A report issued by the World Health Organization and UNICEF states 2.4 billion people lack access to proper toilets. Defecating outdoors bears a significant risk to the fresh water supply and is associated with the death of 700,000 children each year which contact diseases like diarrhoeal.

We take our toilets for granted, but the truth is a flushing toilet is a luxury for a big part of the world. Human poop takes about a year to biodegrade, can be an environmental hazard. Direct contact transfers a slew of harmful bacteria which can be lethal if left untreated. These can transferred indirectly when streams or watersheds become contaminated.

The highest percentage of open defecation in the world belongs to India  with more than 640 million people defecating outside. Twelve per cent of all people worldwide who openly defecate live in Uttar Pradesh alone.  Strangely enough, many people who do have access to a toilet, choose to defecate outside anyway, either because they spend a lot of time on farms or out of habit. This suggests that the government not only needs to improve access to sanitation but address a major cultural flaw as well, which could prove more challenging that most believe.

India still needs to build 100 million toilets to provide everyone access, but experts say the country also needs to invest more in campaigns to change behaviours. This could prove difficult considering the sanitation budget was recently halved.

“There is a kind of a feeling among politicians that if we ignore the problem it will go away,” said Nitya Jacob, who leads policy for the Indian branch of the international charity WaterAid. “And so we’ve had years of poor funding, poor quality equipment and poor solutions being offered to the poor.”

Defecating outside can not only pose life-threatening risks, but can severely hamper physical development and cognition. A paper found that fact that child health and growth is especially poor in India may be attributed to widespread open defecation. Exposure to germs not only gives children diarrhoea, but over the long term, also can cause changes in the tissues of their intestines that prevent the absorption and use of nutrients in food, even when the child does not seem sick. A report authored by the World Bank found a link between open defecation and poor cognition among children. As such, open defecation threats human capital of developing countries.

“Our research showed that six-year-olds who had been exposed to India’s sanitation programme during their first year of life were more likely to recognise letters and simple numbers on learning tests than those who were not,” said Dean Spears, lead author of the paper ‘Effects of Early-Life Exposure to Sanitation on Childhood Cognitive Skills’.

In 2000, the UN set out in its Millennium Development Goals to increase access to proper sanitation facilities in the world to 77%. Today, only 68% of the world’s population has access to proper sanitation facilities, and the UN says it will soon set new “sustainable development goals” that are expected to focus on how $2.5tn in development funds will be spent through 2030. But even though there’s room for a lot of progress, efforts so far haven’t been pointless. Far from it. Some 2.6 billion people received improved access since 1990. As such, the report should not be seen as evidence of failure, but on the contrary.