Session 6: Human Development – Health, Education & Labour Markets (2)

The sixth session was chaired by Lakshmi Iyer (Delhi School of Economics). Presentations were by Diane Coffey (r.i.c.e. and Princeton University) who drew on her paper “Switching to Sanitation in South Asia: Qualitative Evidence on Health Technology,” followed by Rohini Somanathan (Delhi School of Economics) who presented “The Mixture as Before: Student Responses to the Changing Content of School Meal in India.” The discussions were lead by Sunil Jain (Financial Express).

Coffey asked why, in India, there is a very high rate of open defecation in rural areas, which has a serious impact on public health outcomes. Despite rising education levels, there is a very slow decline in the number of Indians defecating in the open, particularly in comparison to other less developed countries. 60% of people who defecate in open worldwide are in India. Poverty is not the explanation, as there is no apparent relationship between open defecation and GDP. Simple latrines are very inexpensive, but India has a low demand for them. Coffey conducted a rigorous qualitative study on four regions in India to look at if culture could explain why economic growth in India has translated into such a slow decline in open defecation.

Coffey’s study found that culture appears to shape the meaning of sanitation behaviours in people in rural India. Open defecation in these areas is culturally aligned with living a wholesome and healthy life, while a latrine implies ritual impurity and uncleanliness. This finding is supported by the fact that, when looking at religion, Hindus are more likely than Muslims to consider a latrine close to the house to be impure. People who do build latrines close to their homes make very expensive toilets to avoid the ritual pollution and social stigma. The cultural idea that cheap, simple latrines are polluting shuts poor people out of the latrine market.In addition, latrine use is perceived as an activity for weaker people, not the strong and healthy. Thus, there is no social pressure to encourage people to build simple latrines, and people who have them tend not to use them due to these cultural ideas. 1/3 of people in study who have a latrine don’t use it. 56% of households which have a latrine at least one person defecates in open.

Coffey concludes that, in order to stop open defecation, cultural ideas need to change. During the discussion mediated by Jain, several questions were raised. One issue was the topic of women’s safety and molestation, and Coffey indicated that her women respondents were less interested in latrines than you would think. This is partly because going to defecate is one of few chances they have to get out of the house, see their friends, etc. Another idea raised was that of community latrines to lessen the pollution stigma. However, if purity and health are wrapped up defecation, then people don’t want to defecate with their neighbours. Many issues arise of who cleans up communal messes, caste mixing, and fears of the pit filling and needing to be emptied. Coffey suggests that, to change cultural attitudes, a shift in policy from building latrines to latrine health education.

Somanathan then presented her paper “The Mixture as Before”, which looked at if the content of school meals affects school attendance in Delhi. Of particular note was that the changes were completely cost neutral, so she was able to see effects without worrying if they were worth the price. The Indian New Delhi school programme they observed is extremely cheap—about 3 cents per meal (USD), $3-6 per child per year. She looked at a natural experiment, where there was a phased roll out of changes in a New Delhi food for education programme. Schools switched over a period of time from giving snacks to giving out cooked lunches, which cost the same but were provided by different private vendors. The treatment was non-random, but she was able to look at attendance rates, menu data before and after transition, and some short term enrolment effects.

Somanathan found that school attendance went up with the transition to cooked meals, and the biggest effects were on the younger students. There appeared to be no intrinsic gender effect. She also looked to see if the type of food on the menu has an effect. By looking at the schools which offered two items (generally wheat and vegetable) as opposed to one item (such as porriage), she found a huge positive effect on youngest students’ enrolment immediately after programme roll out.

Somanathan qualified these promising results by cautioning that they likely vary by context. Food for education programmes need not be expensive, but she shows that design (timing, menus, providers) matter a great deal. During the discussion, Jain raised the issue that the study doesn’t look at educational outcomes and the effect likely wears out. However, it was heartening to see that, with the same costs, governments can be innovative and have a positive impact.

By Kyla Reid, Coordinator, IGC Hub