This week I attended the Pakistan Conference on Sanitation, PACOSAN II, which took place in Islamabad. Among the many interesting issues raised, one stood out as a serious problem for communities within Pakistan. I am talking about the problem of open defecation.
It is not a pleasant subject and nobody really likes to talk about it. However, it needs to be addressed because children suffer and die from it in Pakistan every day.
Too many people throughout the country do not have proper toilets. They are forced to relieve themselves under the open sky, and involuntarily cause a major public health problem.
Let me tell you a story from my childhood. When I was growing up in Delhi, we lived in a middle class neighbourhood that bordered a poorer community of cow herders and dairy farmers. Faeces on the ground and open drains were part and parcel of my environment, even though we had a toilet in my home and I lived in a modern neighbourhood. My mother constantly nagged me not to run barefoot on the streets. However, playing pithoo required me to run fast, especially to defeat the boys, and running fast was not possible in rubber slippers. I would kick them off and run barefoot on the street, picking up the ball from open drains if necessary, and sometimes accidentally stepping in the human waste that lay on the street.
I constantly suffered from intestinal worms and parasites that robbed me of the nutrition that my parents so carefully invested in for their children. It was a source of constant worry for my mother that I was painfully thin and looked malnourished. She took my condition very personally, but could do very little to control it, because of the environment in which we lived.
In the end I was able to escape from the negative impacts of poor sanitation, because I enjoyed the advantages of a middle-class life, in particular a sufficient diet and proper healthcare and hygiene. Many other children are not that lucky.
Many children die because of diarrhoea and other infectious diseases that are linked to poor sanitation. Others develop a chronic infection of the gut, a condition which shows no acute symptoms, but over a long period of time hinders the intake of important nutrients.
These children become chronically malnourished and if nothing is done against it before their second year of age, it becomes too late. They become stunted; their physical and mental development is irreversibly damaged. Stunting is not only a problem for the child itself, it affects the community as well. If almost half of the future workforce suffers from this condition, as is the case in Pakistan, it will be a problem for the development of the country as a whole.
If we want to tackle stunting we need to stop open defecation. Current statistics show that over a third of the population in South Asia practices open defecation. There is also a very high rate of stunting. In Pakistan alone 41 million people do not have access to a household toilet. This is both a challenge and an enormous opportunity for improvement.
We know from other countries in South Asia like Bangladesh that reducing levels of open defecation is possible, by following the right policies and by investment in the right programmes. Policies and programmes that are built on the recognition that access to adequate sanitation is essential for human dignity. Policies and programmes that focus on community engagement and behaviour change. Policies and programmes that capture innovations, not just in the design of new products, such as toilets, but also innovations in processes that foster social change, citizen-led accountability and community education.
Such policies and programmes are also the key to improving gender equality and thereby directly affecting stunting. By giving women and girls, particularly during the adolescent years, more access to suitable sanitation facilities, we are improving the likelihood that they will be healthier and that they will have healthier children, who are not stunted.
Access to sanitation facilities could also reduce violence against girls and women, violence that is more likely when they have to walk far from home to defecate privately. Access to sanitation facilities in schools, that takes account of menstruation, will give adolescent girls less reason to miss class or drop out of school. And all of this – the improved nutrition, less violence, more schooling – we know empowers girls and women, promotes gender equality and has a ripple effect that is immeasurably good for their families, communities and national economies.
Improved sanitation is not a magic bullet, but we will not see real change without it. Investing in sanitation and hygiene will allow us to achieve healthier, more productive communities who live in dignity and are part of a stronger economy.
The writer is the deputy executive director of Unicef.