Open defecation is the human practice of disposing of feces in the environment rather than using a designated toilet or latrine. This practice involves using fields, forests, bodies of water, or other open spaces due to a lack of proper sanitation infrastructure. The persistence of open defecation is a profound global development challenge that undermines human dignity and poses a significant threat to public health and nutrition worldwide. Addressing this issue is fundamental to improving the health, well-being, and economic productivity of affected populations.
Defining the Practice and Its Global Scale
This practice occurs in a variety of settings, ranging from agricultural fields and roadside bushes to urban ditches and the banks of rivers and streams. The lack of a hygienic barrier between human waste and the surrounding environment defines the practice, regardless of the specific outdoor location. The WHO/UNICEF Joint Monitoring Programme (JMP) reported that in 2022, approximately 419 million people globally were still practicing open defecation.
While the number has been steadily decreasing, the scale of the challenge remains immense. A disproportionate number of those affected, specifically 91%, reside in rural areas where sanitation services are often inadequate. The problem is most concentrated in Central and Southern Asia, Eastern and Southeast Asia, and Sub-Saharan Africa, which require accelerated progress to eliminate the practice.
The Immediate Public Health Crisis
Open defecation initiates a vicious cycle of disease transmission, primarily through the faecal-oral route, often illustrated using the “F-diagram.” This diagram outlines how pathogens from feces move into the environment and eventually into a new host via multiple pathways, or “Fs.” These pathways include fluids, fingers, flies, and fields/floors. For example, feces left in the open can contaminate water sources, be carried by insects, or be transferred from the ground to the mouth via contaminated hands.
The direct result is a high burden of infectious diseases, including cholera, typhoid, polio, and intestinal worm infections. Diarrheal diseases are a particularly devastating consequence, and inadequate sanitation is estimated to cause 432,000 diarrheal deaths annually. These waterborne and soil-transmitted diseases are especially dangerous for children under five, who have underdeveloped immune systems.
Repeated exposure to pathogens contributes to a condition known as environmental enteropathy. This chronic infection and inflammation of the small intestine prevents the efficient absorption of nutrients, even when a child receives adequate food. Environmental enteropathy is directly linked to childhood stunting, resulting in long-term cognitive impairment and reduced physical development. This mechanism demonstrates how open defecation translates directly into a permanent reduction in a child’s health and developmental potential.
Broader Environmental and Social Ramifications
Beyond acute disease outbreaks, open defecation causes pervasive environmental contamination and significant social harm. Environmentally, the practice leads to the widespread pollution of shared natural resources, contaminating both surface water and groundwater sources. During heavy rainfall, runoff carries human waste from fields and open spaces directly into rivers, lakes, and aquifers, severely compromising the quality of water used for drinking purposes.
This systemic contamination also affects soil quality and ecosystem health, creating a constant reservoir of pathogens in the immediate living area. The sustained presence of human waste degrades the local environment, perpetuating the cycle of disease transmission. The practice also poses a profound threat to the dignity and safety of individuals, particularly women and girls.
The lack of private sanitation facilities forces women and girls to wait until dark to find a secluded place to defecate, exposing them to increased risk of assault, molestation, and violence. This lack of privacy complicates menstrual hygiene management and often leads to girls missing school during their periods. The social cost extends beyond physical safety to encompass psychosocial stress and gender inequality, impacting educational attainment and overall well-being.
Global Strategies for Elimination
Ending open defecation is explicitly targeted by the international community under Sustainable Development Goal (SDG) 6.2, which calls for achieving access to adequate and equitable sanitation and hygiene for all by 2030. Achieving this goal requires a dual approach combining physical infrastructure development (“hardware”) and behavioral change (“software”).
The hardware component involves constructing safe, non-shared sanitation facilities, such as latrines and toilets, that hygienically separate human excreta from the environment. This infrastructure must be paired with effective “software” strategies, such as the widely adopted Community-Led Total Sanitation (CLTS) approach. CLTS focuses on triggering a collective sense of disgust and shame within a community to motivate the building and use of toilets without relying on external subsidies.
To meet the 2030 target, the current rate of progress in providing safely managed sanitation must increase by approximately five times. Success depends on strong political commitment, increased financial investment, and the implementation of comprehensive, community-based programs. These strategies prioritize universal access to sanitation and hygiene, paying special attention to the needs of vulnerable populations, including women and girls.