Open defecation

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Open defecation (also used in the opposite meaning as open defecation free (ODF)) is the human practice of defecating outside (in the open environment) rather than into a toilet. People may choose fields, bushes, forests, ditches, streets, canals or other open space for defecation. They do so because either they do not have a toilet readily accessible or due to traditional cultural practices. [1] The practice is common where sanitation infrastructure and services are not available. Even if toilets are available, behavior change efforts may still be needed to promote the use of toilets. The term "open defecation free" (ODF) is used to describe communities that have shifted to using a toilet instead of open defecation. This can happen for example after community-led total sanitation programs have been implemented.

Toilet Piece of hardware for the collection or disposal of human excreta

A toilet is a piece of hardware used for the collection or disposal of human urine and feces. In other words: "Toilets are sanitation facilities at the user interface that allow the safe and convenient urination and defecation". Toilets can be with or without flushing water. They can be set up for a sitting posture or for a squatting posture. Flush toilets are usually connected to a sewer system in urban areas and to septic tanks in less built-up areas. Dry toilets are connected to a pit, removable container, composting chamber, or other storage and treatment device. Toilets are commonly made of ceramic (porcelain), concrete, plastic, or wood.

Sanitation public health conditions related to clean drinking water and adequate disposal of human excreta and sewage

Sanitation refers to public health conditions related to clean drinking water and adequate treatment and disposal of human excreta and sewage. Preventing human contact with feces is part of sanitation, as is hand washing with soap. Sanitation systems aim to protect human health by providing a clean environment that will stop the transmission of disease, especially through the fecal–oral route. For example, diarrhea, a main cause of malnutrition and stunted growth in children, can be reduced through sanitation. There are many other diseases which are easily transmitted in communities that have low levels of sanitation, such as ascariasis, cholera, hepatitis, polio, schistosomiasis, trachoma, to name just a few.

Behavior change, in the context of public health, refers to efforts put in place to change people's personal habits and attitudes, to prevent disease. Behavior change in public health is also known as social and behavior change communication (SBCC). More and more, efforts focus on prevention of disease to save healthcare care costs. This is particularly important in low and middle income countries, such as Ghana, where health interventions have come under increased scrutiny because of the cost.


About 892 million people, or 12 percent of the global population, practiced open defecation in 2016. [2] Seventy-six percent (678 million) of the 892 million people practicing open defecation in the world live in just seven countries. [2]

Open defecation can pollute the environment and cause health problems.[ citation needed ] High levels of open defecation are linked to high child mortality, poor nutrition, poverty, and large disparities between rich and poor. [3] (p11)

Child mortality Death rate of infants and young children

Child mortality, also known as child death, refers to the death of children under the age of 14 and encompasses neonatal mortality, under-5 mortality, and mortality of children aged 5–14. Many child deaths go unreported for a variety of reasons, including lack of death registration and lack of data on child migrants. Without accurate data on child deaths, we cannot fully discover and combat the greatest risks to a child's life.

Poverty state of one who lacks a certain amount of material possessions or money

Poverty is not having enough material possessions or income for a person's needs. Poverty may include social, economic, and political elements.

Ending open defecation is an indicator being used to measure progress towards the Sustainable Development Goal Number 6. Extreme poverty and lack of sanitation are statistically linked. Therefore, eliminating open defecation is thought to be an important part of the effort to eliminate poverty. [4]

Sustainable Development Goal 6 The sixth of 17 Sustainable Development Goals calling for clean water and sanitation for all people by 2030

Sustainable Development Goal 6 is one of 17 Sustainable Development Goals established by the United Nations General Assembly in 2015. It calls for clean water and sanitation for all people. The official wording is: "Ensure availability and sustainable management of water and sanitation for all." The goal has eight targets to be achieved by at least 2030. Progress toward the targets will be measured by using eleven "indicators."


Defecating in the open is a very ancient practice. In ancient times, there were more open spaces and less population pressure on land. It was believed that defecating in the open causes little harm when done in areas with low population, forests, or camping type situations. With development and urbanization, open defecating started becoming a challenge and thereby an important public health issue, and an issue of human dignity. [5] With the increase in population in smaller areas, such as cities and towns, more attention was given to hygiene and health. As a result, there was an increase in global attention towards reducing the practice of open defecation. [6]

Public health preventing disease, prolonging life and promoting health through organized efforts and informed choices of society and individuals

Public health has been defined as "the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the health of a population and the threats it faces is the basis for public health. The public can be as small as a handful of people or as large as a village or an entire city; in the case of a pandemic it may encompass several continents. The concept of health takes into account physical, psychological and social well-being. As such, according to the World Health Organization, it is not merely the absence of disease or infirmity.

