Monday, November 24, 2008

Why toilets matter

Another toilet story that should have been posted earlier but got overlooked. Appeared on the website Infochange India (www.infochangeindia.org)

Open defecation in urban India is declining very slowly, with over 5 million people in Indian cities still defecating outside. Could this be because the urban middle class monopolises the existing basic services like water supply and sanitation and therefore does not impel change, asks Kalpana Sharma

At the recent G8 meeting in Japan, world leaders discussed oil prices and climate change. They did not, however, address what is being called a “development emergency” in some countries -- the chronic absence of improved sanitation among large sections of the population, particularly in poor communities, that is contributing to the spread of disease.

Even as countries like India boast of a consistently high rate of economic growth, they cannot hide the abject failure to tackle the consistently low rate of growth in access to improved sanitation.

Year after year, while the number of those getting access to safe water climbs, the equivalent figures for sanitation remain stubbornly low. This is a constant reminder of the failure of many governments to evaluate the importance of improved sanitation and to put enough political will and investment into bridging this deficit.

One of the more unsavoury facts that the government in India would most certainly not want advertised is the fact that one out of every two people in the world who are forced to defecate out in the open is an Indian.

According to a recent report of the Joint Monitoring Project on Drinking Water and Sanitation of Unicef and the World Health Organisation, 18% of the world’s population, or 1.2 billion people, still have no access to sanitation and are compelled to defecate out in the open. Of these, an astounding 665 million live in India.

What is even more depressing is that the rate at which this situation is changing, in India, is slow. Overall, the rate of open defecation has declined from 73% in 1990 to 58% in 2006. However, while in rural India the rate of open defecation has declined from 89% in 1990 to 74% in 2006, in urban India it has gone down by only 10% in 16 years, from 28% in 1990 to 18% in 2006. This means that even today, over 5 million people in Indian cities defecate out in the open. If evidence of this were needed, one has only to take an early morning suburban train in Mumbai to witness the spectacle of people using the open spaces around railway tracks as a vast open-air toilet.

This is the extreme end of the spectrum. What sanitation is available by way of toilets is also generally far from satisfactory. Shared toilets, or community toilets, are generally poorly maintained, leading to contamination of soil and water sources. The problem is exacerbated in urban areas as the settlements where the urban poor live are tightly packed, with few open spaces. In such conditions, open defecation and leaking toilets greatly enhance the danger of contamination and the spread of waterborne diseases.

The link between sanitation and health hardly needs to be emphasised. Yet, although progress has been made in the realm of supplying drinking water, for some reason provision of adequate sanitation continues to lag behind in India. As of now, India is not on target to meet the Millennium Development Goal of providing 46% of its population ply with adequate sanitation by 2015.

The international charity Water Aid put together data on this issue for the recent G8 meeting and emphasised yet again the need to renew commitment and investment in sanitation. According to its report, 40% of the world’s population lacks access to improved sanitation and this, in turn, kills more children than malaria, HIV/AIDS and measles put together.

Water Aid also suggests that as many as 910,000 child deaths from diarrhoea could be avoided each year through the provision of improved sanitation. An estimated 85% of the 1.6 million deaths due to diarrhoea each year can be linked to poor sanitation and unsafe drinking water, it says. Also, the underlying cause of the 5 million child deaths each year is chronic malnutrition. Recurring bouts of diarrhoea in children already malnourished means that nutritional supplements have no impact on their chances of survival, as their weakened digestive systems simply cannot absorb them.

The key input to enhancing child survival is not necessarily more and better food or medical interventions but conditions of living that ensure that children do not get ill. There is simply no shortcut to providing sanitary living conditions and an adequate supply of potable water. Such interventions do not provide instant results that are demonstrable. But they are a long-term investment that pays enormous health dividends for all, poor and rich.

The cost of poor sanitation and unsafe water is borne disproportionately by the poor living in urban or rural areas. However, sometimes the health status of urban poor communities is worse than their counterparts in rural areas.

