upgraded in various ways, one of them being urine diversion which can make them similar to urine-diverting dry toilets. Urine diversion can significantly reduce odors from dry toilets. Examples of using this type of toilet to reduce open defecation are the "MoSan"[81] toilet (used in Kenya) or the urine-diverting dry toilet promoted by SOIL[82] in Haiti.

## Society and culture[edit | edit source]

### Media[edit | edit source]

The mainstream media in some affected countries have recently been picking up on this issue of open defecation, for example, in India[83][84] and Pakistan.[85][86][87]

### Legal status[edit | edit source]

In certain jurisdictions, open or public defecation is a criminal offense which can be punished with a fine or even imprisonment.[88][89][90]

### In popular culture[edit | edit source]

David Sedaris' essay "Adventures at Poo Corner" dealt with people who openly defecate in commercial businesses.[91]

### During outdoor activities[edit | edit source]

Some national parks prohibit open defecation in some areas.[92][93] If defecating openly, the general advice is to defecate into a dug hole, and cover with soil.[93]

## See also[edit | edit source]

* Free bleeding
* Public urination
* Spitting

## References[edit | edit source]

1. ↑ Ritchie, Roser, Mispy, Ortiz-Ospina (2018) "Measuring progress towards the Sustainable Development Goals." (SDG 6) Archived 1 November 2020 at the Wayback Machine SDG-Tracker.org, website
2. ↑ Clasen T, Boisson S, Routray P, Torondel B, Bell M, Cumming O, et al. (November 2014). "Effectiveness of a rural sanitation program on diarrhea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomized trial". The Lancet. Global Health. 2 (11): e645-53. doi:10.1016/S2214-109X(14)70307-9. PMID 25442689.
3. ↑ 3.0 3.1 3.2 3.3 Progress on drinking water and sanitation, 2014 Update. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP). 2014. ISBN 9789241507240. Archived from the original on 2 April 2015. Retrieved 12 March 2015.
4. ↑ 4.0 4.1 4.2 Junaid Ahmad (30 October 2014). "How to eliminate open defecation by 2030". Devex. Archived from the original on 1 June 2016. Retrieved 2 May 2016.
5. ↑ 5.0 5.1 5.2 WHO and UNICEF (2019) Progress on household drinking water, sanitation and hygiene 2000–2017: Special focus on inequalities Archived 25 August 2020 at the Wayback Machine, Geneva, Switzerland
6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 WHO and UNICEF (2017) Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines Archived 27 February 2020 at the Wayback Machine. Geneva: World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF)
7. ↑ O'Reilly K (2016-01-01). "From toilet insecurity to toilet security: creating safe sanitation for women and girls". Wiley Interdisciplinary Reviews: Water. 3 (1): 19–24. doi:10.1002/wat2.1122. ISSN 2049-1948.
8. ↑ "Nearly a Billion People Still Defecate Outdoors. Here's Why". 2017-07-25. Archived from the original on 5 October 2017. Retrieved 2017-10-04.
9. ↑ "United Nations Deputy Secretary-General's Call to Action on Sanitation" (PDF). United Nations. 2013. Archived (PDF) from the original on 1 June 2015. Retrieved 19 October 2014.
10. ↑ 10.0 10.1 10.2 Cavill; Chambers; Vernon (2015). Sustainability and CLTS: Taking Stock Frontiers of CLTS: Innovations and Insights Issue 4 (PDF). Institute of Development Studies. p. 18\. ISBN 978-1-78118-222-2. Archived from the original on 3 July 2015. Retrieved 28 July 2015.
11. ↑ "Guidelines for ODF Verification" (PDF). Indian Ministry of Drinking Water and Sanitation. 2015. Archived (PDF) from the original on 11 April 2016. Retrieved 3 May 2016.
12. ↑ "Definition of ODF – Open Defecation Free (Indian government publication)". 2015-06-18. Archived from the original on 6 October 2017. Retrieved 2017-10-05.