Dignity is the right of a person to be valued and respected for their own sake, and to be treated ethically. It is of significance in morality, ethics, law and politics as an extension of the Enlightenment-era concepts of inherent, inalienable rights. The term may also be used to describe personal conduct, as in "behaving with dignity".

Open defecation perpetuates the vicious cycle of disease and poverty and is widely regarded as an affront to personal dignity. [3] The countries where open defecation is most widely practised have the highest numbers of deaths of children under the age of five, as well as high levels of undernutrition, high levels of poverty, and large disparities between the rich and poor. [3]

Malnutrition Medical condition that results from eating too little, too much, or the wrong nutrients

Malnutrition is a condition that results from eating a diet in which one or more nutrients are either not enough or are too much such that the diet causes health problems. It may involve calories, protein, carbohydrates, vitamins or minerals. Not enough nutrients is called undernutrition or undernourishment while too much is called overnutrition. Malnutrition is often used to specifically refer to undernutrition where an individual is not getting enough calories, protein, or micronutrients. If undernutrition occurs during pregnancy, or before two years of age, it may result in permanent problems with physical and mental development. Extreme undernourishment, known as starvation, may have symptoms that include: a short height, thin body, very poor energy levels, and swollen legs and abdomen. People also often get infections and are frequently cold. The symptoms of micronutrient deficiencies depend on the micronutrient that is lacking.


The term "open defecation" became widely used in the water, sanitation, and hygiene (WASH) sector from about 2008 onwards. This was due to the publications by the Joint Monitoring Programme for Water Supply and Sanitation (JMP) and the UN International Year of Sanitation. The JMP is a joint program by WHO and UNICEF to monitor the water and sanitation targets of the Sustainable Development Goal Number 6.

For monitoring purposes, two categories were created: 1) improved sanitation and (2) unimproved sanitation. Open defecation falls into the category of unimproved sanitation. This means that people who practice open defecation do not have access to improved sanitation.

In 2013 World Toilet Day was celebrated as an official UN day for the first time. The term "open defecation" was used in high-level speeches, that helped to draw global attention to this issue (for example, in the "call to action" on sanitation issued by the Deputy Secretary-General of the United Nations in March 2013). [7]

Open defecation free

"Open defecation free" (ODF) is a phrase first used in community-led total sanitation (CLTS) programs. ODF has now entered use in other contexts. The original meaning of ODF stated that all community members are using sanitation facilities (such as toilets) instead of going to the open for defecation. This definition was improved and more criteria were added in some countries that have adopted the CLTS approach in their programs to stop the practice of open defecation. [8]

The Indian Ministry of Drinking Water and Sanitation has in mid-2015 defined ODF as "the termination of fecal-oral transmission, defined by:

  1. No visible feces found in the environment or village and
  2. Every household as well as public/community institutions using safe technology option for disposal of feces". [9]

Here, 'safe technology option' means toilets that contain feces so that there is no contamination of surface soil, groundwater or surface water; flies or animals do not come in contact with the open feces; no one handles excreta; there is no smell and there are no visible feces around in the environment. [10] This definition is part of the Swachh Bharat Abhiyan (Clean India Campaign).


The reasons for open defecation are varied. It can be a voluntary, semi-voluntary or involuntary choice. Most of the time, a lack of access to a toilet is the reason. However, in some places even people with toilets in their houses prefer to defecate in the open. [8]

A few broad factors that result in the practice of open defecation are listed below.

No toilet

Uncomfortable or unsafe toilet

Unrelated to toilet infrastructure

Public defecation for other reasons

In developed countries, open defecation is either due to homelessness, or considered to be a part of voluntary, recreational outdoor activities in remote areas. It is difficult to estimate how many people practice open defecation in these communities.

The Mad Pooper is the name given to an unidentified woman who regularly defecated in public places while jogging during summer 2017 in the U.S. city of Colorado Springs.

