title: Socio-cultural and behavioural factors constraining latrine adoption in rural coastal Odisha: an exploratory qualitative study.
abstract: BACKGROUND
  Open defecation is widely practiced in India. To improve sanitation and promote better health, the Government of India (GOI) has instituted large scale sanitation programmes supporting construction of public and institutional toilets and extending financial subsidies for poor families in rural areas for building individual household latrines. Nevertheless, many household latrines in rural India, built with government subsidies and the facilitation and support of non-government organizations (NGO), remain unused. Literature on social, cultural and behavioural aspects that constrain latrine adoption and use in rural India is limited. This paper examines defecation patterns of different groups of people in rural areas of Odisha state in India to identify causes and determinants of latrine non-use, with a special focus on government-subsidized latrine owners, and shortcomings in household sanitation infrastructure built with government subsidies.
  
  
  METHODS
  An exploratory study using qualitative methods was conducted in rural communities in Odisha state. Methods used were focus group discussions (FGDs), and observations of latrines and interviews with their owners. FGDs were held with frontline NGO sanitation program staff, and with community members, separately by caste, gender, latrine type, and age group. Data were analysed using a thematic framework and approach.
  
  
  RESULTS
  Government subsidized latrines were mostly found unfinished. Many counted as complete per government standards for disbursement of financial subsidies to contracted NGOs were not accepted by their owners and termed as 'incomplete'. These latrines lacked a roof, door, adequate walls and any provision for water supply in or near the cabin, whereas rural people had elaborate processes of cleansing with water post defecation, making presence of a nearby water source important. Habits, socialising, sanitation rituals and daily routines varying with caste, gender, marital status, age and lifestyle, also hindered the adoption of latrines. Interest in constructing latrines was observed among male heads for their female members especially a newlywed daughter-in-law, reflecting concerns for their privacy, security, and convenience. This paper elaborates on these different factors.
  
  
  CONCLUSIONS
  Findings show that providing infrastructure does not ensure use when there are significant and culturally engrained behavioural barriers to using latrines. Future sanitation programmes in rural India need to focus on understanding and addressing these behavioural barriers.
authors.affiliation: Environmental Health Group, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. parimita.routray@lshtm.ac.uk.
authors.forename: Parimita
authors.initials: P
authors.lastname: Routray
authors.affiliation: Environmental Health Group, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. wolf-peter.schmidt@lshtm.ac.uk.
authors.forename: Wolf-Peter
authors.initials: WP
authors.lastname: Schmidt
authors.affiliation: Environmental Health Group, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. sophie.boisson@lshtm.ac.uk.
authors.forename: Sophie
authors.initials: S
authors.lastname: Boisson
authors.affiliation: Environmental Health Group, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. thomas.f.clasen@emory.edu.|Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. thomas.f.clasen@emory.edu.
authors.forename: Thomas
authors.initials: T
authors.lastname: Clasen
authors.affiliation: Environmental Health Group, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. mwjenkins@ucdavis.edu.|Department of Civil and Environmental Engineering, University of California Davis, One Shields Ave., Davis, CA, 95616, USA. mwjenkins@ucdavis.edu.
authors.forename: Marion W
authors.initials: MW
authors.lastname: Jenkins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003469:Culture; D003672:Defecation; D005191:Family Characteristics; D005260:Female; D005380:Financing, Government; D006184:Habits; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012111:Residence Characteristics; D012424:Rural Population; D012499:Sanitation / Q000379:methods* / Q000592:standards; D012959:Socioeconomic Factors; D014038:Toilet Facilities / Q000592:standards; D055815:Young Adult