2015-11-20

The jokes are too easy, the ramifications too deadly. People are dying all over the world from a lack of proper sanitation and hygiene - and access to basic sanitation services. Every year, 1.4 million children, including 200,000 children in India, die from diseases caused by fecal contamination. Habitat for Humanity is a world leader in addressing this culturally sensitive, often undiscussed issue.



Every family in the world needs access to sanitary facilities.
Photo: Habitat for Humanity.

Let us begin in India, which is said to be the center of the world's sanitation crisis. Of the nearly one billion people in the world who have no choice but to defecate in the open, about 60% of them live in India. This proportion has been steadily increasing, as other countries eliminate open defecation much more quickly than India, where about half of the population still defecates in the open and increases even more in rural areas.

Habitat for Humanity, an international NGO with the vision of a world where everyone has a safe and decent place to live, recognizes that sanitation is one of the smartest investments to be made in well-being and positioning a family and a village to have a brighter future.



In many parts of the world, children must carry water for their family's needs.
Photo: Habitat for Humanity.

According to the Copenhagen Consensus, for every $1 spent on sanitation there is a $6 return. Habitat staff and volunteers work with organizational partners and families across the globe to increase access to improved sanitation Habitat recognizes that housing is not complete without proper sanitation and includes access to water and sanitation in its policy priorities.

Habitats work in more than seventy countries includes installing sanitation units in Nicaragua, which are managed by local water, sanitation and hygiene committees; building ventilated improved pit latrines for vulnerable groups in Uganda; and providing thousands of home improvement loans to Vietnamese families who build enclosed toilets. Given that the world's sanitation crisis is concentrated in India, Habitat India is particularly engaged with sanitation solutions.



Hand cleanliness is vital to avoiding contamination in the home.
Photo: Habitat for Humanity.

A story recently shared in Habitats Annual Report entitled "Together We Build" highlights this work.

Jagdish Bairwa, 48, and his family have benefited from the private latrine they built in their compound in Rajasthan, India, with help from Habitat for Humanity. Bairwa's oldest son, Rameshwar, suffers from polio and depended on others to take him into fields before the latrine was built. Water and sanitation projects like this have provided significant health improvements for families like Bairwa's in many other countries to include Asia, Africa and the Caribbean.

We take our toilets for granted, but the toilet is the invention that has saved the most lives, by improving sanitation and preventing the spread of diseases through feces.  As mentioned, the $1 we spend on ending open defecation creates a $6 return on investment thanks to improved health and productivity. But the gains are even greater than lives and money saved. This World Toilet Day, we focus on how access to toilets is critical for ensuring the safety, equality, and dignity of women worldwide.

Working around refugee camps after the Tsunami in Indonesia and Sri Lanka, or the earthquake in Haiti, I quickly learned that another enormous problem with going to bathroom is safety - rape for example. A story was recently brought to my attention about two Indian girls who were raped and lynched last year after relieving themselves in a field at night.

Although we take clean water for granted here, in much of the world it is lacking. Photo: Habitat for Humanity.

Their state's top police official estimated that more than 60% of the rapes in the Uttar Pradesh state of India occur when the victims went outside to relieve themselves, because they had no toilets in their homes. Just imagine the stress this causes. A study conducted by a University of Oklahoma professor found that poor sanitation generates huge psycho-social stresses for women worldwide, as they worry about spying, sexual assault, and rape.

A Habitat representative told me that a quarter of the girls in India who drop out of school do so because they have no adequate sanitation. Teenage girls are more likely to leave school when they start menstruating because they lack privacy... and this barrier to participation persists, for the average 3,500 days that a woman menstruates over her lifetime. I was stunned to hear this.

Even worse, I was told, women often wait until before dawn or after dark to relieve themselves, so they can have some semblance of privacy. To plan for this, many women either "hold it in," which leads to urinary tract infections, or drink less water, which can lead to dehydration.

All human beings need to be able to go to the bathroom in ways that does
not risk their health. Photo: Habitat for Humanity.

The world has had a tough time meeting its sanitation goals. While the water target for the Millennium Development Goals was met in 2010, we missed the mark for the sanitation target by 9%. Goal 6 of the new Sustainable Development Goals ambitiously aims to "end open defecation, paying special attention to the needs of women and girls" by 2030.

How does India compare to the world? 2.4 billion people in the world lack access to private toilets or latrines, and 1 billion of them have nowhere else to go but outside. The majority of these people live in India. India falls behind poorer, less literate countries in sanitation; just 1% of Chinese and 3% of Bangladeshis defecate outdoors, compared with 48% of Indians. Having visited one of India's poorest states, Bihar, I have witnessed this firsthand.

Last year, Prime Minister Narendra Modi launched the Swachh Bharat "Clean India campaign," with the goal of ending open defecation in India by 2019 - ahead of the U.N.'s goal. This would be a 150th birthday tribute to Mahatma Gandhi, who stated that sanitation is "more important than political independence."

In every country in the world, World Toilet Day has local significance.
Photo: Habitat for Humanity.

Yet, Habitat believes that open defecation in India cannot be eradicated through the installation of toilets alone - root causes must be addressed. For example, defecating in the home is thought to be impure in certain cultures. Further, many Indians are reluctant to use pit latrines because they are disgusted at the idea of having to empty them; traditionally, a duty of the lowest caste of "Untouchables" (Dalit). A RICE Institute recent study found a robust association between the local understanding of untouchability and open defecation.

