Insights from the SQUAT Survey: Unpacking India’s Sanitation Challenges

India is home to one of the world’s most persistent sanitation challenges. For decades, government programmes have constructed millions of toilets in rural areas – and yet, open defecation has continued at rates that defy simple economic explanations. Why would people choose to defecate in the open when a toilet is available? The Sanitation Quality, Use, Access and Trends (SQUAT) Survey, conducted by the Research Institute for Compassionate Economics (r.i.c.e.), set out to answer exactly that question – and its findings turned conventional sanitation policy thinking on its head.

What is the SQUAT survey? 🔗

The SQUAT survey is one of the most comprehensive field studies ever conducted on sanitation behaviour in rural India. Between November 2013 and April 2014, a team of researchers collected data on sanitation beliefs and behaviour for approximately 23,000 individuals across 3,200 households in five states: Haryana, Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh. What made this survey methodologically significant was its design: rather than asking a single household-level question about toilet access, it tracked the actual sanitation behaviour of each person in a household individually. This allowed researchers to separate latrine ownership from latrine use – a distinction that proved to be critical.

The survey was led by researchers Diane Coffey, Aashish Gupta, Payal Hathi, Dean Spears, and colleagues, and its findings were published in Economic and Political Weekly as well as through working papers supported by the International Growth Centre. The data it produced remain foundational to understanding why India’s open defecation rates have historically been far higher than those of comparably poor nations.

The core problem: toilets exist, but are not used 🔗

The SQUAT survey’s most striking headline finding was this: building toilets is not the same as ending open defecation. In the four focus states surveyed, 80% of all interviewed households had at least one member who defecated in the open. More startling still, 40% of households that owned a working latrine had at least one member who regularly defecated outdoors – and more than half of people with government-provided latrines did not use them at all.

When researchers asked those who defecated in the open why they did so, 47% said they found it pleasurable, comfortable, or convenient. In many villages in rural north India, open defecation was seen as a wholesome activity associated with physical wellbeing and bodily purity – not as a problem to be solved.

Why poverty alone does not explain it 🔗

One of the most counterintuitive findings from the SQUAT data was that open defecation in India cannot be explained primarily by poverty, lack of education, or water scarcity. In rural sub-Saharan Africa, where people are, on average, poorer, less educated, and less likely to have access to water, far fewer people defecate in the open than in rural India. In Bangladesh, 39% of rural households use simple pit latrines; in Nigeria, 44% do. In rural India, only about 10% use them – and many more defecate in the open instead of using an inexpensive latrine.

This means the problem is not simply one of income or access to materials. According to the SQUAT researchers, the real barriers are cultural, social, and deeply tied to beliefs about purity and pollution.

Caste, ritual pollution, and the rejection of affordable latrines 🔗

The SQUAT survey found that the type of latrine matters enormously in rural India – not for functional reasons, but for reasons rooted in caste and ritual practice. Researchers found that affordable pit latrines – the kind recommended by the WHO and used across the developing world – are widely considered ritually impure and polluting by rural Hindu communities. Having such a latrine near the house or kitchen was seen as shameful.

A central concern driving this rejection is pit emptying. In India, emptying latrine pits is historically associated with Dalit communities, specifically those who performed manual scavenging – work that is considered deeply stigmatising under caste hierarchy. Even Dalits themselves were found to reject small pit latrines, because such toilets served as physical reminders of their marginalised position. Among latrines that were being used by at least one household member in the SQUAT survey, fewer than 4% had pits that were 60 cubic feet or less – the size recommended by the WHO. The median pit size of a privately-built latrine was five times the WHO-recommended size, with many households aspiring to pits twenty times as large. The cost of building such a large structure makes privately-constructed latrines unaffordable for most poor rural families, while the government’s smaller alternative is culturally unacceptable to them.

Religion as a variable: the Hindu-Muslim gap 🔗

The SQUAT data offered a striking natural experiment in the role of cultural norms: a sharp difference in open defecation rates between Hindu and Muslim households in rural India. About 40% of Hindus who owned a working government latrine still regularly defecated in the open. Among Muslims with the same type of latrine, that figure was only about 7%. Rural Muslims were not only more likely to own latrines – they were specifically more likely to own the affordable, smaller pit latrines that Hindu households tended to reject as polluting. Researchers attributed this difference to the distinct ways in which Muslim communities in India practice norms of purity and pollution, which do not carry the same caste-based associations around pit latrines.

