Open defecation is the act of using the outdoors, such as fields, bushes, forests, or streets, instead of a toilet to eliminate waste. People may do this because they lack access to a toilet or follow old traditions. This practice is common in areas without proper sanitation systems. Even when toilets are available, efforts to change behaviors are often needed to encourage their use. A community that no longer practices open defecation is called "open defecation free" (ODF). This can occur after programs focused on improving sanitation are carried out by local communities.

Open defecation can harm the environment and lead to health issues, such as diseases. High rates of open defecation are connected to higher child deaths, poor nutrition, poverty, and large gaps between wealthy and poor populations. Ending open defecation is a key measure for tracking progress toward Sustainable Development Goal Number 6. Extreme poverty and poor sanitation are closely linked, so reducing open defecation is seen as an important step in reducing poverty.

In 2022, about 420 million people (5.25% of the global population) practiced open defecation, a decrease from about 1.31 billion (21.42%) in 2000. This represents a reduction of 890 million people, or 16.17 percentage points, over 22 years. Of those practicing open defecation, 275 million (65.6%) lived in seven countries. For example, in India, the number of people practicing open defecation dropped by 62% (from 73% in 2000 to 11% in 2022), showing progress toward meeting global goals by 2030. However, as of 2023, India still had the largest number of people practicing open defecation, followed by Nigeria, Ethiopia, Niger, and Pakistan, according to the World Bank.

Overview

In ancient times, when there were more open spaces and fewer people living in crowded areas, open defecation was a common practice that caused fewer health and hygiene problems. As societies developed and more people moved into cities and towns, open defecation became a major public health issue and a problem related to human dignity. With more people living in smaller areas, the need for better hygiene and health became more important. This led to increased global efforts to reduce open defecation.

Open defecation creates a cycle of disease and poverty and is seen as a disrespect to personal dignity. Countries where open defecation is most common have the highest numbers of deaths among children under five years old. These countries also face high levels of undernutrition, poverty, and large differences in living conditions between wealthy and poor people.

Examples of open defecation include:
• Open defecation and waste dumping near a river in Shadda, Cap-Haitien, Haiti
• Evidence of open defecation along a riverbank in Bujumbura, Burundi
• A child defecating in an open canal in the slum of Gege, Ibadan, Nigeria
• Open defecation in Tirin Kowt bazaar, Afghanistan

Terminology

The term "open defecation" became commonly used in the water, sanitation, and hygiene (WASH) sector around 2008. This happened because of reports published by the Joint Monitoring Programme for Water Supply and Sanitation (JMP) and the UN International Year of Sanitation. The JMP is a program run by WHO and UNICEF. It was first created to track progress on water and sanitation goals from the Millennium Development Goals (MDGs). Now, it tracks progress on Sustainable Development Goal Number 6.

To monitor MDG Number 7, two groups were created: 1) improved sanitation and 2) unimproved sanitation. Open defecation is part of the unimproved sanitation group. This means people who practice open defecation do not have access to improved sanitation.

In 2013, World Toilet Day was first recognized as an official UN day. The term "open defecation" was mentioned in speeches by high-level leaders, which helped raise global awareness about this issue. For example, the Deputy Secretary-General of the United Nations included it in a "call to action" on sanitation in March 2013.

The phrase "open defecation free" (ODF) was first used in community-led total sanitation (CLTS) programs. ODF is now used in other programs as well. The original meaning of ODF meant that all people in a community use sanitation facilities, such as toilets, instead of going to open areas to defecate. Some countries that use CLTS programs added more rules to their definitions of ODF to stop open defecation.

In mid-2015, the Indian Ministry of Drinking Water and Sanitation defined ODF as "the end of fecal–oral transmission," which means:

• No feces are visible in the environment or village, and
• Every household and public or community buildings use safe technology to dispose of feces.

A "safe technology option" refers to a toilet that keeps feces contained so that it does not pollute soil, groundwater, or surface water. It also prevents flies or animals from touching open feces, stops people from handling excreta, avoids bad smells, and ensures no feces are visible in the environment. This definition is part of the Swachh Bharat Abhiyan (Clean India Campaign).

Reasons

The reasons for open defecation are varied. It can be a choice people make on purpose, sometimes because they have to, or without meaning to. Most of the time, not having access to a toilet is the main reason. However, in some places, even people who have toilets in their homes may still choose to defecate outside.

Some common factors that lead to open defecation include:

Open defecation often happens when people do not have toilets in their homes or in the places where they live. It also happens when there are no toilets available in areas like schools or farms. In cities, a lack of public toilets can be a problem, especially if businesses do not allow people to use their toilets or if toilets are only open during certain hours. This can be a challenge for homeless people.

