Development, Sanitation and Personal Hygiene in India


The fact that many Indian rural dwellings lack toilets and that, therefore, a significant proportion of India’s rural population is forced to defecate in the open has, by facilitating the spread of bacterial infections, profound consequences for public health. Compounding this is the fact that open defecation means that people carry limited amounts of water with them and so, by default, post-defecation handwashing is cursory. This paper, using data from the Indian Human Development Survey, examines the demand for toilets in India and the quality of post-defecation personal hygiene. Income, education, and ancillary facilities in the dwelling—like kitchens, and proper roofs and floors—were the strongest influences on demand. However, ceteris paribus households in more developed villages were more likely to have a toilet than those in less developed villages. This suggests that, over and above specific factors, households’ toilet demand also depended on their social environment In setting out these results, the paper rejects the idea, put forward in several academic papers, that the problem of open defecation in India exists because considerations caste and ritual pollution lead rural Indians to prefer open defecation to toilet use.


En Inde, de nombreux logements ruraux ne disposent pas de toilettes et une partie importante de la population rurale est forcée de déféquer à l’air libre, ce qui facilite la propagation des infections bactériennes et a ainsi de profondes conséquences en matière de santé publique. À cela s’ajoute le fait que les gens ne transportent que des quantités limitées d’eau avec eux lorsqu’ils défequent à l’air libre et que, par défaut, le lavage des mains après la défécation est superficiel. Cet article utilise les données de l’enquête sur le développement humain en Inde (IHDS) pour étudier la demande de toilettes en Inde ainsi que la qualité de l’hygiène personnelle après la défécation. Le revenu, le niveau de scolarité et la présence d’installations auxiliaires dans le logement—comme la cuisine, un toit et un plancher adaptés—sont les facteurs qui ont le plus d’influence sur la demande. Cependant, toutes choses égales par ailleurs, les ménages situés dans les villages plus développés étaient plus susceptibles d’avoir des toilettes que ceux des villages moins développés. Cela suggère que, au-delà de facteurs spécifiques, la demande de toilettes de la part des ménages dépendrait également de leur environnement social. En exposant ces résultats, l’article rejette l’idée, avancée dans plusieurs articles universitaires, selon laquelle le problème de la défécation à l’air libre existerait en Inde à cause de considérations liées au système de caste et à la pollution rituelle, qui amèneraient les Indiens en milieu rural à préférer la défécation à l’air libre plutôt que l’utilisation de toilettes.

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  1. 1.

    This is particularly important in India where children are fed by hand.

  2. 2.

    Augsburg and Rodríguez-Lesmes (2018) show that the evidence on whether improved sanitation leads to better health outcomes is mixed: some studies offer evidence of positive health outcomes (for example, Dickinson et al. 2015) while others fail to find any effects (for example, Clasen et al. 2014). Although both these studies related to the Indian state of Odisha, they used different methodologies in coming to their conclusions—Dickinson et al. (2015) used regression analysis while Clasen et al. (2014) used randomised control trials.

  3. 3.

    Nallari (2015) showed that where sanitation facilities were lacking, adolescent girls faced multiple deprivations (education, free time, privacy and independent mobility) and risks (sexual harassment and physical and verbal assault).

  4. 4.

    In 1999, the Indian government launched its Total Sanitation Campaign which, in 2012, was renamed the Nirmal Bharat Abhiyan and which was relaunched in 2014, as a central plank of the new BJP government’s policy, as the Swachh Bharat Abhiyan. (Centre for Public Impact: Accessed 18 September 2017.

  5. 5.

    Coffey et al. (2017) also claim that rural women prefer open defecation to using a household toilet because it gives them an opportunity to escape, however temporarily, the confines of their homes.

  6. 6.

    Another source of aversion to pit latrines is anxiety about having them emptied.

  7. 7.

    Typical husbands’ responses were: “Ample space is available for open defecation, so why do we need to construct a toilet?” or “We are used to going to the fields—so why waste water and resources on a toilet?”

  8. 8.

    See also Cairncross (2003).

  9. 9.

    Given the cost of building sewers and sewage treatment plants, a common form of latrine in rural India are pit latrines which store faeces underground. Under WHO guidelines of a pit of around 60 cubic feet, a latrine pit is expected to fill up after approximately five years if used daily by a family two adults and four children after which it must be emptied or a new pit built (Coffey et al. (2017).

  10. 10.

    These figures are from the IHDS-2011 after grossing up by applying the household sample weights.

  11. 11.

    For example, Duflo et al. (2015).

  12. 12.

    Desai et al. (2015).

  13. 13.

    After grossing up, these comprised 68% of the households in IHDS-2011 with 39% and 29% of these households living in, respectively, ‘less’ and ‘more’ developed villages.

  14. 14.

    Five levels of education were distinguished: (i) no education; (ii) up to primary level of schooling; (iii) above primary and up to secondary level of schooling; (iv) higher secondary; (v) graduate or above.

  15. 15.

    Essentially, as Shah et al. (2006, p. 14) state, “untouchability is the avoidance of physical contact with persons and things because of beliefs relating to purity and pollution…[it] is an intrinsic feature of the Hindu caste system…[it] is all pervasive, classifying people according to hierarchy and prescribing how they should interact”.