‘Our cities, our health, our future’, a report to the WHO commission on Social Determinants of Health (the final report is due to be released worldwide in August this year) by the Knowledge Network on Urban Settings, illustrates this point with data from Kenya. The infant mortality rate (IMR) in Kenya is 74 per 1,000 live births -- 76 in rural areas and 57 in urban areas excluding Nairobi. But in the country’s capital city, while the IMR in high-income areas in likely to be under 10, in the slums of Kibera and Embakasi it is 106 and 164 respectively. In Nairobi as a whole, it is 39. This clearly shows that the health status of the urban poor, living in wretched conditions, is much worse than the status of those in rural areas who also live in poverty.

In India too, the data shows that the health status of the urban poor is either the same or worse than that of people in rural areas. For instance, the percentage of underweight children in the urban poor population is 47.1%, compared to 45.6% in the rural population, and stunting is seen in 54.2% of urban poor children, compared to 50.7% of rural children (according to NFHS-3 data). Apart from children, women in poor urban communities are almost as badly off as their rural sisters, with 58.8% of women between the ages of 15-49 years being anaemic, compared to 57.4% of rural women. NFHS-3 data also reveals that there is little difference in the figures for the number of children with diarrhoea in urban poor communities and those in rural communities. This data merely underlines the reality that while urban areas as a whole might have better medical facilities and piped water and sewerage, these facilities do not extend to the urban poor.
In fact, urbanisation should lead to better health for all. That is the lesson drawn not just from richer countries like Japan, Sweden and the Netherlands but also countries like Sri Lanka, Malaysia, Singapore and South Korea. Here, healthy urban living conditions that include provision of housing, water and sanitation have changed the health statistics quite dramatically.
Susan E Chaplin, who did her doctoral thesis on ‘Cities, Services and the State: The Politics of Sanitation in India’ from La Trobe University, Australia, draws a comparison between sanitation in post-Industrial Revolution England and Indian cities, in an essay in the journal Environment and Urbanisation (April, 1999). She looks at the policies pursued in mid-19th century England and now in India, and brings out several useful points.

Sanitary reform in Britain really took off only in the 19th century when the spectre of disease haunted the entire population, rich and poor. Conditions in industrial cities like Liverpool and Manchester were not very different from those that prevail in the slums of Kolkata or Mumbai today. Chaplin quotes Friedrich Engles on these English cities. He wrote that they had “...streets (that) are generally unpaved, rough, dirty, filled with vegetable and animal refuse, without sewers or gutters but supplied with foul, stagnant pools instead”.

The pattern of urbanisation in the two countries has also been similar, with the advent of work and industrialisation drawing in the poor from villages. But in England, Chaplin writes, three factors contributed to sanitary reform. “These were the campaigns by medical practitioners along with reform of local government, advances in science and engineering, and the presence of a ‘threat from below’, in terms of diseases and organised labour.”

Chaplin argues that in India the urban middle class has not been interested in bringing about any change in conditions because it has successfully monopolised the existing basic services like water supply and sanitation. The British built sewers only in areas they inhabited; the native towns were left to manage with the scavenger system that, shockingly, persists in some of the smaller towns. The better-off Indians today live in areas that have benefited from the colonial sewerage systems, while the poor mostly live in unserviced plots.

Furthermore, science and medicine have reduced the possibility of the spread of disease ‘from below’. And the rich really do not need to fear any revolution ‘from below’, as did the rich in England, because the urban poor are mostly unorganised. As a result the urban middle class, and one might add the policymakers, can continue to be indifferent to the conditions of the poor. Combine this with an ineffective local government and you have the situation we see in most Indian cities today.

In England too, the rich were initially not interested in reform that would benefit all classes. The single factor that altered this situation was the prospect of their getting cholera. An epidemic in the 19th century established the link between sanitation and health as nothing else could have done.

Also, the militancy of the working classes prompted the rich to accept that providing them with basic services was a wiser proposition than risking the disruption that would inevitably follow an attempt to overthrow the hold of the ruling classes.

Between 1880 and 1891, urban authorities in many cities in Britain provided sewerage and clean water supply under the Sanitation Act of 1866. This step benefited all citizens, not just the rich.