13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 Routray P, Schmidt WP, Boisson S, Clasen T, Jenkins MW (September 2015). "Socio-cultural and behavioural factors constraining latrine adoption in rural coastal Odisha: an exploratory qualitative study". BMC Public Health. 15: 880. doi:10.1186/s12889-015-2206-3. PMC 4566293. PMID 26357958.
14. ↑ "Public Bathrooms Become Ground Zero in the Opioid Epidemic". www.wbur.org. Archived from the original on 23 June 2018. Retrieved 2018-10-16.
15. ↑ Bardosh K (2015-11-01). "Achieving "Total Sanitation" in Rural African Geographies: Poverty, Participation and Pit Latrines in Eastern Zambia". Geoforum. 66 (Supplement C): 53–63. doi:10.1016/j.geoforum.2015.09.004.
16. ↑ "Understanding Gendered Sanitation Vulnerabilities: A Study in Uttar Pradesh - Resources • SuSanA". www.susana.org. Archived from the original on 24 October 2017. Retrieved 2017-10-23.
17. ↑ O'Connell K. "What Influences Open Defecation and Latrine Ownership in Rural Households?: Findings from a Global Review" (PDF). Archived (PDF) from the original on 18 November 2017. Retrieved 23 October 2017.
18. ↑ "Nowhere to go How a lack of safe toilets threatens to increase violence against women in slums" (PDF). Archived from the original (PDF) on 2014-06-11.
19. ↑ 19.0 19.1 19.2 Kwiringira J, Atekyereza P, Niwagaba C, Günther I (June 2014). "Descending the sanitation ladder in urban Uganda: evidence from Kampala Slums". BMC Public Health. 14: 624. doi:10.1186/1471-2458-14-624. PMC 4071028. PMID 24948084.
20. ↑ "Document". www.amnesty.org. Archived from the original on 24 October 2017. Retrieved 2017-10-23.
21. ↑ 21.0 21.1 21.2 Tsinda A, Abbott P, Pedley S, Charles K, Adogo J, Okurut K, Chenoweth J (December 2013). "Challenges to achieving sustainable sanitation in informal settlements of Kigali, Rwanda". International Journal of Environmental Research and Public Health. 10 (12): 6939–54. doi:10.3390/ijerph10126939. PMC 3881150. PMID 24336021.
22. ↑ Water and Sanitation Programme and the United Nations Children’s Fund (UNICEF) (2015). "Child Feces Disposal in Zambia" (PDF). International Bank for Reconstruction and Development / The World Bank and UNICEF. Archived (PDF) from the original on 2 October 2020. Retrieved 22 September 2020.
23. ↑ O'Reilly K (2006-11-01). ""Traditional" women, "modern" water: Linking gender and commodification in Rajasthan, India". Geoforum. 37 (6): 958–972. doi:10.1016/j.geoforum.2006.05.008.
24. ↑ In 2016, Kunwar Bai Yadav, a woman claiming to be 105 years old, said she had never heard about a toilet until that year, and had always gone into the nearby woods to defecate. Only when she learned about them, did she have one built in her community. Source: BBC News (India): "How a 105-year-old ended open defecation in her village" Archived 21 December 2018 at the Wayback Machine, 1 November 2016
25. ↑ "Revealed Preference for Open Defecation: Evidence from a new survey in rural north India (longer working paper) | r.i.c.e." riceinstitute.org. Archived from the original on 24 October 2017. Retrieved 2017-10-23.
26. ↑ 26.0 26.1 26.2 26.3 Mara D (2017). "The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals". Journal of Water, Sanitation and Hygiene for Development. University of Leeds. 7 (1): 1–12. doi:10.2166/washdev.2017.027. ISSN 2043-9083. Archived from the original on 17 May 2020. Retrieved 29 June 2020.
27. ↑ "Data and estimates". JMP – WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation. WHO/UNICEF. Archived from the original on 19 February 2015. Retrieved 12 March 2015.
28. ↑ Chheng N. "Home toilet access improving". www.phnompenhpost.com. Archived from the original on 2021-07-09. Retrieved 2021-07-04.
29. ↑ "Infographic: Where Open Defecation Is Still Widely Practiced". Statista Infographics. Archived from the original on 2021-01-12. Retrieved 2021-07-04.
