Health, hygiene and appropriate
sanitation: experiences and
Dr Deepa Joshi is Assistant
Professor in Conjunctive Water
Management and Conflict,
South Asia, at the Irrigation
and Water Engineering Group,
Centre for Water and Climate
in Wageningen.
Address: Irrigation and
Water Engineering Group,
Centre for Water and
Climate, Building 100,
Droevendaalsesteeg 3a,
6708 PB, Wageningen, The
Netherlands; e-mail: deepa.
joshi@wur.nl
Ben Fawcett is Adjunct
Senior Lecturer at
the Advanced Water
Management Centre,
University of Queensland.
Address: Advanced Water
Management Centre,
University of Queensland,
Brisbane, Queensland
4072, Australia; e-mail:
benfawcett@linknet.com.au
Dr Fouzia Mannan is
Associate Professor at the
Department of Women
and Gender Studies, Dhaka
University.
Address: 4th Floor, Arts
Building, Dhaka University,
Dhaka 1000, Bangladesh;
e-mail: aurpa@agni.com
This paper draws on
Joshi, D, J Morgan and B
Fawcett (2005), Sanitation
for the Urban Poor:
Whose Choice, Theirs or
Ours?, an unpublished
research report prepared
for DFID, downloadable
from http://www.dfid.
gov.uk/r4d/PDF/Outputs/
Water/R8028-FTR.pdf.
Environment & Urbanization Copyright © 2011 International Institute for Environment and Development (IIED).
Vol 23(1): 91–111. DOI: 10.1177/0956247811398602 www.sagepublications.com
perceptions of the urban poor
DEEPA JOSHI, BEN FAWCETT AND FOUZIA MANNAN
ABSTRACT “Don’t teach us what is sanitation and hygiene.” This quote from Maqbul,
a middle-aged male resident in Modher Bosti, a slum in Dhaka city, summed up
the frustration of many people living in urban poverty to ongoing sanitation
and hygiene programmes. In the light of their experiences, such programmes
provide “inappropriate sanitation”, or demand personal investments in situations
of highly insecure tenure, and/or teach “hygiene practices” that relate neither to
local beliefs nor to the ground realities of a complex urban poverty. A three-year
ethnographic study in Chittagong, Dhaka, Nairobi and Hyderabad illustrated that
excreta disposal systems, packaged and delivered as low-cost “safe sanitation”, do
not match the sanitation needs of a very diverse group of urban men, women and
children. It is of little surprise that the delivered systems are neither appropriate nor
used, and are not sustained beyond the life of the projects. This mismatch, far more
than an assumed lack of user demand for sanitation, contributes to the elusiveness
of the goal of sanitation and health for all. The analysis indicates that unless and
until the technical, financial and ethical discrepancies relating to sanitation for
the urban poor are resolved, there is little reason to celebrate the recent global
declaration on the human right to water and sanitation and health for all.
KEYWORDS gendered identities / mismatch / sanitation and hygiene priorities /
spatial heterogeneity
I. SANITATION FOR THE URBAN POOR: WHOSE AGENDA,
WHOSE PRIORITIES?
One would assume that at a minimum, planning initiatives relating to
sanitation services for the urban poor would take into account the realities
of urban poverty. Yet, as Verhagen and Ryan(1) point out, sanitation
agendas are often not well informed of the complex realities of urban
poverty. The common practice is to “…force the urban poor to accept, and
even expect…limited support” and/or to leave out those who do not fit in.(2)
Among the multiple distinctions that differentiate the urban poor,
the two most critical aspects related to sanitation are first spatial, where
one lives, and second gender, or the complexities of gendered identities
and related sanitation needs and responsibilities in these diverse settings.
However, sanitation policies and strategies for the urban poor rarely analyze
the diverse heterogeneity of the urban poor: who they are; where and how
they live – as illegal, quasi-legal or, in rarer instances, as legal residents of
the city; and what they perceive, need and mostly lack as sanitation. In
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E N V I R O N M E N T & U R B A N I Z AT I O N Vol 23 No 1 April 2011