The practice of open defecation is strongly related to poverty and exclusion particularly, in case of rural areas and informal urban settlements in developing countries. The Joint Monitoring Programme for Water Supply and Sanitation (JMP) of UNICEF and WHO has been collecting data regarding open defecation prevalence worldwide. The figures are segregated by rural and urban areas and by levels of poverty. This program is tasked to monitor progress towards the millennium development goal (MDG) relating to drinking water and sanitation. As open defecation is one example of unimproved sanitation, it is being monitored by JMP for each country and results published on a regular basis. [23] [2] The figures on open defecation used to be lumped together with other figures on unimproved sanitation but are collected separately since 2010.

In recent years, the number of people practicing open defecation fell from 20 percent in 2000 to 12 percent in 2015. [2] (p34) Those 892 million people with no sanitation facility whatsoever continue to defecate in gutters, behind bushes, or in open water bodies. Most people (9 of 10) who practice open defecation live in rural areas, but the vast majority lives in two regions (Central Asia and South Asia). [2] Seventy-six percent (678 million) of the 892 million people practicing open defecation in the world live in just seven countries.

In 2015, India was reported to be the country with the highest number of people practicing open defecation: 524 million people or 40% of the total population. These numbers have since then been reduced significantly due to the efforts of the Indian government's Clean India Mission. [2] [24] However, some of the government data may reflect only the availability of toilets but not the actual daily use of toilets.[ citation needed ]

The countries with large numbers of people who openly defecate are listed in the table below.

People practicing open defecation by country - in alphabetical order (use up and down arrows to order by numbers). The figures in column 2 and 3 are from 2015, as reported in 2017 by JMP [2] and made accessible on several websites [25] [26]
CountryTotal country population (in thousands) in 2015 as reported in 2017 by JMP [2] [26] Percentage of people who defecate in the open and absolute numbers (data from 2015 as reported in 2017 by JMP [2] [26] )More recent estimates of people defecating in the open (not JMP data but government data)
Chad 14,03768% or 10 million
China1,376,0492% or 28 million
Eritrea 5,22876% or 4 million
Ethiopia99,39127% or 27 million
India1,311,05139.84% or 524 millionDevelopments since 2017:
  • 6.6% or 88 millions in 2018 according to NRASS conducted by Independent Verificatiom Agency (IVA) of World Bank [27] [28]
  • 1.4% or 19 million in January 2019
    according to government data [29] [30] [31]
Indonesia257,56412% or 31 million
Niger19,89971% or 14 million
Nigeria182,20226% or 47 million
Pakistan188,92512% or 23 million
  • 11.5% or 21.8 million in 2015 as per WaterAid report [32]
  • 21.7% or 41 million in 2015 as per UNICEF [33]
South Sudan 12,34061% or 8 million
Sudan40,23527% or 11 million


A dirty pit latrine in Mongolia leading people to choose open defecation instead Dirty pit latrine in Mongolia in winter (5321157342).jpg
A dirty pit latrine in Mongolia leading people to choose open defecation instead

Public health

The negative public health impacts of open defecation are the same as those described when there is no access to sanitation at all. Open defecation—and lack of sanitation and hygiene in general—is an important factor that cause various diseases; the most common being diarrhea and intestinal worm infections but also typhoid, cholera, hepatitis, polio, trachoma, and others. [34] [35]

In 2011, infectious diarrhea resulted in about 0.7 million deaths in children under five years old and 250 million lost school days. [34] [36] It can also lead to malnutrition and stunted growth among children. [37] [38]

Certain diseases are grouped together under the name of waterborne diseases, which are diseases transmitted via fecal pathogens in water. Open defecation can lead to water pollution when rain flushes feces that are dispersed in the environment into surface water or unprotected wells.

Open defecation was found by the WHO in 2014 to be a leading cause of diarrheal death. An average of 2,000 children under the age of five die every day from diarrhea. [39]

Young children are particularly vulnerable to ingesting feces of other people that are lying around after open defecation, because young children crawl on the ground, walk barefoot, and put things in their mouths without washing their hands. Feces of farmed animals are equally a cause of concern when children are playing in the yard.

