10 Million Child Deaths Attributed to a Lack of Toilets


Randall Hackley


In a world in which 14 percent of the population in the 21st century still defecate outdoors, children remain among the most vulnerable to a lack of toilets, contamination from human waste and dirty water.

The young are suffering the brunt of a health and development crisis that has claimed the lives of at least 10 million children under the age of five since 2000 because they have no access to a basic toilet, according to a new report from the international development organization WaterAid.

The United Nations, which designated today as World Toilet Day to highlight sanitation as a developmental priority, says about 35 percent -- 2.5 billion of the planet’s 7 billion people -- live without basic sanitation facilities such as toilets and latrines. That’s at a time when more people have mobile phones on Earth than a toilet. Globally, an estimated 1.8 billion drink fouled water that’s faecally contaminated, according to World Health Organization/UNICEF figures.

Yet the water and sanitation picture isn’t all grim, said Jack Sim, the Singapore-based founder of the World Toilet Organization that spurred today’s UN events. From 1990 to 2012, 2.3 billion people around the world gained access to an improved drinking-water source, according to UN-Water data.

In that time frame, child fatalities from diarrheal diseases -- strongly associated with poor water, sanitation and hygiene -- fell from about 1.5 million to about 578,000 children four and younger who died last year from diarrheal causes, a Lancet study published last month showed.

‘Preventable Deaths’

The WHO estimates that 88 percent of diarrheal mortality among the young can be attributed to a lack of access to sanitation, clean water and hygiene. Which WaterAid calculated as about 508,000 children who died last year because those services weren’t available -- “preventable deaths” as Sim said in a Nov. 17 phone interview from New York.

In many poorer countries, no access to soap and water to wash hands and inadequate sanitation practices fuel the spread of disease, not only in households and communities but in schools and health centers. Poor water, sanitation and hygiene conditions in communities and institutional settings, especially health facilities, exacerbated the spread of Ebola in West Africa, according to medical authorities.

‘Ground Zero’

In India, perhaps Ground Zero in the sanitation and faecal contamination battle, the government has set Mahatma Gandhi’s 150th birthday in 2019 as its target for achieving “total sanitation,” including access to toilets for all 1.2 billion residents.

India accounts for about 60 percent of Earth’s residents without toilets, highest in the world. Human and animal excrement that goes into its fields pollute groundwater, crops and waterways, causing diarrhea and cholera.

Central to the problem is that for behavioral and other reasons, many in India with latrines don’t use them, said Payal Hathi, associate director of the Research Institute for Compassionate Economics.

A “squat survey” in five Indian states of 22,000 people found that in 56 percent of the households surveyed, every member of the family was defecating in the open. Only 26 percent of the households used latrines. In 40 percent of the homes with an open latrine, at least one person didn’t use it.

People with government-funded toilets, part of a plan to build 111 million within five years, are twice as likely to go out to defecate, Hathi said in New Delhi. The institute predicts that more than half the households will continue to defecate in the open even with the toilet-building program.

‘Deep-Seated Beliefs’

“Our survey shows deep-seated beliefs in the ideas about pollution and impurity,” Hathi said. Many think “having a toilet at home pollutes their home. Also, cleaning toilets and the pit dug for feces has been connected to certain castes.”

And “many believe that walking out in the open in early mornings to defecate in the fields or open spaces is good for their health.”

That’s one of Prime Minister Narendra Modi’s challenges in combating the sanitation problem, one that costs India 600,000 lives annually from diarrhea. An estimated 1.1 million liters (290,000 gallons) of excrement enters the Ganges River every minute, the revered 2,525-kilometer (1,570-mile) waterway Modi has promised to clean.

India’s situation also exposes a third of its females to the risk of rape or sexual assault, a danger that gained worldwide attention in May when two girls from an Uttar Pradesh village were raped and hanged from a mango tree after they went outdoors to defecate.

India’s 50 percent open defecation rate in contrast trails a 3 percent rate in Bangladesh and 1 percent in China, according to a May report by WHO and Unicef. Modi last year said if elected he’d construct “toilets first, temples later.”

“Let’s be optimistic,” Sim said. Modi represents the future and those reluctant to accept building toilets across India should “think of the toilet as something normal, a lifestyle, sell it as a fashion, a status symbol.”