Despite economic growth, government latrine construction, and increasing recognition among policy-makers that it constitutes a health and human capital crisis, open defecation remains stubbornly widespread in rural India. Indeed, 67% of rural Indian households in the 2011 census reported defecating in the open. We present evidence from new survey data collected in villages in five states in India: Bihar, Haryana, Madhya Pradesh, Rajasthan, and Uttar Pradesh. The authors found that rural households do not build inexpensive latrines of the sort that commonly reduce open defecation and save lives in Bangladesh, Southeast Asia, and sub-Saharan Africa. Many survey respondents‘ behaviour reveals a preference for open defecation: over 40% of households with a working latrine have at least one member who defecates in the open. In the sample from the four largest states, more than half of people in households which own a government latrine defecate in the open.

The authors apply a demographic model of latrine use which predicts that if the government were to build a latrine for every rural household that lacks one, without changing sanitation preferences, most people in the sample in these states would nevertheless defecate in the open. Further evidence supports a preference for open defecation: many survey respondents report that open defecation is more pleasurable and desirable than latrine use. Among people who defecate in the open, a majority report that widespread open defecation would be at least as good for child health as latrine use by everyone in the village. These findings suggest that intensifying existing policies of latrine construction will not be enough to substantially reduce open defecation. Policy-makers in India must lead a large scale campaign to promote latrine use.