our study, we found that policy and programme details ignored the subtle 1. Verhagen, Joep and Peter
Ryan (2008), “Sanitation
and not so subtle distinctions concerning the power structures and politics
services for the urban poor”,
that determine how and why certain slums exist and become Iegalized and Background Paper for the
“officially recognized” and hence recipient of services, or why some are Symposium on Sanitation for
considered illegal and emptied of their residents overnight or excluded the Urban Poor – Partnerships
and Governance, IRC, Delft, The
from basic infrastructure. Likewise, the complex cross-cutting issues that Netherlands, 19–21 November.
make some more vulnerable than others in any location are too often 2. Quoting Gita Dewan Verma
ignored. As Ahmed reports: “…because programme design demands…local in B McKean (2009), “Invisible
agencies select working areas [among slums] that are relatively stable…whose lives: stories of innovation
and transition in Mumbai”,
populations [in Ahmed’s case] seem economically strong [enough] to pay for the
Intersections Vol 10, No 2,
provided facilities.”(3) The most striking fact in this study was the invisibility page 13.
of the poorest and most deprived urban populations, of residents living in 3. Ahmed, R (2006), A Case
the worst urban environments who had and would have for a long time Study on Reaching the Poorest
nothing resembling adequate sanitation. The objective of this paper is to and Vulnerable, Proceedings
of the 32nd WEDC International
compare the rhetoric of policy, projects and global sanitation targets with Conference, Colombo, Sri
the realities of the sanitation needs and experiences of the urban poor. The Lanka, November, page 584.
findings demonstrate that men, women, children, the elderly, the sick and 4. SIWI and the UN Millennium
disabled among the poor living in diverse urban locations, differentiated as Project (2005), Health, Dignity
they are, are no different from others in their need for the range of services and Development: What
Will It Take? United Nations
that make up a holistic package of sanitation, hygiene and health. Despite Millennium Project Task Force
an acknowledgement that basic sanitation needs include “…facilities and on Water and Sanitation, Final
services that provide personal privacy and dignity and ensure a clean and healthy Report, Stockholm International
Water Institute (SIWI),
living environment both at home and in the neighbourhood of users”, what is Stockholm, page 11.
currently promoted as basic sanitation is (demand for) low-cost household 5. Evans, Barbara (2005),
excreta disposal systems and hygiene awareness related to hand washing.(4) Securing Sanitation – The
As Evans states: “While the choice of the word ‘basic’…may seem like semantic Compelling Case to Address
nit-picking, it is not. It explicitly recognizes that access is access – to any means the Crisis, Stockholm
International Water Institute
of safe excreta disposal, and that this, linked to improved hygiene behaviour and the World Health
(principally hand washing) will yield large benefits.”(5) Such “…engineering Organization, Stockholm,
and public health domination of sanitation can obscure local level priorities, page 6.
needs and socio-cultural practices.”(6) Added to this, Penner(7) reports from 6. Mehta, L (2007), “Liquid
dynamics”, STEPS Briefing 6
South Africa on what was a common feature in the research locations in from L Mehta, F Marshall, S
our study, namely that the increasing emphasis on cost saving and cost Movik, A Stirling, E Shah, A
recovery options for the currently underserved poorest populations results Smith and J Thompson (2007),
in interventions that are often stripped of basic considerations of human Liquid Dynamics: Challenges
for Sustainability in Water and
dignity, especially for women, children, the disabled and the elderly. Yet, Sanitation, STEPS Working
as we illustrate below, even these limited interventions exclude significant Paper 6, STEPS Centre,
numbers among the urban poor. Few poverty and health gains can be Brighton, page 2.
anticipated if the mismatch persists between sanitation policies and 7. Penner, Barbara (2010),
“Flush with inequality:
programme interventions and ground realities of urban poverty. sanitation in South Africa”,
Places, accessed 19 November
2010 at http://places.
II. RETHINKING GENDER, SANITATION AND URBAN POVERTY designobserver.com/entry.
html?entry=21619.

The findings in this paper are an outcome of a three-year research

study supported by the UK government’s Department for International
Development (DFID) to assess gender issues in sanitation for the urban
poor. Gender and urban sanitation have long been discussed and
understood largely as “urban poor women lacking private spaces to
defecate”, resulting in both inconvenience and indignity as well as health
issues. In this study, we wanted to assess how the singular “development”
image of the “urban poor woman” compared to gendered experiences
of sanitation, or the lack of it, among a diverse group of urban poor

92

8. Two each in Dhaka and
Chittagong (Bangladesh); and
three each in Hyderabad (India)
and Nairobi (Kenya).
9. IIED (2001), “Rethinking aid
to urban poverty reduction:
lessons for donors”,
Environment and Urbanization
Brief No 3, International
Institute for Environment and
Development, London, page 1.
H E A LT H , H Y G I E N E A N D A P P R O P R I A T E S A N I T A T I O N
women and men. The study required an entirely qualitative approach:
observing, listening to and documenting what was perceived, understood
and experienced as sanitation and/or the lack of it.
The study, funded under DFID’s Knowledge and Research Initiative,
was conducted between 2003 and 2005 and included an in-depth analysis
of several pavement locations, 10 slum and squatter settlements(8) of
varying degrees of tenure security in Chittagong and Dhaka in Bangladesh,
in Hyderabad in India, and in Nairobi in Kenya. The decision to research
urban poor residents in these diverse settings was the outcome of a very
relevant accident. An initial list of research locations, i.e. urban poor
settlements or slums, was identified in each city through discussions with
local official and non-governmental agencies. By default, these locations
were areas where some (official and/or non-governmental) sanitation
interventions were ongoing. An exception to the rule was an inner-city
slum, the Mazar Road settlement in Dhaka city. The Bangladeshi research
team had identified this settlement because, despite the fact that it had
existed for several years in the middle of Dhaka city, it had attracted no
“development” attention from official or non-governmental water and
sanitation agencies. Two weeks after research was initiated, Mazar Road
settlement was bulldozed by officials authorized by the Ministry of Home
Affairs. The evicting authorities gave the slum residents only one day’s
notice and, lacking as they were in any kind of NGO or official support,
they were provided with no rehabilitation support or compensation
whatsoever. This dramatic experience sharpened the boundaries of the
research agenda, and we gravitated from normative water and sanitation
circles and agencies to dialogue with a wider range of urban policy
professionals and activist organizations in order to attempt to map and
understand the spatial and structural exclusions in urban planning
processes. Through these interactions it was quite evident that official
and non-governmental planning and implementing urban water and
sanitation agencies largely ignored the realities of citizenship, legality
and security of tenure, which, as we discovered in this study, are central
to the larger goal of sustainable sanitation. Our research findings closely
mirrored what was pointed out in an Environment and Urbanization policy
brief – namely that most of the “…urban poor would be bewildered by the
number of international organizations [claiming to work for them] with so
much money, whose efforts have by-passed them…while a minority few would
recall sporadic moments of an intense activity over which they had little or
no say.”(9) In adopting a real-life, broad lens to view the urban poor, we
learnt that “where one lived” was as relevant to sanitation or the lack
of it as gendered identities. Our initial list of research locations thus
changed, and the homeless urban poor were included in the community
to be researched. Likewise, in the process of analyzing the illegality and
vulnerability of different slum settlements, we discovered the chaos that
existed in the formal processes for classifying the urban poor, resulting
in some slums being “adopted” or “recognized” and being provided with
services, while others missed out and/or were evicted.
Following a broad area overview of the identified locations, case study
households and/or individuals were identified in each site, specific to the
population size and poverty disparities, and ensuring a representative
sampling. The focus was to ensure inclusion of the under-represented,
especially among the most vulnerable. An intensive ethnographic study
was pursued with individuals and their households over a period of three
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to six months. To validate these observations and experiences, the research

teams occasionally visited other “similar” settings, and also discussed and
presented their findings regularly with a wide group of local individuals
working in official and non-governmental planning, implementing,
research and policy institutions.
A relatively unfettered research agenda allowed us a closer view of what
McKean refers to as “…the liminality of the urban poor”, …of these “…threshold
people…who are at once no longer classified and not classified…betwixt and
between.”(10) It is important to mention here what these “threshold people” 10. See reference 2, McKean
made of the research. The researchers met many among the urban poor in (2009), page 6.

