By – Pallavi Raghavan
India’s sanitation record has long drawn global scrutiny as a barometer of its development, and often, derision. Scenes of open defecation in fields and garbage-choked drains have been highlighted by international commentators for decades. Meanwhile, an ironic twist has emerged, even in first-world cities, sanitation troubles are resurfacing. Ageing sewer systems in Britain have led to more than 460,000 untreated sewage discharges in a year, and parts of San Francisco and Los Angeles struggle with unhygienic homeless encampments. These instances, however, remain marginal in comparison to India’s colossal sanitation challenge. Nowhere is the crisis more acute or urgent than in India, where basic sanitation shortfalls for hundreds of millions of people threaten public health, dignity, and the nation’s global ambitions. This article examines the depth of India’s sanitation problems since independence, the communities most affected, government responses across levels, and why solving sanitation is pivotal for India’s future, connecting local failures to global public health and environmental risks.
The Evolving Sanitation Crisis Since Independence
At the time of India’s independence in 1947, sanitation was a neglected priority, with most of the population lacking safe toilets or sewage systems. For decades thereafter, progress was painfully slow. As harsh as it may sound, the reality is that indeed until late 2000, nearly 75% of Indians still practiced open defecation, according to World Bank surveys. The impacts of this were dire, preventable diseases like diarrhoea, cholera, and intestinal infections became endemic, particularly among children. A landmark World Bank study estimated that in 2006, the economic losses due to inadequate sanitation amounted to 6.4% of India’s GDP, roughly $54 billion at the time. These losses stem from health costs, lost productivity, and the toll of water contamination; over 70% of the damage was health-related, with children under 5 accounting for nearly half of all health impacts. Such staggering figures underscore how poor sanitation has been not only a public health disaster but a severe economic drain on the country. In the 21st century, India’s sanitation metrics have started to shift. Government initiatives ramped up in the 2000s, notable examples being the Total Sanitation Campaign and Nirmal Bharat Abhiyan, leading to a watershed moment in 2014. That year, the newly elected Prime Minister, Narendra Modi, launched the Swachh Bharat (“Clean India”) Mission, pledging to eliminate open defecation by building toilets and promoting hygiene nationwide. The campaign led to the construction of over 110 million latrines in rural areas and countless urban toilet complexes, and by October 2019, the government declared the country “open defecation free” (ODF). This declaration was bold, and controversial. Independent data suggest major improvements but stop short of a complete victory. In 2015, approximately 550 million Indians, half the population, still defecated in the open. By 2020, government figures claimed that open defecation had plummeted to under 15% of the population. The latest surveys by WHO and UNICEF paint a nuanced picture, as of 2022, 17% of rural Indians were still defecating outdoors and about 25% lacked even basic sanitation facilities, meaning no household toilet at all. Nationally, this represents tremendous progress from just a decade ago, yet tens of millions remain without toilets or still do not use them. The gap between official claims and independent surveys suggests that some “ODF” communities may have slipped back or never fully ended old habits. In short, India has achieved a sanitation revolution on paper, and to a great extent on ground, nevertheless sustaining and further pervading the objectives of ‘Swachh Bharat’ is an ongoing battle. Quintessentially, the sanitation challenge extends beyond building toilets, it includes the safe management of waste after it is flushed or pit-collected. Here, India’s infrastructure lags woefully behind. The country generates an estimated 72,000 million litres of sewage per day, yet only 28% of this wastewater is treated. The rest, over 50,000 MLD of raw sewage, flows into rivers, lakes, and groundwater unchecked, contributing to the pollution of water bodies like the holy rivers of Ganga and Yamuna. In cities, aging drainage networks and the lack of sewage treatment plants mean that human waste often ends up in the environment, contaminating drinking water sources and urban landscapes. This underinvestment in treatment not only negates some of the health gains from toilet-building but also creates secondary crises, which is water scarcity, since polluted water cannot be reused, and environmental degradation. The Centre for Science and Environment notes that India’s water-stressed future demands turning wastewater into a resource, yet today over 70% of urban sewage is released untreated, poisoning ecosystems and public health. The evolution of India’s sanitation crisis, therefore, is a story of two halves, significant strides in access to toilets, but persistent failure in the broader sanitation value chain of safe waste disposal and water management.
