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Uttering the word “defecation” is often considered impolite. People say “going to the back” in Indonesia and “folding legs” in Cambodia. Many people also ask where to wash their hands rather than where the toilet is, avoiding the “dirty” word for the sake of politeness.
While talking openly about defecation may cause discomfort or embarrassment, it is a topic we all need to discuss. More than 1 billion people around the world still practice open defecation, the practice of defecating outdoors. Of this number, more than 60 percent live in Asia, according to a World Health Organization/UNICEF Joint Monitoring Program report.
Excreta, the product of defecation (commonly referred to as “shit”, “poo” etc.), causes diarrhea and other deadly infectious diseases. WHO statistics show that more than one in 10 child deaths (about 800,000 per year worldwide are caused by diarrhea. Among other negative consequences, open defecation can cause the contamination of water, food and soil and increases the number of flies and insects carrying excreta and spreading disease.
When people do not wash their hands before meals and after defecating, this further increases the risk of disease.
The economic impact of sanitation is enormous. A World Bank study on the Economic Impact of Sanitation in Southeast Asia found that poor sanitation brought economic losses of at least US$9 billion per year, with communities suffering from illness, loss of life, high medical costs and time off work. For the millions of boys and girls who miss school every year due to illnesses resulting from poor sanitation the implications are far-reaching, affecting their ability to learn and fully participate in their education.
Poor sanitation also has a big impact on the safety and wellbeing of women and girls; the day-to-day humiliation and risks faced by women and girls without access to appropriate sanitation facilities have been demonstrated time and again.
In countries such as Pakistan, women and girls who do not have sanitation facilities but still observe strict social codes will only defecate at night, further increasing their risk of violence and abuse. As recently as last month, a girl was raped in East Java on the way back from defecating near her home.
Among the underlying problems that perpetuate open defecation is a wide acceptance of this long-entrenched habit in many communities and a lack of leadership at different levels, from communities to local and national governments.
In many countries, sanitation improvement is still considered the main responsibility of the water and sanitation sector, which is often fragmented and lacking the necessary resources to undertake significant initiatives.
What can be done? First, we need to talk about open defecation! Global sanitation advocates are leading the way this year for the Nov. 19 World Toilet Day, with the Water Supply and Sanitation Collaborative Council and its partners encouraging people to talk in plain language about “giving a shit”. Water Aid is drawing attention to the fact that one in three women worldwide risk shame, disease, harassment and even attack because they have nowhere safe to go to the toilet.
Second, we need to work together to amplify the message and increase impact. Governments and development partners can combine efforts to highlight how improved sanitation is benefiting communities, particularly girls, boys and women. At all times we should focus on the powerful effects of collaboration, involving development partners, governments and communities in creating sustainable solutions that benefit everyone.
Third, make sanitation a community-wide issue! By enlisting the support of mass organizations active in many countries in Asia, we can build on experience and expertise from within and outside the water and sanitation sector.
This engagement needs to be long term as previous “on and off” efforts in some countries have proved ineffective in creating and sustaining the momentum needed to bring about lasting change.
Fourth, empower those who work on the front line. Health and sanitation facilitators need to be better equipped to motivate communities to take part in collective action to improve sanitation, drawing on the best available evidence and skills necessary to bring about change. These critical front-line agents of change also need to be able to convey upwards the communities’ expectations and aspirations.
At the decision-making level, local governments need to be better resourced to facilitate community-based activities and to plan, implement and monitor local sanitation improvements.
Spearheaded by its water and sanitation teams in 13 countries, Plan has for more than 50 years been participating in collective efforts to enable communities, particularly women and children, across Asia to lead healthier and safer lives with dignity. To date, approximately 10,000 communities, including those in Bangladesh, Cambodia, Indonesia, Laos, Nepal, Pakistan, the Philippines and Vietnam, have been supported to stop open defecation through the Community-Led Total Sanitation (CLTS) approach. CLTS does not involve the provision of materials but focuses on triggering communities to eradicate open defecation practices.
World Toilet Day offers a timely reminder that we have a long way to go — and that the humble toilet is one of the key tools in the fight to create healthier, safer and more dignified living conditions for all.
The writer is the WASH specialist at Plan International’s Asia Regional Office.