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India has made impressive strides in recent decades. It has one of the world's largest economies. It's a leader in high-tech and software development. India is sending a space probe to Mars. But here's a sobering statistic that paints a very different picture. Six hundred and twenty-six million people, about half the country, have no access to toilets. The result is a public health crisis which India's government is now confronting. NPR's Julie McCarthy reports.
JULIE MCCARTHY, BYLINE: A young girl sweeps fallen debris from a tempest that blew through her village of Katra Shadat Ganj, one recent evening. This remote spot in Uttar Pradesh, India's largest state, has become the center of another gathering storm. It was, here two weeks ago, where two young girls were audaciously attacked, raped and hanged from a tree. Inter-caste violence and patriarchy made a chilling spectacle in this impoverished place of mud caked children and hand pumped water. But the deaths, conceivably, could have been averted if the girls had had access to a toilet at home. Lacking one on the night they were killed, the two teens did what hundreds of millions of women do across India each day. Under the cloak of darkness, before sunrise or after sunset, they set out for an open field to relieve themselves. Guddo Devi is a cousin of the two slain girls and says women normally move in pairs to avoid being preyed upon.
GUDDO DEVI: (Through translator) Yes, when we step out of the house, we are scared, and we have to go in the mornings and evenings. And when we cannot stop ourselves, we at times, go in the afternoons, as well. And there are no bathrooms. We don't have any kind of facility. We have to go out.
MCCARTHY: Others complained of harassment in the fields. But only now, after the double rape and murder, do they fear for their lives, performing the simplest bodily function. Social entrepreneur Bindeshwar Pathak has offered to build a toilet for every house in this village. It wouldn't be the first time for the man known as India's toilet guru. Nine hours' drive away, in the bordering state of Haryana, Pathak has already transformed the village of Hir Mathala with his simple to two-pit design.
BINDESHWAR PATHAK: You see that toilet. That requires only one liter to flush.
MCCARTHY: With Pathak's low-maintenance, low-cost toilet - about $250 - one pit gets filled while the other biodegrades the waste, which can be used as fertilizer. Each of the 144 households has been outfitted in this village - a village Pathak calls a pathfinder.
PATHAK: To show the entire nation that you should have toilets in your house, and here nobody goes outside - this is the beauty of this village.
MCCARTHY: The women of this Hir Mathala village literally sing the praises of the 71-year-old Pathak, whose lowly toilet has become a tool of social change.
UNIDENTIFIED WOMEN: (Singing in Hindi).
MCCARTHY: Their song is about a wife's plea for a toilet. In rural India, households that can't afford to build a latrine, often don't. Resident Shelia Nahelia says her husband refused because of the expense. So Nahelia stitched clothes to raise $50 - her family's portion of the cost and a small fortune for her. Thirty-five-year-old Vijay Laxmi smiles radiantly and says she and her children have never been healthier.
VIJAY LAXMI: (Foreign language spoken).
MCCARTHY: Laxmi says that there has been a huge change our lives. Before, the men would follow us, wait for us to sit in the field and watch. Now thanks to Mr.Pathak, she says, we have a lavatory at home, and we feel better. Laxmi adds, our dignity, which is an ornament for us, is now safe. Pathak's NGO, Sulabh International, has built 1.3 million toilets in Indian homes the past four decades. While commendable, the Sulabh toilet has not dramatically reduced the incidence of open defecation, which presents dire consequences for public health. The practice contaminates food and water and transmits diarrheal diseases that kill 700,000 children every year worldwide.
BRIAN ARBOGAST: And 200,000 of them are in India.
MCCARTHY: That's Brian Arbogast, Director of the Water Sanitation and Hygiene program at the Bill and Melinda Gates Foundation.
ARBOGAST: There's an increasing body of evidence that says that poor sanitation, when a child is young, can lead to mental and cognitive stunting.
MCCARTHY: Arbogast says the Gates Foundation set up a challenge to reinvent the toilet.
ARBOGAST: It can't have to be connected to the water. It can't have to be connected to the sewer grid. It can't have to be connected to the electricity grid. It needs to kill all of the pathogens. And so what comes out of their toilets doesn't smell and can't make anybody sick. And it has to be cheap.
MCCARTHY: The Gates Foundation's Arbogast says even affordable innovations won't alone solve India's sanitation problem. He says India needs a shift in attitude from open defecation is natural, to it's not healthy.
ARBOGAST: You teach them that their children and their families are suffering a lot of sickness because of, you know, basically, fecal matter being transmitted, by flies or other ways, to the food they eat. And once people really realize that, that can really be a triggering event for a community.
MCCARTHY: Diane Coffey of Princeton's Woodrow Wilson School says simply providing latrines is no guarantee that people will use them. She studied five northern Indian states and found that 19 percent of women in a household with access to a latrine still preferred to defecate in the open. Gouri Choudhury, director of the human rights group Action India, says the country's political leadership has failed to grasp the gravity of the problem.
GOURI CHOUDHURY: It's a question of belief in human dignity, which somewhere along the line, we seem to have lost.
MCCARTHY: India and China each have more than 1 billion people, and here's the contrast. The World Health Organization says, in China, 1 out of 100 people defecates out in the open. In India, 1 out of every 2 people openly defecates. But India's former rural development minister, Jairam Ramesh, says increased government assistance for building toilets has spurred construction, as has the issue of women's privacy.
JAIRAM RAMESH: We launched a campaign called the No Toilet, No Bride campaign, where, you know, we would - I would go out and exhort women not to get married into families that did not have toilets. And this worked.
MCCARTHY: A social movement to revolutionize attitudes and behavior toward sanitation may be in order. And many Indians look to their new prime minister, Narendra Modi, to make good on his recent election campaign promise - toilets first, temples later. Julie McCarthy, NPR News, New Delhi.
GREENE: And it is worth noting, the Gates foundation, which was mentioned in Julie's piece, also supports NPR programming. This is NPR News.
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