Gender, Caste, and Socio-Economic Disparities
India’s sanitation pitfall do not affect all citizens equally. As is often the case in public health, it is the poorest and most marginalised who bear the brunt, and are largely the source, of inadequate sanitation. A World Bank evaluation underlined bluntly that “children and poor households bear the brunt of poor sanitation”. Children in communities without toilets suffer chronic diarrhoea and intestinal infections that impede nutrition, causing India’s child stunting rates to be among the highest in the world. In fact, research has linked open defecation to widespread stunting and underweight status among Indian children, helping explain why even families with enough food can have malnourished kids. It is telling that more than three-fourths of the health and productivity losses due to poor sanitation are accrued by children under 5 and by low-income families. Simply put, a child born into a village that lacks sanitation is far more likely to fall sick, miss school, and face lifelong developmental challenges than a peer born into a sanitised environment. Women and girls are another demographic disproportionately impacted by sanitation failures. In communities without private toilets, women face the indignity, and danger, of relieving themselves in the open. Many rise before dawn or wait until dusk for privacy, risking harassment and sexual violence. The link between sanitation and safety is tragically well documented, lacking a toilet raises the risk of sexual assault, as women may encounter predators when walking to isolated fields or public areas. A report by the World Economic Forum highlighted that inadequate sanitation has farreaching consequences, from higher rates of child mortality to increases in sexual violence. Adolescent girls frequently miss school or even drop out once they reach puberty if their schools or homes lack proper toilets and water for menstrual hygiene. Prior to the Swachh Bharat campaign, surveys estimated that around 20-25% of girls in some regions would leave school after menarche due to the absence of safe toilets and sanitation. For working-age women, the absence of facilities in workplaces or markets can limit their mobility and economic participation. In these ways, poor sanitation reinforces gender inequality, it’s not just a matter of comfort or convenience, but of dignity, education, health, and safety for India’s women. The injustice of India’s sanitation crisis is also starkly evident along caste lines. Sanitation in India has always carried the stigma of “untouchability.” Members of the Dalit, formerly “untouchable,” castes have traditionally been relegated to the most degrading sanitation tasks, and despite laws prohibiting such practices, the legacy persists. Nowhere is this more horrific than in the continuing practice of manual scavenging, the cleaning of human excrement from dry latrines or open drains by hand. By official counts, over 180,000 households still relied on manual scavengers as of 2011, and activists say the real number is likely higher. An overwhelming majority of these workers are from the lowest rungs of the caste hierarchy, and at least 90% of the estimated 1.3 million manual scavengers are women. They often are paid a pittance to clean feces with no protective gear, facing not just social indignity but severe health risks from constant exposure to pathogens and toxic fumes. This is a double burden of discrimination, Dalit women, among the poorest of the poor, literally carry away the waste of others at the cost of their health and rights. Despite a ban on manual scavenging and rehabilitation programs, enforcement is weak. Many Dalits remain trapped in this occupation by poverty and social coercion, illustrating how sanitation failure isn’t just about toilets, it is intertwined with India’s most intractable social stratifications. Urban versus rural divides further define vulnerability. Rural India historically had far worse sanitation coverage, accounting for half of open defecations globally, until recent years, the situation has mitigated moderately. That gap is closing as rural toilet coverage rises, but rural areas still lag in waste treatment and sustained use of toilets. On the other hand, in cities, it is the urban poor living in slums and informal settlements who suffer most. Mumbai’s glittering skyline is shadowed by sprawling slums where thousands may share a handful of public latrines. Overcrowding and lack of piped water make maintenance of these shared toilets difficult, so many urban poor resort to open areas or payper-use facilities. The World Bank’s 2010 study found that the poorest 20% of urban households experienced per capita economic losses from poor sanitation 75% higher than the national average. This is because the urban poor live in densely packed areas where one family’s lack of a toilet swiftly becomes everyone’s health problem. They are also more likely to miss work during illness and spend scarce income on medical care for water-borne diseases. Whether in a mudhut village or a city slum, the common thread is poverty, inadequate sanitation entrenches the deprivations of the already deprived, hitting women, children, Dalits, and low-income communities the hardest.
