Promoting Latrine Use in Rural India
Citation (APA 7)
Lahiri, S., Yegbemey, R. N., Goel, N., Mathew, L., & Puri, J. (2017). Promoting Latrine Use in Rural India. New Delhi, India: International Initiative for Impact Evaluation.
Abstract
Open defecation represents a major social and health burden for individuals, families and societies. India alone accounts for approximately 60 per cent of the global population defecating in the open, with the majority residing in rural India. Open defecation spreads diseases such as diarrhoea, schistosomiasis and trachoma and results in stunting and malnutrition of children. It can be dangerous and represent an affront to the dignity of vulnerable groups such as women, adolescent girls, the elderly and individuals with disabilities.
This scoping study informs the focus of 3ie’s thematic window on Promoting Latrine Use in Rural India. It examines the state of rigorous evidence regarding latrine use in rural India, as well as benefitting from a consultation with experts and a field visit. We conducted a systematic literature search in March 2016 to answer the research question, ‘What is the state of quantitative evidence of latrine use in rural India?’ We were interested only in completed quantitative studies that examine latrine use as a primary or secondary outcome. Only 11 studies met inclusion criteria, and of these, four studies used experimental study designs. The marked lack of studies measuring causal change represents a critical knowledge gap and priority area that needs to be addressed by future research.
We find that the most frequently cited barriers to latrine use were knowledge, attitudes and practices related to latrine use and poor quality of latrines. Latrine use is measured in various ways. The most common method is surveys that solicit self-reported latrine use in a household. We also examine correlations between latrine use and different subgroups and explore demand-driven approaches to promoting latrine use. The most common approaches to encourage demand in rural India are community mobilisation, such as Community-Led Total Sanitation. A clear finding from our review is that latrine design and functionality are important determinants of latrine use. Knowledge, attitudes and practices that inhibit latrine use must be addressed through reframing latrines as attractive commodities.
Our findings lead to several recommendations for future research. First, effective sanitation efforts must give adequate weight to the sociohistorical nature of entrenched behaviours that have been reinforced by generations of habit. Shifting these behaviours requires multilevel interventions that target multiple determinants of behaviour. The use of psychosocial theories of behaviour change allows for a framework in which different intervention components can be tested. Second, sanitation efforts must conduct appropriate disaggregated and formative analyses to address the differential needs of and programme impacts on vulnerable populations such as women, children, individuals from lower socioeconomic classes and scheduled castes and tribes. Third, measuring latrine use is difficult, relies primarily on self-reporting and observation and is prone to bias. Future efforts should explore triangulating the measurement of latrine use through disaggregated survey instruments that combine observation and self-reporting.