Those countries where open defecation is most widely practiced have the highest numbers of deaths of children under the age of five, as well as high levels of malnourishment (leading to stunted growth in children), high levels of poverty and large disparities between rich and poor. [3]

Research from India has shown that detrimental health impacts (particularly for early life health) are even more significant from open defecation when the population density is high: "The same amount of open defecation is twice as bad in a place with a high population density average like India versus a low population density average like sub-Saharan Africa." [40]

Safety of women

There are strong gender impacts connected with open defecation. The lack of safe, private toilets makes women and girls vulnerable to violence and is an impediment to girls' education. [41] Women are at risk of sexual molestation and rape as they search for places for open defecation that are secluded and private, often during hours of darkness. [42] [41]

Lack of privacy has an especially large effect on the safety and sense of dignity of women and girls in developing countries. They face the shame of having to defecate in public so often wait until nightfall to relieve themselves. They risk being attacked after dark, though it means painfully holding their bladder and bowels all day. [43] [44] Women in developing countries increasingly express fear of assault or rape when having to leave the house after dark. Reports of attacks or harassment near or in toilet facilities, as well as near or in areas where women defecate openly, are common. [43] [44]


There are several drivers used to eradicate open defecation, one of which is behaviour change. SaniFOAM (Focus on Opportunity, Ability and Motivation) is a conceptual framework which was developed specifically to address issues of sanitation and hygiene. Using focus, opportunity, ability and motivation as categories of determinants, SaniFOAM model identifies barriers to latrine adoption while simultaneously serving as a tool for designing, monitoring and evaluating sanitation interventions. [45] [46] The following are some of the key drivers used to fight against open defecation in addition to behavior change: [4]

Integrated initiatives

Efforts to reduce open defecation are more or less the same as those to achieve the MDG target on access to sanitation. A key aspect is awareness raising (for example via the UN World Toilet Day at a global level), behaviour change campaigns, increasing political will as well as demand for sanitation. Community-Led Total Sanitation (CLTS) campaigns have placed a particular focus on ending open defecation by "triggering" the communities themselves into action. [47]

As India has such a high number of people practicing open defecation, various Indian government-led initiatives are ongoing to reduce open defecation in that country. It began as the "Total Sanitation Campaign", which was relaunched as Nirmal Bharat Abhiyan in 2012 and integrated into the wider Swachh Bharat Abhiyan (Clean India Mission) in 2014 - see country section below for more details.

Also in 2014, UNICEF began a multimedia campaign against open defecation in India, urging citizens to "take their poo to the loo." [48]

Simple sanitation technology options

Residents in Mymensingh, Bangladesh participate in a workshop to discover more about mobile sanitation options (MoSan) as an alternative to open defecation Photo by Ashley Wheaton, May 2011 (6376606733).jpg
Residents in Mymensingh, Bangladesh participate in a workshop to discover more about mobile sanitation options (MoSan) as an alternative to open defecation

There are some simple sanitation technology options available to reduce open defecation prevalence if the open defecation behavior is due to not having toilets in the household and shared toilets being too far or too dangerous to reach, e.g., at night.

Toilet bags

People might already use plastic bags (also called flying toilets) at night to contain their feces. However, a more advanced solution of the plastic toilet bag has been provided by the Swedish company Peepoople who are producing the "Peepoo bag", a "personal, single-use, self-sanitizing, fully biodegradable toilet that prevents feces from contaminating the immediate area as well as the surrounding ecosystem". [49] This bag is now being used in humanitarian responses, schools, and urban slums in developing countries. [50] [51]

Bucket toilets and urine diversion

Bucket toilets are a simple portable toilet option. They can be upgraded in various ways, one of them being urine diversion which can make them similar to urine-diverting dry toilets. Urine diversion can significantly reduce odors from dry toilets. Examples of using this type of toilet to reduce open defecation are the "MoSan" [52] toilet (used in Kenya) or the urine-diverting dry toilet promoted by SOIL [53] in Haiti.

