This is a problem we should be talking about.

Jessica Carter and Bebi.

Silence is not something you come across often in India. But there we were, in the middle of a rural area in the country’s north, where it was dark, silent and still. The workers had come in from the fields, the cows had been brought in and milked, and there was a lull while families stopped and took a deep breath.

I was at a small village in the state of Bihar, one of the poorest states of northern India, working with Opportunity International Australia. As the fog set in, we huddled into a van to take the potholed roads back to the town of Buxar for the night. We weren’t even two minutes down the road when a woman’s silhouette appeared from nowhere.

The driver slowed right down, and we stared back into the face of a lone woman, standing motionless by the edge of the road with a small tin bowl in her hands. Another hundred metres down the road, another woman appeared. And another. And another.

We were interrupting the silent, private moment that nearly one billion people around the world experience every day: open defecation. In Bihar, open defecation is particularly prevalent – 83 per cent according to 2011 census data. Roughly, that means that only two in every 10 people have access to a toilet.

The consequences of this extend far beyond the inconvenience of not being able to duck to the loo anytime. Firstly, there are the health issues. Open defecation contaminates the waterways, making drinking water unsafe and causing illnesses like diarrhoea. Then there are the problems that stem from only being able to go to the bathroom at certain hours – while men can squat any time of day, women are expected to go in privacy, which means going in the darkness. This means that many women purposefully dehydrate themselves so they can avoid going, which leads to other health problems such as urinary tract infections.

As well as health issues, not having access to a private toilet poses a safety problem too. Earlier this year, two teenage cousins in northern India made their daily journey into the fields outside their village because they had no toilet at home. In the darkness, they were gang-raped and killed – left hanging from a tree for their family to find hours later. Police in Bihar say that at least 400 women could have avoided rape last year if they’d had private toilets in their homes. But the solution is not as simple as building toilets – the silence around the issue of open defecation stems from a lack of knowledge and understanding around why a private toilet is important.


In communities where literacy levels are low and poverty levels are high, knowledge is crucial to improving health outcomes for many families who still lack access to toilets, clean water and basic health and hygiene information. Slowly, this is changing through education programs led by local women, known as community health leaders. I saw this in action when I met a mother called Nisha the next day.


Nisha is a health leader that Opportunity International Australia is training to raise awareness of the importance of basic health, hygiene and nutrition. She has reached out to hundreds of households in her area. The community takes her – and the messages she shares – very seriously. I watched Nisha speak with groups of mothers and daughters who’d travelled to her home to learn from her. Her lessons are helping those mothers and daughters apply basic health advice and openly challenge cultural norms, talking about once taboo topics like sanitary napkins, breast cancer and open defecation. Nisha has also helped more than 100 women access funds to build toilets in their own homes – toilets they will use because they have an understanding of why this simple piece of infrastructure is so life-changing.

Nisha’s commitment to change is inspiring. She is one of nearly 1,230 health leaders working with communities in Bihar, Uttar Pradesh and other regions in India’s north. These health leaders build healthy communities in poor regions – so far more than 100,000 families have been reached through this innovative project. Opportunity has seen real success already – a recent impact assessment found that before receiving health education, only 33% of mothers gave birth in a hospital; after the training this increased to an incredible 79%.

But there is still so much more to be done. In 2011, the Indian government released a report to say that it could be 2135 – more than 100 years from now – before people in the state of Bihar no longer practice open defecation,  unless progress happens faster. Opportunity is hoping to train 2,000 women like Nisha by the end of 2014, enough to reach 400,000 families and make a significant difference.

Opportunity relies on the generosity of its supporters to support mothers like Nisha and continue improving the lives of thousands of people living in poverty. You can help equip community health leaders to make a difference here.  

Jessica Carter is an international development professional with experience in community engagement and media production, who is passionate about helping people share their stories to inspire change and make the world a better place. She has worked with a range of people and communities in India, Bangladesh, China, South Korea, Canada and Australia for a diverse range of development, media and research organisations. At Opportunity International Australia, Jessica is the Proposal and Program Coordinator, helping to support and communicate about innovative programs such as training health leaders

 Opportunity International Australia provides people living in poverty with the opportunity to transform their lives. Offering a hand up rather than a hand-out, they use a sustainable approach to solve poverty – empowering families through community development programs and loans as small as $100 to help them grow their own small business. These services mean that families no longer have to struggle to afford food, water, healthcare and an education for their children. For more information, please visit

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