Government Efforts: Successes, Shortcomings, and Stark Inequalities
Sanitation in India is a multi-tier governance challenge, cutting across central directives and state and local implementation. The central government’s Swachh Bharat Mission (SBM) has been the marquee effort in recent times. In its first phase (2014–2019), SBM-Gramin (rural) focused on toilet construction and ending open defecation, while SBM-Urban targeted solid waste management and city cleanliness. By official accounts, SBM was a resounding success, over 100 million rural toilets built and all of India’s villages, districts, and states self-declared ODF by the end of 2019. This massive mobilisation, often compared to a wartime effort, involved public funding, private philanthropy, and a public relations blitz, from prime-time ads to street plays, encouraging latrine use and cleanliness. Many credit SBM for bringing sanitation into the mainstream political discourse; a country where politicians once never talked of toilets now had the Prime Minister himself wielding a broom on camera to inspire the masses. However, the government’s glowing statistics have met with skepticism. Surveys by the National Sample Survey Office (NSSO) and the National Family Health Survey (NFHS) suggest that toilet usage and coverage, while greatly improved, did not reach universal levels. Another independent national survey in late 2018 found only 71.3% of Indian households had access to a household toilet, a figure far lower than the 93.3% coverage claimed by the government’s own monitoring that year. Likewise, NFHS data from 2019-20 indicate that many states still had significant pockets of open defecation despite being declared ODF. Except for a few high-performing states like Kerala, which historically had near-universal literacy and better sanitation, most states saw NFHS findings contradict the official ODF status claims. What explains this gap? Observers point to “ODF self-declarations” that may have been overly optimistic or even politically driven. Under pressure to meet targets, some local officials likely rushed the certification process, building toilets quickly, but without ensuring water supply, behaviour change, or proper fecal waste disposal. The “achievement” of ODF in many districts may thus have been on paper, while in reality some villagers reverted to old habits or toilets fell into disuse due to poor construction and maintenance. The government has implicitly acknowledged these issues by launching ODF-Plus in 2020, a follow-up scheme aiming to sustain ODF status and improve solid and liquid waste management. But sustaining behaviour change requires persistent community engagement, and waste management requires infrastructure that many villages still lack. At the state level, the sanitation record is mixed. Some states leveraged SBM effectively and even added their own innovations. Tamil Nadu, one of India’s most industrialised southern states, supplemented central funds to ensure water connections to toilets and launched aggressive information campaigns; it also pioneered menstrual hygiene programs to complement school toilet construction, tackling a key reason for girls’ dropout. Sikkim and Himachal Pradesh achieved rural ODF status early, thanks in part to smaller populations and political will, becoming models for others. In contrast, populous states like Uttar Pradesh and Bihar struggled more, facing greater social resistance to latrine use and administrative challenges in reaching remote communities. Maharashtra has shown strong urban initiatives, Mumbai and Pune have experimented with “toilet malls,” large community toilet complexes with subsidised entry, to serve slum areas, while smaller cities like Nagpur have integrated waste-to-energy plants to treat sewage. Still, state efforts often suffer from siloed approaches. Rural sanitation might be handled by one department, urban sanitation by another, and water supply by yet another, leading to coordination failures. Moreover, many states are guilty of underfunding municipal bodies, which are at the frontline of urban sanitation. India’s municipalities depend on state governments for finances, and sanitation is frequently low on their spending list behind visible priorities like roads or electricity. This creates a vicious cycle as without funds, city sanitation staff and infrastructure remain inadequate, and the resulting filth is then seen as a local failure rather than a symptom of higher-level neglect. At the municipal and district level, leadership or its lack can make a dramatic difference. Some local success stories shine bright. The city of Indore in Madhya Pradesh is a case in point, it underwent an outright metamorphosis from a litter-strewn town to India’s cleanest city for six years running in the national Swachh Survekshan rankings. Indore’s municipal corporation eliminated garbage dumps, instituted 100% door-to-door waste collection and segregation, and built a robust system to compost and recycle waste. Crucially, Indore achieved this by involving citizens through awareness campaigns and even a catchy cleanup anthem, partnering with the private sector for efficient waste processing, and enforcing bylaws strictly. The result is a city where residents take pride in not littering and where nearly all of the 1,200 tonnes of daily waste is processed instead of dumped. Other municipalities have begun to emulate this model, though none yet at Indore’s scale. On the rural side, many districts that once had abysmal sanitation have made