An entire nation drowning in its own excreta is an unpleasant thought, but this is what is happening, at least according to Sunita Narain, Indian environmentalist and Director General of the Centre for Science and Environment, author of “Excreta Matters“, “India’s first and most comprehensive survey …on the state of its water and its management”, in a comment piece published on June 14 in Nature.

Open defecation is practiced by more than 600 million Indians, according to the World Health Organization. The WHO calls open defecation the riskiest sanitation practice of all due to the ease of disease spread. More often than not, water is contaminated by the same people who drink it. Open defecation is rampant in slums and rural areas because alternatives simply don’t exist as pit toilets and flush or pour toilets are found primarily in urban areas. In the slums and rural areas, there might be public toilet areas, however, due to long lines and privacy concerns, many residents still wait until nightfall to go –increasing the risk of related violence, especially against women and girls. Open defecation and ill-maintained sewage and septic systems leak pathogen-laden contaminates into surrounding rivers and lakes, leading to disease outbreaks of waterborne pathogens and contributing to early mortality and is a major contributor to malnutrition due to chronic diarrhea and possibly improper absorption of nutrients due to an imbalance of intestinal microflora from consuming pathogen-laden water and food in a condition/syndrome called “environmental enteropathy“. Infants and children under five years old are particularly susceptible to diarrheal diseases.