all four cities who were clearly tired of being researched. They had spoken to
countless others like us, who came during the day (never at night), carried
“safe” food and water, and wrote copious volumes of notes. If they had
earlier pinned their hopes on such exchanges, they were right in their anger
to question the motive for this happening over and over again. Yet, the
precarious nature of their survival made some desperately “believe” that the
research would lead to some intervention. Despite our clarifying that this
was “just a study”, there were sometimes terse conflicts as we talked about
who lived where in some of the “less secure” slums. Similarly, pavement
dwellers, often tracked, harassed or chased by the police, thugs and others,
on both the legal and illegal sides of the fence, were clearly uncomfortable
when our researchers arrived night after night to talk to them.
In the slums and on the streets, we encountered a wide array of familial
arrangements. Families with formal unions; temporary families formed
from a desperate need for social protection; both young and the elderly
living alone; and in several cases, complex sub-letting arrangements in
slums, or even sharing the same house/space in the slums and on the
street during the day and at night. Achieving a glimpse of these intricate
complexities required the researchers to work around the clock; to speak
to people on day and night shifts and to explore the hidden underbellies
of the cities. The only time when street or pavement dwellers could be
meaningfully contacted for a conversation was around 10 pm, when the
pavements began to empty of cars and the shops started to close, enabling
the residents to unroll their meagre belongings, to cook and sit down. The
research resulted in some poignant relationships between researchers and
the researched, and the collection of many stories through the nurturing
of “longer-term” interactions. When shared at “water and sanitation
forums”, we have sometimes been told that these stories, although
interesting, are anecdotal, journalistic or lacking in “scientific” rigour. But
a headcount was not our objective and these stories are indeed continuing
experiences of real people. We present this evidence in the hope that
those who plan sanitation for the urban poor will see the logical link
between basic needs, sustainable environmental services, better health
and fundamental human dignity.

III. WHO ARE THE URBAN POOR?

While there may be disagreements about the meaning of the term

sanitation, there is generally little dispute globally about who the urban 11. UN–Habitat (2010), State of
the World’s Cities 2010–2011.
poor are: slum dwellers in developing countries. The near complete lack
Cities for All: Bridging the Urban
of any reference to the homeless poor in the recent UN–Habitat report Divide, Nairobi, Kenya, 244
State of the World Cities, 2010–2011(11) is evidence of such a common pages.

94

12. Beall, Jo, Owen Crankshaw
and Susan Parnell (2008),
“Victims, villains and fixers:
the urban environment and
Johannesburg’s poor”, Journal
of South African Studies Vol 26,
No 4, page 835.
13. WSP (2009), Guidance Notes
on Services for the Urban
Poor: A Practical Guide for
Improving Water Supply and
Sanitation, Water and Sanitation
Programme, World Bank,
Washington DC, page 7.
14. See reference 2, McKean
(2009), page 6.
15. See reference 11.
16. Joshi, D, J Morgan and
B Fawcett (2005), Sanitation for
the Urban Poor: Whose Choice,
Theirs or Ours?, unpublished
research report prepared
for DFID, downloadable from
http://www.dfid.gov.uk/r4d/
PDF/Outputs/Water/R8028-
FTR.pdf, page 51. Most of the
quotes throughout this paper
derive from this report, but it
must be noted that in many
instances changes to the
original quote have been made
for the purposes of this paper.
17. Begum, A (1999),
Destination Dhaka: Urban
Migration: Expectations and
Reality, Vedams Books (P) Ltd,
New Delhi, 194 pages.
18. A UNICEF–Bangladesh
report quoted a study where
nine out of 10 boys living in
slums were reported to have
been sexually abused (mostly
by a male relative), many of
them having had full anal
penetration by the time they
were 18 years old; see Kabir,
Rachel (2002), “Assessment
and analysis of the situation
of adolescent boys in
Bangladesh”, Report prepared
for UNICEF-Bangladesh, Dhaka.
H E A LT H , H Y G I E N E A N D A P P R O P R I A T E S A N I T A T I O N
homogenization of the urban poor. In the cities where we worked, where
one lives is a determinant of poverty and vulnerability. There are those
who live in officially recognized or unrecognized slums or squatter
settlements and those who are simply homeless. This variation is not a
minor happenstance and its impacts are complex. Where one lives goes
“…a long way in determining access to [basic] services.”(12)
There are popular claims to “…give the urban poor a voice and clear
misconceptions about poverty”,(13) yet we found no urban water and
sanitation programme catering to the needs of the homeless poor or those
who lived in insecure settlements such as Mazar Road settlement. In our
analysis, we try to identify both the variations between different locations
as well as how various households and individuals live in these diverse
situations, to demonstrate how policies and programmes for the urban
poor rarely acknowledge and address the complexity of micro-political
environments, as well as disparities among less and more vulnerable
individuals and households.
a. The homeless urban poor
McKean’s analysis of “…threshold people…at once no longer classified and
not classified”(14) applies well to the situation of the homeless urban poor.
They are occasionally enumerated in global and national poverty counts;
for example, the government of India is credited with having assessed the
count of its homeless poor(15) and, in some cities, even having provided
their “street” status with a legal identity. Yet the attitude to criminalizing
the homeless is widely prevalent and, ironically, there are official attempts
to “remove” them.
“Leading Supreme Court lawyer and civil rights activist in India, S
Murlidhar, points to the ‘power’ of police to ‘[mis]deal’ with pavement
dwellers. Murlidhar reports that some municipalities have formal
rules against squatting on the pavement, legalizing the penalization
of the civic nuisances attributed to squatting.”(16)
In such fragile situations, statistics, when available, are often nonsensical.
For example, the 1997 National Census of Bangladesh identified (only)
32,081 homeless in the whole country. In contrast, an Asian Development
Bank survey a year earlier (1996) identified 155,000 homeless in Dhaka
city alone. The homeless “pavement dwellers” are vulnerable not only
because they lack the very means around which they can build an identity
and move up the ladder to accessing basic services, but also because they
represent a large number of individuals with fractured socioeconomic
backgrounds. Pavement dwellers are a heterogeneous group that includes
families, adults, and children and the elderly living on their own, and our
research findings mirror what Begum(17) has reported, namely that around
15 per cent of pavement dwellers are physically disabled. Of the children
living on the streets, some live with families, while others are abandoned
or are children whose fractured early life experiences have led them to
sever constraining family ties. Girl children are considered to be more
vulnerable given the assumption of higher levels of female sexual abuse
on the streets; however, there is evidence that risks of molestation are
equally high for young boys.(18) What makes the difference is perceptions
of sexuality. In most cultures, female sexual dignity is fragile, its sanctity
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easily broken and rarely possible to restore. Among the children