strides via the “community-led total sanitation” approach, examples being parts of Maharashtra and Gujarat, which used behavioural nudges, and occasionally strict fines, to get villages to collectively abandon open defecation, fostering peer pressure for cleanliness. Still, these remain scattered victories. Far too many cities, from megacities like Delhi, which still pumps tons of sewage into the Yamuna daily, to small towns with virtually no garbage management, continue to flounder. At the local level, the weaknesses are evident as insufficient waste workers, lack of safe equipment, poor planning for waste disposal, and corruption or apathy that leaves public toilets filthy and unusable. A particularly troubling aspect of governance is the persistence of manual scavenging and sewer deaths. Despite the Modi government’s emphasis on toilets, activists point out that sewage workers, often low-caste people made to descend into toxic manholes to unclog drains, remain a forgotten underclass. Dozens of these workers die each year from asphyxiation by noxious gases while cleaning city sewers or septic tanks. Their plight did not significantly improve under Swachh Bharat, exposing the limits of the campaign’s focus. Laws exist that mandate modern equipment and machines for cleaning sewers, but implementation is lax; protective gear is scant, and contractors prefer cheap manual labor. This indicates that government action has been uneven, easier tasks like funding toilet construction got priority, whereas systemic fixes like upgrading sewer infrastructure or rehabilitating sanitation workers were slower. The government’s record, therefore, is a paradox, an unprecedented mobilisation that indubitably bettered sanitation access for millions, something that was blatantly negated by all previous Indian administrations, yet marred by exaggerated claims, patchy quality, and blind spots in enforcement. As India moves to consolidate its gains, it must confront these shortcomings head-on, or risk undermining the progress made.
Sanitation and India’s Global Ambitions
India today aspires to be a global powerhouse, a $5 trillion economy, a manufacturing hub, a geopolitical heavyweight, a space explorer among myriad other things. But lurking beneath those ambitions is the question, can India truly claim great-power status if it cannot provide something as basic as a clean toilet to all its citizens? The persistence of unsanitary conditions poses a reputational risk that goes beyond symbolism. In the eyes of global investors and partners, basic infrastructure like water and sanitation is a litmus test of governance capacity. It is perhaps no coincidence that Singapore’s founding leader Lee Kuan Yew famously said “first-world societies have first-world sanitation.” For India, lagging sanitation standards could become a stumbling block in attracting foreign investment and tourism and in projecting an image of modernity. There is an economic argument to be made, better sanitation is not just a social good, but a smart investment in human capital. International businesses considering operations in India evaluate factors like the health and productivity of the workforce and the quality of urban infrastructure. Poor sanitation, which causes workers to fall ill frequently and raises healthcare costs, can deter investment just as much as unreliable electricity can. A study in the medical journal The Lancet summed it up pointedly, for every $1 invested in sanitation, the economic return can be as high as $5.50 through lower health costs and higher productivity, a figure often cited by global health organisations. From a pure dollars-andcents view, India’s past neglect of sanitation has been a self-inflicted economic wound. Conversely, fixing sanitation could yield a “health dividend” that propels growth. The World Bank’s estimate of 6.4% GDP loss from poor sanitation implies that closing the sanitation gap could add a significant chunk to India’s GDP, essentially boosting investor confidence that India is tackling an inefficiency dragging on its economy. Beyond economics, there is the matter of national image and soft power. India has rightfully gained plaudits for cuttingedge achievements, from running a successful Mars mission on a shoestring budget to being the pharmacy of the developing world. Yet, it has also endured global criticism and even ridicule for the open defecation problem. The contrast is often stark in international media, a nation with nuclear weapons and IT giants, yet also home to the largest number of people defecating in the open until recently. Prime Minister Modi recognised this dichotomy himself when he said he wanted to prioritise “toilets before temples,” underscoring that spiritual or high-tech accomplishments ring hollow if basic sanitation is lacking. India’s ability to lead on the world stage, as manifested during its G 20 2023 leadership, is only further buttressed when it can show success in uplifting the quality of life of its masses. Contrariwise, persistent filth and sanitation-related diseases can undercut India’s credibility when advocating global development or public health initiatives. Global investors, too, are increasingly conscious of environmental, social, and governance (ESG) factors. Sanitation hits all three, it is an environmental issue, perhaps the biggest being the untreated sewage polluting rivers, a social issue of health equity and gender safety, and a governance issue pertaining to effective public service delivery. A country that visibly