Country examples


India's prime minister Modi launched Swachh Bharat Mission in 2014 which aims to end open defecation by October 2019 PM Modi launches the Swachh Bharat Abhiyaan (1).jpg
India's prime minister Modi launched Swachh Bharat Mission in 2014 which aims to end open defecation by October 2019

The Government of India (GoI) has taken up an initiative called Swachh Bharat Mission (Clean India Mission) wherein a large scale drive has been initiated to construct toilets on mass level. The government has increased subsidies on toilet construction to INR 15,000. [54] [55] The Government of India claims that the situation has been improving rapidly since 2015, mainly due to the Swachh Bharat Abhiyan campaign. According to Government of India's October 2018 estimate, only 5% of the total population have no access to toilets and are still doing open defecation. [29]

As of September 2018, around 93 percent of the rural population had access to proper sanitation, with the number of people defecating in the open reduced to 150 million, down from 550 million in 2014. [54] The goal is to declare India open defecation free (ODF) before 2 October 2019, but the government of India is approaching the initiative much faster and India is likely to achieve ODF status before the deadline. [2] [56] However, some newspaper articles suggest that open defecation has not fallen as rapidly and sustainably as the government claims. [57] [58] [59]

In an attempt to stop city residents from urinating and defecating in public, a city council in western India is planning to pay residents to use public toilets. In 2015, the Ahmedabad Municipal Corporation announced it will give residents one rupee a visit in a bid to draw them into its 300 public toilets and away from open areas and public walls, which often reek of urine. [60]

In India, the State of Rajasthan became the first state in the country to make a "functional toilet" mandatory in the house of a contestant for contesting elections to Panchayati Raj institutions. The post of village head is called sarpanch in Rajasthan, India. A person cannot contest for the post of sarpanch unless they have a functional toilet at their residence. [61]

A number of industries in India are manufacturing affordable toilets using pre-fabrication techniques to meet high demand for toilets created after this new legislation.

California (United States)

Frequent reports of open defecation in California cities have led to what was reported in local news sources as the "Poop Crisis". [62] [63]

Society and culture


The mainstream media in some affected countries have recently been picking up on this issue of open defecation, for example, in India [64] [65] and Pakistan. [66] [67] [68]

In certain jurisdictions, open or public defecation is a criminal offense which can be punished with a fine or even imprisonment. [69] [70] [71] [72]

David Sedaris' essay "Adventures At Poo Corner" dealt with people who openly defecate in commercial businesses. [73]

See also

Related Research Articles

Defecation Expulsion of feces from the digestive tract via the anus

Defecation is the final act of digestion, by which organisms eliminate solid, semisolid, or liquid waste material from the digestive tract via the anus.

Human waste refers to the waste products of the human digestive system and the human metabolism, namely feces and urine. As part of a sanitation system that is in place, human waste is collected, transported, treated and disposed of or reused by one method or another, depending on the type of toilet being used, ability by the users to pay for services and other factors.

World Toilet Day United Nations day on 19 November to tackle global sanitation crisis

World Toilet Day (WTD) is an official United Nations international observance day on 19 November to inspire action to tackle the global sanitation crisis. Worldwide, 4.5 billion people live without "safely managed sanitation" and around 892 million people practise open defecation. Sustainable Development Goal 6 aims to achieve sanitation for all and end open defecation. World Toilet Day exists to inform, engage and inspire people to take action toward achieving this goal.

Pit latrine Toilet that collects human feces in a hole in the ground

A pit latrine, also known as pit toilet or long drop, is a type of toilet that collects human feces in a hole in the ground. Urine and feces enter the pit through a drop hole in the floor, which might be connected to a toilet seat or squatting pan for user comfort. Pit latrines can be built to function without water or they can have a water seal. When properly built and maintained, pit latrines can decrease the spread of disease by reducing the amount of human feces in the environment from open defecation. This decreases the transfer of pathogens between feces and food by flies. These pathogens are major causes of infectious diarrhea and intestinal worm infections. Infectious diarrhea resulted in about 700,000 deaths in children under five years old in 2011 and 250 million lost school days. Pit latrines are a low cost method of separating feces from people.

Bucket toilet A basic form of a dry toilet with a bucket

A bucket toilet is a basic form of a dry toilet whereby a bucket (pail) is used to collect excreta. Usually, feces and urine are collected together in the same bucket, leading to odor issues. The bucket may be situated inside a dwelling, or in a nearby small structure.

Community-led total sanitation An approach to improve sanitation and hygiene practices, mainly in developing countries

Community-led total sanitation (CLTS) is an approach used mainly in developing countries to improve sanitation and hygiene practices in a community. It focuses on spontaneous and long-lasting behavior change of an entire community. The goal of CLTS is to end open defecation. The term "triggering" is central to the CLTS process. It refers to ways of igniting community interest in ending open defecation, usually by building simple toilets, such as pit latrines. CLTS involves actions leading to increased self-respect and pride in one's community. It also involves shame and disgust about one's own open defecation behaviors.