themselves, perceptions of the lack of sanitation are closely inter-related
to indignity and broader psychological traumas of abuse. Street children
in Kenya describe themselves as “…one that is spoiled and rotten; one who
comes from a poor family; one who sleeps anywhere because he has no parents;
a child with a child who does not wash and dresses badly.”(19) 19. Kariuki, P W (1999), “Street
The urban not-poor often emphasize that pavement living is a chosen children and their families
in Nairobi”, in S Jones and N
lifestyle. “These people have no overheads, no housing costs. Why should they Nelson (editors), Urban Poverty
spend money [to rent] in some rundown part of the city, when they can live here in Africa: From Understanding
for free in a good neighbourhood?”(20) Yet only three of the 33 respondents to Alleviation, Intermediate
Technology Publications,
(a single man and two young women) in this study indicated that it
London, page 11.
worked to their benefit to live on the streets. The man sold drugs and the
20. Reported by J Crandall
two women were sex workers. Most decisions to live on the streets are Hollick (2000), Apna Street; see
circumstantial and living there is often not a preferred choice. http://www.ibaradio.org/India/
apna/apna.htm.
“Mumtaj Begum (aged 42) moved to her current ‘home’, a pavement
in Dhaka city, after she was left by her husband for another woman.
Mumtaj works as a maid to support herself, her two children and an
elderly mother. ‘This is close to my place of work. I can neither afford to
rent nor to pay transport charges if I stay elsewhere.’ Yet pavement living
is far from easy. ‘We can only sleep when other activities come to a close
late at night. Many times we are displaced by heavy rain. We have to get
up and stand until the rain comes to a halt, and after that, the floors are
all wet.’ There is nowhere else to go and she expects no more than
some form of shelter from the rain and storage facilities. Currently,
the family pays Taka 5 each day to a grocer to keep their money and
belongings.”(21) 21. See reference 16, pages 48
and 49.
Begum reports “distress” migration, which pushes a large proportion of
the poor to the pavements.
“We met a family of four (husband, wife and two young sons) who were
spending their first night on the pavement, near the sports stadium in
Dhaka. A series of circumstances had made it inevitable for them to
come to the city. All that they had packed – clothes, utensils, bedding
– to bring to Dhaka had either fallen off or been stolen from the roof
of the bus. No compensation had been provided for this loss. In Dhaka
they stayed with a relative, who lived in a slum, for a few days. ‘Insha
Allah, we were well looked after, but we knew we were becoming a burden.
This is our first night here. We bought some food to eat.’ Their bedding
consisted of newspapers and old cardboard sheets, begged from shops.
‘How will we bathe, wash or dry the few clothes we have?’”(22) 22. See reference 16, page 49.

Areas of intense activity, such as train and bus stations, mosques,

market centres etc. offer the advantage of some basic services as well as
employment opportunities. Yet any benefits from living on the streets are
often outweighed by the sheer challenges of a “naked” living.
“Safia is a young married girl living near a big temple on the streets
in Hyderabad. She ended up on the streets as a result of marrying a
Muslim man (she was a Hindu) and the non-acceptance of the alliance
by both families. Safia finds it very difficult to live on the pavement.
‘Everything is a problem on the pavement. There is no privacy. People are
watching all the time. It is like living your life on a stage. People are waiting
to take advantage. There’s no safety. One has to carry one’s belongings