30. ↑ Abebe TA, Tucho GT (November 2020). "Open defecation-free slippage and its associated factors in Ethiopia: a systematic review". Systematic Reviews. 9 (1): 252. doi:10.1186/s13643-020-01511-6. PMC 7641843. PMID 33143715.
31. ↑ "Archive copy". Archived from the original on 2020-08-07. Retrieved 2022-01-20.`{{cite web}}`: CS1 maint: archived copy as title (link)
32. ↑ "Archive copy". Archived from the original on 2018-09-15. Retrieved 2022-01-20.`{{cite web}}`: CS1 maint: archived copy as title (link)
33. ↑ "Archive copy". Archived from the original on 2022-01-17. Retrieved 2022-01-20.`{{cite web}}`: CS1 maint: archived copy as title (link)
34. ↑ "Swachh Bharat Mission – Gramin". Archived from the original on 16 October 2018. Retrieved 15 October 2018.
35. ↑ "Over 83 9 million toilets constructed under Swachh Bharat Mission". UNI India. Archived from the original on 15 September 2018. Retrieved 14 September 2018.
36. ↑ "Cleaning Up India With Gandhiji". Economic Times. Archived from the original on 24 November 2018. Retrieved 20 September 2018.
37. ↑ "93 Per Cent Households In Rural India Have Access To Toilets, Says Government Survey | News". NDTV-Dettol Banega Swasth Swachh India. 2019-03-05. Archived from the original on 2021-07-09. Retrieved 2021-07-04.
38. ↑ "Water, sanitation and hygiene". www.unicef.org. Archived from the original on 2017-11-15. Retrieved 2021-07-04.
39. ↑ @therecord. "Toilet trauma - The Record". www.recordnepal.com. Archived from the original on 2021-07-09. Retrieved 2021-07-04.
40. ↑ "Water, Sanitation and Hygiene". www.unicef.org. Archived from the original on 2021-07-09. Retrieved 2021-07-04.
41. ↑ 41.0 41.1 "People practicing open defecation (% of population) - Pakistan". World Bank. Archived from the original on 29 November 2021.
42. ↑ Lalu GP (2020-11-23). "SWS: 4% of PH households still have no toilets; 6% share facilities". INQUIRER.net. Archived from the original on 2021-07-09. Retrieved 2021-07-04.
43. ↑ "India has highest number of people without basic sanitation: Report". Times of India. 7 November 2017. Archived from the original on 28 January 2022. Retrieved 20 January 2022.
44. ↑ "India Has Highest Number Of People Without Basic Sanitation: Report". NDTV. 7 November 2017. Archived from the original on 3 January 2022. Retrieved 20 January 2022.
45. ↑ Zakaria R (11 April 2019). "India's Futile War on Open Defecation". The New Republic. ISSN 0028-6583. Archived from the original on 13 April 2020. Retrieved 13 April 2020.
46. ↑ Dinnoo S (17 June 2014). "Why do millions of Indians defecate in the open?". BBC News. Archived from the original on 6 March 2020. Retrieved 13 April 2020.
47. ↑ Coffey D (2017). Where India goes : abandoned toilets, stunted development and the costs of caste. Spears, Dean E. Noida, Uttar Pradesh. pp. 7–11. ISBN 978-93-5264-565-7. OCLC 994315306.
48. ↑ "An open defecation free India". unicef.org. Archived from the original on 7 August 2020. Retrieved 29 July 2020. "According to the national statistics, over 100 million household toilets were constructed by the deadline benefiting 500 million people across 630,000 villages, but the government acknowledged that more had to be done."
49. ↑ "Gates Foundation award seen as boost to Swachh Bharat Abhiyan". Mint. 25 September 2019. Archived from the original on 30 November 2020. Retrieved 20 December 2020.
50. ↑ "A Clean (Sampoorna Swachh) India". www.unicef.org. Archived from the original on 2020-08-07. Retrieved 2021-07-07.
51. ↑ "93 Percent Households In Rural India Have Access To Toilets, Says Government Survey | News". NDTV-Dettol Banega Swasth Swachh India. 2019-03-05. Archived from the original on 2021-07-09. Retrieved 2021-07-07.
52. ↑ Helen Regan and Manveena Suri (2019-10-06). "Half of India couldn't access a toilet 5 years ago. Modi built 110M latrines -- but will people use them?". CNN. Archived from the original on 2021-11-30. Retrieved 2021-07-07.
