Allisyn the barovik slums in Mumbai
which is one of the largest slums in the
world where I was doing some research to
understand the effect of toilets at the
latrines on health outcomes now I was
really interested in this topic of
toilets for a certain reason
toilets we’ve been talking about now for
a very long time and it seems like it’s
very glamorized but there’s a lot more
to it there’s a lot more than just the
topic of dignity around it it really has
very clear and direct health outcomes
they’re seeing India has one of the
highest rates of child mortality in this
country due to diarrhea and other
waterborne illnesses poor sanitation has
clear linkages with waterborne illnesses
and hence with child mortality also
really interesting research some of
which has been coming out in various
states in the country in relation to the
total sanitation campaign and now such
model as well as with some of my work
has tried to look at the effect of
toilets on stunting and look at the
effect of open defecation
on stunting to see how not just lack of
nutrition but your body not being able
to absorb enough nutrition has an effect
on your child’s height as well this is a
very very important topic in a grave one
to considering India is going to have
the highest number of children in the
world in just a couple years so now
let’s go back to the very slums I
started working in the slums where you
know at first I thought that there’s
just a lack of toilets because there’s a
lack of toilets maybe people can’t use
toilets and hence have poor health
outcomes in fact in some of my research
and in talking to those incredible women
I just realised in a couple of days
there there was no lack of toilet cell
in fact that Harvey’s lungs have more
than 451 toilet blocks with each toilet
block having about thirty two cubicles
which means about 14,500 toilet cubicles
for a population of about 10 lakh people
which means they were actually more than
enough toilets but most of those toilets
were not maintained most of these
toilets were dirty they were stinking
people openly defecated outside of those
toilets and in this
giving another toilet providing another
toilet was not the solution the problem
was that there were not enough toilets
the problem was that the toilets were
not being maintained people didn’t care
again if you don’t use toilets you can’t
show health outcomes you will not have
improved health outcomes if you don’t
use these things it’s not just about
providing a toilet it’s also about
ensuring its uptake
now when you often think about toilets
in India we think that it’s too
expensive to build a toilet the poor
people people in low income communities
can’t afford toilets and hence we have
less toilets in this country because we
do have a large majority of the
population still living below the
poverty line if that was the case then
low-income communities in countries
around the world would extrude
experience similar things should also
experience high rates of open defecation
and have low uptake of toilets but even
just looking at the world map and
looking at our neighbours Bangladesh and
Pakistan Bangladesh has an open
defecation rate of 1% Pakistan that of
13% India that of 44% six hundred
million Indians still do not use toilets
as you can see in the on the world map
it’s very concentrated India they’re not
the only low-income country in the world
this has more to do with other things
than just cost it’s not just that it’s
too expensive to build a toilet it’s
also that toilets in India is linked to
purity and impurity and deeply embedded
within our caste system people if the
higher caste don’t want to be cleaning
the crap out of a toilet because it
would demean their stature in society
people are for lower caste don’t want to
be demeaning their status in society
further because they’ve been demeaned
for generations they want to move up so
if neither caste is actually able to
advance to clean a toilet then you can’t
be using a toilet giving out a toilet to
these people is not going to make them
use it and hence it won’t affect their
health outcomes now lets us try to
understand how sanitation success
is measured today we have various levels
to be various grades in which we can
remove up the ladder in sanitation so g0
grade 0 is essentially open defecation
it’s the cheapest alternative if you
have to do nothing but walk to an open
education site and carry a pail of water
if you move up the ladder you have a
grade one a makeshift toilet this could
be a simple hole in the ground toilet
just something that could cost less than
2 thousand rupees to build it could be
something as simple as this and the
interesting thing is people around the
world outside of India actually
comfortable and okay using something
like this people in the Philippines
where I was working recently were more
than happy to use something like this if
they realize that open defecation was
not an option but they couldn’t afford a
fancy or toilet but in India we link
this to purity again it’s supposed to be
something that has to do so much with
cleanliness that we are not okay with
using something like this if we can’t
afford a toilet we will either openly
defecate so be a g0 all we will want to
jump to g2 which is a really fancy
toilet these are tiny toilets brick
walls proper roof proper door we want
all of that to be in place which costs
every every little addition costs more
so this cost eleven thousand rupees and
upwards depending on just how many
features they add into that toilet and
then g3 is adding a septic tank and
these toilets can cost upwards of thirty
thousand rupees and hence in India that
notion of a toilet is too expensive kind
of comes from this it’s not too
expensive to build any kind of a toilet
it’s too expensive to build the kind of
toilet that we want to build and hence
we’ll either openly defecate or we will
jump to that level but to jump to that
level it’s it’s too expensive
and also it requires us to get over this
stigma of culture and disgust that’s
associated with that toilet that is also
very expensive to get over and it takes
time it will not happen by just giving
