Earlier this year in India, two teenage girls went to the fields to defecate, a commonplace practice in a country desperately lacking in running toilets and latrines. But the girls never came back. They had been assaulted and, later, their bodies were found.

A senior police official in Bihar—an Indian state of nearly 100 million where 85 percent lack access to basic sanitation—told BBC News that about four hundred women would have “escaped” similar attacks last year if they had toilets in their homes.

The evidence tying lack of basic sanitation to violence is overwhelming. This year’s designated World Toilet Day, which took place in November, sought to emphasize the threat of sexual violence that girls and women are faced with on a daily basis because of the lack of privacy and the inequality inherent in inadequate toilet solutions.

United Nations Secretary General Ban Ki-moon said in a special message for World Toilet Day, “We have a moral imperative to end open defecation and a duty to ensure women and girls are not at risk of assault and rape simply because they lack a sanitation facility.”

Although the moniker “World Toilet Day” might sound peculiar, or laughable—or even cringe inducing—the statistics are dire: More than a third of the world population is currently without access to improved sanitation facilities (with half of them living in developing regions); over a billion people practice open defecation; every twenty seconds, a child dies as a result of poor sanitation. The hardest hit coverage areas remain in sub-Saharan Africa, Southern Asia, and Eastern Asia.

Access to sanitation is proven to bestow benefits on public health, livelihoods, and dignity-advancement—affecting not only individual households but also entire communities. Studies cutting across countries all show that the method of disposing of excreta is one of the strongest indicators of child survival: according to United Nations statistics, the transition from unimproved to improved sanitation reduces overall child mortality rates by about a third.

Overhauling the sanitation system is not only the right and humane thing to do, it’s also economical: as United Nations data show, every dollar the U.S. government spends on sanitation brings a return of $5.50, by keeping people healthy and productive. The Millennium Development Goal—one of eight such goals devised by the UN and agreed to by all the world’s countries as a blueprint for change—set a target of halving the percentage of people without sustainable access to basic sanitation and safe drinking water by next year. But improvement has been slow going: unless the pace of change in sanitation is increased, the MDG has stated, its target may not be reached until 2026.

The state of basic sanitation varies drastically across the globe, of course, with rural communities representing the hardest afflicted areas—facing half the sanitation coverage that exists in urban areas. But with the ongoing accelerated rate of migration from rural areas to cities, city planners are faced with a major concern: extending sanitation services to some 2.5 billion new urban dwellers by 2050. Solutions will depend greatly on the region of coverage.

According to a World Health Organization report on the urban and rural challenge of the decade, “While increasing the number of toilets connected to sewerage systems with functioning sewage treatment plants is important for many urban settings, for rural settings social marketing of a range of designs options for on-site sanitation is equally important.” The challenge with sanitation, in other words, is not only to increase access to functioning toilets in cities but also to reconceive the very notion of what a functioning toilet is, and to be able to apply the findings on-site, in rural areas that suffer from low sanitation coverage.

Several large-scale engineering and investment models have drastically changed lives in urban communities across the globe. In 1997, the Sri Lankan central province of Greater Kandy faced a water crisis, rationing water access for residents—for plumbing and drinking needs—to just once a week. The existing pipeline hadn’t been built to handle the needs of a growing population and poor quality water pumps wore down from the tropical island’s sandy water, leading to frequently bursting pipes. The government partnered with Hitachi to build reliable water pumping stations, a water purifying treatment plant, and a new 16.5-mile pipeline winding its way through the mountainous Kandy terrain. Since 2006, the water system has functioned without any disruption.

As far as reimagining the concept of toilet for far-flung rural communities with no access to sewage treatment plants, in 2011 the Bill & Melinda Gates Foundation launched a Reinvent the Toilet Challenge. Its aim was to bring sustainable sanitation solutions for the 2.5 billion people who currently have no access to safe, affordable sanitation. The challenge culminated in a two-day fair that brought together participants from twenty nine countries, including researchers, designers, investors, advocates, and representatives from the communities most in need of sanitation improvements. Of the participants, sixteen researchers then received grants to develop innovative engineering approaches for the management of human waste. The challenge sought to create a toilet cost less than $0.05 cents per user per day and one that was able to operate in “off the grid” locations without connections to water, sewer, or electrical lines.

This year, a second Reinvent the Toilet Fair was held in New Delhi, in partnership with the Indian Ministry of Science of Technology. The grant recipients included a team that is field-testing a solar-powered modular electronic toilet with a mixed-waste processing unit; a team that is examining the role viral agents might play in killing off pathogens and bacteria in human waste; and one that uses ultrasound to reduce the use of water in toilets.

Brian Arbogast, director of the Water, Sanitation & Hygiene team at the Gates Foundation, said: “We believe that with governmental leadership, new business models, and innovation, we can dramatically increase the progress made in tackling this global sanitation crisis.”

Because many developing countries have decentralized and devalued their water supply and sanitation, municipalities and individual households are left having to fend for themselves when it comes to the access and maintenance of sanitation. Yet as these examples illustrate, implementation of large-scale and small-scale enterprises such as these, working in collaboration with government agencies and international organizations, has been shown to make a difference in people’s lives when it comes to ensuring basic sanitation solutions.

“Effective and comprehensive sanitation seems an impossible dream for India,” said K. Vijay Raghavan, chairman of India's Biotechnology Industry Research Assistance Council. “Yet today we see a congruence of new and applicable science and technology, its affordability, and sustainable implementation. This congruence is a great opportunity, which we cannot afford to let slip.”  

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