India: The Problem of Open Defecation
Scout Senyk's essay for Youth World Food Prize covers hygiene and malnutrition issues in India.
India is the seventh largest country in the world and is ranked second in population with 1,320,844,000 people. Located in South Asia, with the Indian Ocean to the south, the Arabian Sea to the southwest and the Bay of Bengal on the southeast. The Himalayas along with the Thar desert form the northern boundary of India. India has a total area of 1,222,550 square miles which is divided up into 29 separate states. Although India is one of the most populated countries, 67.6% of its population still resides in rural areas. The Himalayas play an important role in India's climate protecting it from the cold Central Asian winds keeping the country warmer than other countries at similar latitudes. India has a monsoon climate with hot wet weather from June until September and cooler dryer weather from October until February. The average winter temperatures in India are 50-59 *Fahrenheit, and the average summer temperatures are 90-104 *Fahrenheit. The monsoon rainfall is unpredictable year to year and in years of low rainfall drought frequently occurs.
Although India has one of the fastest growing countries economies in the world, it, unfortunately, has the largest number of people living underneath the World Bank's international poverty line of US $1.25 a day. As of the recent 2010 census, 31% of India's 1.35 billion people still live below the international poverty line that translates into 499,000,000 people. At 48%, India also leads the world in the number of children under five who are underweight. Rural India has rate of malnutrition due to a higher level of poverty than urban areas, due primarily to many factors, such as higher poverty rates, lack of sanitation, and decreased level of education.
Indian culture revolves heavily around family and caste. Indian families are patriarchal with the oldest male making many of decisions for the family. The traditional Indian family can include multiple generations living together in one household. The household may also include aunts, uncles, nieces, nephews. The members of the household share incomes, expenses, and household chores. The family cares for the old and disabled, and those to young to work. The property is inherited along the male line, therefore making male children more desirable than female children. When a female is married, she leaves her family and moves in with her husband's family the bride's family also customarily provides a dowry gift to the male's family. The caste system also heavily influences a family's future. The caste system is an easy of ranking individuals by the social status that they were born into. With the lowest class being the untouchables. Although discrimination through the caste system was made illegal, and the name untouchables changes to the scheduled class, it still plays a role in employment and income level.
Education is free and compulsory for all Indian children between the ages of six and fourteen. However since the individual states establish their own education laws, the length of primary education is not uniform. Primary education also suffers from a lack of resources, high teacher-student ratios, and the inability to enforce compliance. Fewer girls also attend school due to their lower status. Females also have a much lower literacy rate than males. Secondary education is available, but students must take entrance exams. Higher education is available once students pass the Higher Secondary Exam.
India lacks state provided healthcare. Instead, most health care is provided through the private sector. Most people in India pay out of pocket for all of their health care, and only 12 percent have any type of healthcare insurance. There are two state-run welfare programs. The first is the National Rural Health Mission which attempts to bring healthcare to the high poverty rural areas. In the rural areas, there is a lack of physicians only 2 percent of doctors live in rural areas while 68 percent of the population live in rural areas. There are also few hospitals in rural areas and a lack of equipment and diagnostic tools. The other system is the Urban Health Mission, which focuses on making healthcare available to the urban poor. Many of the urban poor still avoid state-run hospitals however because of lack of trained personnel and lack of basic equipment. To pay for treatment at private hospitals, many Indians are forced to go into debt and once they are unable to pay they are discharged whether or not they are well enough to leave.
Even though India has a diverse economy agriculture remains the largest employment source. Over half the population earns their income from agriculture. India now ranks seventh in agricultural exports. Rice, buffalo, cotton, wheat and soybean are the major exports of India. More than half of the country is under cultivation with that number steadily increasing. Due to India's reliance on the monsoon system for water, they are only able to raise one crop a year. A major problem for the agriculture industry, however, is the unpredictable nature of the monsoon season in times of low rainfall they lack an irrigation system to water their crops, so they face the risk of crop loss. Much of India's land has lost its fertility due to excessive irrigation, and over cultivation leading to depleted nutrients.
The average farm owned by a family in India is less than 1.2 hectares (3 acres). Sugarcane is the most profitable crop followed by cotton and soybeans. Many farms grow rice and wheat with over half of what is raised being kept by the farmer for their families consumption. Most of the work on farms is labor intensive, with little use of mechanized equipment. Labour and fertilizer are the highest expenditures on the typical farm. Most farmers sell their surplus crops to a private trader who frequently doesn't pay the state mandated price. Unfortunately, over 65 percent of households have less than one hectare of land, which is not enough land to raise a profit on crops grown. Due to the small size of their farms, many are classified as subsistence farms. The typical Indian family spends 40 percent of their income on food and eats a diet primarily of rice, vegetables and flat bread made from wheat. Due to the fact that a large part of their farm needs to feed their family the farmer usually needs to find another source of employment to make ends meet. Because of the dependence on rains from the monsoons for irrigation, crop failure is also frequent when the rainfall is inadequate. This frequently leads to the farmer having to borrow money from local moneylenders who charge higher than average interest rates. More than half of all agricultural households are in debt. Once a farmer goes into debt it is nearly impossible to get out of.
One of the major concerns facing India is malnutrition due to lack of clean water and sanitation. Malnutrition is defined as the lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things, or the inability to use the food that one does eat. India’s malnutrition rates are some of the highest in the world. At 48 percent nearly half the children in India are underweight. At 15.1 percent India ranks 120th out of 130 countries for child wasting. Another large problem India has related to malnutrition is stunting, meaning underdevelopment, 48% of children under five are stunted. What is unusual about India is this isn’t only occurring to India’s poor children a third of the children are from the upper classes.