In some rural areas, toilets are used for other purposes, such as storing items, keeping animals, or as kitchens. When this happens, people may choose to go outside to defecate.

Sometimes people have access to a toilet, but the toilet may be broken or of poor quality. Outdoor toilets, like pit latrines, often lack cleaning and have strong, unpleasant smells. Some toilets are not well lit, especially in areas without electricity. Others may not have doors, water, or proper lighting. Toilets with pests like maggots or cockroaches are also avoided.

Some toilets are risky to use. People may feel unsafe at night because of poor lighting, criminals nearby, or dangerous animals like snakes or dogs. Women and children who do not have toilets at home may be afraid to use shared or public toilets at night. People with disabilities may also find it difficult to access toilets outside their homes, especially at night. In some places, like Zambia, very young children are discouraged from using pit latrines because of the risk of falling into the open hole. Some toilets do not have real doors, only a cloth hung as a door. In certain communities, women may avoid using toilets where men are present.

If there is no water supply, people may need to walk far to get water before using the toilet. This adds extra time and effort.

When too many people want to use a toilet at the same time, some may choose to go outside instead of waiting. In some cases, people may not be able to wait because of illness or urgency. In homes with pit latrines, some families worry that the toilet pit will fill up quickly if everyone uses it every day, so they choose to go outside to delay this.

Some communities have safe and accessible toilets, but people still prefer to defecate outside. This can happen if people do not like the toilets, do not understand their benefits, or are not used to using them. Older people are often found to defecate outside and may be reluctant to change their habits.

Some people prefer to defecate outdoors because they enjoy being in nature. This is common in rural or less populated areas, where people may walk to fields or bushes in the morning to go. In some cultures, open defecation is a habit or tradition. For example, some people view it as a social activity, especially women who enjoy talking to others while outside.

In some regions, open defecation is a normal part of daily life. A 2011 survey in rural East Java, Indonesia, found that many men considered the practice normal and even beneficial for social interaction and comfort. In some cultures, there may be social rules, such as a father-in-law avoiding the same toilet as a daughter-in-law in the same household. Surveys from 2015 showed that some people found open defecation more enjoyable than using latrines. In certain societies, open defecation is used intentionally to fertilize crops.

People with fecal incontinence may not have enough time to reach a toilet during emergencies, making open defecation their only option.

In developed countries, open defecation can happen because of homelessness. It is also common during outdoor recreational activities, like camping in remote areas. It is hard to estimate how many people in these areas practice open defecation.

Prevalence and trends

The practice of open defecation is closely connected to poverty and social exclusion, especially in rural areas and informal urban settlements in developing countries. The Joint Monitoring Programme for Water Supply and Sanitation (JMP), run by UNICEF and WHO, collects global data on open defecation. This data is divided by rural and urban areas and by levels of poverty. The program tracks progress toward the Millennium Development Goal (MDG) related to drinking water and sanitation. Open defecation is one type of unimproved sanitation and is monitored separately by JMP since 2010.

In 2000, about 20% of the world’s population practiced open defecation. By 2015, this number had dropped to 12%. In 2016, an estimated 892 million people had no sanitation facilities and practiced open defecation in places like gutters, behind bushes, or in open water. Most of these people (9 out of 10) lived in rural areas, but the majority were in Central Africa and South Asia. In 2016, 76% of those practicing open defecation lived in seven countries.

A campaign to build toilets in urban and rural areas reduced open defecation significantly between 2014 and 2019. In 2019, the Bill & Melinda Gates Foundation honored Indian leader Narendra Modi for improving sanitation. According to UNICEF, the five-year Swachh Bharat Mission (SBM) helped reduce open defecation by 500 million people. Some reports say people avoid using toilets even when available, but a World Bank project found that 96% of Indians used their toilets. In 2019, Modi declared India "open defecation free."

Phase 2 of the Swachh Bharat Mission, from 2020 to 2025, focuses on waste segregation and further reducing open defecation.

In Pakistan, 94% of people had toilet facilities in 2017–18 (99% in urban areas, 91% in rural areas), while 6% did not (1% urban, 9% rural). In 2009, only 42% of Pakistanis had sanitation access (65% urban, 30% rural). In 2017, WaterAid reported that 79 million Pakistanis lacked decent toilets. In 2018, UNICEF estimated that 12% (26 million) practiced open defecation. By 2022, this number had dropped to 7% (15.92 million).

In the United States, rising homelessness and the growth of tent cities have increased open defecation due to a lack of public toilets. Many cities closed public restrooms since the 1970s, fearing vandalism or drug use.