struggles to manage waste may be seen as facing deeper governance deficits. This doesn’t mean investors avoid India en masse due to toilets, but it factors into assessments of urban liveability and sustainability. Multinational companies setting up in a city will consider whether that city can reliably provide clean water and if their expat employees would have a healthy environment. Cities like Bengaluru, despite being tech hubs, suffer annual images of frothing polluted lakes due to sewage, which certainly do not inspire confidence in local governance. As India seeks more foreign tourists, basic sanitation in tourist hotspots becomes critical. No one wants their holiday marred by gastroenteritis from contaminated water or by the sight of garbage and human waste in streets. Thus, sanitation failures can erode India’s soft power by reinforcing stereotypes of uncleanliness that India has been trying to shed. Finally, consider the public health ramifications beyond India’s borders. In a globalised world, diseases born of poor sanitation do not necessarily stay local. India’s high burden of antibiotic-resistant infections is partly fuelled by rampant diarrhoea cases and unsanitary hospitals, posing a risk of exporting superbugs. Polio was endemic in India until 2014 largely due to open defecation allowing the virus to spread; global health officials feared that as long as India had wild polio cases, the whole world would be at risk. Although India eradicated polio, the lesson remains, India’s sanitation is a global public health concern. Persistent outbreaks of cholera or typhoid in any country of 1.4 billion people are a threat to international health security. Therefore, India’s success in sanitation is not just its own business, it bolsters its stature as a responsible global player contributing positively to worldwide well-being.
Reforms and Investments for a Sanitary Future
Turning India’s sanitation situation around in a meaningful, lasting way will require bolder policy reforms, hefty investments, and innovative strategies at all levels of government. The past few years have proven that progress is possible, but to truly solve the sanitation crisis, India must tackle the problem holistically, from toilet pans to treatment plants, and from cities to the most remote hamlets. First, policy reforms must strengthen the weakest links in the sanitation chain. One priority is integrating sanitation with water supply and housing programs. A household is likely to maintain and use a latrine if it has piped water and is part of a decent housing unit; thus, schemes like the Housing for All initiative and Jal Jeevan Mission, which provides tap water, should be dovetailed with sanitation goals. Building millions of toilets is futile if they are not accompanied by water for flushing/cleaning and solid waste disposal systems for sludge. The government could introduce mandatory sanitation impact assessments for new housing colonies and infrastructure projects, just as environmental impact assessments are required, to ensure sewage management isn’t an afterthought. Another policy leap would be enforcing fecal sludge management (FSM) regulations, since much of rural India and smaller towns will use on-site sanitation, pit latrines and septic tanks, for years to come, proper emptying and treatment of that waste is essential. Standards exist on paper, but India needs to build a market for FSM services, training entrepreneurs, subsidising vacuum trucks for villages, and strictly prohibiting manual cleaning of pits. This not only prevents dangerous manual scavenging but also stops faecal matter from seeping into fields and groundwater. Investment priorities must shift toward wastewater and solid waste infrastructure. India’s spending on sanitation has so far been skewed towards visible, politically sellable items like toilets and city beautification. The next stage demands pouring funds into the less glamorous but vital backbone, sewer networks, sewage treatment plants (STPs), decentralised waste treatment units, and drainage in flood-prone areas. As of 2021, India had the capacity to treat only about 28-40% of its sewage (estimates vary), and even that capacity isn’t fully utilised due to erratic power supply or poor maintenance. The government’s Smart Cities Mission and urban renewal programs should prioritise closing this gap. Public-private partnerships can be explored for large STPs, while smaller towns might opt for modular, naturebased solutions, like constructed wetlands or biodigesters, that are cheaper and easier to maintain than huge plants. The central government’s recent initiative to encourage “One City, One Operator” for water and waste services could help bring professional maintenance to urban sanitation systems. Moreover, monitoring of outcomes needs investment, remote sensors and IoT technologies can be used to monitor toilet usage, whether rural toilets are being used or abandoned, and track sewage flows, enabling quicker fixes when problems arise. At the community level, strategies should focus on behavioural change and inclusion. The lesson from the Swachh Bharat campaign and global sanitation drives is that infrastructure alone is insufficient as cultural norms and personal habits must also evolve. Programs that involve local influencers, women’s self-help groups, and schoolchildren as sanitation ambassadors can reinforce the message that a toilet is a personal pride and community asset, not a symbol of impurity or inconvenience. Some successful approaches in