The safety dimension: women and open defecation 🔗

Open defecation is not merely a health issue – it is also a safety one, particularly for women. Government campaigns promoting sanitation have often used the message that toilets protect women’s dignity and safety, particularly from sexual violence. The SQUAT survey found that this framing, while not entirely wrong, was incomplete and potentially misleading. Of 1,046 women interviewed, 4.3% reported that they had been the victim of someone attempting to molest them while going out to defecate – but 7.6% reported the same had happened while going to the market. Researchers cautioned that using the threat of sexual violence to promote toilet use distracts from the deeper caste-based and cultural barriers that actually drive open defecation – and unfairly frames open defecation primarily as a women’s issue.

Public health consequences: stunting, disease, and child mortality 🔗

The health cost of widespread open defecation is severe. Research using national health survey data found that the chances of stunting among children were 13% higher, and the chances of being underweight were 28% higher, in households that practised open defecation compared to those using improved toilet facilities. A separate ecological analysis of data from 112 Indian districts found that a 10% increase in open defecation was associated with a 0.7 percentage point rise in both stunting and severe stunting, even after controlling for socioeconomic factors and calorie intake.

Faecal pathogens spread through the environment cause intestinal infections, diarrhoea, and environmental enteric dysfunction, which reduce children’s ability to absorb nutrients – resulting in malnutrition even when food is available. This is why India, despite significant economic growth and food availability, has long had child stunting rates more comparable to much poorer nations.

Policy implications: from construction to behaviour change 🔗

The SQUAT survey directly challenged the assumptions underlying India’s successive sanitation programmes, which for years measured progress in terms of toilets built rather than toilets used. The survey called for what it termed a “Latrine Use Revolution” – a fundamental shift in policy focus from hardware (building toilets) to behaviour change (motivating people to use them).

In 2014, Prime Minister Narendra Modi launched the Swachh Bharat Mission (SBM) with the goal of making India open defecation free by 2019. Within five years, over 100 million toilets were built, reaching an estimated 500 million people, and rural sanitation coverage improved from 38.7% to 100% according to government figures. UNICEF, a key partner in the mission, noted that in ODF environments there are fewer episodes of diarrhoea and improved child nutrition outcomes. The WHO estimated that at least 180,000 diarrhoeal deaths were averted in rural India since the mission’s launch.

However, independent researchers flagged important caveats. A systematic review published in Frontiers in Environmental Science found that the government’s monitoring system likely overestimates ODF village numbers and actual toilet coverage, and that behaviour change has not uniformly followed toilet construction. A survey in Rajasthan showed that even after the state declared itself ODF in 2018, 21.7% of rural households with a toilet still had at least one member who continued to openly defecate.

India’s Phase II of the Swachh Bharat Mission has attempted to address this by moving toward ODF Plus status – sustaining ODF gains while adding solid and liquid waste management. As of recent reports, more than 50% of India’s villages have declared ODF Plus status, reflecting a shift toward more holistic sanitation outcomes.

What the SQUAT survey tells journalists and policymakers 🔗

For journalism students and practitioners covering development issues, the SQUAT survey is an important case study in why data must go beyond infrastructure counts. The survey demonstrated that sanitation is not merely a technical or economic problem – it is a deeply social one, shaped by norms, identity, caste hierarchy, and centuries-old ideas about the body. Reporting on sanitation effectively means asking not just “how many toilets were built?” but “who is using them, why, and why not?”

The survey also illustrates the limits of top-down policy solutions when they are not backed by genuine community-level behaviour change. A cluster-randomised trial in rural India found that combining community-led behaviour change campaigns with subsidised toilet construction was significantly more effective at eliminating open defecation than toilet construction alone – confirming the SQUAT researchers’ central argument that demand creation, not supply alone, is the path forward.

What do you think? If cultural norms around purity and caste play a greater role in open defecation than poverty does, what does that mean for how sanitation campaigns should be designed and communicated? And when government data and independent surveys tell different stories about policy success, whose account should shape public reporting on health and development?

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