  16. 16.

    The infrastructure used to classify villages into ‘less developed’ and ‘more developed’ were: the quality of roads; availability of public transportation; range of communication facilities; availability of electricity; sources of drinking water; types of cooking fuel most commonly used; presence of public institutions like police stations, banks, post office, public distribution shops; and the presence of voluntary organisations like a Mahila Mandal.

  17. 17.

    So, for example, households with a particular education level ceteris paribus would be more likely to have a toilet in a MDV than in a LDV.

  18. 18.

    See Long and Freese (2014).

  19. 19.

    These were computed first under the assumption that all households lived in LDV and then that all lived in MDV.

  20. 20.

    Inter alia the burial and disposal of animal carcasses; the skinning of animals; tanning leather and making shoes; scavenging; the removal of excreta. Moreover, since the property of being ‘untouchable’ is hereditary, the descendants of ‘untouchables’ are also ‘untouchable’ even though they might have long ceased to work in ‘polluting’ occupations.

  21. 21.

    See Smith (1776) who wrote: “a creditable day-labourer would be ashamed to appear in public without a linen shirt, the want of which would be supposed to denote that disgraceful degree of poverty, which, it is presumed, nobody can well fall into without extreme bad conduct” (Book 5, chapter 2, part 2, article 4) .

  22. 22.

    The results on untouchability reported in this paper show that the link between the practise of untouchability and the demand for toilets is considerably weaker than that, for example, in Spears and Thorat (2015).

  23. 23.

    In both less and more developed villages, there was a gap of 25 points, in the predicted likelihood of having a toilet, between households without an educated adult and households which had a graduate (Table 2: 30.9% versus 54.3% and 32.1% and 56.3%). There was a gap, in both less and more developed villages, of nearly 15 points, in the predicted likelihood of having a toilet, between households whose water supply was within the dwelling and households which had to obtain their water from outside the home (Table 2: 48.8% versus 33.3% and 52.3% versus 38.6%).

  24. 24.

    =0 included households that always washed their hands but without soap and included households that sometimes washed their hands with soap.


  1. Azeez, A., D.P. Negi, and A. Mishra. 2019. Women’s Experiences of Defecating in the Open: A Qualitative Study. Indian Journal of Gender Studies 26: 160–170.

    Article  Google Scholar 

  2. Augsburg, B., and P.A. Rodríguez-Lesmes. 2018. Sanitation and Child Health in India. World Development 107: 22–39.

    Article  Google Scholar 

  3. Borooah, V.K. 2004. On the Incidence of Diarrhoea Among Young Indian Children. Economics and Human Biology 2: 119–130.

    Article  Google Scholar 

  4. Borooah, V.K. 2018. Health and Well-Being in India. Basingstoke: Palgrave Macmillan.

    Google Scholar 

  5. Borooah, V.K., A. Tagat, and V. Mishra. 2019. Conflict, Caste and resolution: A Quantitative Analysis for Indian Villages. Indian Growth and Development Review.

    Article  Google Scholar 

  6. Burra, N. 1996. Buddhism, Conversion, and Identity: a Case Study of Village Mahars. In Caste: Its Twentieth-Century Avatar, ed. M.N. Srinivas. New Delhi: Viking.

    Google Scholar 

  7. Cairncross, S. 2003. Sanitation in the Developing World: Current Status and Future Solutions. International Journal of Environmental Health Research 13: S123–S131.

    Article  Google Scholar 

  8. Chambers, R., and G. von Medeazza. 2013. Sanitation and Stunting in India: Undernutrition’s Blind Spot. Economic and Political Weekly 48: 15–18.

    Google Scholar 

  9. Clasen, T., S. Boisson, P. Routray, B. Torondel, M. Bell, O. Cumming, J. Ensink, M. Freeman, M. Jenkins, M. Odagiri, S. Ray, A. Sinha, M. Suar, and P.S. Wolf. 2014. Effectiveness of a Rural Sanitation Programme on Diarrhoea, Soil-Transmitted Helminth Infection, and Child Malnutrition in Odisha, India: A Cluster-Randomised Trial. The Lancet Global Health 2: e645–e653.

    Article  Google Scholar 

  10. Coffey, D., and D. Spears. 2017. Where India Goes: Abandoned Toilets, Stunted Development and the Costs of Caste. Noida, Uttar Pradesh: Harper Collins Publishers India.

    Google Scholar 

  11. Coffey, D., A. Gupta, P. Hathi, D. Spears, N. Srivastav, and S. Vyas. 2017. Understanding Open Defecation in India. Economic and Political Weekly 52: 59–66.

    Google Scholar 

  12. Desai, S., A. Dubey, and R. Reeve Vanneman. 2015. India Human Development Survey-II University of Maryland and National Council of Applied Economic Research, New Delhi. Ann Arbor, MI: Inter-university Consortium for Political and Social Research.

