People look for some privacy between sugar cane, trees and cold walls. They find their site, go to the bathroom and clean up with water that is often contaminated. Of course, they do not have toilet paper. 524 million people follow this daily routine when defecating in India, the most populous country in South Asia according to United Nations data. One in two Indians cannot “go to the bathroom,” because they do not have one.

World Toilet Day is celebrated on November 19 and helps raise public awareness of the health problems faced by millions of people without resources. Open defecation causes serious diseases, especially in children, who are the most vulnerable sector of the population. Each year, diarrhea kills 120,000 children under the age of five and causes much more malnutrition, atrophy and dangerous infections. But this doesn’t just affect the smallest ones: women are also vulnerable. They are afraid of encountering animals when going to the bathroom and of sexual harassment from craven men who target them.

But how can we fight against such a widespread practice in India? A lack of resources is combined with a lack of knowledge about the associated health risks. Thus, there is a double challenge: getting toilets and making the population aware of their benefits in order to end open-air defecation. If they are installed, but no one knows about the advantages of using them, people will continue going to the bathroom in the street.

The first step requires a lot of money and physical space, both of which are difficult to obtain. A viable solution is the installation of community toilets, but unused toilets are a big problem. Many people avoid community toilets currently available because they accumulate dirt, smell terrible, and even sometimes lack a door. However, several investigations have shown that their use increases with clean conditions and proper maintenance.

“The biggest problem is unused toilets”

A study from the Institute for Fiscal Studies in the United Kingdom (Alex Armand, a researcher for the Navarra Center for International Development, also participates in said center) will investigate the relationship between the willingness to pay for using a community toilet, available health information and the quality of the facilities. The study will take place in India during 2018; the results will come out the following year. It hopes to contribute to the end of open-air defecation and to a better understanding of locals’ predisposition to pay for community bathrooms.

Informing the population of the benefits of using a toilet is the first step for millions of Indian citizens to start using them and to prevent the proliferation of diseases. World Toilet Day is a good time to remember that in some parts of the world there are people who die because they do not have a bathroom. Millions of people still do not know what it means to flush. We have to invest in research and work in the field to disseminate the fact that a simple toilet can save lives, especially when it comes to children.