One billion people worldwide still practise "open defecation"
and they need to be told that this leads to the spread of
fatal diseases, U.N. experts said at the launch of a study on
drinking water and sanitation.
"'Excreta', 'faeces', 'poo', I could even say 's***' maybe,
this is the root cause of so many diseases," said Bruce
Gordon, acting coordinator for sanitation and health at the
World Health Organization.
Societies that practise open defecation - putting them at
risk from cholera, diarrhoea, dysentry, hepatitis A and
typhoid - tend to have large income disparities and the
world's highest numbers of deaths of children under 5 years
Attempts to improve sanitation among the poorest have long
focused on building latrines, but the United Nations says
that money literally went down the toilet. Attitudes, not
infrastructure, need to change, it said.
"In all honesty the results have been abysmal," said Rolf
Luyendijk, a statistician at the U.N.'s children's fund
"There are so many latrines that have been abandoned, or were
not used, or got used as storage sheds. We may think it's a
good idea but if people are not convinced that it's a good
idea to use a latrine, they have an extra room."
Many countries have made great progress in tackling open
defecation, with Vietnam and Bangladesh - where more than one
in three people relieved themselves in the open in 1990 -
virtually stamping out the practice entirely by 2012.
The global number has fallen from 1.3 billion in 1990. But
one billion people - 90 percent of them living in rural areas
- "continue to defecate in gutters, behind bushes or in open
water bodies, with no dignity or privacy", the U.N. study
The practice is still increasing in 26 countries in
sub-Saharan Africa. Nigeria was the worst offender, with 39
million open defecators in 2012 compared to 23 million in
Although the prevalence of open defecation is in decline, it
is often common in fast-growing populations, so the total
number of people doing it is not falling so fast, or is even
The country with the largest number of public defecators is
India, which has 600 million. India's relatively "hands off"
approach has long been at odds with the more successful
strategy of neighbouring Bangladesh, which has put a big
focus on fighting water-borne diseases since the 1970s,
"The Indian government did provide tremendous amounts,
billions of dollars, for sanitation for the poorest," he
"But this was disbursed from the central level to the
provinces and then all the provinces had their own mechanisms
of implementing. And as their own data showed, those billions
of dollars did not reach the poorest," added Luyendijk.
India's government has now woken up to the need to change
attitudes, he said, with a "Take the poo to the loo" campaign
that aims to make open defecation unacceptable, helped by a
catchy Youtube video. (Warning: Contains offensive
"What is shocking in India is this picture of someone
practising open defecation and in the other hand having a
mobile phone," said Maria Neira, director of Public Health at
Making the practice unacceptable has worked in more than 80
countries, the U.N. says. The goal is to eliminate the
practice entirely by 2025. Poverty is no excuse, the study
said, noting the role of cultural differences.
In the Democratic Republic of Congo, 14 percent of the
population are open defecators. But where the head of the
household is an Animist, the figure is twice as high, at 30
percent. Among households headed by Jehovah's Witnesses, it
is only 9 percent.