In India, the provision of improved sanitation, especially for the urban poor population that is estimated to grow at an annual rate of 5-7%, requires similar action and political will. Already, one-third of the country’s population lives in cities and towns. Of this, anywhere between a quarter and a half live in slums and informal housing with inadequate provision of water and sanitation. Health parameters of the urban poor are uniformly worse than those in formal housing, for the obvious reason that, besides poverty, overcrowding and unsanitary conditions expose this population to ill health. Compounding the situation is inadequate and affordable healthcare.

Health data in India has shown that the poor turn to private healthcare wherever the public health system is inadequate. In urban areas, the absence of adequate public health outposts in slums and the presence of private practitioners guarantee that people turn to the latter rather than seek free healthcare from the public system. The pressure on the budgets of people living on the margins is enormous and often unbearable. For instance, a 2003 study of 850 households in Dhaka, Bangladesh, found that increased expenditure on healthcare due to illness had forced many families to take loans, sell assets and even resort to begging to meet the costs of ill health. This pattern is evident in most developing countries with large populations of urban poor, including India.

“Lack of investment in sanitation reveals a blind spot in development policy: a failure to recognise sanitation’s integral role in reducing poverty,” the Water Aid report rightly points out.

In these times of political turmoil, such issues are not high on India’s priority list. Nor is the media interested in highlighting them. Yet, economic growth cannot be sustained if almost half the country’s population lacks access to something as basic as sanitation. Boasts of being an economic power -- or even a nuclear weapons state -- seem quite hollow against this ugly reality.

The toilet test

Posting this article now. I've just attended Sacosan III, the South Asian Sanitation Conference. Despite the importance of the subject, the conference was more or less ignored by the so-called "national" media.


Published in DNA, Mumbai, September 12, 2008


As a traveller, you often judge a country by its public toilets. India fails this toilet test miserably. For even as our country appears poised to become an economic giant at some future date, one of the many appalling statistics that brings us down to earth is our toilet story, or rather the lack of toilets story.

A recent joint monitoring report prepared by the World Health Organisation and Unicef found that out of the 1.2 billion people around the world who are forced to defecate in the open, half live in India. An estimated 665 million Indians, one in every two, lack access to a toilet. That is not a pleasant statistic. Yet, few Indians would challenge it, as the embarrassing evidence is before our eyes everywhere we look.

While public facilities like bus stations, railway stations and airports have distressingly inadequate toilets, even institutions like hospitals, schools and offices, both government and private, often fail the toilet test. Ask women who work in these places. Even highly placed professional women in India will have at least one toilet story about an office where they have worked.

The problem, of course, is not something to joke about. We know that the absence of sanitation has a devastating impact on health. It affects women and girls more directly as they have to wait sometimes an entire day until dark to relieve themselves. But this unmet need also has another fall out. It is negating efforts to increase female literacy.

The city of Mumbai, which has a high overall literacy rate, provides us with a vivid example of this. According to a report in this newspaper, six out of ten municipal schools do not have adequate or any toilets for girls. As a result, the dropout rate of girl students after Std V is 50 per cent.

The story is worse in rural schools. Little wonder then that India’s female literacy rate is not advancing at the rate at which girls are being enrolled in schools. The answer is simple: give them toilets that are clean and can be used and they will attend school.
The sanitation story is not just about toilets. It is about investment in sewerage systems.
This can only be done by the State. So why, if water supply is given a priority, is sewerage neglected? Is the government not too concerned because while people riot when there is no water, you don’t see demonstrations demanding toilets? In the water-sanitation duet, the latter is forgotten or overlooked.

What will it take to get the State to act? Before the days of modern medicine, the absence of sanitation would mean the spread of diseases that could afflict everyone, rich and poor. As a result, sanitation could not be neglected. Today, those who can afford medicine, and also have clean water and sanitation, can generally avoid some of these diseases. As these very people also make policies, the problem seems less urgent as it does not impact their lives.