In San Francisco, complaints about street feces increased fivefold from 2011 to 2018, with 28,084 cases reported. This was linked to rising homelessness. The city created the Poop Patrol to address the issue. Similar problems occurred in Los Angeles and Miami.

In 2017, an unidentified woman in Colorado Springs, known as the "Mad Pooper," regularly defecated in public places while jogging.

Impacts

Open defecation causes the same negative effects on public health as having no access to sanitation at all. It is a major cause of many diseases, including diarrhea, intestinal worm infections, typhoid, cholera, hepatitis, polio, trachoma, and others. These health problems happen because open defecation leads to contamination of the environment with human waste. People who defecate in the open are often exposed to harmful bacteria and other germs found in feces. This is especially dangerous for young children, whose bodies and brains are still developing.

Some diseases are called waterborne diseases because they spread through water that is polluted with fecal germs. When rain washes feces into rivers, lakes, or wells that are not protected, it can pollute drinking water and spread illness.

In 2014, the World Health Organization (WHO) found that open defecation is a leading cause of deaths from diarrhea. In 2013, about 2,000 children under five years old died each day from diarrhea.

Young children are at greater risk of eating feces left behind after open defecation because they often crawl on the ground, walk barefoot, and put objects in their mouths without washing their hands. Feces from farm animals can also cause health problems when children play outside.

Countries where open defecation is common have the highest rates of child deaths under five years old, along with high levels of malnourishment (which causes poor growth in children), high poverty, and large differences in wealth between people.

Research in India shows that the health effects of open defecation are worse in areas with many people. For example, the same amount of open defecation causes twice as much harm in a densely populated area like India compared to a sparsely populated area like sub-Saharan Africa.

Open defecation harms children’s health and reduces their quality of life, including causing emotional and psychological issues.

Lack of proper sanitation also has strong effects on gender. In addition to the problems caused by open defecation, women and girls face extra risks when they have to urinate or defecate in the open. Without safe, private toilets, women and girls are more likely to be harmed or attacked. They may also avoid going to school because they fear being exposed or unsafe.

In many developing countries, the lack of privacy makes it harder for women and girls to feel safe or respected. Many women wait until nighttime to use the bathroom, which can lead to serious discomfort and health risks. They may also face fear of being attacked or harassed when they leave their homes after dark. Reports show that attacks or harassment near public areas where people defecate or urinate are common.

Prevention

Strategies that help communities, both rural and near cities, become and stay free of open defecation include sanitation marketing, behavior change communication, and improved community-led total sanitation (CLTS+), along with methods called "nudging."

One key way to stop open defecation is by changing behaviors. SaniFOAM is a framework that helps understand and solve problems related to sanitation and hygiene. It uses four areas—focus, opportunity, ability, and motivation—to identify reasons people may not use toilets. This model also helps plan, track, and assess sanitation efforts. Other important factors that help reduce open defecation include:

• Support from leaders and government
• Sanitation solutions that are better than open defecation
• Stronger systems for local services
• Creating systems that encourage people to use toilets

Efforts to reduce open defecation are similar to those aimed at meeting the Millennium Development Goal (MDG) of improving access to sanitation. Key steps include raising awareness (like through the UN World Toilet Day), campaigns to change behavior, and increasing government support and public demand for better sanitation. Community-Led Total Sanitation (CLTS) programs focus on helping communities take action themselves to stop open defecation.

Simple toilet technologies can help reduce open defecation when people lack toilets at home or when shared toilets are too far or unsafe to use, such as at night. Some people use plastic bags, called "flying toilets," to collect waste at night. A more advanced option is the "Peepoo bag," created by a Swedish company. This bag is a single-use, self-cleaning, biodegradable toilet that stops waste from polluting the environment. It is used in areas affected by crises, schools, and poor urban areas in developing countries.

Bucket toilets are a simple, portable option. They can be improved by adding urine diversion, which separates urine from solid waste. This reduces odors and makes the toilet more similar to dry toilets that separate urine. Examples of this type of toilet include the "MoSan" toilet in Kenya and urine-diverting dry toilets promoted by SOIL in Haiti.

Society and culture

In some countries where open defecation is a problem, such as India and Pakistan, the main news sources have been discussing this issue. In some places, openly defecating is considered a crime and can lead to fines or jail time. In an essay titled "Adventures at Poo Corner," David Sedaris wrote about people who use public restrooms for this activity. Some national parks do not allow open defecation in certain areas. If someone must defecate in the open, they are advised to dig a hole, use it, and then cover it with dirt.