Toilet Behavior Changes Begins
with Asking “Why”
Written by E4C contributing editor Susan Davis,
executive director of Improve International
TO CHANGE HUMAN BEHAVIOR, we need to understand the human. A review of research on sanitation
successes in developing countries shows that the
sector needs a different way of thinking.
About 68 percent of the world’s population has
access to improved sanitation facilities, ranging
from seven percent in South Sudan to 100 percent
in advanced countries, according to the World Bank.
We don’t know how many people actually use these
toilets, however, or whether they use them hygienically. Actually, the little evidence that we have
suggests that many people don’t use a toilet even
when one is available.
It seems obvious that toilets and latrines must be
used to be effective. Research suggests that regular,
hygienic latrine use depends on these factors:
Differences within households: Surveys often
assume one household respondent represents the
whole household, but one study in India found that
more than 40 percent of households with a working
latrine have at least one member who still chooses
Gender: One study in Ethiopia showed latrine
use differed between men, women, girls, and
boys. In India, women are more likely to use
latrines than men.
Age: Children’s use of toilets and disposal of
children’s feces is an area of concern. Many mothers
believe children’s feces are harmless, even though
children’s feces are more likely to be contaminated
with diarrhea causing pathogens than adult feces.
But because of this belief, many mothers practice
unsafe disposal. In Cambodia, for example, only 20
percent of children's feces were disposed of safely. In
sub-Saharan Africa and Southeast Asia, burying children’s feces is common, while disposal by garbage is
widely practiced in middle- and high-income countries.
Experts say these disposal methods should not be
considered safe or improved.
Where to go: A study in Ethiopia found a stark
difference between how people use latrines at
home and away: 33 percent of adults practice open
defecation at home, but 77 percent practice open
defecation at a workplace.
Religion and culture: Several studies have found
that providing toilets does not ensure use when there
are culturally-ingrained behavioral barriers to using
them. One survey of 3,200 households in India reported
that household latrines are seen as damaging to the
purity of the home. Most Hindus are opposed to emptying their own latrine pits, while people from the lowest
“untouchable” castes resist this work because it is seen
as degrading and reinforces their low social status.
Dry or wet: In the Middle East, sanitation is primarily water-based, as dry sanitation is not culturally
acceptable. The same applies to other predominantly
Muslim regions. In the Jordan Valley, for example, 97
percent of households install their own pour-flush
latrines. Meanwhile, in Nigeria, WaterAid found that
“a low-quality toilet is an embarrassment for the family.” Instead, people prefer a water-based toilet even
though they often cost 44 to 77 percent of an average
family’s annual income.
Washing or wiping: How people clean themselves
after defecation also varies community to community. Some people wipe using paper or other material,
while others wash, using water and their hand. Water
supplies may therefore be needed for cleansing,
flushing and hand-washing.
Understanding why and how people use toilets will
help us think about improving the user experience, and
thus increase hygienic use. Given the many human
factors involved, design thinking combined with behavior change science might be a better way to develop
sanitation solutions that people can and will use, rather
than strict infrastructure-focused approaches. •
PERCENT OF POPULATION
WITH ACCESS TO IMPROVED
SOURCE: WORLD BANK
SOU TH SUDAN