World Toilet Day: Changing Children’s Behaviour And Lives

By VK Madhavan

More children in India benefit from supplementary nutrition that anganwadi centres provide than the entire population of Madhya Pradesh. Almost half the children aged 0-6 in India are registered in anganwadis.

Why is this important? What is the opportunity?

As per the National Family Health Survey 5 (2019-21), 35.5% of children, or one out of three children in India, were found to suffer from stunting – an indicator of chronic nutritional deficiency. The survey also revealed that diarrhoea was more prevalent in rural India as compared to urban India.

The POSHAN Abhiyaan was launched to improve nutritional outcomes for children, pregnant women and lactating mothers. In March 2018, Mission POSHAN 2.0 further integrated the supplementary nutrition programme into it, which seeks to scale up the Integrated Child Development Services (ICDS) programme to the entire country. The Mission seeks to reduce stunting, undernutrition, anaemia and low birth weight. One of the interventions under Mission POSHAN 2.0 is to ensure water, sanitation, and hygiene (WASH) services. Whilst water and sanitation at a community level have received significant public investment and attention through the Swachh Bharat Mission and Jal Jeevan Mission, there is a critical need to focus on institutions – schools, health care centres and anganwadis.

There are multiple studies that reveal that unsafe water, poor sanitation and unhygienic behaviours cause stunting. Stunting compromises a child’s physical and cognitive growth. The existence of a positive correlation between nutritional status and levels of learning would suggest that stunting could compromise not just long-term health but lead to poorer educational outcomes and learning.

It is believed that nearly 45% of global malnutrition-related deaths could be prevented by improving WASH conditions and practices.

There are close to 14 lakh operational anganwadi centres in India where supplementary nutrition is provided to nearly 7.4 crore children. Almost 2 crore children benefit from preschool education in these centres.

Government data suggests that 88% of the operational anganwadis have a drinking water facility and nearly 80% have a toilet facility. However, there are serious concerns regarding both the adequacy of the infrastructure and the appropriateness of the infrastructure.

Nearly one-fourth of anganwadis in the country operate from rented premises. It is not clear whether these get covered and considered. There is a strong case to ensure that irrespective of the ownership of the building, all operational anganwadis should possess adequate and appropriate water and sanitation facilities.

A survey undertaken by WaterAid India of 1,020 anganwadi centres in March 2021 revealed that only 7% had adequate WASH facilities and only 2% had both adequate and child-friendly structures.

The absence of guidelines or standards for WASH infrastructure in anganwadis like the Swachha Vidyalaya guidelines for schools lead to mere availability of a toilet or access to water as being deemed adequate. There is a need to create norms for the number of toilets or handwashing stations or drinking water points as a proportion of children. Inadequate infrastructure will lead to children defecating or urinating in the open.

Further, there is a need to ensure that the infrastructure is age appropriate. The infrastructure must ensure that taps and door latches are at a height appropriate for children.

A common concern with regard to all public toilets or community toilets pertains to the quality of operation and maintenance and the hygienic condition of these facilities. This is relevant for anganwadis, too. But are there adequate resources made available for the maintenance of the WASH infrastructure?

Finally, anganwadi centres provide us with a unique opportunity to ensure that at an early age, children inculcate the right hygiene behaviours with regard to washing their hands correctly, prior to and post meals and after using the toilet. The availability of appropriate and adequate infrastructure can ensure that latrine use, for example, becomes a habit at an early age. The anganwadi workers can play a critical role in motivating children to practise the right behaviours and this could lead to changes in their behaviours at home.

By focussing on adequate and appropriate WASH in anganwadis and by emphasising the right behaviours, we would not just be investing in the health and well-being of our children but would help them realise their full potential.

The author is chief executive at WaterAid India