Researchers investigate sanitation facility use in Indian slums

Inadequate sanitation is a major public health problem that affects more than 2 billion people globally, mostly in low- and middle-income countries. Without proper sanitation, waterborne diseases can spread more easily, posing a significant health risk, especially for children under five, for whom diarrheal disease is one of the leading causes of death. Areas with poor living standards that lack basic infrastructures, commonly denoted as slums, are particularly at risk for poor sanitation.

Governments in low- and middle-income nations such as India have attempted to promote development of in-home latrines among residents and build public latrines in urban slums throughout the country. However, research has found that simply making sanitation facilities available is not enough, as many people living in slums are not using the new latrines.

To investigate this matter, Tiffany Radcliff, PhD, associate dean of research and professor at the Texas A&M School of Public Health, joined YuJung Julia Lee, PhD, previously a postdoctoral research fellow at the Bush School of Government and Public Service and now an assistant professor at Colorado State University, to find out what factors affect the use of sanitary facilities once public latrines become available. Their findings were recently published in the journal Urban Studies.

Their study surveyed people living in slums in Delhi, India. They focused specifically on slums built on public land where sanitation facilities are public and provided by the local government.

Their research team interviewed slum community leaders identified by survey respondents. Their analysis focused on daily use of a public sanitation facility as the outcome, with interaction with community leaders and demographic characteristics, such as gender, as independent variables.

Their analysis found that households where there was more interaction with a community leader were more likely to regularly use public latrines. Slum community leaders indicated that a lack of latrines was the largest problem their communities faced, unlike survey respondents who placed them second. More than 80 percent of slum leaders stated that the main actions they have taken to improve sanitation was educating residents on the use of toilets, with maintenance and cleaning being the next most common action. Requesting or building new latrines were cited far less often, indicating that availability and access to sanitation facilities is less of a problem than keeping toilets clean and functional and getting people to use them.

They also found differences in public latrine use and interaction with community leaders based on gender. About 1 percent of male respondents stated that they did not have a community leader to speak to about problems; however, for women that figure was approximately 12 percent, and women who interacted with slum community leaders were more likely to use public sanitation facilities than those who interacted mostly with religious leaders. Such gender-based differences point to the importance of including women in efforts to promote toilet use and access and the need to address women’s needs and concerns.

“The findings from this study indicate that efforts to improve sanitation need to move past access to latrines to making use of social networks within communities where sanitation facility use is lowest,” Radcliff said. “As the world continues to become more urban, the need for further improvements in sanitation will be needed to address a major public health threat and keep populations healthy.”

This article was originally published in 2019 and has been edited with updated information.