96

23. See reference 16, pages 63
and 64.
24. See reference 11, pages 12
and 14.
25. Centre on Housing Rights
and Evictions (COHRE) and
Asian Coalition of Housing
Rights (ACHR) (2001), Forced
Evictions in Bangladesh: We
Didn’t Stand A Chance, page 20.
H E A LT H , H Y G I E N E A N D A P P R O P R I A T E S A N I T A T I O N
everywhere or be prepared to lose them.’ She lost all her belongings in the
first week of living on the pavement. She doesn’t cook because the
police often do not allow cooking on the pavement, but the temple
location provides for food and money offered to beggars like her. Her
first baby, born on the streets, died a few months later. Her second
child is three years old. On the day the team met Safia, she had just
suffered the miscarriage of her third child – on the street.”(23)
Even if they represent only around two per cent of the total urban
population, the homeless are a significant number of people. Largely
ignored by their national and local governments and viewed as scars on
the social and physical landscapes of the cities, they live in debilitating
situations and make do without even the minimum of basic necessities.
There are few programmes that benefit the pavement dwellers and where
they do exist they “band-aid” the situation, rarely challenging the “illegal
identity” of citizens in their own countries.
b. Heterogeneous slums and their diverse residents
The in-depth analysis of 10 slum and squatter settlements in Chittagong,
Dhaka, Hyderabad and Nairobi points to general chaos in the arbitrary
selection through which some slums manage to become “adopted” and
are provided with services while others miss out. Water and sanitation
interventions reiterate these illogical divides and also often ignore the
heterogeneity that exists between households and individuals within
any location. In such competitive settings, individual resources, or their
lack, influences how some manage to receive services in “unrecognized”
slums while the poorest and most vulnerable remain excluded or are even
ousted as an outcome of service delivery and provision in “recognized”
slums. Ignoring these complexities impacts upon the sustainability of
what is provided, resulting in an ever-increasing number of slums. Indeed
the UN–Habitat report states that while a total of 227 million people
have moved out of slum conditions in the decade since 2000, collectively
surpassing the Millennium Development Goal (MDG) target by 2.2 times,
the “absolute number” of slum dwellers actually increased from 776.7
million in 2000 to some 827.6 million in 2010.(24) A primary reason why
policy goals of decreasing urban poverty are rarely implemented in their
spirit and magnitude is the overwhelmingly negative attitude towards the
urban poor. Police and those acting on behalf of the Home Ministry in
Bangladesh are quoted as saying that “...these settlements were harbouring
terrorists and the government needed to wipe out terrorism, and therefore the
government had to evict these people.”(25) While official policies on slums vary
across countries, we found little variation in the policy and programme
chaos of dealing with urban poverty.
Of the three countries where the research took place, India was
the most progressive in acknowledging slums. However, the norms of
classifying slums in India result in arbitrary categorization:
• “notified” slums or legally recognized and therefore eligible for slum-
upgrading schemes;
• “non-notified” slums or officially recognized, but not qualified for
official support; and
• “squatter settlements”, which do exist – but are not recognized.
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This process of “notification”, or official acknowledgement, is not

defined by the length of the settlement’s existence or the needs of its
residents, but by strange strokes of fate that are often influenced by 26. Banashree, B (2002),
the residents’ ability, or lack of it, to secure formal or informal political “Mainstreaming the urban poor
leverage. In India, squatter settlements are the most scantily served as in Andhra Pradesh”, in David
Westendorff and Deborah Eade
well as the most deserving given the lack of relevant social, economic (editors), Development and
and political networking of the residents. Yet both official and non- Cities, UNRISD, Geneva, and
governmental agencies chose to work in recognized slums, even in Oxfam, Oxford, page 220.
programmes that were exclusively devised to reach the unreached. The 27. See reference 16, page 111.
flagship British DFID-supported Andhra Pradesh Urban Basic Services
for the Poor (APUSP) programme was designed to reach the poorest. 28. Islam, Nazrul (1996), The
However, programme documents conveniently justified the exclusion: Urban Poor in Bangladesh,
Centre for Urban Studies,
“… a better targeting of poor is related to inadequate data: only notified slums Dhaka; also Islam, N, N Huda, D
have been included [in the APUSP] even though they form only a part of all poor Narayan, B Francis, B Rana and
settlements in a town.[In Andhra Pradesh] the practice is to carry out detailed B Pradumna (editors) (1997),
Addressing the Urban Poverty
surveys only in slums notified under the Andhra Pradesh Slum Improvement Act Agenda in Bangladesh: Critical
of 1956 (Government of Andhra Pradesh).”(26) Issues and the 1995 Survey
Findings, Dhaka University
“Barely a kilometre away from the Revenue Office of Quthbullapur Press Limited (for the Asian
municipality (identified as an exemplary APUSP district) lies Krishna Development Bank).
Nagar, a settlement of around 300 households, which has been illegal 29. Ahmed, Iftekhar K (2007),
and not notified for around 10 years. Three years ago the settlement Urban Poor Housing in
Bangladesh and Potential Role
was demolished, but some of its hardy residents have rebuilt homes. of the ACHR, Commissioned
The Revenue Officer in charge of ‘notifying’ slums in his municipality Report for the Asian Coalition
claimed that these were land grabbers who had purchased plots from for Housing Rights, Bangladesh
University of Engineering and
local politicians of the previous government. Our questioning seemed Technology, Dhaka, Bangladesh,
to enrage him and he declared [to us] that another demolition was page 4.
due in a week’s time. About half of the residents in Krishna Nagar 30. Rashid, Sabina F (2004),
are Muslims and migrants from outside the state, which probably Worried Lives: Poverty, Gender
accounts for their weak bargaining power.”(27) and Reproductive Health of
Married Adolescent Women
In the 1990s, Islam(28) critiqued that Bangladesh counted its urban poor, Living in Urban Slums in Dhaka,
Bangladesh, unpublished PhD
including its pavement dwellers, but lacked an explicit operational policy thesis, the Australian National
relating to land tenure and housing for the urban poor. A decade later, University, Canberra, Australia;
there was little change in the situation. Ahmed(29) reports that tenure also Wood, G (1998), “Investing
in networks: livelihoods and
insecurity continues to be a dominant feature in urban Bangladesh; 90 social capital in Dhaka slums”,
per cent of slum and squatter settlements in different cities of Bangladesh Paper presented at the National
lack clear land titles. As Ahmed reports, evictions occur regularly, Workshop on Urban Livelihoods,
irrespective of changes in government, and although there are policies Institute of Development
Policy Analysis and Advocacy
against eviction without resettlement, these are usually not followed, or (IDPAA), Dhaka, 14–18 January;
are mostly inappropriate to the needs of those evicted. see reference 28; and Paul-
In Bangladesh, an incoherent urban policy has encouraged an Majumder, P, S Mahmud and R
Afsar (1996), The Squatters of
entrenched and often violent local slum politics or mastaanism, which has Dhaka City: Dynamism in the
been well researched and reported.(30) In the contested local environments Life of Agargaon Squatters,
of most slums, the residents are often embroiled in complex negotiations Dhaka University Press Limited,
116 pages.
with the informally influential men, mastaans, who demand tolls and
bribes for small and large basic needs. There are, of course, hierarchies 31. Sobhan, R (2002), “Moving
from confrontational politics
among mastaans, but they are all intricately networked to local and towards sustainable democracy
national politicians, municipal authorities and the police. In turn, these in Bangladesh”, Dhaka Courier,
authorities rely on links with local mastaans primarily for electoral 26 April. A newspaper report
found that 60 per cent of MPs
support, for intimidating opposition grassroots supporters, and for various in the government have links
illegal activities such as arms smuggling, the drugs trade, prostitution with smuggling or criminal
etc. A patronage relationship characterizes slum politics, from the slum elements in the country (New
Age (2004)).
up to local authorities and political parties.(31) It is therefore no surprise