Susan E Chaplin, who did her doctoral thesis on “Cities, services and the State: The Politics of Sanitation in India” from La Trobe University, Australia, draws an interesting comparison between sanitation in the post-Industrial Revolution England and Indian cities. In an essay in the journal Environment and Urbanisation (April, 1999), Chaplin points out that sanitary reform in Britain took off only in the 19th century when the spectre of disease haunted the entire population, the rich and the poor.

Between 1880 and 1891, urban authorities in many cities in Britain provided sewerage and clean water supply under the Sanitation Act of 1866. This step benefited all citizens, and not just the rich. In contrast, in India, the middle class has monopolised those areas where the British built sewers while the poor living in slums occupy low-lying, unserviced areas. As a result, the class that could have taken the initiative to press for sanitary reform remains indifferent to it.

Additionally, in India sanitation also has a caste dimension. As long as there are people available to clean up the dirt, we can pretend it does not exist. In many smaller towns, even a rudimentary underground sewer system does not exist and the disgusting practice of manual scavenging continues. This is something that should shame all Indians.

The toilet story exposes the hollowness of the “India prospering, shining India” imagery. More than the real numbers of India’s poor, this illustrates the daily deprivation and lack of dignity that marks the lives of millions of people in this country. We need to urgently think of a Sanitation Act that makes it incumbent on local authorities to address the issue of sanitation and restore dignity to people’s lives.

Sunday, November 16, 2008

Faceless Citizens

The Hindu, Sunday Magazine, November 16, 2008

The Other Half



Every alternate day, for as long as I can remember, a vendor selling vegetables loaded on a handcart parked himself in our neighbourhood in Mumbai. He would push that cart several kilometres from the wholesale market and arrive in our neighbourhood early in the morning. In a few hours, his handcart would be emptied of its load as he made his return trip.

Many people bought small quantities of fresh vegetables from him. Few knew his name. Yet, when he spoke, you could tell he was a “North Indian”. And if you asked, he told you he was from Jaunpur in Uttar Pradesh. This nameless vendor provided fresh vegetables at reasonable prices to a middle class neighbourhood. He also delivered the goods to your home, free of charge. If you didn’t have enough change to pay him, he would readily agree to wait until the next day. If you complained about the quality of something you had bought the previous time, he could immediately replace it, free of charge.

Our friendly neighbourhood vegetable vendor has disappeared. Without a trace. No one is able to tell me what happened to him. I ask the man who sells bananas. He also comes every day by taxi with a basket load of bananas. In a few hours, his basket is empty. But he doesn’t know what happened to the vegetable vendor.

But we do know what happened. There are two possibilities. He could be one of the many “North Indians” who is now too frightened to live in Mumbai after the launch of the anti-outsider tirade by Raj Thackeray and his Maharashtra Navnirman Sena. Even if they did not attack him directly, he would have seen the images of hawkers being attacked, their goods splayed on the street.

Another reason could be economic. A new retail store has opened in the area selling fresh vegetables at marginally lower prices than what the vegetable vendor charged. So, even though his vegetables were decidedly fresher than those sold in the store, and people had an old relationship with him, the majority graduated to the novelty of going to the store and buying vegetables wrapped in plastic. The store used economies of scale to lower prices. The neighbourhood vendor could not compete. He tried by coming an hour earlier. He tried by reducing the amount of vegetables he brought on his cart to cut his losses. In the end, he gave up and disappeared.

I narrate this story, which will have echoes in most other cities across India, because it tells us of the largest number of people who are losing jobs and livelihood. The media runs front page stories when airlines staff are laid off. We hear about redundancies in the private sector. Raj Thackeray sends his MNS cadre to beat up Biharis trying for jobs in the railways.

The people who are paying the price for the changes in the economy and the slowing down of the growth rate are people like this vegetable vendor. While the spurt in retail in perishables has destroyed the livelihood of thousands of men and women who survived on their daily sale of fruits and vegetables, the slowdown has resulted in closing down thousands of small manufacturing units that were a part of the informal economy.