53. ↑ Sharma, Aman. "96% usage of toilets under Swachh Bharat, shows a survey by an independent verification agency". The Economic Times. Archived from the original on 2021-07-10. Retrieved 2021-07-07.
54. ↑ Kuchay B (2 October 2019). "Modi declares India open defecation free, claim questioned". Al Jazeera. Archived from the original on 18 August 2021. Retrieved 20 January 2022.`{{cite news}}`: CS1 maint: uses authors parameter (link)
55. ↑ Santosh Mehrotra (January 2019). "Is India Really 96% Open Defecation Free?". The Wire (India). Archived from the original on 2022-01-03. Retrieved 2022-01-20.
56. ↑ "Second phase of Swachh Bharat Mission (Grameen) launched". The Hindu. Press Trust of India. 2020-03-04. ISSN 0971-751X. Archived from the original on 2022-01-28. Retrieved 2021-07-07.`{{cite news}}`: CS1 maint: others (link)
57. ↑ "Phase 2 of Swachh Bharat Mission to focus on waste segregation at source". The Indian Express. 2021-03-03. Archived from the original on 2021-07-09. Retrieved 2021-07-07.
58. ↑ "79m Pakistanis still lack a decent toilet: report". Daily Times. 2017-11-23. Archived from the original on 2021-01-22. Retrieved 2021-06-23.
59. ↑ "Pakistan | WaterAid Global". www.wateraid.org. Archived from the original on 2021-06-13. Retrieved 2021-06-23.
60. ↑ "People practicing open defecation (% of population) - Pakistan". World Bank. Archived from the original on 2021-11-29. Retrieved 2022-01-20.
61. ↑ "Women in Pakistan fight for toilets, while men have 'other priorities'". The Hindu. 24 November 2018. Archived from the original on 17 July 2021. Retrieved 27 May 2021.
62. ↑ Moffitt M (3 December 2019). "San Francisco plans to power-wash the poop out of the Tenderloin". SFGATE. Archived from the original on 6 December 2019.
63. ↑ Grover, Joel; Corral, Amy (February 19, 2020). "Homeless People Are Without Toilets and Going in the Streets. We Asked the Mayor of LA Why". NBC Los Angeles. Archived from the original on December 1, 2021. Retrieved January 20, 2022.
64. ↑ LINDA ROBERTSON (October 19, 2019). "Poop and urine turn downtown streets into outdoor toilet". Miami Herald. Archived from the original on September 8, 2021. Retrieved January 20, 2022.
65. ↑ "We Urge You 'Mad Pooper,' Stop Crapping in Your Neighbor's Yard". Runner's World. 19 September 2017. Archived from the original on 7 November 2017. Retrieved 3 November 2017.
66. ↑ "Call to action on sanitation" (PDF). United Nations. Archived from the original (PDF) on 19 August 2014. Retrieved 15 August 2014.
67. ↑ Spears D, Ghosh A, Cumming O (2013). "Open defecation and childhood stunting in India: an ecological analysis of new data from 112 districts". PLOS ONE. 8 (9): e73784. Bibcode:2013PLoSO...873784S. doi:10.1371/journal.pone.0073784. PMC 3774764. PMID 24066070.
68. ↑ "WHO | Diarrhoeal disease". World Health Organization. 2013. Archived from the original on 1 April 2014. Retrieved 10 March 2014.
69. ↑ Vyas (2014). Population density and the effect of sanitation on early-life health], slide 19 (presentation at UNC conference in Oct. 2014) (PDF). Research Institute for Compassionate Economics, project (r.i.c.e.). Archived (PDF) from the original on 2 April 2015. Retrieved 12 March 2015 - via Sustainable Sanitation Alliance.
70. ↑ "Archive copy". Archived from the original on 2021-03-01. Retrieved 2022-01-20.`{{cite web}}`: CS1 maint: archived copy as title (link)
71. ↑ 71.0 71.1 House, Sarah, Suzanne Ferron, Marni Sommer and Sue Cavil (2014) Violence, Gender & WASH: A Practitioner’s Toolkit & nbsp ;– Making water, sanitation and hygiene safer through improved programming and services Archived 4 October 2015 at the Wayback Machine. London, UK: WaterAid/SHARE.
72. ↑ Lennon, S. (2011). Fear and anger: Perceptions of risks related to sexual violence against women linked to water and sanitation in Delhi, India Archived 24 September 2015 at the Wayback Machine – Briefing Note. SHARE (Sanitation and Hygiene Applied Research for Equity) and WaterAid, UK