98

32. See reference 30, Rashid
(2004). During Rashid’s PhD
fieldwork, the slum she was
working in, Phulbari, located
in Mirpur, was evicted. This
was the government’s second
attempt to illegally evict
the residents. The first was
in 1993, but the residents
managed to hold on to their
space. However, on 25 July
2002, the slum population
was evicted again. Around
eight bulldozers demolished
the shack settlements, while
hundreds of armed policemen
supervised the demolition and
thousands of slum residents
watched helplessly; a large
number of the residents had
lived in this slum for 20 years.
Rashid followed up on the
residents as they scattered
around close neighbouring
areas, and up until the time of
our research (December 2004),
the government had made no
attempts to rehabilitate the
residents.
33. See reference 30, Wood
(1998).
34. This development has
implications for NGOs and other
institutions that remain reluctant
to commit to interventions in
Beguntila slum, because it is
so new and will certainly face
eviction; page 101.
35. See reference 16, drawn
from various pages but
primarily pages 74, 75 and 101.
NB. the text has been adapted
considerably.
H E A LT H , H Y G I E N E A N D A P P R O P R I A T E S A N I T A T I O N
that slum politics are marked by often violent power struggles, which
involve not only the mastaans but also other innocent residents. During
the fieldwork, the president of the slum committee in Modher Bosti was
murdered. The fallout from this murder affected several of his tenants and
even those only vaguely associated with the accused.
A constant fear of sudden and forcible eviction linked to a skewed
urban development process is a key reason why slum dwellers remain
vulnerable to, and tied in with, exploitative local politics.(32) As Wood(33)
mentions, the most critical function of the mastaans is their ability to
prevent, or equally to enable, evictions.
“One of the research areas in Bangladesh, Beguntila, was an outcome
of the forced rehabilitation of some residents from around 49 slums
that were evicted in a mass process in 1999. Then, support from local
politicians had resulted in the government-assisted transfer of some of
the evictees to a locationally hostile land site. Offered as a temporary
transit, a permanent rehabilitation location had been promised
within a few weeks. Six years later, Beguntila residents continued
to live insecure lives there, still fearing eviction even though they
had made enormous efforts to clear the setting. Recently, a private
real estate company had started filling the low-lying land around
Beguntila and rumours were rife of new development and eviction.(34)
In contrast, the other settlement, Modher Bosti, a site officially
granted to low-income municipality staff, boasts roads, public latrines
and water points, provided by both official and non-governmental
agencies. However, as we will note below, Modher Bosti now has
a dizzying array of owner households (municipality staff and new
residents who bought land from the formerly settled, tenants, sub-
tenants, squatters etc.) and there are equally complex norms on who
gets access to services.”(35)
In Kenya too, as in Bangladesh, there is official silence on an acknow­
ledgement of legal rights for the urban poor; this is obvious in the lack
of urban land tenure legislation. All slums are therefore officially illegal.
What make the difference in terms of access to basic services are the twists
of fate in the form of occasional and inadequate attention from official
or non-governmental organizations. For example, Maili Saba, one of the
research locations, has been in existence since the 1930s, initially as a
labour outlet for a white-owned sisal farm. The settlement has grown
enormously in population but 70 per cent of the residents have never
had access to any public or donor-provided services. On the other hand,
Kibera, a very large slum in Nairobi, attracts significant attention from
multiple non-governmental agencies. However, the diverse, scattered and
uncoordinated water and sanitation interventions makes one wonder
whether these interventions improve or further fracture the divides
within the settlement.
The quality of life for those living in slum settlements is marked by
disparities in income and basic services but equally by violence, insecurity
and social indignity. Unpredictable events can change entitlements and
outcomes for many families, either beneficially or adversely. However,
not all slum residents are equally vulnerable. In all three research
countries there were a significant number of women-headed, women-
only households. Marital disruptions are often traumatic for women, even
when dependence on male income is low. Given the common prevalence
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of an abusive but defined patriarchy in the slums, many of the women

