Shifting social norms to reduce open defecation in rural India

Abstract

Toilet ownership in India has grown in recent years, but open defecation can persist even when rural households own latrines. There are at least two pathways through which social norms inhibit the use of toilets in rural India: (1) beliefs/expectations that others do not use toilets or latrines or find open defecation unacceptable; and (2) beliefs about ritual notions of purity that dissociate latrines from cleanliness. A survey in Uttar Pradesh, India, finds a positive correlation between latrine use and social norms at baseline. To confront these, an information campaign was piloted to test the effectiveness of rebranding latrine use and promoting positive social norms. The intervention targeted mental models by rebranding latrine use and associating it with cleanliness, and it made information about growing latrine use among latrine owners more salient. Following the intervention, open defecation practices went down across all treatment households, with the average latrine use score in treatment villages increasing by up to 11% relative to baseline. Large improvements were also observed in pro-latrine beliefs. This suggests that low-cost information campaigns can effectively improve pro-latrine beliefs and practices, as well as shift perceptions of why many people still find open defecation acceptable. Measuring social norms as described can help diagnose barriers to reducing open defecation, contribute to the quality of large-scale surveys and make development interventions more sustainable.

Nudge strategies for behavior-based prevention and control of neglected tropical diseases: a scoping review and ethical assessment

“…During that first modest increase (2010 – 2017), 12 studies were published [39, 41, 46, 49, 56, 59-61, 63-65, 67]. The exponential increase is most noticeable in 2018 resulting in 7 eligible studies [42, 43, 48, 50, 55, 57, 58], while in 2019, there were 9 included studies [38, 44, 45, 52, 54, 62, 66, 69, 70], and finally up until 6 th September 2020 we identified 5 additional studies [40, 47, 51, 53, 68].…”

“…Half of the included studies were conducted in Asia (16 records), with India making up the largest cohort of studies [39, 44, 47, 48, 57, 63, 68], followed by Bangladesh [38, 41, 50, 59], the Philippines [51, 54] Nepal [49], and Iraq [69]. One study was conducted in both Bangladesh and Kenya [60].…”

“…The participants included only mothers or caregivers of children under the age of 5 (5 records [38, 46, 47, 49, 58]), both caregivers and children (2 records [57, 63]), and only including children (8 records [42, 50, 51, 54, 62, 66, 69, 70]). Several studies targeted an entire household (8 records [39-41, 43, 47, 48, 60, 68]) or the entire community (7 records [44, 53, 55, 56, 59, 61, 64]), whilst a fewer records specified targeting the school community [65], young women [52], or users of a certain facility with specified traits such as shared compound toilets [67].…”

“…Half of the studies targeted handwashing with soap (HWWS) or simply handwashing (17 records [38-42, 46, 50, 51, 53, 54, 57, 59, 62, 63, 65, 69, 70]). Seven studies targeted defecation behaviors such as latrine usage, building or cleaning, and safe disposal of child feces [44, 47, 48, 61, 64, 67, 68], 4 studies focused on water disinfection through chlorination or solar disinfection [52, 56, 58, 60], 2 studies targeted a mix of food hygiene behaviors [45, 49], one study each targeted drug intake for deworming [55], face washing [66], and engaging the population to participate in an indoor residual spraying (IRS) campaign [43].…”

Estimating the cost of interventions to improve water, sanitation and hygiene in healthcare facilities across India

“…Lessons learnt from SBA demonstrate the need for major transformations in social-behavioural norms around cleanliness and hygiene alongside delivery of sanitation services. 61 Behavioural challenges such as the custom of open defecation, which has been observed in HCFs across India, 13 are especially common in rural areas, where investments in sanitation are most needed. Village Health Sanitation and Nutrition Committees can serve as a key resource in challenging these norms and optimising WASH uptake in HCFs through community action and participation.…”