73. ↑ 73.0 73.1 Cavil S. "Violence, gender and WASH: A practitioner's toolkit: Making Water, Sanitation and hygiene safer through improved programming and services". WaterAid, SHARE Research Consortium. Archived from the original on 4 October 2015. Retrieved 7 October 2015.
74. ↑ 74.0 74.1 Lennon S (November 2011). "Fear and anger: Perceptions of risks related to sexual violence against women linked to water and sanitation in Delhi, India". SHARE (Sanitation and Hygiene Applied Research for Equity) and WaterAid, UK. Archived from the original on 24 September 2015. Retrieved 7 October 2015.
75. ↑ Devine J (2009). Introducing Sanifoam: A Framework to Analyze Sanitation Behaviors to Design Effective Sanitation Programs. Washington, DC, USA: World Bank.
76. ↑ Devine J (2010). "Beyond tippt-taps: The role of enabling products in scaling up and sustaining handwashing". Waterlines. 29 (4): 304–314. doi:10.3362/1756-3488.2010.033.
77. ↑ "Field Notes: UNICEF Policy and Programming in Practice" (PDF). UNICEF. Archived (PDF) from the original on 2 April 2015. Retrieved 10 March 2015.
78. ↑ Wheaton, A. (2009). Results of a medium-scale trial of single-use, self-sanitising toilet bags in poor urban settlements in Bangladesh Archived 27 April 2015 at the Wayback Machine. Deutsche Gesellschaft für Technische Zusammenarbeit GmbH (GTZ), Dhaka, Bangladesh
79. ↑ Owako, E. (2012). Nyando peepoo trial project report Archived 7 April 2015 at the Wayback Machine. Kenya Red Cross, Kenya
80. ↑ Naeem, K., Berndtsson, M. (2011). Peepoo Try Pakistan – Sindh Floods Archived 7 April 2015 at the Wayback Machine, November 2011. UN-HABITAT, Pakistan
81. ↑ Mijthab M., Woods E., Lokey H., Foote A., Rieck. C (2013). Sanivation and MoSan Toilet – 4 week Service Pilot in Karagita Naivasha, Kenya Archived 20 October 2014 at the Wayback Machine. GIZ and Sanivation
82. ↑ Russel, K. (2013). Mobile sanitation services for dense urban slums – Various documents on results from research grant. Archived 18 October 2014 at the Wayback Machine Stanford University, U.S.
83. ↑ Biswas S (2014-10-06). "Why India's sanitation crisis needs more than toilets". BBC News. BBC. Archived from the original on 17 March 2015. Retrieved 10 March 2015.
84. ↑ "India has highest number of people practicing open defecation &#124". DNA India. 19 November 2014. Archived from the original on 2 April 2015. Retrieved 10 March 2015.
85. ↑ "More than 40m Pakistanis defecate openly: Unicef – Pakistan". Dawn. 2015-03-08. Archived from the original on 10 March 2015. Retrieved 10 March 2015.
86. ↑ "Lack of toilets tied to stunted growth in Pakistan: UNICEF". The Express Tribune. 13 March 2012. Archived from the original on 11 March 2015. Retrieved 10 March 2015.
87. ↑ "Over 43 million people in Pakistan defecate in the open". The News International. Archived from the original on 2 April 2015. Retrieved 10 March 2015.
88. ↑ "Municode Library". library.municode.com. Archived from the original on 16 January 2018. Retrieved 2018-01-30.
89. ↑ "'Mad Pooper': Jogger Wanted for Defecating in Front Yards of Colorado Homes". WNEP.com. 2017-09-19. Archived from the original on 16 January 2018. Retrieved 2018-01-30.
90. ↑ Manning A. "The world is NOT your toilet, Columbus police note". The Columbus Dispatch. Archived from the original on 16 January 2018. Retrieved 2018-01-30.
91. ↑ "Adventures at Poo Corner". This American Life. 2017-12-12. Archived from the original on 18 August 2019. Retrieved 2019-08-18.
92. ↑ "Leave No Trace". National Park Service. Archived from the original on 26 September 2020. Retrieved 20 September 2020.
93. ↑ 93.0 93.1 Martineau C (5 June 2019). "Nature is calling: Here's how to poop properly in the great outdoors". Roadtrippers. Archived from the original on 27 October 2020.