spoke of the insecurity of living without males. This was also illustrated
in the often abusive relationships that they continued to maintain with
real or make do “husbands”. In Bangladesh, Kabeer(36) writes of both 36. See reference 16, page 81.
the constraints and opportunities for urban poor women who have
foregone cultural restrictions to work outside the home. Yet, often, there
is no significant gender gain. Women working outside the home face
considerable “moral denunciations” even as working outside the home
places huge additional demands on poor women already overburdened
with household responsibilities and childrearing. It was no surprise then,
that in Bangladesh men linked poverty to poor networking, lack of jobs
and loss of social prestige in the public sphere, while women linked it
to the need to go out and earn and the absence of support from a male
guardian, be he a husband, son or uncle.(37) Men do not see women as 37. See reference 16, pages 96
integral to their poverty situation, whereas women see men as integral and 97.
to their survival, thus reflecting the gendered structure of society and the 38. See reference 28, Islam
insecurity of women.(38) et al. (1997); also Opel, Aftab
E A (1998), Livelihoods of the
“Ismail Prodhan, a 45 year-old man living in Beguntila in Dhaka is Vulnerable, Paper presented
well connected with local politicians. They paid Taka 40,000 for his at the National Workshop on
Urban Livelihoods, Institute of
daughter’s wedding and have assured a job for his son when he passes
Development Policy Analysis
high school. Ismail is reluctant to allow his wife to work. ‘So far in our and Advocacy (IDPAA), Dhaka,
family, women do not work outside the home…my wife’s job is not to go 14–18 January.
outside the house to work.’”(39) 39. Kabeer, N (2000), The Power
to Choose: Bangladeshi Women
“Kulsuma, also living in Beguntila, is in her forties but looks worn and Labour Markets Decisions
beyond her age. In her youth, deserted by her husband, she worked in London and Dhaka, Verso,
London, page 82.
on two construction shifts a day to bring up her young daughter and
son. She used the money she earned to build a home in Beguntila,
but neither the home nor her land are legally authorized. Today
she begs, as she has little energy to do anything else. Her daughter
was also divorced but recently remarried. The new husband did not
accept children from the earlier marriage, and Kulsuma was left the
two young grandchildren to care for. As we spoke, Kulsuma showed
a deep, open wound on her leg, a result of a recent fall, and the fact
that she is often dizzy. There is no question of going to a doctor or
getting any medicine. She has more urgent needs, to pay for water,
food and fuel for herself and the young grandchildren each day.”(40) 40. See reference 30, Rashid
(2004).
There are multiple dimensions of disparity, including between those who
officially or unofficially own land and have homes in the slums and those
who rent or sub-rent these spaces. Age, disability, religion and ethnicity
are other angles of disparity, as are issues of income, livelihood security
and/or lack of social networks in the city or in rural villages. Monetary
income and expenditure are a necessary characteristic of urban life. Cash
is needed at all times to pay for everything – water, food, rent, services.
And yet, a reliable cash income is often out of reach for the poorest,
most of whom lack the education or training/skills to get formal sector
employment. Many who live in households that cannot make ends meet
resort to occasional or regular begging. Working largely as unskilled
labourers in the informal sector, the urban poor perform labour-intensive,
stressful jobs for little pay and no other service benefits. There are always
more suitable people than there are jobs, so that when a worker becomes
sick, other workers are easily substituted.

100

41. Mannan Fouzia and
Sabina F. Rashid (2004), “The
heterogeneity of the urban
poor”, unpublished paper,
Dhaka.
42. See reference 30, Wood
(1998).
43. See reference 16, page 91.
44. See reference 11.
H E A LT H , H Y G I E N E A N D A P P R O P R I A T E S A N I T A T I O N
The location of a settlement, whether in Bangladesh, India or Kenya,
critically determines employment opportunities for its residents. Inner-
city slums have poorer infrastructure, worse congestion and often low
security of tenure, but they offer more jobs and higher wages. The urban
labour market does offer employment opportunities for women as well as
men; however, job sectors, levels and locations remain defined by gender.
It is men and young boys who can congregate in teashops, at roadside
stalls and on the streets, which enables them to meet, bond and form
relations with politically relevant networks, thus providing them with
information and access to different spheres of the economy and helping
them to mobilize resources during times of crisis.(41) Women earn less than
men, even when they do the same work in the same occupations. The
livelihoods and incomes of the poorest are inadequate and unpredictable,
and old age, disability and/or the misfortune of even minor calamities
pushes people into destitution.
For many in the slums, inter-generational poverty is unavoidable.
Beguntila is eerily devoid of its young female residents during the week.
To find them, one must visit on a Friday, when these young workers in
Bangladesh’s garment factories are on holiday. They work six days a week
throughout the year in menial positions for dismal salaries.(42)
“We would love to study, to be able to read and write. This might get
us better jobs, but even if it doesn’t we still want to be able to read
and write…It is so unfair, people like you can study. We know where
you live it is clean, we feel stuck here in this small, dark, dirty place,
no toilets, no water, bathing in these dirty ponds… What is there to
look forward to? We will soon be married and our husbands will be
equally poor and we will go on living this life…” (Majeda (aged 15)
in Beguntila)(43)
The poor living in slums are estimated to comprise around 70 per cent of
the total urban population, and their numbers are growing.(44) The lack of
basic infrastructure in slums is often raised as a policy concern by global
organizations such as UN–Habitat, but our analysis, in common with the
work of other researchers on urban poverty, revealed a greater vulnerability.
Erratic incomes and livelihoods, food insecurity, social indignity and
violence are basic characteristics of the lives of most of the urban poor
living in slums. Lack of explicit policies and/or comprehensive poverty
initiatives influence the vulnerability and unpredictability of the lives of
those living on the fringes of urban economies. Where programmes exist,
they are both inadequate and self-select the beneficiaries, providing little
real voice to those in greatest need. In the absence of legal entitlements,
the slum poor manoeuvre complex and mostly exploitative “informal”
arrangements for basic survival needs. How effective this is depends on
where one is placed in the social and political matrix of the slums, and it
is quite obvious that the most vulnerable are often the losers.
IV. APPROPRIATE SANITATION: EXPERIENCES AND
PERCEPTIONS OF THE URBAN POOR
Multiple dimensions of complex urban poverty determine where and
how the less and more vulnerable among the urban poor live in cities.
In discussing what was identified and articulated as sanitation, we found,
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from Chittagong to Dhaka to Hyderabad to Nairobi, a universal aspiration

