Nafisha, a 15 year old girl from Rasooolpura slum, Hyderabad tells her story of how people peep at them while they defecate and bath in open. The dignity of their life being hampered due to not having toilet was something that she and her friends have faced while growing up in the slum. Open defecation has impacted many kids adversely and maximum children in the slum have got diarrhea and other diseases related to water and sanitation.

As per joint monitoring programme (JMP), carried out by WHO and UNI¬CEF as of 2010, India contributes to 58 per cent of the world’s population defecating in the open. The recent political war between Mr. Jai¬ram Ramesh and Mr. Narendra Modi has brought back the focus on the lack of basic toilet facilities in most parts of the country. According to world health organization (WHO) and UNICEF's joint monitoring pro¬gramme; India loses more than 1,000 children of less than five years of age to diarrhea everyday; 80% of such deaths are below the age of two.

The millennium development goals (MDGs) enjoins upon the signatory nations to extend access to improved sanitation to at least half the urban population by 2015, and 100% access by 2025. This implies extending cov¬erage to households with poor sanita¬tion, and providing proper sanitation facilities in public places to make cit¬ies open defecation free.

More than 2.5 billion people lack ad¬equate sanitation worldwide especial¬ly in developing countries like India. Of these, 1 billion people defecate in open. In the least developed countries one in four people defecate in the open, largely as a result of poverty and inability to build separate toilets and the issues of space and land as well.

According to a report by The Guard¬ian, Diarrhea is, after pneumonia, the biggest killer of children under five in the world, responsible for 800,000 deaths each year – around 2,000 children every day. Even when diarrhea does not kill, it empties nu¬trients from the body which in turn, after repeated occurrences results in stunting, stopping children in their growth. Stunted children are not just shorter and thinner. They are more vulnerable to disease and their brains do not develop as they should.

Recent studies suggest a strong link between open defecation and under nutrition in India, where rates of stunt¬ing are high, despite strong economic growth. The latest estimates show that 48% of children under-five in In¬dia are stunted. Children there tend to be shorter than their sub-Saharan African counterparts, even though In¬dians are, on average, richer.

The scenario of availability of latrine facilities in India has improved in the 10 years between 2001 and 2011; but more than half of the nation's households still lack toilet facilities. From as high as 78 per cent of the households without toilet facilities in Jharkhand and Odisha to 2 per cent in Lakshadweep, a large number of people defecate in the open because they cannot afford to build a toilet from their own resources.

The main reasons for large number of population in India still defecating in open are large sections of the Indian population are not convinced of the need to stop open defecation, because of lack of proper awareness about the problems associated with open def¬ecation. Building toilets is often not a priority even for people who can af¬ford to construct toilets and use them.

Sanitation is a major national problem in India, requiring urgent action, es-pecially given the rate of urbaniza¬tion expected in the coming decade. India’s urban sanitation sector is pres¬ently inadequate and the situation could worsen in the coming decades unless acted upon immediately.

Poor sanitation not only affects the health of the people of the country, but also affects the development of the nation. In fact, women are most affected by the hazards of lack of proper sanitation.

Slum dwellers in major metropolitan cities especially residing along railway tracks and roadsides with little living space are having no ac¬cess to toilets or a running supply of water. The situation in urban areas in terms of scale is not as serious as in rural areas. However, what escalate the problems in urban areas are poor sewerage systems and highly con¬gested living conditions.

India has exceptionally poor sanita¬tion: the country accounts for 60% of the incidence of open defecation. Open defecation is an immense hard¬ship for those who have no other prac¬tical option and an important issue of human dignity. The conference also presented striking convergence in the evidence showing open defecation as a key factor explaining widespread stunting in the country.

In a country like India, where more than 37% people live below the pover¬ty line, assuring basic hygiene for one and all is a major task for the Govern¬ment. In India, sanitation issues be¬gin from lack of availability of clean drinking water, to improper disposal of human and other waste. Poor sani¬tation is responsible for vector borne diseases like malaria and diarrhea.

In fact, the lack of sanitation is linked with both child protection and educa-tion. Most girls drop out from school because of lack of toilets in the school as they don’t feel safe going out in the open. India cannot become a devel¬oped country without ensuring that every household and every school has a toilet. This is very much necessary in cities as mostly schools and anganwadis are neglected and ignored in urban set up. It is a basic necessity which we can no longer afford to ignore if we want to have a safer healthier and produc¬tive childhood and life.

Though these issues are having greater impact in urban India; but the total sanitation Campaign of Central Gov¬ernment focuses on rural households. Under Total sanitation Campaign (TSC), significant progress has been made since its inception; over 9.04 crore toilets have been provided for rural households. However, open def¬ecation by large population in India remains a matter of concern. To ad¬dress the issues and to accelerate the progress of sanitation in rural areas, the Government of India has designed a paradigm shift in Total Sanitation Campaign (TSC) which is now called the Nirmal Bharat Abhiyan (NBA), in the XIIth Five Year Plan. Urban prospective of this sanitation drive has been a demand from many civil society organizations working on living conditions in urban poverty.

A sanitation programme should be or¬ganised for urban slums and schools in major Indian cities keeping the growing slum populace in mind. This programme should be handled keeping the views and concerns of slum dwellers and specifically of children. This must include a behavioral change practice discouraging open defecation to all. The absence of which is leading India to misery. The programme should include converting existing toilet complexes to start functioning as community managed toilets, and repair toilet complexes and associated sanitation facilities like drains and dustbins. It should also been included in major housing and neighborhood development plans.

The programme should have long last¬ing initiatives to improve the hygiene and sanitation facilities for the most marginalized urban and rural house¬holds in India and increasing the ac¬cess to clean and hygienic sanitation facilities and the knowledge particu¬larly of girl’s health. These activities will contribute to an improved quality of life for families and their children, and provide them with the dignity and privacy they deserve.

It's also a social problem; women hold all day and it’s a question of dignity.” Open defecation doesn’t go away because of the reason in urban India that open defecation does not emerge as a key factor explaining shortfalls in child growth. The link between sanitation and child health outcomes across countries at the population lev¬el was also examined. An internation¬al comparison by Dean Spears shows that countries where people defecate in the open are the same countries where the most children are stunted and the average child is shortest. In a country like India, where more than 37% people live below the poverty line, as¬suring basic hygiene for one and all is a major task for the Government. In India, sanita¬tion issues begin from lack of availability of clean drinking water, to improper disposal of human and other waste.

There has been much discussion about World Toilet day these days. When the UN designated November 19 as World Toilet Day, it urged member states and other organizations to discuss and act on the sanitation issues plaguing developing countries. Through our work with CEPT, we hope to fulfill that call to action by engaging banks, social investors, and foundations to make small town sanitation a big deal.

The ramification of this sanitation shortage in Small and medium towns in India have particularly felt in the context of its impact on children.  Of the 1.2 billion people living in India, roughly 112 million live in small and medium towns and 7.6 million young children live in the slums of these cities.

Jawaharlal Nehru National Urban Renewal Mission (JNNURM), the major urban development policy in India has focused most of its budget on infrastructure investments in 65 major cities. Only one-fifth of the total budget was allocated towards small and medium towns where one-third of the urban population resides. Furthermore, this investment was focused mainly on improving the water supply rather than sanitation.

Maharashtra, being the India’s most urbanized state, 46.9% of households lack a toilet. Out of which 13% of people depend on public toilets and 34% defecation in open.