out and constructing a toilet now let’s
take the case of sanitary napkins
something else had been really
glamorized today but toilets and
sanitary napkin
actually very very links to each other
and how so we think that women girls in
India today are not using sanitary
napkins because it’s too expensive
girls can’t afford to buy sanitary
napkins today but it’s cost the real
problem if you ask a woman today what
she prioritizes in her budget list she
will start saying things like groceries
mini sub Jia then she’ll start saying
you know other kitchen items then school
supplies for my children clothes for my
children clothes and items for my
husband maybe clips and jewelry for
herself and her daughter and then maybe
if she has some additional money on
sanitary napkins why because she can
make do with heads she can make do with
using cloths and these cloth items which
are not but it’s not bad to use a cloth
on its own but it’s bad if you don’t
have access to hot water and access to a
place to dry it onto the Sun under UV
radiation and in that case they still
treat bath is an aspirational product
not as a necessity it doesn’t fall under
her prioritization list now say that she
actually has some additional money in a
month and she actually fits in pads on
that list because it somehow becomes the
aspiration product um from that list
how does she buy it today in India now
that’s assuming if you have access to a
medical store medical shop where you
normally buy sunshine napkins
you’ll go with the chit of people
something like this says packet of eight
pads or you will send a male member of
your family to avoid being so
embarrassed you’ll go to a medical store
that looks somewhat like this packed
with men
male shopkeeper male guy Sandoz male
customers and in front of all of these
people you have to ask and give this
or ask for a packet of pads where
they look at you and they’ll know that
you know you have your periods now which
is why you’re asking for a packet of
paths the shopkeeper himself will be
embarrassed he’ll try to look away from
you and then when he actually hands the
packet to you they wrap it up in layers
and layers of newspaper put it in a
black polythene bag and then hand it to
you you he’ll cover it under the do but
there further and then look down on the
and then walk away everyone pretends
like this incident never happened all
the shame and stigma for what had she
asked for a bomb a grenade maybe it was
something as simple and medical as a
band-aid it was to stop natural blood
flow but she was made to feel
stigmatized and victimized for asking
something so simple and natural of
course she feel impure of course she
feel like it’s her fault
of course she feels small giving out a
free back to her is not going to get
over that stigma that’s associated with
it it will only get over the cost we
need to understand that all of this has
to do with health we need to keep going
back and understanding why are we doing
this why are we focusing on toilets why
are we focusing on pads it’s because
they have direct health outcomes but you
won’t have those health outcomes until
you actually use these products and
understand their importance in terms of
the health language not just that
they’re receiving these pads and you can
use them for as long as we receive them
and because we still don’t prioritize it
we will remove them from that necessary
sesame list and include them as an
aspirational product because it still
doesn’t fit in our budget girls now get
their periods for 450 times in their
lifetime we get this every every month
from the age of nine to the age of 45
for many girls in this case in such a
scenario girls are I essentially told
that well if you for the time of you
receiving these free schemes and three
paths you can possibly you can possibly
accept it for 450 times do you think is
this possible we need to get over this
stigma and this culture that’s
associated with it for women to really
take it on themselves and consider this
a priority now the interesting thing is
actually how we as I founded this okay
along with a couple of incredible
community leaders I’ll call the Menem
Heller Foundation which is an
organization that we have designed to
start talking about these issues
it’s called mana because it’s the bird
that talks a lot like thathe men are
because you want these women to really
understand and get over that stigma we
are using pads not as the end goal but
as a means to start talking about a
taboo topic and that would link to other
taboo topics like domestic violence and
sexual assault which are all linked to
each other a woman that opens up about
one topic is more likely to start
talking about others as well and it’s
very important for us to realize all of
this in the context of health outcomes
again health outcomes links to increase
attendance whether it’s at work in
school that leads to increase
productivity and that leads to increased
equality in society where we start to
feel like we’re equal and they’re not
small another really interesting thing
is how all of this is actually links to
each other when we’re thinking about the
different products and latrine sanitary
pads adherence to medications improve
cooking stoves a woman and a family that
prioritizes health and that prioritizes
any one of these products is likely to
prioritize the others as well a family
that is prioritize the toilet because
they understand the importance of this
in terms of health outcomes is likely to
also use pads is also likely to adhere
to medications and also likely to use
improving stores and a family that
doesn’t prioritize health is unlikely to
use any of these items and many more so
by giving any of these items alone for
free is not going to induce them to use
the other items because they don’t see
it in terms of their health outcomes so
if you take anything away from this talk
let it be this giving out free pads and
toilets alone is not the solution to our
inherent culture of disgust and shame
that surrounds these these medical
health hygiene topics we need to change
our values and that change begins with you thank you