## External links[edit | edit source]

Wikipedia's health care articles can be viewed offline with the Medical Wikipedia app.

* UN Call to action to end open defecation
* Documents about open defecation Archived 2019-03-27 at the Wayback Machine in library of Sustainable Sanitation Alliance

* v
* t
* e

Toilets

Equipment|

* Automatic toilet paper dispenser
* Ballcock
* Bedpan
* Bidet
* Bidet shower
* Brush
* Cistern
* Commode
* Electronic bidet
* Flushometer
* Roll holder
* Seat
* Seat cover
* Self-cleaning toilet seat
* Toilet
* Toilet paper
* Trap (U-bend)

Types|

* Aircraft
* Arborloo
* Blair
* Bucket
* Cathole
* Chemical
* Composting
* Container-based
* Dry
* Dual flush
* Electronic toilet
* Flush
* Freezing
* Head (boat)
* Hudo (Scouting)
* Incinerating
* Intelligent
* Latrine
* Low-flush
* On-board
* Passenger train
* Pay
* Pit
* Pig
* Portable
* Potty
* Public
* Sanisette (self-cleaning)
* Space
* Squat
* Treebog
* Urine-diverting dry
* Vacuum
* Washlet (combined toilet and bidet)

Cultural and
policy aspects|

* Accessible
* Adult diaper
* Bathroom privileges
* Honeywagon (vehicle)
* Incontinence pad
* Islamic toilet etiquette
* Istinja
* Latrinalia
* Privatization of public toilets
* Swachh Bharat Mission
* Toilet god
* Toilet humour
* Toilet paper orientation
* Toilet plume
* Toilet-related injuries and deaths
* Toilet Revolution in China
* Toilet training
* Toilet Twinning
* Unisex public
* Vacuum truck

Jobs and activities|

* Manual scavenging
* Sanitation worker
* Slopping out
* Toileting
* Toilet training
* Restroom attendant

Urine-related aspects|

* Female urinal
* Female urination device
* Interactive urinal
* Pissoir
* Pollee
* Sanistand
* Urination
* Urinal
* Urinal (health care)
* Urine collection device
* Urine diversion

Feces-related aspects|

* Anal hygiene
* Defecation
* Defecation postures
* Fecal sludge management
* Flying toilet
* Open defecation
* Scatology

