Socio-cultural and behavioural factors constraining latrine adoption in rural coastal Odisha: An exploratory qualitative study.
Open accessAbstract
BACKGROUND: Open defecation is widely practiced in India. To improve sanitation and promote better health, the Government of India (GOI) has instituted large scale sanitation programmes supporting construction of public and institutional toilets and extending financial subsidies for poor families in rural areas for building individual household latrines. Nevertheless, many household latrines in rural India, built with government subsidies and the facilitation and support of non-government organizations (NGO), remain unused. Literature on social, cultural and behavioural aspects that constrain latrine adoption and use in rural India is limited. This paper examines defecation patterns of different groups of people in rural areas of Odisha state in India to identify causes and determinants of latrine non-use, with a special focus on government-subsidized latrine owners, and shortcomings in household sanitation infrastructure built with government subsidies. METHODS: An exploratory study using qualitative methods was conducted in rural communities in Odisha state. Methods used were focus group discussions (FGDs), and observations of latrines and interviews with their owners. FGDs were held with frontline NGO sanitation program staff, and with community members, separately by caste, gender, latrine type, and age group. Data were analysed using a thematic framework and approach. RESULTS: Government subsidized latrines were mostly found unfinished. Many counted as complete per government standards for disbursement of financial subsidies to contracted NGOs were not accepted by their owners and termed as 'incomplete'. These latrines lacked a roof, door, adequate walls and any provision for water supply in or near the cabin, whereas rural people had elaborate processes of cleansing with water post defecation, making presence of a nearby water source important. Habits, socialising, sanitation rituals and daily routines varying with caste, gender, marital status, age and lifestyle, also hindered the adoption of latrines. Interest in constructing latrines was observed among male heads for their female members especially a newlywed daughter-in-law, reflecting concerns for their privacy, security, and convenience. This paper elaborates on these different factors. CONCLUSIONS: Findings show that providing infrastructure does not ensure use when there are significant and culturally engrained behavioural barriers to using latrines. Future sanitation programmes in rural India need to focus on understanding and addressing these behavioural barriers.
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Family members (often husbands, fathers, and in-laws) restricted water fetching and sanitation-related movements, most intensely for unmarried daughters and recently married and pregnant women, less intensely for women of lower castes and widows.
“Research in India found that family members (often husbands, fathers, and in-laws) restricted water fetching and sanitation-related movements, most intensely for unmarried daughters [174,182,190] and recently married and pregnant women, [178, 182, 189] (less intensely for women of lower castes [135] and widows [174]).”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [182]
Movement restrictions influenced women and girls' access to water and defecation, urination, and menstrual management locations, and are most widely reported in India.
“Movement restrictions influenced women and girls' access to water [101, 110, 178] and defecation, urination, and menstrual management locations, and are most widely reported in India [62, 135, 174, 181, 182, 184, 187], [101,110,187,[189][190][191].”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [182]
General safety concerns were widely noted, including feeling unsafe collecting water or using sanitation facilities at night, and when toilets lack doors, locks, lighting, or are far; safety issues were particularly intense for adolescent girls, young women, and minorities.
“General safety concerns were widely noted, [100, 119, 123, 139, 143, 147, 171, 177, 182, 186, 188, 191, 201, 202, 223, 226-229, 233, 238, 240, 241, 251, 255, 257] including feeling unsafe collecting water, [100, 119, 177] or using sanitation facilities at night, [168, 171, 190, 229, 255-257] and when toilets lack doors, locks, lighting, or are far [171, 190, 214, 223, 239-241, 252, 255].Safety”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [182]
Sanitation facilities often enable privacy, though privacy can be challenging to obtain for those without sanitation facilities and for some using household or shared facilities; in India, women with latrines reported a greater sense of privacy, and adolescent girls and women found latrines useful for privacy during menstruation and defecation.
“Sanitation facilities often enable privacy, though privacy can be challenging to obtain for those without sanitation facilities and for some using household or shared facilities.In India, women with latrines reported a greater sense of privacy, [139] and adolescent girls and women found latrines particularly useful for maintaining privacy during menstruation and defecation, especially during the”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [182]
Social capital has facilitated sanitation access; women and girls have formed and maintained social connections when accessing sanitation locations, and sought social support to ensure privacy and safety and to protect reputations when urinating or defecating.
“Social capital has facilitated sanitation access.Women and girls have formed and maintained social connections when accessing sanitation locations, [130, 182, 189] and sought social support to ensure privacy and safety and to protect reputations when urinating or defecating [173, 182, 184, 187-190, 223, 226].”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [182]
Women frequently accompanied one another or asked men to accompany them for safety when open defecating.
“Regarding sanitation, women frequently accompanied one another or asked men to accompany them for safety when open defecating, [135, 173-175, 182, 187, 189, 251]”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [182]
The social norms around latrine use in rural India, including the perception that these facilities are dirty, is likely more powerful of a barrier to use than the potential draw to find privacy within.
“The social norms around latrine use in rural India, including the perception that these facilities are dirty, is likely more powerful of a barrier to use than the potential draw to find privacy within [60].”
From ’It’s like a burden on the head’: Redefining adequate menstrual hygiene management throughout women’s varied life stages in Odisha, India. (2019) · cites this paper as [60]
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- Authors
- Routray, P., Schmidt, W.-P., Boisson, S., Clasen, T., & Jenkins, M. W.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Emory University (US)
- Corresponding author
- Routray, Parimita
- Jenkins, Marion W.
- Venue
- BMC Public Health
- Published
- 2015-09-10
- Volume
- 15
- Issue
- 1
- Pages
- 880-880
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC4566293
- OpenAlex
- W2143080676
- Cited by
- 253
- References
- 26
- Citations by year
- 2026: 17 · 2025: 23 · 2024: 19 · 2023: 29 · 2022: 26 · 2021: 23 · 2020: 29 · 2019: 25 · 2018: 27 · 2017: 25 · 2016: 7 · 2015: 1 · 2014: 1
- FWCI
- 19.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- Bill and Melinda Gates Foundation
- London School of Hygiene and Tropical Medicine
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Social Sciences › Gender Studies › Gender Studies and Social Issues
- Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
- Keywords
- open defecation, sanitation behavior, behavioral barriers, sanitation programs, caste, gender, domestic water supply, rural sanitation, Odisha
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, Culture, Defecation, Family Characteristics, Female, Financing, Government, Habits, Humans, India, Infant, Infant, Newborn, Male, Middle Aged, Residence Characteristics, Rural Population, Sanitation, Socioeconomic Factors, Toilet Facilities, Qualitative Research, Young Adult
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