The United Nations’ Sustainable Development Goal 6 calls for the elimination of open defecation practices by 2030, and sub-Saharan Africa remains the greatest challenge in achieving this objective. With this goal in mind, concerted global efforts are being made to ensure success.

Open Defecation

According to the U.N., open defecation is the practice of excreting in an open space such as a field, river, or street, rather than using a toilet. The U.N. also reports that in 2017, despite open defecation rates nearly halving since the turn of the century, around 670 million people still practiced open defecation.

Two main issues surround the practice. Firstly, open defecation leads to the spread of diarrheal diseases, through the contamination of drinking water and crops. Diarrheal diseases are the leading global cause of child deaths, leading to around 800 children under the age of 5 dying each day.

Secondly, the practice leads to an increased risk of sexual violence against women. In 2016, UNICEF estimated that 50% of rapes that took place in India happened whilst women were defecating in the open.

Successes in India

India has been the focus of efforts to end open defecation for many years, due to the proportion of the large population that were practicing it. Between 2000 and 2017, the number of people practicing open defecation in India fell by 55%. While many question the government’s claim that India became “open-defecation-free” in 2019, there have undoubtedly been huge successes in reducing the rates of this practice across the country.

Global support and government funding under Prime Minister Narendra Modi led to a rapid and widespread rollout of toilets across India. Modi’s “Clean India” campaign began in 2014 and led to the building of 110 million toilets; one initiative led by LIXIL built 47,000 toilets each day.

Despite the successful roll-out of toilets across India, open defecation remains a common practice. Many researchers put this down to cultural barriers; rather than being the result of a lack of toilet, open defecation is most commonly an “ingrained cultural norm,” according to the U.N. Consequently, any long-term solution requires a focus on community perception and behavior alongside the construction and maintenance of proper toilets and sanitation services.

A 2020 study highlighted the successes of a community-based information campaign in Uttar Pradesh, India, aimed at rebranding the use of toilets and instilling new beliefs around the importance of sanitation. The social beliefs that are behind the persistent open defecation in India are twofold: beliefs that no one in the community uses toilets, and beliefs about rituals of purity and cleanliness. By directly tackling these social beliefs, the information campaign saw an increase of 11% in toilet use in villages across Uttar Pradesh.

Applying These Lessons in Africa

Open defecation in sub-Saharan Africa has become an increasingly significant focus in global health efforts. Based on the most recent data available, nine of the 10 countries with the highest percentage of the population practicing open defecation were in sub-Saharan Africa.

Furthermore, between 2015 and 2018, most of the countries with the highest proportion of the population exposed to community open defecation and its impacts were found in Africa, reaching a high of around 90% of the population in Benin and Ethiopia.

As in India, many of the reasons for open defecation in sub-Saharan African nations surround socio-cultural beliefs and values. Therefore, the successes and limitations of the approach taken in India have the potential to inform more effective practices across this region.

In Niger, 68% of the population was practicing open defecating as of 2020, according to the World Bank and only 13% of the population had access to basic sanitation services such as a toilet. Therefore a rapid and widespread roll-out of these sanitation services, as seen in India, has the potential to drastically change open defecation rates in Niger.

Practical and Cultural Approach

There are some examples of practical and cultural approaches to reducing open defecation rates. Between 2017 and 2018, UNICEF partnered with the Government of Niger to develop a plan to end open defecation by 2030. In 2020, the Bagaroua commune became the first Open-Defecation-Free community in Niger. The community chief put the success down to the roll-out of toilets in the region, which saw access to latrines increase from 10.3% to 100%, as well as the “sensitization” program which promoted behavior change. As a result of the work done by UNICEF and the Government of Niger, many parents in the Bagaroua commune reported that they realized the need to change their behaviors to keep their children safe.