By Ajit Chaudhuri
“Toilets are more important than Temples” J. Ramesh in 2012, N. Modi in 2013
One of the myths we grow up with is that Indian Muslims are dirty – they bathe less, they have unclean personal habits, and their habitations are unsanitary compared with other communities in India. Don’t deny it – many of us think it, not just those with Hindu right wing leanings. Even I remember, back in 1986 when I shared a barsati with two friends, one of us Muslim and all three non-religious, his younger brother visited for a day en route to some other destination and decided against having a bath. Two of us smirked, and the third furiously hauled his befuddled brother off into the bathroom.
It was therefore a pleasure to read an econometric paper whose findings contradict this common assumption. Now, I normally give academic papers that use structural equation modelling and multivariate analyses a wide berth, but there was something compelling about this one; the simplicity with which it was written, the sheer force of what it was saying, and the policy implications emanating from its findings. This note attempts to describe the paper ‘Sanitation and Health Externalities: Resolving the Muslim Mortality Paradox’.
Indian Muslims are poorer, less educated, and more backward on average than Hindus, which should contribute to them having higher child mortality rates (I will use Ms and Hs to abbreviate for the two communities respectively, and CMR is the number of children dying before their fifth birthday per 1,000 live births). And yet, the CMR for M children is 18 percent lower than for H children across socio-economic categories, a robust and consistent pattern that has been evident since the 1960s. It means, in effect, that an additional 1.7 M children per hundred survive up to age 5. This phenomenon is well documented, does not reconcile with the literature on the importance of income and education in explaining mortality differences, and has therefore been termed ‘the puzzle of the Muslim Child Mortality advantage’.
The paper uses data from three rounds of the National Health and Family Survey (1992/93, 1998/99, and 2005/06), studies mortality rates from birth history information of 310,000 children, and shows that differences in defecation practices between Ms and Hs account for the entire CMR gap.
This is because human shit is particularly dirty – it contains pathogens (bacteria and parasites, such as worms), and open defecation (I will use OD for this one) introduces these pathogens into the environment, into feet, hands, mouths and the water supply, leading to acute and chronic illnesses.
Ms are 40 percent more likely than Hs to use pit latrines or toilets, which serve to safely dispose of excreta. The reason for this is difficult to trace! It could be because of institutional features of the respective religions – the Hadith forbids OD (‘Guard against three things that produce cursing: relieving oneself in watering places, in the middle of the road, and in the shade’, something that any modern epidemiologist would parrot), whereas H tradition views excreta as something to be kept away from home (‘Far from his dwelling let him remove his urine and excreta’ – The Law of Manu, chapter 4, verse 151). It could also be that different sanitary practises evolved between the largely segregated H and M communities for purely secular reasons. Either way, H households are more likely to have electricity than to use a toilet, even better off H households, with assets such as motorcycles, opt for OD, and toilets constructed or paid for by the government for Hs tend to remain unused or be re-purposed. The prominence of OD among Hs is not due to affordability.
More importantly, Ms are more likely to have M neighbours who do the same. The defecation practise of a neighbourhood as a whole is far more important than that of a particular household in accounting for mortality rates, to the extent that moving from a locality where everyone ODs to one where no one does is associated with a larger difference in CMR than moving from the bottom to the top twenty percent of the population in terms of wealth. And it is defecation practise that explains the difference in CMR, not idiosyncratic religious or cultural differences between Hs and Ms; Hs living in mainly M villages have lower CMRs than Hs living among other Hs; in places where Ms and Hs have similar OD rates, they also have similar CMRs; and the M advantage reverses in the rare places where Hs have less OD rates than Ms.
The persistence of OD among Hs has been of concern for some time. MK Gandhi famously observed in 1925 that ‘sanitation is more important than independence’, and cultural scholars have associated it with the caste system, where the link between human waste and ‘polluted’ castes reinforces norms that make sanitation problems ignored even by upper caste Hs. Policy makers have recognized the problem, and there are a multitude of government schemes that encourage the building and use of toilets. Thinking politicians from both ends of the political spectrum, as can be seen from the title quote, have also joined in despite the issue not being a vote-catcher.
I hope they succeed! And yet, I remember with fondness my own defecation habits in the villages I worked in in western Rajasthan in the early 1990s, in each of which I had my designated spot and time, where the long trek with a lota in hand would enable the building of pressure (or ‘vatavaran nirman’, as we called it), and where we joked about situations when a crow came and tipped the lota over (my favourite – when it happened to a person twice in a row, he washed up before defecating the third time). I also remember my time in the harsh Changthang (eastern Ladakh) winters of 1997 and 1998, when the job had to be done in -30c temperatures every morning, where the task of minimising the exposed surface area without impeding the free fall of matter was arduous, and where discussions on the most important invention of all time unanimously settled on toilet paper. Coming generations of rural extension workers will miss the opportunities that OD provides for building relationships from one of the few things in which we are all on an equal plane.
 Borrowed from the sign on the toilet door at the students’ accommodation ‘Citadel’ in VV Nagar, Gujarat.
 By Michael Geruso and Dean Spears, March 2014, available on the Internet.
 Mishkat-al-Masabih (a Muslim sacred text), page 76.
 The local term for a metal urn that is used to carry water for washing up in the aftermath.