This week’s column considers the various kinds of problems that appalling sanitation brings with it.A large majority of Indians do not have access to proper sanitation facilities. Credit: Reuters/FilesAt 18, I moved to Delhi to go to college. I was to live in a hostel. It was all very thrilling, leaving the nest and roughing it out (or so I thought), but secretly, I was also very nervous. And one of the things that figured shockingly high on my list of things to be worried about was the loo. Would it be an ‘Indian style’ thing, or would I be lucky enough to have WCs? For someone who has very rarely had to squat in the loo, the idea of an Indian toilet was terrifying. This anxiety was shared by most of the girls in the hostel – largely from the same class demographic.But for a large majority of Indians, the sanitary anxieties of the urban middle-class are first world problems. On November 19, World Toilet Day – instituted thus by Singaporean businessman, Jack Sim in 2001 and adopted by the UN in 2013 – the government claimed that over 1.2 lakh villages have been made ‘open-defecation free’ under the Swachh Bharat Abhiyan, among other claims.Let's join hands and work towards creating an open defecation free (ODF) India by 2019. #WorldToiletDay #GoIInformation pic.twitter.com/DZ9q1tbpIT— MyGovIndia (@mygovindia) November 19, 2016On the same day, though, IndiaSpend reported that 157 million Indians make do without proper toilets. The Swachh Bharat mission, the report says, managed to build 9% of the number of public toilets it sought to build and 40% of the individual toilets.In fact, according to a Water Aid report, India has the highest number of people without access to any system of removing human waste – which consequently leads to several other problems.On #worldtoiletday, worth noting that more people worldwide have cell phones than toilets. Poor sanitation causes disease & malnutrition.— Nicholas Kristof (@NickKristof) November 18, 2016Of diarrhoea and toilet heroesOver 1.5 million people die of diarrhoea each year according to the World Health Organization and it can be especially fatal for children. People without access to proper sanitation facilities are especially susceptible to diarrhoea because they are exposed to pathogens like E.coli which cause intestinal infection.NPR reported that India has the highest number of deaths caused by diarrhoea in children under five. The report says that more than 1,30,000 children died of diarrhoea in 2013. Even if the children do survive, though, the chances of malnutrition are aggravated. A persistently infected system finds it harder to absorb nutrients, weakening the body’s immune system further, thereby making it vulnerable to more infections.On World Toilet Day, this year, UNICEF decided to recognise ‘toilet heroes’ – children from around the world who have contributed to the cause of sanitation. Toilet hero, Ram, for example, is an 11-year-old from Delhi, who had been denied his sanitary rights and now uses his experience to sensitise his community.Women and sanitationIn 2014, Modi had said that the “dignity of women” depended on proper sanitation. Dignity, in that case, has not secured.Women are forced to defecate in the open, under the cover of darkness to avoid being seen. Credit: Reuters/FilesIn addition to disease, women also have to worry about assault in the absence of proper toilets. Rape, it would appear, is a very real threat to women who are forced to defecate in the open. Rose George, the author of The Big Necessity: The Unmentionable World of Human Waste and Why It Matters wrote about women in Odisha who go in groups under the cover of darkness to do their business in the fields, wary of the relentless male gaze. She also referred to the Baudaun rape, saying that the girls “had gone out to use the field as a toilet; they had been gang raped and lynched.”Dignity for Her, a study by the Bank of America this year, wrote, “This fear of sexual assault and the largely poor state of sanitation facilities results in girls controlling their bladders for as long as 13 hours a day. This has significant, long-term repercussions on their overall as well as reproductive and sexual health.”Menstruation is another major hurdle. Already taboo-ridden, menstruation has led to at least 23% of Indian girls dropping out of school at puberty in the absence of proper facilities, Dignity for Her claimed. According to Factchecker, 80% of schools in India do not have enough facilities to help girls manage menstruation, such as proper disposal solutions and areas to dry used towels.In fact, the report points out that 24% of the schools in nine states across the country do not have separate toilets for girls, which often forces them to resort to fields.The purity of the looWith sanitation comes stigma. Not being conversation for polite society, several pressing sanitary issues remain undiscussed and on the shelf.While we may have been horrified about the ‘Indian style’ loos of the hostel given the notions of hygiene we had been conditioned to believe in, some have suggested that traditional belief systems have prevented a large majority of Indians from adopting private toilets in their homes.The stigma attached to toilets implicitly ushers in a notion of purity. But as Youth Ki Awaaz asked, “But how do we react when a domestic worker who works in our homes needs to answer nature’s call?” Curating responses from social media, the article suggests that most urban-dwelling, middle-class Indians use hygiene as an excuse to deny their bathrooms to domestic helpers, or believe that they need to be “trained” before being allowed to use the loo.The word ‘hygiene’ becomes a scapegoat for entrenched classist-casteist biases. As Youth Ki Awaaz writes, “It highlights the apathy of the privileged towards those who clean toilets, collect garbage, sweep roads, or are manual scavengers,” adding that building more toilets simply isn’t going to be enough.Earlier this year, in August, Bezwada Wilson – social activist and Magsaysay award winner – had said that more than 12 crore toilets are being built under the Swachh Bharat Abhiyan, but the government is relying on the services of manual scavengers – who are overwhelmingly Dalit – to clean these toilets.If you want to receive regular email updates from this column, subscribe to the Freedom Under Fire newsletter.If you know of any other incident we should highlight in this column, write to me at titash@cms.thewire.in.