India is building millions of toilets. Getting people to use them is a bigger task

Natholi received an unexpected gift from the government recently when workers descended on his modest home in this rural village in the northern Indian state of Uttar Pradesh and built a brand new toilet in his front yard.

, a , said he never wanted one. Most people in his village have been relieving themselves in the open fields for years.

But as part of Prime Minister Narendra Modi's "Clean India" campaign to provide new sanitary toilets to more than 60 million homes by 2019, Mukhrai has been in the midst of a toilet-building boom since April.

More than 53 percent of all Indian homes — about 70 percent the villages — lack a toilet. Poor sanitation and infected water cause 80 percent of afflicting rural India, and diarrhea is a leading killer of children younger than 5, Unicef says.

Modi says this is a shame for a country that has global aspirations and that it is demeaning to women.

But constructing toilets the easy part. Getting people to use them is the real challenge, officials say.

"We never asked for a toilet. Now we are stuck with it," said Natholi, 22, as he opened the newly built squat toilet to show that it has not been used. His 62-year-old father peered and shook his head. "Having a toilet so close to the house is not a good idea. The pit is too small; it will fill up quickly. I don't want the bother of cleaning it up frequently. Going out to the open field is healthier. The open breeze outside is better than sitting inside this tiny room."

Modi has made toilet-building and sanitation a rallying cry since October. He has enlisted large companies to help. In the past year, his government has built more than 5.8 million toilets — up from 4.9 million the previous year. reports show that many of them are unused, or they are being used to store grain, clothes or to tether goats, thwarting Modi's toilet revolution.

"Even as we accelerate toilet construction now, much more needs to be done to persuade people to use them," said Chaudhary Birender Singh, India's minister for rural development, sanitation and drinking water. "For long, we assumed that if the toilets are built, people will automatically use it. But we have to diligently monitor the use over a period of time and reward them with cash incentives to the village councils at every stage. Only then will it become a daily habit."

The government budget for raising awareness largely remained unspent for years. Thousands of villages were declared to have ended open defecation since 2006, but many have since returned to the practice.

Critics also say that the government's great toilet race has turned into a vortex of corruption in which villagers and middlemen siphon money by creating fake ledger entries about toilet construction.

After years of promoting toilet use by advocating the health benefits, many regions of India began using women as toilet ambassadors. Brides were urged to shun grooms whose villages did not have toilets. Now the campaign has begun to promote toilets as key to women's security.

Numerous television ads and signs on village walls ask families to forbid their daughters and daughters-in-law from defecating in the open.

But an unintended consequence of this campaign has been the perception that toilets are just for women.

"Men can go out to the open fields, but for women who wear veils all day a toilet in the home is a good idea," said Sarvesh Sharma, 28, speaking with her face covered in Mukhrai, in front of her half-built toilet.

In the southern state of Karnataka, a film about responsible fathers of adolescent daughters was used to get men to construct toilets in their villages.

"Whether you like it or not, it's the men who make the decisions. And sanitation is just not a priority for the men. So we had to convey a message about toilets that enhances their manliness," said Jayamala Subramaniam, chief executive of Arghyam, a group in Bangalore that works on sanitation and water projects.

In many villages, the new toilets are being used by women and the elderly. Researchers say that families use toilets sparingly because they do not want the toilet pits to fill up too quickly.

said he wants a toilet pit so large that he can forget about emptying it for 20 years.

India's poor toilet habits have little to do with income or limited access to water. They are more influenced by India's centuries-old caste system, in which members of the lowest group — formerly called "untouchables" — were forced to clean human waste.

"The act of emptying the pit latrine is associated with the socially degrading caste system," said Sangita Vyas, managing director at Rice, a New Delhi-based research group that studies sanitation issues. "People fear a situation when their pit fills up and there is nobody willing to clean it because of the social stigma. That fear discourages sustained use of toilets. "

A Rice survey in 300 villages last year showed that more than 40 percent of homes that have a working toilet still showed evidence of open defecation. The report said that by the government, typically smaller, are most unlikely to be used.

But conversations about caste are not part of the government's toilet and sanitation campaign, activists say.

"How can you speak about toilets for everyone without first freeing certain caste groups from the degrading work of cleaning human waste?" said Bezwada Wilson, founder of Sanitation Workers Movement. "For any sanitation program to be successful in India, the government has to first mechanize the entire cleaning activities of the pit latrines, sewer lines and septic tanks."

Sanitation is not just a rural problem. Even in big cities, only 30 percent of sewage is treated and disposed of.

"If all of us begin to use toilets in India tomorrow, India will still not be in a position to solve the public health problem," said Madhu Krishna, senior program officer for sanitation at the Bill & Melinda Gates Foundation.

Mukhrai, Man Pal Chaudhury, the Mukhrai village chief, said the 114 newly built toilets will bring change, but not overnight.

"The goal is to free my village of open defecation. But for that each and every person has to fall in line," he said. "That is several years away.