“They No Longer Needed to Put Themselves in Danger” – GFA World Report Part 2

Open Defecation Still Persists Worldwide, Even in America

While places like South Asia, Nigeria and Indonesia are noted for problems with open defecation, this poor health habit exists worldwide. In late 2019, the Pan American Health Organization (PAHO) said 15.5 million people in Latin America and the Caribbean are forced to practice open defecation. Calling it an “unhealthy practice,” PAHO official Marco Espinal said, “Improving access to water and sanitation through multisectoral policies and actions is critical to prevent disease and save lives.”⁸

After attending the toilet expo in China, NPR reporter Katrina Yu noted that toilet innovations may be a hard sell in other countries.

“Sanitation just isn’t sexy,” Yu wrote. “In fact, it stinks. According to the World Health Organization, governments, including many of those in Sub-Saharan Africa and Latin America, often neglect to consider safe sanitation when drawing up budgets and policies. ‘To have any hope of solving sanitation problems,’ said [Jim Yong] Kim of the World Bank, ‘we have to break taboos and get over our discomfort in talking about poop.’”⁹

The public declarations against open defecation stretch back for two decades. The Singapore-based World Toilet Association established its special day in 2001, with the United Nations General Assembly officially declaring November 19 as World Toilet Day in 2013. The observance aims to inform, engage and inspire people to achieve the goal of ensuring the availability of clean water and sanitation for all by 2030.

Yet as the UN and numerous governments, non-profits and non-governmental organizations (NGOs) work to eliminate the problem, it even exists on the streets of prosperous America. An October 2019 report by Environmental Justice said without sanitation when and where it is needed, the human right to sanitation for the homeless population has not been realized, leaving valid concerns about the risks of infectious disease transmission.

“The experience of Street Medicine physicians has yielded significant insight into how and why people experiencing homelessness resort to open defecation: the lack of public resources, perceptions about public toilets and the feelings of being unwelcome at them, concerns about safety, and physical and mental illness—including addiction—are all factors that contribute to OD,” the report said.¹⁰

The concerns raised by lack of access to sustainable sanitation and proper handwashing facilities have taken on new importance during the COVID-19 outbreak that engulfed the world in 2020. A report late last year from the World Bank placed the global costs of inadequate sanitation at an estimated $260 billion.

“Even before the COVID outbreak, our research conducted in 18 countries around the world showed that it’s poor children who suffer the most from inadequate sanitation,” said a summary issued on last November’s World Toilet Day. “Intestinal diseases related to poor sanitation, along with malnutrition and infections, contribute to stunting—one of the most serious and irreversible developmental problems facing children and impacting their future livelihoods as productive adults. In many countries, poor sanitation catalyzes a vicious cycle of poverty.”¹¹

Long-term Progress is Producing Slow but Steady Results

Yet, in spite of such gloomy realities, there has been long-term progress in the battle. Between 2000 and 2017, the number of people practicing OD was reduced from 1.3 billion to around 670 million, or 9 percent of the world’s population.¹² The UNICEF South Asia Progress Report for 2018–2021 said the proportion of people practicing OD fell from 65 percent to 34 percent in the region as a whole, with India, Bangladesh, Nepal and Pakistan all achieving more than 30 percent reductions since 1990.¹³ There is a financial advantage to toilet installation: the World Health Organization estimates a return of $5.50 for every dollar spent on sanitation.¹⁴

Improvements have been steadily moving in the right direction, says one report: “The global population using safely managed sanitation services increased from 28 percent in 2000 to 45 percent in 2017, with the greatest increases occurring in Latin America and the Caribbean, sub-Saharan Africa, and East and South-East Asia. In the period from 2000-2017, 2.1 billion people across the globe gained access to at least basic services and the population lacking basic services decreased from 2.7 billion to 2 billion.”¹⁵

More Direct Aid Needed to Sustain Progress

Amid these encouraging developments, though, a reality remains: As of 2020 only one in five countries with greater than 1 percent OD reported being on track to achieve near elimination of it among the poorest fifth of rural populations by 2030.¹⁶ That and the still-high numbers of OD mean direct aid is still vital in many regions of the world.