Ending open defecation by 2030? - Review paper by Duncan Mara: The elimination of open defecation and its adverse health effects

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Ending open defecation by 2030?

Please see attached paper of mine on open defecation and its adverse health effects.
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Review Paper, Journal of Water, Sanitation and Hygiene for Development | 07.1 | 2017

The elimination of open defecation and its adverse health
effects: a moral imperative for governments and
development professionals

Duncan Mara

In 2015 there were 965 million people in the world forced to practise open defecation (OD). The
adverse health effects of OD are many: acute effects include infectious intestinal diseases, including
diarrheal diseases which are exacerbated by poor water supplies, sanitation and hygiene; adverse
pregnancy outcomes; and life-threatening violence against women and girls. Chronic effects include
soil-transmitted helminthiases, increased anaemia, giardiasis, environmental enteropathy and smallintestine
bacterial overgrowth, and stunting and long-term impaired cognition. If OD elimination by
2030 is to be accelerated, then a clear understanding is needed of what prevents and what drives the
transition from OD to using a latrine. Sanitation marketing, behaviour change communication, and
‘enhanced’ community-led total sanitation (‘CLTS þ ’), supplemented by ‘nudging’, are the three most
likely joint strategies to enable communities, both rural and periurban, to become completely
OD-free and remain so. It will be a major Sanitation Challenge to achieve the elimination of OD by
2030, but helping the poorest currently plagued by OD and its serious adverse health effects should
be our principal task as we seek to achieve the sanitation target of the Sustainable Development
Goals – indeed it is a moral imperative for all governments and development professionals.

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