Yet, these people remain invisible. Economic problems always mean stock exchange news, or news of some big factories closing down or stopping production for a few days. But what will happen to people who did not have security in their employment, could never dream of a salaried job, but survived nonetheless on their wits and by providing a much needed service? Who is counting these losses? Is anyone even bothered? The tragic part of the agitation launched by Raj Thackeray is not just that it is irrelevant — he is only bothered about the minuscule minority of Maharashtrians who are seeking jobs in the formal sector — but that it is obscuring the real crisis that is facing millions of people in our cities.

(To read the rest of the article, click on the link above)

Sunday, November 02, 2008

Going public

The Hindu, November 2, 2008

Sunday Magazine


THE OTHER HALF



On Friday, October 24, a nun from Orissa did something incredibly brave. In full view of television cameras, she went public. For months, no one knew her name or what she looked like. Yet, everyone knew that in the ghastly sectarian violence that has gripped Orissa, one of the foulest acts was the gang rape of this nun. We also knew that the local police failed to follow up the case, despite her having filed an FIR in her traumatised state. We now know that the police tried to dissuade her from filing the FIR. Also, despite the medical report having confirmed the rape, nothing was done.

Now there is some movement, but only as a consequence of concerted pressure from media and civil society. The nun has said she does not trust that there will be justice if the same police that includes men who did not hesitate to warmly greet the men who had attacked and raped her, are entrusted the task of investigating the crime.

We have to salute the courage of this woman. Few if any women are prepared to speak out after they are raped. Hundreds never report rape. Yet, Bilkis Bano from Gujarat did. And as a result, the men who raped her were convicted. But then Bhanwari Devi in Rajasthan did. But the men who raped her got away. So going public comes with risk of never getting justice, and living forever with the shame.

Not a random incident

Yet, it is important to realise that this is not just the story of one woman, a nun, who was raped. It is a reminder that rape continues to be used as a weapon of war. This woman was raped because the men waging war against the Christians in Orissa wanted to teach them a lesson they would not forget. So apart from burning homes, beating up people, including a priest, and burning churches, they decided that the rape of a woman who had committed herself to serve the church was the most effective way to make their point. They believed that this would silence their “enemy” forever.

This weapon of war has been wielded for centuries. And women, regardless of race, class or creed, have been its principal victims. For the majority, there has been no justice, no closure to the wound on their bodies and their souls that can sometimes never heal.

Ten days before this press conference in Delhi, another public event took place thousands of miles away — in the Democratic Republic of Congo on Africa’s west coast. Here is a country that has been at war with itself for years. Government forces are fighting many different rebel groups. Every day you hear stories of thousands being displaced as they flee the fighting. Peace seems nowhere in sight despite 17,000 UN peacekeeping forces being stationed there.

The U.N. acknowledges that women in the Congo are experiencing more sexual violence than in any other country in the world. According to a recent survey, one out of every four adults in eastern Congo had witnessed sexual violence and one in six had actually experienced it. Twelve per cent of those surveyed said they had been sexually violated more than once.

Even in such a horrific theatre of war, women are finding the courage to go public, to speak about being raped in the hope that this will put pressure on the government to act against the rapists. Like the nun, these women have little faith that they will get justice. Yet they are willing to try, as there is no other option.

Here are the words of one of these women who spoke at the meeting (as reported in The New York Times, October 18, 2008): “There was no dinner. It was me for dinner because they kicked me roughly to the ground, and they ripped of all my clothes, and between the two of them, they held my feet. One took my left foot, one took my right, and the same with my arms, and between the two of them they proceeded to rape me. Then all five of them raped me.”

(To read the rest of the article, click on the link above)

Saturday, November 01, 2008

Crime and the media

Chief Justice of India K. G. Balakrishnan has once again reminded the media about its role in reporting crime and on-going investigations. Speaking at a workshop organised by the Bombay High Court on Sunday, October 19 on “Reporting of Court Proceedings by Media”, he said, “Privacy of the person must be protected. Sometimes damaging information is revealed during the investigation. It adversely affects people’s right to a fair trial” (as reported by Express Newsline, Oct 20, 2008). He also reportedly criticised police officers revealing information to the media during investigation and said that this encroached upon the right to privacy.