Places|

* Hundertwasser Toilets
* Modern Toilet Restaurant
* National Poo Museum
* Outhouse
* Rest area
* Shit Museum
* Sulabh International Museum of Toilets
* Toilet (room)
* Toilets in Japan

Historical terms|

* Aphedron
* Chamber pot
* Close stool
* Dansker
* Garderobe
* Gong farmer
* Groom of the Stool
* Night soil
* Pail closet
* Privy midden
* Reredorter

See also|

* History of water supply and sanitation
* Madison Museum of Bathroom Tissue
* Sanitation
* Sewage treatment
* World Toilet Day

* v
* t
* e

Public health

General|

* Auxology
* Biological hazard
* Chief Medical Officer
* Cultural competence
* Deviance
* Environmental health
* Euthenics
* Genomics
* Globalization and disease
* Health economics
* Health literacy
* Health policy
* Health system
* Health care reform
* Public health law
* Maternal health
* Medical anthropology
* Medical sociology
* Mental health
* Pharmaceutical policy
* Public health intervention
* Public health laboratory
* Reproductive health
* Social psychology
* Sociology of health and illness

Preventive healthcare|

* Behavior change
* Theories
* Family planning
* Health promotion
* Human nutrition
* Preventive nutrition
* Hygiene
* Food safety
* Hand washing
* Infection control
* Oral hygiene
* Occupational safety and health
* Human factors and ergonomics
* Hygiene
* Injury prevention
* Medicine
* Nursing
* Patient safety
* Organization
* Pharmacovigilance
* Safe sex
* Sanitation
* Emergency
* Fecal–oral transmission
* Open defecation
* Sanitary sewer
* Waterborne diseases
* Smoking cessation
* Vaccination
* Vector control

Population health|

* Biostatistics
* Child mortality
* Community health
* Epidemiology
* Global health
* Health impact assessment
* Health system
* Infant mortality
* Open-source healthcare software
* Public health informatics
* Social determinants of health
* Health equity
* Race and health
* Social medicine

Biological and
epidemiological statistics|

* Case–control study
* Randomized controlled trial
* Relative risk
* Statistical hypothesis testing
* Analysis of variance (ANOVA)
* Regression analysis
* ROC curve
* Student's t-test
* Z-test
* Statistical software

Infectious and epidemic
disease prevention|

* Asymptomatic carrier
* Epidemics
* List
* Notifiable diseases
* List
* Public health surveillance
* Disease surveillance
* Quarantine
* Sexually transmitted infection
* Social distancing
* Tropical disease
* Vaccine trial

Food hygiene and
safety management|

* Food
* Additive
* Chemistry
* Engineering
* Microbiology
* Processing
* Safety
* Safety scandals
* Genetically modified food
* Good agricultural practice
* Good manufacturing practice
* HACCP
* ISO 22000

Health behavioral
sciences|

* Diffusion of innovations
* Health belief model
* Health communication
* Health psychology
* Positive deviance
* PRECEDE-PROCEED model
* Social cognitive theory
* Social norms approach
* Theory of planned behavior
* Transtheoretical model

Organizations,
education
and history|

| Organizations|

* Caribbean
* Caribbean Public Health Agency
* China
* Center for Disease Control and Prevention
* Europe
* Centre for Disease Prevention and Control
* Committee on the Environment, Public Health and Food Safety
* India
* Ministry of Health and Family Welfare
* U.S.
* Centers for Disease Control and Prevention
* City and county health departments
* Council on Education for Public Health
* Public Health Service
* World Health Organization
* World Toilet Organization

|

Education|

* Health education
* Higher education
* Bachelor of Science in Public Health
* Doctor of Public Health
* Professional degrees of public health
* Schools of public health

History|

* Sara Josephine Baker
* Samuel Jay Crumbine
* Carl Rogers Darnall
* Joseph Lister
* Margaret Sanger
* John Snow
* Typhoid Mary
* Radium Girls
* Germ theory of disease
* Social hygiene movement

* Category
* Commons
* WikiProject

*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template