Civil & Environmental Engineering, Stanford University, Palo Alto, CA 94305, USA.
School of Public Health, U.C. Berkeley, Berkeley, CA 74707, USA.
Int J Environ Res Public Health. 2020 Feb 21;17(4):1384. doi: 10.3390/ijerph17041384.
Swachh Bharat Abhiyan, India's flagship sanitation intervention, set out to end open defecation by October 2019. While the program improved toilet coverage nationally, large regional disparities in construction and use remain. Our study used ethnographic methods to explore perspectives on open defecation and latrine use, and the socio-economic and political reasons for these perspectives, in rural Bihar. We draw on insights from social epidemiology and political ecology to explore the structural determinants of latrine ownership and use. Though researchers have often pointed to rural residents' preference for open defecation, we found that people were aware of its many risks. We also found that (i) while sanitation research and "behavior change" campaigns often conflate the reluctance to adopt latrines with a preference for open defecation, this is an erroneous conflation; (ii) a subsidy can help (some) households to construct latrines but the amount of the subsidy and the manner of its disbursement are key to its usefulness; and (iii) widespread resentment towards what many rural residents view as a development bias against rural areas reinforces distrust towards the government overall and its Swachh Bharat Abhiyan-funded latrines in particular. These social-structural explanations for the slow uptake of sanitation in rural Bihar (and potentially elsewhere) deserve more attention in sanitation research and promotion efforts.
印度的旗舰卫生干预计划“清洁印度行动”（Swachh Bharat Abhiyan）旨在 2019 年 10 月之前结束露天排便。虽然该计划提高了全国范围内的厕所覆盖率，但在建设和使用方面仍存在较大的地区差异。我们的研究使用民族志方法，探索了在比哈尔邦农村地区，人们对露天排便和厕所使用的看法，以及这些看法背后的社会经济和政治原因。我们借鉴社会流行病学和政治生态学的观点，探讨了厕所拥有和使用的结构决定因素。尽管研究人员经常指出农村居民对露天排便的偏好，但我们发现人们已经意识到其存在的诸多风险。我们还发现：（i）尽管卫生研究和“行为改变”运动经常将不愿使用厕所与偏好露天排便混为一谈，但这是一种错误的混淆；（ii）补贴可以帮助（一些）家庭建造厕所，但补贴的金额和发放方式是其有效性的关键；（iii）许多农村居民认为这是一种对农村地区的发展偏见，对此他们普遍感到不满，这加剧了他们对政府的不信任，尤其是对政府的“清洁印度行动”资助的厕所的不信任。这些对比哈尔邦农村地区卫生设施普及缓慢的社会结构性解释（可能在其他地方也同样适用），在卫生研究和推广工作中应得到更多关注。
