Toilets before Temples – Rohit Lamba

Where India Goes: Abandoned Toilets, Stunted Development and the Costs of Caste

by Diane Coffey and Dean Spears

Harper Collins India, 288 pp., 2017.

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“Sanitation is more important than political independence”

-Mahatma Gandhi

Diane Coffey and Dean Spears are social scientists par excellence who are addressing intellectual puzzles that directly matter in improving the lives of the disadvantaged. Their new book Where India Goes is a culmination of patient and personal understanding of open defecation in India. (Disclosure: The authors and I went to graduate school together and I’ve admired their work for many years).

There are three key arguments that run through the book – (i) open defecation in India is a particularly Indian problem, (ii) the adverse health effects of defecating in the open, especially in dense dwellings, are far reaching, and (iii) we, as in the elites and policymakers, are failing to recognize and work through the key variables.

The stage is set with a stark empirical reality – in trying to correlate open defecation with economic growth, poverty and education, India stands out as a clear outlier. There are many regions in the world, for example sub-Saharan Africa and Bangladesh, which perform worse than India on these indicators but have done significantly better over the last few decades in reducing open defecation. There is something stubbornly unique about the astonishingly large number of open defecators in India, especially rural India.

At its core, the practice of open defecation, the authors argue, is steeped in caste, notions of purity, and the historic humiliation of the so-called untouchables. Using a combination of empirical, anecdotal and cultural arguments, Coffey and Spears make the case for putting on an Indian hat rather than the general “international development” hat in trying to address this puzzle. You may be able to convince people to build a toilet next to their shanty, but its use requires regular cleaning, or in the case of pit latrines periodic emptying, activities which are tied to caste hierarchies. In one of the first surveys on the subject that the authors and their team conducted, toilet use, even when they were available, was found to be the primary constraint. Providing resources to build toilets, the book rightly argues, is useless without simultaneous changes in social norms.

I differ slightly with authors on the bundling of purity, caste and untouchability. Sections of society can and have overcome at least an overt practice of untouchability while domestically or subconsciously maintaining notions of purity or even caste. Let me give you an American analogy. In large parts of America, people of color, especially African-Americans, were considered racially inferior and one of the instruments of segregation was toilets. In the gut wrenching novel The Help, which was later made into a movie, Kathryn Stockett tells the story of the white belief that certain diseases are carried by black people and spread through the sharing of toilets. Desegregation has not solved the problem of racial discrimination in the United States, but there are no more separate toilets. So yes caste, notions of purity and untouchability all contribute towards sustaining open defecation, however their role is not symmetric, and a good policy response would internalize this as such.

Moreover, caste is not uniform across the country. The authors’ analysis is Uttar Pradesh centric. There is little mention of local understandings of the problem almost as if they did not exist. What do local organizations and activists think? What knowledge has been accumulated over the years? To give you one example, the hilly states of Himachal Pradesh and Sikkim have been highly successful in reducing open defecation. What did these states find? What was it that worked there that has not worked or been tried in Uttar Pradesh?

The human cost of open defecation is morally repugnant; it manifests tellingly in stunting amongst young children. While precise causality between open defecation and stunting is hard to establish, enough research exists to suggest that through the mechanism of germs, diarrhea and inability of children to absorb nutrients, open defecation contributes to infant mortality and muted growth of our children. In what should be a health emergency, we are imperiling the physical and cognitive development of millions of children who would be denied the ability to accumulate any decent levels of human capital. The authors are completely sure footed in this part of the book, and execute it with an admirable precision.

In fact, Dean Spears was one of the first researchers to provide a rigorous explanation for the relationship between stunting and sanitation in his paper, “How much international variation in child height can sanitation explain?” He then followed it up with another fantastic paper with Mike Geruso titled “Neighborhood Sanitation and Infant Mortality,” which explains the difference in survival rates of Hindu and Muslim children. Externalities due to poor sanitation link the religious composition of neighborhoods to infant mortality which is lower amongst Muslim children.

The third part of the book tackles policy – what is being done and what can be done? This is a tough one. Coffey and Spears effectively show us what has not worked. But, there are no silver bullets to “solve” this problem. In what was a remarkable push to the cause, Prime Minister Narendra Modi put sanitation at the front and center of his first Independence Day address to the nation on August 15th, 2014. It was supposed to send a clear message to the polity and masses. A lot of what has followed after, the authors argue, has been much of the same – a bureaucratic rather than a scientific approach to end open defecation. The unrealistic target of making India open defecation free by 2019 may have even hurt the cause. I would add that combining the drive for cleanliness with ending open defecation under Swachh Bharat Mission may have diluted the message; these are different problems that require different strategies.

In their criticism of the state apparatus, the authors are rightly and wrongly impatient. They are rightly impatient because impatience is what is required to translate intent into reality. Some glaring errors, focusing on building toilets rather than behavioral changes for example, must make us extremely impatient and the authors deserve credit for making these measurable variables part of the policy parlance.

However, the authors are wrongly impatient too. Given the cultural history and state capacity, these things take time. Even though they acknowledge this reality towards the end, the criticism has already assumed a self-serving tone. Not much publicly available data exists yet to make sharp evaluations about how various parts of the country are faring in the goal towards becoming open defecation free. The survey conducted by the authors is already four years old but concluding commentary is on current policy. I had the opportunity to sit through a presentation by the Ministry of Drinking Water and Sanitation that showed recent evidence by independent authorities on the noticeable decline of open defecation in many parts of the country. I am skeptical but not dismissive. The challenge going forward, it was pointed out, is to make sure the villages marked “open defecation free” remain as such. Pontifications driven by the wrong impatience is the weakest part of the book that quickly becomes preachy with little content.

An important issue in the near term that the book does not touch upon in much detail is a potential track change in government strategy from building toilets and changing norms to aggressively investing in sewage systems. Pumping out sewage household by household helps sustain caste hierarchies. A sewage system with mechanized cleaning is how most developed countries made the management of solid and liquid waste more humane. This change in track will not be as easy task but it has to be an important component of the future course of action.

Finally, my main point of disagreement with the authors is this. Solving caste, a structure that still governs life in much of rural India, is not a necessary condition for solving the problem of open defecation. It could perhaps be a sufficient condition. Many problems including open defecation could be resolved if India became a casteless society. However, caste and its remnants are only gradually becoming less relevant; it will take decades, if not more, to make them irrelevant. Ending open defecation though is an instrument towards ameliorating the role of caste in society, not the reverse.

The above disagreement aside, Where India Goes exemplifies good research and writing in development. Social science would do well to encourage more Dianes and Deans within our clan.

Rohit Lamba is an Assistant Professor of Economics at Pennsylvania State University. He can be found at www.rohitlamba.com