Study on rural sanitation in India aims to answer questions on behaviour change


A newly published research study by the India WASH Forum that took place in rural Indian villages has identified and analysed key barriers and motivators of change in sanitation and hygiene behaviour.

The WHO funded study entitled “Formative Research to Develop Appropriate Participatory Approaches towards Water, Sanitation and Hygiene in Rural Areas” was conducted in the states of Gujarat, Telangana, and Jharkhand in India in 2015 and 2016.

“We believe this is a credible intensive research undertaken by India WASH Forum on the basic questions of why people are using, not using and not building toilets. These questions need to be asked repeatedly and the deeper motivation and barriers explored and addressed for improved sanitation and hygiene behaviours,” explained Depinder Kapur, a member of the core team of research.

Credit: WSSCCCredit: WSSCC

Research questions included – “Are there barriers to sanitation arising owing to the lack of knowledge and ignorance about the benefits of having and using toilets or from a deeper level of self-perception barriers of caste, class and gender? Who among village habitants are adopting building and using toilets and why? At what threshold level are more people willing to adopt or change their behaviors to start building and using toilets? What is the role of Behavior Change Communication (BCC) messaging and how is it perceived by the people? Why is it not working?”

Sanitation and Hygiene Understanding

The research documented in detail the current sanitation and hygiene practices of rural communities, developing an understanding why people behave the way they do and why building and using toilets remains a challenge in rural India.

It explains why people have a high level of cultural sensibility and knowledge of personal hygiene and cleanliness of their home environment, yet their understanding does not translate into adoption of safe sanitation and hygiene practices.

For example, one of the most common findings was that the awareness on the transmission of diseases through oral faecal route is highly limited in all the villages.

Moreover, the study highlighted that people do not attribute lack of sanitation to be the primary cause for major illness but think that it is due to a lack of proper nutrition, hard physical labour or general weakness of the human system over the years from early marriage, child birth, weakness from repeated attacks of malaria and viral fevers, etc.

Subsistence livelihoods and living conditions, generate a lower hope for improvement.

“Aspirations for a better quality and healthy life do not include sanitation and toilet in their list of priorities,” the report reads.

Notions of purity and cleanliness (purity is not equated with cleanliness, hence higher caste and purer people may display a poor hygiene standard) are very different in some tribal areas. A belief that open defecation is a safer sanitation management practice—not related to notions of purity-, dominates the tribal communities and other lower castes.


The research highlights and analyses several barriers to sanitation and hygiene in those rural areas. Among those are financial limitations, physical limitations but also gender inequalities.

“Low sanitation coverage could be an outcome of material conditions of the lack of water and space for toilets, as well as a result of subsistence livelihoods.”

The sanitation situation often varies from one village to another, with growing density of population, the practices of open defecation are shrinking, which promotes people to build toilets. However, where open spaces are plenty, there is often less pressure to build toilets.

Credit: WSSCCCredit: WSSCC

Gender barriers to sanitation uptakes are not as simple as they appear.

“Many women, girls and elderly do feel a desperate need for toilet, but they think that it is unreasonable to make the demand considering the financial crisis of the family and the struggle of their parents or head of the family,” explains the report.

Although men make most financial decisions including construction of a toilet, women said that they understood and agreed with the men whenever financial stress was a limiting factor.

There is an acute agrarian crisis in rural India and its impact on rural sanitation cannot be explained in gender relations alone.

Sanitation: a needed goal for the country

India faces the challenge of having the most number of people in the world defecating in the open and also has a burgeoning crisis of untreated faecal waste that is contaminating surfaces and ground water creating an imminent health crisis.

The research recommends the need to identify appropriate BCC messages from the perspective of the people and not of the implementation agencies (donor or government or NGOs) or from the skills and practices of some agencies who have employed commercial or social marketing approaches to sell products.

“Sanitation behavior change should not be reduced to selling toilets to people,” reads the report.

“WASH Behaviour Change messages are perceived for urban audiences, stereotyping rural people as ignorant and dirty. BCC messages in WASH should begin by honouring and respecting the hard physical labour and their dirty hands and feet. Only then should the hand washing and toilets message follow.”

Both motivating people to build and to use toilets is emerging as a major national priority as outlined in the Swachh Bharat Mission (Clean India Mission) initiated in October 2014 by Prime Minister Narendra Modi for achieving open defecation free India by 2nd October 2019.

“For a large country like India, with different social and economic contexts, this research tried to take more than a snapshot of the rural sanitation reality of India,” explained the report.