Open defecation (OD) is the practice of defecating outside - in nature such as in a forest, field or near bushes, or in public spaces like streets, urban parks, open fields etc. This behavior may be result of cultural practices or caused by lack of access to toilets.

It is a practice widely considered to be at the heart of issues around sanitation worldwide, having a significant impact on public health in those countries where a large proportion of the population has to resort to open defecation mainly for lack of other hygienic choices. Even if there are choices, i.e. toilets are available, convincing people to refrain from open defecation and to use these toilets can be difficult for a variety of reasons which is why behaviour change activities are seen as more and more important instead of merely providing toilets. Some parts of rural India are a very good example for this.^[1]

Open defecation in the developing world causes diseases which keep people poor.^[2] Some also see it as an "affront to personal dignity".^[2] It is thought that we cannot end extreme poverty without improving access to sanitation. Eliminating open defecation is an important part in development efforts.^[3] This includes campaigns to promote areas being "open defecation free" (ODF).

About one billion people in the developing world, or 15% of the global population, practice open defecation.^[4][5] As of November 2014, as per UN report— the Progress on Drinking Water and Sanitation- 2014 update, India is the country with the highest number of people (597 million people) practicing open defecation.^[6] This is 47% of the India's population.^[7][8][2] Indonesia (54 million people) and Pakistan (41 million people) are at second and third spot behind India in open defecation. ^{[9][10][11][12]}

Background

Open defecation is practiced all over the world in nature or camping type situations and represents no health and environmental problems when done in sparsely populated settlements and when the "cat method" is used, i.e. covering the feces with some soil, leaves or sand.^{[citation needed]} During war times, soldiers may use this option. It is often the method of choice for hikers and campers in remote areas.

Open defecation becomes a significant health problem and an issue for human dignity when it occurs in more densely populated areas, such as in larger villages or in urban informal settlements in developing countries. Here, the practice is usually associated with poverty and exclusion.

Use of the term

The term "open defecation" became widely used in the WASH sector in about 2008 when the publications of the Joint Monitoring Programme for Water Supply and Sanitation (JMP) started having an impact during the UN International Year of Sanitation. The JMP is a joint program by WHO and UNICEF to monitor the water and sanitation targets for the Millennium Development Goals (MDGs). For monitoring purposes, two categories were created: improved sanitation and unimproved sanitation. Open defecation falls into the latter category. This means that people practicing open defecation are counted having no access to improved sanitation.

The term "open defecation" has also become more popular due to the successes of the Community-Led Total Sanitation (CLTS) programs which have shown promising results in many countries after starting in Bangladesh by Dr. Kamal Kar. In the CLTS concept, a village can be declared "open defecation free" (ODF) if all villagers are using toilets (the toilets should normally have a water seal to prevent access by flies.

The significance of the first toilet is enormous in terms of breaking the habit of open defecation and getting people into the habit of using a latrine.^[13]

In 2013 World Toilet Day was celebrated as an official UN day for the first time and the term "open defecation" was used in high-level speeches, helping to draw attention to this issue (for example on the "call to action" on sanitation issued by the Deputy Secretary-General of the United Nations in March 2013).^[14]

Prevalence

The prevalence of open defecation as part of voluntary, recreational outdoor activities in remote areas is difficult to estimate but — as mentioned above — is also of very little concern from a public health, environmental resource protection and human dignity perspective.^{[citation needed]}

In developing countries however, the situation is entirely different. There, open defecation is a practice strongly associated with poverty and exclusion particularly when it comes to less remote and less rural areas, such as urban informal settlements. The good news is that over the past 22 years, the number of people practicing open defecation fell by a remarkable 21%, from 1.3 billion in 1990 to one billion in 2012.^[2] Those one billion people with no sanitation facility whatsoever continue to defecate in gutters, behind bushes or in open water bodies, with no dignity or privacy. Nine out of 10 people who practice open defecation live in rural areas, but the number in urban areas is gradually increasing.^[2]

82% of the one billion people practicing open defecation in the world live in just 10 countries. Globally, India continues to be the country with the highest number of people (597 million people) practicing open defecation according to the latest estimate from 2012.^[2] Other countries in the Top-10 list of countries with the highest number of people practicing open defecation (in absolute terms) are Indonesia, Pakistan, Nigeria, Ethiopia, Sudan, Niger, Nepal, China and Mozambique.^[2]

Reasons

There can be many reasons why a person openly defecates and these may include:

• Lack of other choices, i.e. no toilet available
• Toilets are available but are filthy, dark, smelly, or unattractive (often the case for shared or public toilets)
• Toilets are available but there is a risk of personal safety, e.g. if the toilets are public or shared and criminals are known to gather at those toilets to wait for possible victims
• Toilets are not available as part of the household but only at some distance and it may be dangerous to get there at night
• Diarrhoea attack may mean there is not enough time to go to the shared toilet which may be at some distance
• Cultural or habitual preference for going to the toilet "in the open air"; Using a local river or stream, or even the bush, may feel better than using a hole in the ground that smells or has flies and lacks light.^[3]

Therefore the reasons for open defecation are varied and it can indeed be a voluntary choice but in most cases it is due to the fact that the alternatives (i.e. toilets) are not available or not attractive.

Impacts

The health and personal safety impacts due to open defecation are principally the same as those from lack of sanitation.

Health impacts

Open defecation — or lack of sanitation - is a major factor in causing various diseases, most notably diarrhea and intestinal worm infections but also typhoid, cholera, hepatitis, polio, trachoma and others.^[15][16] For example, infectious diarrhea resulted in about 0.7 million deaths in children under five years old in 2011 and 250 million lost school days.^[15][17] It can also lead to malnutrition and stunted growth in children. Open defecation is a leading cause of diarrheal death; 2,000 children under the age of five die every day, one every 40 seconds, from diarrhea.^[18]

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 farmed 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 the rich and poor.^[2]

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."^[19]

Safety and gender impacts

There are also strong gender impacts: lack of safe, private toilets makes women and girls vulnerable to violence and is an impediment to girls’ education. Rapes and sexual molestation take place when women search for places for open defecation that are secluded and private, often during hours of darkness.^[20][21]

Prevention

Key drivers to eradicate open defecation include:^[3]

• Political will
• A focus on behavior change
• 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

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), behaviour 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.^[13]

As the highest number (in absolute terms) of people practicing open defecation live in India,^[2] various Indian government-led initiatives are ongoing to reduce open defecation in that country. One of them was called the "Total Sanitation Campaign" but as it was not very successful it has now become more similar to Community-Led Total Sanitation (CLTS) under the new name of Nirmal Bharat Abhiyan. In 2014, Unicef began a multimedia campaign against open defecation in India, urging citizens to "take [their] poo to the loo."^[22]

Short-term technologies

Long-term sustainable solutions are very important, but there are also technological possibilities that can reduce that proportion of open defecation which is due to not having toilets in the household and the shared toilets being too far or too dangerous to reach at night.

Whilst people might already use plastic bags (also called flying toilets) at night, a more advanced solution has been provided by the Swedish company Peepoople 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". This bag is now being used in humanitarian responses, schools and urban slums in developing countries.

A vast improvement on a conventional bucket (historically called chamber pot) are modern plastic urine-diverting dry toilets which can be operated odor-free in the household, used at night or during the day by people with disabilities and emptied for example on a daily basis. Due to the urine diversion, there is nearly no odor. Examples of this design are the MoSan^[23] toilet (currently on trial in Kenya), the urine-diverting dry toilet promoted by SOIL^[24] in Haiti or the urine-diverting dry toilet promoted by the Clean Team in Ghana.