which is one of the largest slums in the
world where I was doing some research to
understand the effect of toilets at the
latrines on health outcomes now I was
really interested in this topic of
toilets for a certain reason
toilets we’ve been talking about now for
a very long time and it seems like it’s
very glamorized but there’s a lot more
to it there’s a lot more than just the
topic of dignity around it it really has
very clear and direct health outcomes
they’re seeing India has one of the
highest rates of child mortality in this
country due to diarrhea and other
waterborne illnesses poor sanitation has
clear linkages with waterborne illnesses
and hence with child mortality also
really interesting research some of
which has been coming out in various
states in the country in relation to the
total sanitation campaign and now such
model as well as with some of my work
has tried to look at the effect of
toilets on stunting and look at the
effect of open defecation
on stunting to see how not just lack of
nutrition but your body not being able
to absorb enough nutrition has an effect
on your child’s height as well this is a
very very important topic in a grave one
to considering India is going to have
the highest number of children in the
world in just a couple years so now
let’s go back to the very slums I
started working in the slums where you
know at first I thought that there’s
just a lack of toilets because there’s a
lack of toilets maybe people can’t use
toilets and hence have poor health
outcomes in fact in some of my research
and in talking to those incredible women
I just realised in a couple of days
there there was no lack of toilet cell
in fact that Harvey’s lungs have more
than 451 toilet blocks with each toilet
block having about thirty two cubicles
which means about 14,500 toilet cubicles
for a population of about 10 lakh people
which means they were actually more than
enough toilets but most of those toilets
were not maintained most of these
toilets were dirty they were stinking
people openly defecated outside of those
toilets and in this
giving another toilet providing another
toilet was not the solution the problem
was that there were not enough toilets
the problem was that the toilets were
not being maintained people didn’t care
again if you don’t use toilets you can’t
show health outcomes you will not have
improved health outcomes if you don’t
use these things it’s not just about
providing a toilet it’s also about
ensuring its uptake
now when you often think about toilets
in India we think that it’s too
expensive to build a toilet the poor
people people in low income communities
can’t afford toilets and hence we have
less toilets in this country because we
do have a large majority of the
population still living below the
poverty line if that was the case then
low-income communities in countries
around the world would extrude
experience similar things should also
experience high rates of open defecation
and have low uptake of toilets but even
just looking at the world map and
looking at our neighbours Bangladesh and
Pakistan Bangladesh has an open
defecation rate of 1% Pakistan that of
13% India that of 44% six hundred
million Indians still do not use toilets
as you can see in the on the world map
it’s very concentrated India they’re not
the only low-income country in the world
this has more to do with other things
than just cost it’s not just that it’s
too expensive to build a toilet it’s
also that toilets in India is linked to
purity and impurity and deeply embedded
within our caste system people if the
higher caste don’t want to be cleaning
the crap out of a toilet because it
would demean their stature in society
people are for lower caste don’t want to
be demeaning their status in society
further because they’ve been demeaned
for generations they want to move up so
if neither caste is actually able to
advance to clean a toilet then you can’t
be using a toilet giving out a toilet to
these people is not going to make them
use it and hence it won’t affect their
health outcomes now lets us try to
understand how sanitation success
is measured today we have various levels
to be various grades in which we can
remove up the ladder in sanitation so g0
grade 0 is essentially open defecation
it’s the cheapest alternative if you
have to do nothing but walk to an open
education site and carry a pail of water
if you move up the ladder you have a
grade one a makeshift toilet this could
be a simple hole in the ground toilet
just something that could cost less than
2 thousand rupees to build it could be
something as simple as this and the
interesting thing is people around the
world outside of India actually
comfortable and okay using something
like this people in the Philippines
where I was working recently were more
than happy to use something like this if
they realize that open defecation was
not an option but they couldn’t afford a
fancy or toilet but in India we link
this to purity again it’s supposed to be
something that has to do so much with
cleanliness that we are not okay with
using something like this if we can’t
afford a toilet we will either openly
defecate so be a g0 all we will want to
jump to g2 which is a really fancy
toilet these are tiny toilets brick
walls proper roof proper door we want
all of that to be in place which costs
every every little addition costs more
so this cost eleven thousand rupees and
upwards depending on just how many
features they add into that toilet and
then g3 is adding a septic tank and
these toilets can cost upwards of thirty
thousand rupees and hence in India that
notion of a toilet is too expensive kind
of comes from this it’s not too
expensive to build any kind of a toilet
it’s too expensive to build the kind of
toilet that we want to build and hence
we’ll either openly defecate or we will
jump to that level but to jump to that
level it’s it’s too expensive
and also it requires us to get over this
stigma of culture and disgust that’s
associated with that toilet that is also
very expensive to get over and it takes
time it will not happen by just giving
out and constructing a toilet now let’s
