Toilets and social networks: Is there a connection?

Of late, there have been plenty of discussions around the topic of sanitation, which have focussed on building toilets on a massive scale. These are in the aftermath of the new and recently released Millennium Development Goals Report 2014 by the United Nations that shows that India has the world's largest population that defecates out in the open, with it being as high as 66% in rural India [1].

This, despite efforts to achieve universal sanitation coverage since 1986 through constructing toilets under government schemes such as the Central Rural Sanitation Programme, the Total Sanitation Campaign (TSC), and the Nirmal Bharat Abhiyan. However, most of the toilets remain unused [5]. The new NDA government has now launched Swacch Bharat Abhiyan to deal with this problem [12].

But is it enough to just build toilets?

What influences toilet use?

A study conducted by the Research Institute for Compassionate Economics, Uttar Pradesh, from rural households in Bihar, Madhya Pradesh, Uttar Pradesh, Haryana and Rajasthan has made some very surprising and embarrassing revelations. It has found that although 40 percent of the households in these states have a functional toilet, at least one member from the household chooses to defecate out in the open [3, 6]. 

So why do people with a functional toilet at home still defecate out in the open?

This question, which has left a number of policy makers, planners, researchers and scientists perplexed, finds its answer in experiences gained from certain states in the country.

Behavioural change is key: Findings from qualitative and quantitative studies

Social dynamics and community must be factored: Findings from qualitative studies

• Latrines, a luxury:

  Open defecation is a socially accepted norm and latrines are considered luxury items or expensive assets. Latrine building decisions are rooted in motivations such as prestige and have little to do with concerns regarding health. Thus households that build their own latrines are the ones that come from a higher socio-economic status, are better educated or have a greater awareness of the benefits of latrines. They are likely to build latrines that are more expensive and those that match their preferences [3,4,9].

• Inexpensive localised latrines ignored:

  Concepts of purity and pollution hinder the use of inexpensive locally suitable latrine models. Household-built latrines are preferred and used as compared to government-built latrines as the latter's pits are smaller making it necessary for latrine pit emptying that people do not prefer due to concepts of purity and pollution. This also hinders the use of inexpensive locally suitable latrine models with more people preferring expensive toilet options [4].

• Age and gender dynamics:

  Open defecation behaviour is found to vary by age and gender. Villagers prefer open defecation as it allows them to chat together or because it is a time-honoured custom in their community. Open defecation is found to be correlated to age and gender with older men and women more likely to use a latrine while middle aged earning men of the house preferring open defecation. Among men and women, men have been found to show more preference for open defecation as compared to women who are more concerned with privacy issues [3,4,9]. 

Want change? Understand the importance of social networks!

• Individuals are more likely to own latrines if their social contacts own latrines. This relationship is stronger among those of the same caste, the same education, and those with stronger social ties [9].
• People who are more important or central in the community are most likely to own latrines as they have better exposure to the outside world and it is more likely for their social contacts to build toilets because of social pressures and expectations.
• However, those people who remain at the periphery or those who belong to marginalised communities are many a times not a part of the social networks and are the ones that do not have latrines. Among these individuals, studies show that the correlation between adoption of latrines through social contacts is strongest when the opportunity arises [9]. 

Latrine building efforts by the government through subsidies have been unsuccessful as they have been unable to address deeper social forces such as caste-based social divides that influence the adoption of toilets. [9]. The studies discussed have added a new dimension to intervention efforts directed at sanitation and have revealed the intricacies in decision making patterns at the community level that influence not only taking up, but the using of of toilets. The studies show that:

• Intervention efforts should be directed at communities, and not individuals.
• Caste and class differences do influence people’s decisions to adopt new norms. Many a time, it is important to target individuals at the periphery who, being deprived and marginalised, are at times faster in adopting toilet use due to being influenced by social contacts [9].
• Latrine building needs to be an accepted norm within a community rather than a matter of individual preference. For this, norms already prevalent in the community need to be overcome through extensive health education and communication, involving the community and through gradually introducing new norms [9]. 

This is a gradual process, though. As new norms begin to become entrenched in a community, there comes a tipping point, or a point at which a high enough proportion of the population has adopted the new process, after which it spreads rapidly and gradually uproots the earlier norm [9].

Interventions directed at sanitation must take into consideration the complex social processes that influence toilet acceptance in a community and move away from the blanket, supply-based target-oriented strategies that yield no results in the long run. Experience has shown that localised, community-based efforts that involve and take into consideration all sections of the community, bring about a gradual change in the health behaviour of people through convincing of the community and aiding them to make their own decisions.

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