The risk of malnutrition frequently begins at birth, many babies are born to teenage mothers, and 75 percent of them are underweight and anemic and frequently put in insufficient weight leading to a low birth weight baby. Even when children are born at a normal birth weight they frequently become malnourished. Malnourishment causes the body to divert food intended for development to fight off infections causing decreased growth and a loss of cognitive skills. When this occurs within the first two years of a child's life the effects are irreversible, leading to lower education levels and up to 45 percent reduction in lifetime earning potential. Malnourishment does not occur in just one economic demographic however, babies born to wealthy families often face the same problems of malnourishment that occurs in poor families. This leads to the one thing poor families and their wealthy counterparts have in common: poor sanitation and access to clean water.
Open defecation, the practice of people defecating out in the open wherever it is convenient, is one of the main factors leading to malnutrition. In the urban setting, 12 percent of the population open defecate and rural areas that number is 72 percent. Open defecation leads to polluted water; up to 75 percent of India's surface water is polluted. When water is exposed to untreated sewage it becomes a breeding ground for parasites and water-borne diseases such as cholera, dysentery, e.coli, and salmonella. Human exposure can come from consuming the contaminated water or eating foods that are washed or irrigated with the polluted water. Children are more susceptible to these diseases which frequently lead to diarrhea. Once a child becomes infected and begins diarrhea it becomes difficult for them to absorb need nutrients in the food that they consume. The inability of their bodies to adequately absorb the food that they eat may eventually lead to malnutrition, stunting, and even death. Even once they seek medical treatment for their low birth rate and the problem is corrected, it frequently recurs once they return home due to the continued consumption of contaminated water. Many families also wish not to stay long periods at government nutrition centers due to the loss of work and income which puts a heavy financial strain on the family.
There are two huge obstacles to eliminating the practice of open defecation. If India is eventually able to solve these problems however the incidences of disease related malnutrition will decrease dramatically. First, it is culturally acceptable. Many Indians have grown up in an environment where everyone does it. Defecating in the open is frequently considered good and healthy among rural Indians. The second major problem is lack of toilets ad infrastructure. Currently, only 30 percent of villages in rural India have a toilet, or the toilet they have needs to be emptied by hand every 5 years because there are no sewage treatment facilities. Due to the caste system, this becomes an issue due to the touching of excrement is associated with only the lowest caste. Eliminating the practice of open defecation will not occur until both problems are solved. To eliminate these problems, education and changing the social acceptability of open defecation should be a priority. The second factor is considering the types of toilets available and finding one that is acceptable to the people. Currently, the government of India is attempting to do theses two things with limited success.
The government of India has built 10 million toilets in rural areas in the last two years. Unfortunately, most are not utilized by the villagers. A Rice survey indicated that many Indians don't want to use the pit or latrine type toilets provided by the government because they fear the stigma attached to cleaning it. The fear that touching the excrement and being associated with the lowest castes is stronger than the fear of illness from unsanitary conditions.Two initiatives that the government is employing is the paying of a cash incentive to the village councils to enforce toilet use. There is also a campaign encouraging women to not marry a man unless his village has a toilet. These have had limited success. Unless the village is monitored closely they frequently go back to open defecation. The marriage campaign created the view that toilets were for women only. Due to the cost of building infrastructure, sewage treatment facilities are not being constructed in rural areas, so the dilemma of who will clean the toilet facilities needs to be addressed.
One current program that is showing success is bio-toilets currently in use by the Indian Railways. Biodigester toilets have several advantages over latrine or pit toilets making them more desirable to use. Bio-toilets use bacteria in the septic tanks of the toilets that break down waste products into usable water and methane gas through an anaerobic process. The process eliminates odors, harmful pathogens and decreases solid matter by 90%, does not require water, is maintenance free. Eliminating the need of villagers to touch the excrement eliminating the social stigma that comes with doing so.
Once toilets are built, the people have to be convinced to use them. One program that has shown success in the city of Ahmedabad is paying children to use the toilets. Children are paid one rupee a day (less than a penny) each day that they use the toilets intend of defecating in the open. Another method that worked in neighboring Bangladesh is a strategy called Community Led Total Sanitation which uses social pressure in villages to install toilets and discourage individuals from defecating in the open. Once you educate and convince some family members to use a toilet, pressure is put on the other members of the family to change their habits.
The country of India is experiencing an enormous public health crisis in the midst of large population growth. It accounts for the highest amount of deaths of children under five and 50 percent of these can be attributed to lack of clean drinking water and basic sanitation. When malnourishment occurs under the age of two irreversible cognitive deficits and motor delays occur; this costs India valuable human potential. India is a growing country, and the loss of human brain power will slow its growth and eventually cost it millions income potential. Ways to decrease these problems in India are through education, starting with children and mothers who are most at risk. Also if India invested in technology such as bio-toilets this would help reduce or eliminate the stigma that is currently associated with common pit toilets eventually increasing toilet use. Most of rural India lives in tightly knit communities real change needs to be started at the local level. If the village council enforces their local rules, educated their village members, and socially pressures those who are resistant to change, the acceptability of using toilets will increase. These changes will lead to cleaner water, healthier crops and animals and most of all healthier people. Indian families are frequently living on the edge of financial disaster, and one illness is all it takes to push them over that edge. By educating them on the long term financial benefits of using a toilet not only will they become wealthier but India as a country will become stronger and wealthier.
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