India have included naming and faming, villages declared ODF get public recognition and additional grants, while those slipping backward face social audits. This kind of community-driven accountability could be institutionalised through annual “sanitation rankings” for villages and city wards, sparking a healthy competition much like the Swachh Survekshan did for cities. Special focus is needed for gender-sensitive sanitation, for instance, designing public toilets with women’s needs in mind by considering factors of a safe location, menstrual waste bins, adequate lighting, and ensuring all girls’ schools have functional, private toilets with water. Since women often shoulder family health responsibilities, empowering them with sanitation decisionmaking, such as via mothers’ committees overseeing village cleanliness, can yield sustained results. One can’t ignore the caste dimension in reforms. Eradicating manual scavenging must be non-negotiable. This calls for fully implementing the existing law, with strict punishment for officials or contractors who still send people into sewers, and expanding rehabilitation packages for those freed from this practice. The occupational safety of sanitation workers in general needs urgent improvement, giving sewer workers proper protective gear, oxygen masks, mechanised tools, health insurance, and dignity in employment. Cities like Chennai have started using robots to clean sewers; scaling such innovations could save lives and attract more workers to sanitation jobs, which are often understaffed due to their stigmas and risks. In rural areas, where caste biases sometimes discourage building toilets, a misguided notion among some that having a toilet inside the house is impure, campaigns should specifically counter such beliefs by enlisting local religious and social leaders to endorse sanitation for all. Involving traditionally marginalised communities in the planning and monitoring of sanitation projects can also ensure the benefits reach them and build social cohesion around the shared goal of a clean habitat.
India’s Sanitation: A Colossal Concern for Global Health, Environment, and Climate Challenges
India’s sanitation crisis does not exist in isolation; it is interlinked with broader global concerns of public health, environmental sustainability, and climate resilience. Ameliorating sanitation in India would thus generate positive ripple effects far beyond its borders, while failure to do so could exacerbate international challenges. On the global public health front, sanitation is fundamentally about disease prevention. Indian Nobel laureate biologist Dr. Venki Ramakrishnan once noted that if Alexander Fleming’s discovery of antibiotics was the great medical revolution of the 20th century, the 21st century’s revolution should be the provision of clean water and sanitation, because without it, antibiotics and other interventions will keep getting undermined by preventable infections. In India, recurring outbreaks of gastrointestinal diseases including cholera or rotavirus, and even newer threats such as the COVID-19 pandemic underscore how sanitation and hygiene are first lines of defense. During the pandemic, millions in dense urban slums struggled with “hand-washing” advisories simply because clean water and basic sanitation were lacking. Poor sanitation can act as a force multiplier for viruses and bacteria. The risk of a dangerous pathogen spreading globally is higher when basic hygiene is not observed in a populous country, a sobering thought in the age of global air travel. By the same token, the proliferation of antibiotic-resistant bacteria has been tied to sewage contamination; in Indian rivers and soils laced with sewage, scientists have found high concentrations of superbugs that could eventually travel abroad. Thus, improving India’s sanitation is a global public good, it would reduce the reservoir of infectious disease and drug resistance that threatens health security worldwide. The environmental impacts are equally significant. India’s rivers, once civilisational lifelines, have turned into carriers of waste. The mighty Ganga, absorbs over a billion litres of untreated sewage daily along its course, alongside industrial effluents. This not only threatens biodiversity such as fish kills, dead zones, and loss of aquatic life, but also contaminates the downstream water that millions rely on. Efforts are underway, the prime one among them being the Namami Gange program, to build treatment plants and clean the river, but unless every town on its banks has proper sanitation, the pollution will persist. Moreover, raw sewage contributes to the eutrophication of water bodies, fosters algae blooms, and can create breeding grounds for mosquitoes, propelling diseases like malaria and dengue. On land, indiscriminate dumping of solid waste and fecal sludge leads to soil contamination and can render farmland less productive. There’s also a link to deforestation, in some rural areas, people cut trees or bushes to have privacy for open defecation, gradually degrading local ecosystems. By fixing sanitation, India would also be addressing these environmental strains. Quintessentially, wastewater treatment and recycling can alleviate water scarcity,treated water can be reused for agriculture or industry, reducing the pressure on freshwater sources. With India projected to face severe water stress in coming decades, maximising reuse of every drop, including the dirty ones, will be key. Currently, cities like Bengaluru and Chennai