Water supply and sanitation in India Drinking water supply and sanitation in India continue to be inadequate

Rapid improvements are being made in augmenting drinking water supply and sanitation in India, due to concerted efforts by the various levels of government and communities at improving coverage. The level of investment in water and sanitation, albeit low by international standards, has increased in size during the 2000s. For example, in 1980 rural sanitation coverage was estimated at 1% and reached 95% in 2018. Also, the share of Indians with access to improved sources of water has increased significantly from 72% in 1990 to 88% in 2008. At the same time, local government institutions in charge of operating and maintaining the infrastructure are seen as weak and lack the financial resources to carry out their functions. In addition, only two Indian cities have continuous water supply and according to an estimate from 2018 about 8% of Indians still lack access to improved sanitation facilities. A study by Water Aid estimated as many as 10 million Indians, or 5 percent of Indians living in urban areas, live without adequate sanitation. India comes in first place globally for having the greatest number of urban-dwelling inhabitants living without sanitation. India tops the urban sanitation crisis, has the largest amount of urban dwellers without sanitation, and the most open defecators(urban) with over 5 million people.

Sustainable sanitation Sanitation system designed to meet certain criteria and to work well over the long-term

Sustainable sanitation is a sanitation system designed to meet certain criteria and to work well over the long-term. The Sustainable Sanitation Alliance (SuSanA) includes five features in its definition of "sustainable sanitation." Systems need to be economically and socially acceptable, technically and institutionally appropriate and protect the environment and natural resources.

Improved sanitation is a term used to categorize types or levels of sanitation for monitoring purposes. The term was coined by the Joint Monitoring Program (JMP) for Water Supply and Sanitation of UNICEF and WHO in 2002 to help monitor the progress towards Goal Number 7 of the Millennium Development Goals (MDGs). The opposite of "improved sanitation" has been termed "unimproved sanitation" in the JMP definitions.

The Joint Monitoring Programme (JMP) for Water Supply and Sanitation by WHO and UNICEF is the official United Nations mechanism tasked with monitoring progress towards the Sustainable Development Goal Number 6 (SDG6) since 2016.

WASH Acronym that stands for "water, sanitation and hygiene"

WASH is an acronym that stands for "water, sanitation and hygiene". Universal, affordable and sustainable access to WASH is a key public health issue within international development and is the focus of Sustainable Development Goal 6.

Swachh Bharat mission national level to clean up India by 2019

Swachh Bharat Abhiyan (SBA) or Swachh Bharat Mission (SBM) is a nation-wide campaign in India for the period 2014 to 2019 that aims to clean up the streets, roads and infrastructure of India's cities, towns, urban and rural areas. The campaign's official name is in Hindi and translates to "Neat and tidy India Mission" in English. The objectives of Swachh Bharat include eliminating open defecation through the construction of household-owned and community-owned toilets and establishing an accountable mechanism of monitoring toilet use. Run by the Government of India, the mission aims to achieve an "open-defecation free" (ODF) India by 2 October 2019, the 150th birth anniversary of Mahatma Gandhi, by constructing 100 million toilets in rural India at a projected cost of ₹1.96 lakh crore. The mission will also contribute to India reaching Sustainable Development Goal 6, established by the UN in 2015.

The Global Sanitation Fund (GSF) is a multi-donor United Nations trust fund that aims to help large numbers of people in developing countries improve their sanitation and adopt good hygiene practices. GSF is an innovative way to finance sustainable development.

This is a list of Indian states and territories ranked before the availability of toilet facilities per household. Figures are from the 2011 census of India. In a massive cleanliness drive after the election of Narendra Modi in 2014, over 90 million toilets have been built over the course of 4 years, ferociously taking India towards an open defecation free country. Modi's government also has been building toilets in people's individual households. Google is helping Modi and his government set up toilets across the nation, too.

This is a list of Indian states and territories ranked by their households with open defecation free in both urban and rural areas. Figures are from ministry of drinking water and sanitation. Below table shows ODF( Open Defecation Free), households with Toilets as percentage of total population.


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