This is why Habitat India has launched its Sensitize to Sanitize campaign, which aims to build a demand for toilets while raising awareness around the need for proper sanitation systems. Habitat India sends team members to village panchayat meetings, in order to work in tandem with local leaders. Toilet types are tailored to specific communities. During the first year of the campaign, Habitat India has already built 5,735 toilets.

These toilets do not match the western conception of a flush toilet, but are tailored to the specific community. Usually for a rural family of five, a twin pit latrine is the best choice. There is a one-time expense of around $350. After the first pit fills in about three years, the second pit is used.

The ability to live life to its fullest is based on a home with sanitary facilities.
Photo: Habitat for Humanity.

In the meantime, the liquid waste in the first pit seeps into leach pits, and the remaining solid waste decomposes. The compost is high in nitrogen and phosphorus and can be used safely to fertilize fields. With minimal investment in areas without water piping infrastructure, families can still enjoy the benefits of private toilets.

Habitat India builds demand for these toilets, by visiting village panchayat meetings and working in tandem with local leaders. In collaboration with key decision makers, the team employs a methodology known as Community-Led Total Sanitation (CLTS). CLTS is a process of social awakening within a community, such that community members understand the collective benefit of ending open defecation. Once the community is convinced of the need for toilets, they create their own plan for a more hygienic environment, and come forward to Habitat for both technical and financial support.

Access to clean water is a must for all people. Photo: Habitat for Humanity.

In addition, Habitat is using microloans to help India build toilets.  Habitat India raises funds to fill the gap between government subsidies and the cost of actually installing toilets, recognizing that the poor often cannot access finance because they do not have proper documentation or account history. In assessing need, Habitat India prioritizes women-led households, widows, and families with menstruating girls.

Another story shared by Habitat indicates how important something we take for granted - a toilet - is for the women in India who do not have access to toilets.

Sharda Kamble lives in a village in Maharashtra where Habitat has a presence. She came forward to Habitat India along with the 20 other women, in order to end open defecation in their community. Habitat India complemented the money they had saved with a loan to build 20 toilets.

As per the Swachh Bharat campaign, the local district council was also supposed to subsidize each of the women, but their grants did not come through. The women did not let the delay stop them. Sharda Kamble sold her mangal sutra (wedding necklace), and encouraged the others to leverage their resources, and they managed to raise funds to install the sanitation units.

Sharda proudly told Habitat's team, "I can make many mangal sutras, but this was an opportunity to change our future and help others in my village." The dedication of these women to install a toilet - a luxury we often take for granted - is truly heroic.

The accomplishments are many. Habitat India has built nearly 30,000 homes with sanitation units, and over 10,000 sanitation facilities, mostly in rural India. Since launching the Sensitize to Sanitize campaign in October 2014, Habitat India has proven that it is possible to create demand, and has supported the installation of an additional 5,735 toilets.

Habitat India is also implementing a school sanitation program, to ensure that girls have private bathrooms in school - one less obstacle to continuing their education. School children are then looped into the awareness campaign, as ambassadors of change who promote hygiene in their community.

Habitat's India team believes that India is on track to end open defecation by 2019, thanks to the confluence of government investment, recent mandates for corporations to spend at least 2% of profits on Corporate Social Responsibilities, and NGOs who are mobilizing the grassroots.

In Myanmar, boys use pit latrines. Photo: The United Nations.

Through sanitation interventions, we can get to the bottom of a host of development issues and provide a safer brighter future for people. We can reduce fecally transmitted diseases, which cause the majority of illnesses in the world. We can curb malnutrition - open defecation leads to the spread of intestinal worms, and increased risk of diarrhea.

According to the World Health Organization, about 50% of all malnutrition cases are associated with diarrhea or intestinal worm infections. For diarrhea prevention, the return on investment is astounding: every $1 spent results in an average return of $25.50.

Despite eating enough food, children lose the nutrients to worms or diarrhea. Stunting is caused by chronic malnutrition, and almost 62 million Indian children are stunted, the highest prevalence worldwide. The RICE Institute study found that poor sanitation explains 54% of international variation in child height. A recent Stanford study reveals that child growth improved after communities reduced open defecation.

Finding a bathroom here in New York City can be a challenge - especially for tourists. But, having been in the field in Haiti, India, Indonesia, Mexico, Peru, Togo, Sri Lanka - even in Romania and Greece, I have witnessed the dire conditions around the world.

World Toilet Day is a day to appreciate this life saving invention... and to imagine how we can save many more. I call on you, the next time you sit on your toilet, to consider your privilege.

What can you do to save the life of children like this? Photo: Habitat for Humanity.

So what can you do on World Toilet Day to help more than one million children not die from dirty toilets - or lack thereof?  Check out these links and learn more; then share what you have learned with at least two of your friends:

Share this article (LINK).

View the My Toilet exhibition, a collection of photographs and stories of women around the world with their toilets.

Listen to this TedTalk, "Let's Talk Crap, seriously."

Watch this video about a see-through loo. Finally, donate to Habitat for Humanity.

The J. Luce Foundation and its sister charity, Orphans International Worldwide (OIWW), note the extreme importance of this day and its cause. Our Stewardship Report on Connecting Goodness published Marking World Toilet Day, U.N. urges 'Open, Frank' Discussion only hours ago. We salute and support Habitat for Humanity International as not only a global thought leader on the importance of homes with proper sanitation, but also as the leading organization in the world that is actually building them.

Habitat for Humanity International

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