The Chief Justice’s comments come at a time when there is a great deal of chatter, particularly on the Internet, about the relationship between the police and the media. Author Arundhati Roy has also been critical on this count in her recent interview to Karan Thapar on CNN-IBN. It is an issue that we in the media have to consider seriously particularly in the light of the on-going investigations by various police agencies into the string of terror attacks in different cities.

The point that has to be debated and considered is not whether the media should report what the police reveals about a crime under investigation but how it should report it. We also need to question whether the police should leak to a few chosen journalists, or publicly release, incremental information on investigations into crimes. Sometimes the information is not just incremental, it is also unsubstantiated and later contradicted by the police. But in the meantime, the individual involved is victim to grievous injustice, judged without a fair trial.

As far as the media is concerned, the norms of reporting on crime, or terror, should not differ. If suspects are picked up for a crime, they are precisely that – suspects. Until a case is made out that will hold in a court of law, we in the media cannot name them as “murderer”, “thief”, “cheat” or even “terrorist”. Regardless of what the police reveal to the public, based on their investigations or confessions of these suspects, the media must qualify what it reports. That is the only guarantee for the innocent amongst these suspects to have any chance of rebuilding their lives if they are proved innocent, or if the police are unable to establish their guilt. These norms have been well established and just because we now live in a more competitive media environment, they surely should not be abandoned. Yet, even a cursory survey of both print and broadcast would reveal how easily some of these norms have slipped or even disappeared altogether. Their absence does nothing to enhance the credibility of the media.

We should be equally disturbed at the way various police units are rushing to the media with information. During the Arushi murder case, the police was shown up clearly to have crossed the line. The media could argue that it had no option but to report what the police said. But it is also evident that some of the media used the police information to dramatise the ghastly murder to increase their viewership. In the process, where was the individual’s right to privacy or a fair trial?

The rash of media briefings, official and unofficial, continues unabated in the terror investigations. Why are they necessary? Do people need to know every detail about on-going information or is it more important to investigate and produce credible results? Today, ordinary people are genuinely confused about what really is going on and inevitably, there are questions raised about the credibility, and even efficiency, of the various police forces. This is not the result of some inherent suspicion in the minds of people about the police. It is the consequence of the manner in which the police have exposed themselves by putting out half-baked information into the public domain through the media.

Apart from the terror investigations, media briefings are gradually becoming the norm amongst police in different cities even for minor crimes. For instance, earlier this month, the Mumbai police held a media briefing where they paraded a 10-year-old boy suspected of being responsible for spreading a rumour about people being kidnapped as part of a kidney racket. The boy apparently confessed. His father was also present at the briefing. The juvenile offender was photographed and the police officer gave his name and other details even though this is prohibited under the Juvenile Justice Act.

This particular briefing cannot be dismissed as an aberration, the action of a police officer bitten by the publicity bug. It raises the same questions as in the terror investigations -- is the police using the media because the media feeds off such information or is the media’s aggressive demand for information on crime forcing the police to go public?

Another offshoot of the issue emphasised by the Chief Justice impinges on women who are victims of violence. When the rape of the nun in Kandhamal, Orissa, was first reported, no paper gave away her name or identity. And rightly so. Even when she spoke to some television channels, there was no hint of where she was, or who she was. But in subsequent days, some newspapers tracked down her family, carried photographs of the village where they lived, gave details of the location of the village, quoted her father and brother, giving their full names. In other words, every bit of information short of the name of the victim was reported. Can this be explained away as the inevitable consequence of a competitive media? How does such reporting conform to the Chief Justice’s appeal for the individual’s right to privacy? Should we just conform to the letter of the rule of not revealing the identity of rape victims or do we also have a responsibility to adhere to the spirit that informed that rule?

These are questions that the media must address. We need to seriously interrogate our approach towards crime and justice and ensure that we are not abetting the former and negating the latter.