Public health in India has long been plagued by the problem of open defecation and public urination, consequently creating barriers to maintain sanitation and hygiene in rapidly urbanizing environments (UNICEF, 2015). While open defecation remains a predominantly rural problem (only 12% of urban India faces this problem), public urination continues to harm the fabric of urban growth in India. In the context of the recently launched Swachh Bharat Abhiyan (Clean India Campaign), the need to remedy public urination in India's cities has re-emerged as a key challenge to achieving cleaner cities, and instilling a greater sense of civic duty in residents.
A number of studies in India (and abroad) have shown that open defecation can have deleterious effects on nutrition (Spears, Ghosh, & Cumming, 2013), cognitive development , and overall economic productivity (Research Institute for Compassionate Economics, 2015). Accordingly, government policies have adopted a mix of tools to address this problem: everything from cash incentives to constructing toilets (Kaiser, 2015), to celebrity social messages, to constructing the toilets themselves. While it may be too early to evaluate the Swachh Bharat Abhiyan for impacts, it is clear that open defecation presents a unique and persistent public health challenge for rural India.
Given that building toilets and granting access is not the core problem, academic studies (and eventually policy) turned their attention to social and behavioural norms that may be underlying open defecation. Gertler, Shah, Alzua, and Cameron (2015) studied the impact of community-led sanitation interventions in villages from two districts in rural Madhya Pradesh. They found a 10% reduction in open defecation rates as a result of the intervention, pointing towards the idea that ‘shaming’ (and thus social norms) significantly deter individual decisions to defecate in the open (Pattanayak et al., 2009). These effects are somewhat amplified when community leaders take efforts to curb unsanitary practices in the village (Lamba & Spears, 2013; Rommel & Janssen, 2015), suggesting that influential persons may be key complementarities to effective public policy (Banerjee, Chandrasekhar, Duflo, & Jackson, 2014). Indeed, among the more interesting findings related to open defecation alludes to traditional Hindu norms of ‘untouchability’ and ‘purity’, which deters them from using toilets even if good quality facilities are available in their homes (Coffey, Gupta, & Hathi, 2014). This qualitative study found that caste-based social rules influence decisions of use of pit-based latrines built in their homes.
If using a toilet at home violates norms of sacredness, then perhaps public urination is not a completely inexplicable act of public nuisance. Ironically, religious imagery is commonplace when it comes to preventing vandalism and public nuisance in India, but the effects of using such imagery are yet to be rigorously or empirically assessed. Given that ideas of the ‘sacred’ play an important role in sanitation decisions, it is worth exploring how they can be harnessed to address problems of public urination. Solutions to the problem of public urination and defacement include (but are not restricted to) painting of street art reflecting historical and cultural motifs; public shaming; use of water cannons to hose down offenders; and cash incentives to use public toilets. Each have experienced varied levels of success in their respective cities, but so far no one-size-fits-all approach has been used across cities and states. The use of imagery or text that is perceived to be sacred (in the religious context) fits broadly into the framework of choice architecture and nudging (Thaler & Sunstein, 2008), as a method to alter malpractices such as public urination without explicitly forbidding the practice itself.
While some of these nudges have come at an institutional level, others have operated at a smaller scale, usually for a particular building or community. This offers scope for scaling up the intervention using a combination of sacred imagery, social shaming by religious and cultural (sacred) institutions, and/or cash benefits. Ultimately, any case for social and behavioural change will have to be made in the context of the costs of status-quo for public health in India's cities, where improving sanitation is a key challenge. In invoking the sacred and priming citizens with morality, perhaps the threat posed by public urination can be communicated subtly, thereby aiding the improvement of public health and sanitation in cities. Being a deeply religious nation, religious imagery is an apt starting point to induce behaviour change, especially in the public realm. Using the sacred to instil a sense of civic duty may seem underhanded, but is nevertheless ingenious in this context.