take the case of sanitary napkins
something else had been really
glamorized today but toilets and
sanitary napkin
actually very very links to each other
and how so we think that women girls in
India today are not using sanitary
napkins because it’s too expensive
girls can’t afford to buy sanitary
napkins today but it’s cost the real
problem if you ask a woman today what
she prioritizes in her budget list she
will start saying things like groceries
mini sub Jia then she’ll start saying
you know other kitchen items then school
supplies for my children clothes for my
children clothes and items for my
husband maybe clips and jewelry for
herself and her daughter and then maybe
if she has some additional money on
sanitary napkins why because she can
make do with heads she can make do with
using cloths and these cloth items which
are not but it’s not bad to use a cloth
on its own but it’s bad if you don’t
have access to hot water and access to a
place to dry it onto the Sun under UV
radiation and in that case they still
treat bath is an aspirational product
not as a necessity it doesn’t fall under
her prioritization list now say that she
actually has some additional money in a
month and she actually fits in pads on
that list because it somehow becomes the
aspiration product um from that list
how does she buy it today in India now
that’s assuming if you have access to a
medical store medical shop where you
normally buy sunshine napkins
you’ll go with the chit of people
something like this says packet of eight
pads or you will send a male member of
your family to avoid being so
embarrassed you’ll go to a medical store
that looks somewhat like this packed
with men
male shopkeeper male guy Sandoz male
customers and in front of all of these
people you have to ask and give this
or ask for a packet of pads where
they look at you and they’ll know that
you know you have your periods now which
is why you’re asking for a packet of
paths the shopkeeper himself will be
embarrassed he’ll try to look away from
you and then when he actually hands the
packet to you they wrap it up in layers
and layers of newspaper put it in a
black polythene bag and then hand it to
you you he’ll cover it under the do but
there further and then look down on the
and then walk away everyone pretends
like this incident never happened all
the shame and stigma for what had she
asked for a bomb a grenade maybe it was
something as simple and medical as a
band-aid it was to stop natural blood
flow but she was made to feel
stigmatized and victimized for asking
something so simple and natural of
course she feel impure of course she
feel like it’s her fault
of course she feels small giving out a
free back to her is not going to get
over that stigma that’s associated with
it it will only get over the cost we
need to understand that all of this has
to do with health we need to keep going
back and understanding why are we doing
this why are we focusing on toilets why
are we focusing on pads it’s because
they have direct health outcomes but you
won’t have those health outcomes until
you actually use these products and
understand their importance in terms of
the health language not just that
they’re receiving these pads and you can
use them for as long as we receive them
and because we still don’t prioritize it
we will remove them from that necessary
sesame list and include them as an
aspirational product because it still
doesn’t fit in our budget girls now get
their periods for 450 times in their
lifetime we get this every every month
from the age of nine to the age of 45
for many girls in this case in such a
scenario girls are I essentially told
that well if you for the time of you
receiving these free schemes and three
paths you can possibly you can possibly
accept it for 450 times do you think is
this possible we need to get over this
stigma and this culture that’s
associated with it for women to really
take it on themselves and consider this
a priority now the interesting thing is
actually how we as I founded this okay
along with a couple of incredible
community leaders I’ll call the Menem
Heller Foundation which is an
organization that we have designed to
start talking about these issues
it’s called mana because it’s the bird
that talks a lot like thathe men are
because you want these women to really
understand and get over that stigma we
are using pads not as the end goal but
as a means to start talking about a
taboo topic and that would link to other
taboo topics like domestic violence and
sexual assault which are all linked to
each other a woman that opens up about
one topic is more likely to start
talking about others as well and it’s
very important for us to realize all of
this in the context of health outcomes
again health outcomes links to increase
attendance whether it’s at work in
school that leads to increase
productivity and that leads to increased
equality in society where we start to
feel like we’re equal and they’re not
small another really interesting thing
is how all of this is actually links to
each other when we’re thinking about the
different products and latrine sanitary
pads adherence to medications improve
cooking stoves a woman and a family that
prioritizes health and that prioritizes
any one of these products is likely to
prioritize the others as well a family
that is prioritize the toilet because
they understand the importance of this
in terms of health outcomes is likely to
also use pads is also likely to adhere
to medications and also likely to use
improving stores and a family that
doesn’t prioritize health is unlikely to
use any of these items and many more so
by giving any of these items alone for
free is not going to induce them to use
the other items because they don’t see
it in terms of their health outcomes so
if you take anything away from this talk
let it be this giving out free pads and
toilets alone is not the solution to our
inherent culture of disgust and shame
that surrounds these these medical
health hygiene topics we need to change
our values and that change begins with you thank you
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