    Google Scholar 

  13. Dickinson, K.L., S.R. Patil, S.K. Pattanayak, C. Poulos, and J.-H. Yang. 2015. Nature’s Call: Impact of Sanitation Choices in Orissa, India. Economic Development and Cultural Change 64: 1–29.

    Article  Google Scholar 

  14. Duesenberry, J. 1967. Income, Saving, and the Theory of Consumer Behavior. New York: Oxford University Press.

    Google Scholar 

  15. Duflo, E., M. Greenstone, R. Guiteras, and T. Clasen. 2015. Toilets Can Work: Short and Medium Term Health Impacts of Addressing Complementarities and Externalities in Water and Sanitation, NBER Discussion Paper 21521. Cambridge, MA: National Bureau of Economic Research.

    Google Scholar 

  16. Ejemot-Nwadiaro, R.I., J.E. Ehri, M.M. Meremikwu, and J.A. Critchley. 2015. Hand Washing Promotion for Preventing Diarrhoea, Cochrane Database of Systematic Reviews. New York: Wiley.

    Google Scholar 

  17. Ghose, S. 2003. The Dalit in India. Social Research 70: 83–109.

    Google Scholar 

  18. Ghosh, A., A. Gupta, and D. Spears. 2014. Are Children in West Bengal Shorter Than in Bangladesh. Economic and Political Weekly 49: 21–24.

    Google Scholar 

  19. Huang, D.B., and J. Zhou. 2007. Effect of Effective Handwashing in the Prevention of Diarrhoeal Illness among Patients with Aids. Journal of Medical Microbiology 56: 659–663.

    Article  Google Scholar 

  20. Jenkins, M.W., and V. Curtis. 2005. Achieving the Good Life: Why Some People Want Latrines in Rural Benin. Social Science and Medicine 61: 2446–2459.

    Article  Google Scholar 

  21. Kunnath, G. 2018. Rebels From the Mud Houses: Dalits and the Making of the Maoist Revolution in Bihar. Abingdon: Routledge.

    Google Scholar 

  22. Long, J.S., and J. Freese. 2014. Regression Models for Categorical Dependent Variables using Stata. College Station, TX: Stata Press.

    Google Scholar 

  23. Mendelsohn, O., and M. Vicziany. 2000. The Untouchables: Subordination, Poverty, and the State in Modern India. New Delhi: Cambridge University Press.

    Google Scholar 

  24. Nair, M. 2018. Educated Dalits are Mobilising Against Upper Class Antagonism, Rise of Hindutva Forces”, India Spend. Accessed 7 June 2010.

  25. Nallari, A. 2015. All We Want is a Toilet Inside Our Homes: The Critical Role of Sanitation in the Lives of Urban Poor Adolescent Girls in Bengaluru. Environment and Urbanization 27: 73–88.

    Article  Google Scholar 

  26. Pai, S. 2013. Dalit Assertion. New Delhi: Oxford University Press.

    Google Scholar 

  27. Planning Commission. 2013. Evaluation Study on the Total Sanitation Campaign. New Delhi: Government of India.

    Google Scholar 

  28. Rosenboom, J.W., C. Jacks, K. Phyrum, M. Roberts, and T. Baker. 2011. Sanitation Marketing in Cambodia. Waterlines 30: 21–40.

    Article  Google Scholar 

  29. Saleem, M., T. Burdett, and V. Heaslip. 2019. Health and Social Impacts of Open Defecation on Women: A Systematic Review”. BMC Public Health 19: 1–12.

    Article  Google Scholar 

  30. Sarah, H., Ferron, S., Sommer, M., and Cavill, S. (2014), Violence, gender, and WASH: A Practitioner’s Toolkit-Making Water, Sanitation and Hygiene Safer Through Improved Programming and Services. London: Water Aid/SHARE.

  31. Shah, G., H. Mander, S. Thorat, S. Despande, and A. Baviskar. 2006. Untouchability in Rural India. New Delhi: Sage Books.

    Google Scholar 

  32. Smith, A. 1776. An Enquiry into the Nature and Causes of The Wealth of Nations, K. Sutherland (Ed.) Oxford: Oxford University Press, 1993.

  33. Srinivas, M.N. 1962. Caste in Modern India and Other Essays. Bombay: Asia Publishing House.

    Google Scholar 

  34. Spears, D. and Thorat, A. 2015. Caste, Purity and Pollution and the Puzzle of Open Defecation in India, Working Paper, Research Institute for Compassionate Economics.

  35. Zainulbhai, A. 2017. A People’s Movement. Indian Express, 28 September Accessed 28 September 2017.

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An extended version of this paper appeared as chapter 2 of my book Health and Well-Being in India (Palgrave Macmillan, 2018) and is also available on the Munich Personal RePEc Archive (MPRA) The present paper is a major revision of the original version and, for that, I am grateful to two anonymous referees for comments and suggestions that have, by adding and subtracting from the paper, greatly improved it. While acknowledging this debt, I remain solely responsible for the paper’s deficiencies.

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Borooah, V.K. Development, Sanitation and Personal Hygiene in India. Eur J Dev Res (2021).

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  • India
  • Sanitation
  • Hygiene
  • Development
  • Caste
  • Religion

JEL classification

  • I12
  • I15