Shifting Households’ Attitudes and Behaviors to Increase Toilet Use in India


  • Open defecation has an important impact on infant mortality and malnutrition, yet despite significant investment, consistent usage of latrines in India continues to be a challenge.
  • Working with Oxford Policy Management and World Vision India, we developed interventions to increase consistent latrine usage in Bihar, India.
  • Our findings point to the need for deeper behavioral design work, including the potential redesign of latrines to decrease the hassles to use latrines that may impact intention and follow-through.

The Challenge

Despite significant programmatic investment in the last two decades, rates of open defecation (OD) in India remain high compared to other countries with similar socioeconomic characteristics. This challenge leads to increased rates of infant mortality in addition to contributing to malnutrition. A 2015 report highlighted that 52.1% of the Indian rural population was defecating in the open. Bihar has among the highest rates of OD, with 70% of people in rural Bihar defecating in the open. While much focus has been placed on latrine construction, findings suggest that rates of OD continue to be high, even among families with a latrine. 


Our Approach

Formative research with community members highlighted a series of behavioral barriers inhibiting the consistent use of latrines.

  • Latrines were viewed as a “scarce” resource reserved for women due to aversions to empty the latrine frequently.
  • Communities had faulty mental models around how quickly the pit would fill up, which further contributed to rationed use.
  • Existing habits and rituals related to open defecation were challenging to break, particularly without salient rewards for latrine use. 

These insights informed the design of a package of interventions focused on household and community-level behavior. Our design package included a card game, french drain demo, and other components delivered in community meetings, such as a system of latrine ownership accompanied by pledges and dated latrine-emptying posters provided through home visits.

More on these solutions can be found here



The study found significant improvements in toilet use but the difference in rates was not significant between intervention and control areas, suggesting that the intervention did not contribute to this improvement. Changes in intermediate outcomes related to knowledge and attitudes around pit filling and pit emptying were not significant.



Solutions to address open defecation must consider the multi-faceted nature of the issue, including deeply entrenched beliefs and practices. This work highlights the importance of treating sanitation as a social issue and not simply as one of access to toilet infrastructure, while also pointing out the real challenges in increasing latrine usage.

Our findings suggest that communities often hold real and valid concerns about the experience of latrine use and its associated hassles, which could perhaps better be addressed through the construction of higher-quality latrines that are simpler to use and maintain. The opportunity to apply a behavioral lens to infrastructure investments such as sanitation facilities prior to their construction is ripe for opportunity.

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