India's missing toilets: Poor sanitation leads to malnutrition, stunted babies

‘Pehle shauchalaya, phir devalaya’ (toilets first, temples later). These words were uttered by then Gujarat chief minister and now Prime Minister Narendra Modi on 2 October 2013 in New Delhi. A month and half into his tenure, his promise requires lightning execution, it appears. A detailed report in New York Times on Sunday revealed that even children from well-to-do Indian families are prone to malnutrition due to poor sanitation. In a first, bad sanitation has also been linked to stunting of growth among children. Stunted growth is a potentially dangerous phenomenon. Simply speaking, stunted growth is a reduced growth rate in human development but it can even lead to early death. A piece on Wikipedia explains: “It is a primary manifestation of malnutrition in early childhood, including malnutrition during fetal development brought on by the malnourished mother. According to the latest UN estimates, an estimated 162 million children under 5 years of age, or 25%, were stunted in 2012. More than 90% of the world’s stunted children live in Africa and Asia, where respectively 36% and 56% of children are affected. Once established, stunting and its effects typically become permanent. Stunted children may never regain the height lost as a result of stunting, and most children will never gain the corresponding body weight. It also leads to premature death later in life because vital organs never fully develop during childhood.” [caption id=“attachment_1620043” align=“alignnone” width=“300”]  Demanding sanitation. AFP[/caption] There is no doubt that India needs to press the alarm button on this deadly trinity of poor sanitation, malnutrition and stunted growth. “Our realization about the connection between stunting and sanitation is just emerging,” Sue Coates, chief of water, sanitation and hygiene at Unicef India,  was quoted as saying by the New York Times. “At this point, it is still just an hypothesis, but it is an incredibly exciting and important one because of its potential impact.” This new linkage has only compounded the problems for India. Despite plans like Nirmal Bharat Abhiyan, the Centre has not succeeded in putting an end to open defecation. The background of the Nirmal Bharat Abhiyan says: “The concept of sanitation was expanded to include personal hygiene, home sanitation, safe water, garbage disposal, excreta disposal and waste water disposal. With this broader concept of sanitation, CRSP adopted a “demand driven” approach with the name “Total Sanitation Campaign” (TSC) ( now renamed as Nirmal Bharat Abhiyan) with effect from 1999. The revised approach emphasized more on Information, Education and Communication (IEC), Human Resource Development, Capacity Development activities to increase awareness among the rural people and generation of demand for sanitary facilities. This enhanced people’s capacity to choose appropriate options through alternate delivery mechanisms as per their economic condition. The Programme was implemented with focus on community-led and people centered initiatives. Financial incentives were provided to Below Poverty Line (BPL) households for construction and usage of individual household latrines (IHHL) in recognition of their achievements. Assistance was also extended for construction of school toilet units, Anganwadi toilets and Community Sanitary Complexes (CSC) apart from undertaking activities under Solid and Liquid Waste Management (SLWM).” The new government at the Centre has also focussed on Nirmal Bharat Abhiyan in its 100-day agenda. States were also asked to pull up their socks to achieve their target as seen in this internal directive from the Ministry of Drinking Water and Sanitation. But the problem remains, regardless of the effort and planning. “Just building toilets is not going to solve the problem, because open defecation is a practice acquired from the time you learn how to walk. When you grow up in an environment where everyone does it, even if later in life you have access to proper sanitation, you will revert back to it,” Coates told BBC as a part of different story. Although there is a declining trend seen in open defecation, the efforts get back to square one because of the burgeoning population. According to New York Times: “__Half of India’s population, or at least 620 million people, defecate outdoors. And while this share has declined slightly in the past decade, an analysis of census data shows that rapid population growth has meant that most Indians are being exposed to more human waste than ever before___."_ It goes on to say: “India is an increasingly risky place to raise children. The country’s sanitation and air quality are among the worst in the world. Parasitic diseases and infections like tuberculosis, often linked with poor sanitation, are most common in India. More than one in four newborn deaths occur in India.” Blaming the Central government alone for lack of sanitation will be a blunder. The people at large and the state governments in particular are equal stakeholders to make the programme a success. Internal communications between the Centre and the states are enough to indicate that the states have not performed upto the mark. In a letter to all the states regarding the Nirmal Bharat Abhiyan baseline survey data, 2013 the Centre urged all states to give “urgent attention” on the programme. So severe is the problem of open defecation in India that in February, Unicef India started a campaign Take Poo to the Loo to fight against this menace on the streets and online by involving the youth. It also came out with a song called Poo Party. Pathetic state of sanitation index in India has put the country behind China, Bangladesh and many African nations. The health and economic implications that a bad state of sanitation will have is abundantly clear. It is time to flush out open defecation in India.