are experimenting with using treated wastewater to rejuvenate lakes and recharge groundwater, a strategy that should be expanded nationally. Finally, consider climate change and how sanitation intersects with it. Climate change is expected to bring more extreme weather, heavier downpours, stronger floods, and also harsher droughts. India, with its long coastline and vast river basins, is extremely vulnerable to flooding. When floods strike areas without good sanitation, the impact is doubly disastrous. Contaminated floodwaters can turn a natural disaster into a massive health crisis by spreading fecal bacteria and toxic waste over entire neighbourhoods. As one analysis noted, if flood waters mingle with human waste, the likelihood of fecal-oral disease transmission rises sharply, leading to surges in diarrhoeal illnesses and infections. South Asia has seen this repeatedly, floods triggering outbreaks of cholera or hepatitis because sewage lines overflow or latrines collapse. Building climate-resilient sanitation systems, raised toilets and flood-protected sewage plants, is therefore a critical adaptation measure. On the flip side, droughts and water scarcity threaten sanitation by making toilets inoperable, no water to flush or clean. Many parts of India, such as Maharashtra’s drought-prone districts, have seen villagers revert to open defecation during droughts because there wasn’t enough water to maintain latrines. Solutions like rainwater harvesting and grey-water reuse can provide backup water for sanitation in such times. Along similar lines, there is an emerging field of climate-friendly sanitation technology, generating biogas from human waste, which reduces methane emissions that would occur if waste is left to decay in the open, or innovating toilets that use little or no water, such as vacuum-based or composting toilets suited for arid areas. By investing in these, India can mitigate some greenhouse gas emissions and build resilience. Notably, elevated sanitation standards also bolsters climate mitigation efforts indirectly. A healthier population is better able to cope with climate stress. Frequent bouts of illness from poor sanitation sap community resilience; in contrast, if people are healthier and not expending resources on preventable disease, they can better adapt to climate challenges. Moreover, proper waste management can reduce pollution that exacerbates climate impacts. In essence, sanitation is part of the foundation for sustainable development, without it, other initiatives, be it climate adaptation, education, or economic growth, will rest on fragile ground.
Conclusion
From the alleys of Mumbai’s slums to the rural fields of Uttar Pradesh, sanitation in India remains a defining challenge of our time. The country has undeniably come a long way from the post-independence era when the vast majority had no access to toilets. In the past decade, India’s concerted push has led to tens of millions of toilets being built and a steep drop in open defecation. These achievements have been praised as historic in scale, changing the daily lives of countless citizens, especially women and children who now enjoy a modicum of privacy and safety that was previously elusive. Yet, the job is only half done. As this analysis has shown, many toilets remain unused or unusable, large sections of the population, particularly the marginalised, continue to suffer the consequences of poor sanitation, and the underlying systems to manage waste safely are woefully deficient. India’s sanitation crisis is not just about building more latrines; it is about changing mindsets, enforcing laws and standards, investing in heavy infrastructure, and integrating sanitation into the broader tapestry of urban planning, education, health, and environmental policy. The urgency cannot be overstated. In a world where headlines alternately celebrate India’s rise and lament its persistent poverty, solving sanitation is one way to bridge that dichotomy. It would signal that India can deliver on the most fundamental needs of its people even as it reaches for the stars in other domains. The experience of COVID-19 and other global health scares has also reinforced that sanitation anywhere is sanitation everywhere, a reminder that one country’s public health lapses can have worldwide repercussions. As such, the international community has a stake in India’s success, and India can draw on global best practices and perhaps financial support to augment its efforts. There is precedent, the world rallied to help India end polio and to improve rural drinking water; a similar focus on sanitation would be in the interest of all. For India’s policymakers, the message is unambiguous. Toilets are only the beginning. The next steps require political will as strong as that which launched Swachh Bharat, coupled with technical ingenuity and community engagement. If India can, in the coming decade, ensure every village has not just toilets but also a waste disposal system, every city treats its sewage, and no person has to suffer the indignity of manual scavenging or the fear of disease from dirty surroundings, it would be a transformation as profound as any in its 75-year history. Such an outcome would save thousands of lives each year, add billions to the economy, enhance India’s global image, and most importantly, affirm the right of every Indian to a life of health and dignity. The challenge is immense, but so are the stakes, and the rewards of finally cleaning up India would reverberate around the world.