among a diverse group of the urban poor to facilities and services that
provide personal privacy and dignity and ensure a clean and healthy
living environment both at home and in the neighbourhood of users.
As we outline in this section, notions of appropriate sanitation derived
from basic human needs are strongly influenced by religious beliefs, local
culture, individual needs and preferences, and by what is seen and learnt
from the media and from one another.
However, this holistic package of basic sanitation needs is
considerably broader than internationally used yardsticks to define and
measure sanitation services, access and coverage, for example by the Joint
Monitoring Programme for Water Supply and Sanitation (JMP), which is
administered by the World Health Organization and the UN Children’s
Fund.(45) As discussed below, what is provided as sanitation is determined 45. See reference 4.
not by what is basic to human needs but, as Mehta(46) points out, by 46. See reference 6.
obscure engineering and public health concerns that are far removed from
local level needs and socio-cultural practices. Basic sanitation, as defined
and currently promoted, is a shrinking package of low-cost household
excreta disposal systems and hygiene awareness related to hand washing,
expected to yield large (health) benefits.(47) 47. See reference 5.
Given the mismatch, our findings illustrate that what is experienced
as a lack of appropriate sanitation is defined significantly by where one
lives: security of tenure, the motivation and ability to make investments
in sanitation services, and access to service providers and/or facilitators,
as well as by differences that create a complex, cross-cutting inequality
among the urban poor. Hence, while sanitation needs are indeed universal,
the implications of an inappropriate positioning and promotion of basic
sanitation are not universal for a diverse group of the urban poor.
It is often argued that the water in “water and sanitation” dilutes
the focus on sanitation. Equally importantly, the water target in the
Millennium Development Goals focuses on drinking water, and ignores
the water required for sanitation and hygiene. In crowded living spaces, the
urban poor are especially challenged by the lack of adequate, appropriate
water for their sanitation needs. An angry retort to one of the researchers
by a middle-aged man in one settlement in Dhaka sums it all up: “Give
us water, and we will teach you what is sanitation.” McKean, drawing on
Mary Douglas’ analysis of hygiene, religion and pollution, identifies “…
how polluting individuals are seen as dangerous because they are considered at
fault for their conditions and actions.” (48) The urban poor are very aware of 48. See reference 2, McKean
the stigma of looking dirty, unclean, polluted, poor – or simply “other”. (2009), page 7.
Looking dirty is the most visible stamp of their poverty or their ascribed
sub-human status, which is explicitly or otherwise expressed to them by
the “not poor, not illegal, not dirty others”. Few things bother 20 year-
old Nasimuddin, who lives on the streets in Dhaka, more than looking
dirty: “If someone is unclean, we call them pocha (rotten, filthy).” He spends
a good amount of his monthly income as a rickshaw puller on bathing
and laundry soap and tooth powder, which he carries around and uses
whenever the opportunity – available clean water and the permission
to use it – allows. “One has to be clean to hang around with others.” For
many adolescent and young men and women, physical attractiveness,
social acceptance, aspiring to look like the “not poor” are high priorities.
The young and unmarried girls working in the garment factories in
Bangladesh take great care to look and smell clean – even in the most

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constraining circumstances. But age is not the only key determinant of a

felt need for cleanliness. Kuddoz, 40 years old, is a blind beggar in Dhaka.
Challenged physically and considered as a man with a lower masculinity
given his dependence on others, his need for inclusion is high: “Everybody
likes cleanliness. People think I don’t need to be clean because I am blind. I
can’t see how I look but I can certainly smell myself. I feel very uncomfortable
when I have not had a bath.” And there are yet others, who need to smell
and look clean for a living. We met two young sex workers who live
on the pavement and rent only toilet and bathing facilities in nearby
dwellings. Social perceptions on appropriate gender identities place
different boundaries on “cleanliness” for urban poor women. Twenty-five
year-old Saleha, married and with two children, also feels the need to look
clean; yet as a pavement dweller, she is careful: “If I look [too] clean, people
approach me as a sex worker.” The intense discomfort in not being clean
manifests itself in many expressions and experiences.
“‘I feel unwell when I am not clean, yet it’s an enormous effort to stay
clean on the streets’ says Marium, a 55 year-old woman who lives
on the streets in Dhaka. Water, toilets and bathing spaces require
building relationships with those who can provide access, yet this
does not guarantee full access. ‘I have a rapport with the guards of the
sports stadium. I am allowed to fill my container with water for drinking.
I often lie and take a quick shower under the tap, with my clothes on, and
pretend I got wet in filling my pot. I would like to take the time to bathe
but that would be too much to ask.’ Marium has norms for such social
networking as well as for spending on sanitation needs. ‘I will not
allow my daughter-in-law to go to the stadium. The guards will harass her
for a ‘relationship’. It is difficult but I try to find water to bathe my eight
year-old grandson. He goes to school and needs to be clean.’ Keeping him
dirty, she fears, will expose him to diseases like jaundice (hepatitis).
‘My son pays Taka 5 every day (as a bribe) for freely accessing the toilet and
49. See reference 16, page 106. bathing facilities in the stadium – this is justifiable for an earning man.’”(49)
In the cash-dependent economies of urban slums, gendered identities closely
determine sanitation privileges. In general, it is mostly adolescent boys and
girls and adult men who “can” invest in the resources and time to look and
feel clean. However, there are no simple divisions between women and men.
For example, earning, unmarried daughters can claim and spend a part of
their salary on (perfumed) soap, cotton rags (bought from tailors) and cotton
pads as sanitary towels, and hair oil, etc. Daughters-in-law of the same age,
who are mostly not allowed to work outside the house, especially if they
are recently married, cannot make the same demands and must rely on
the “individual thoughtfulness” of their husbands. Age and disability have
significant impacts on staying clean. The inability to earn and contribute to
the family income, or being abandoned by their children and/or saddled with
grandchildren, means that the elderly not only lack appropriate sanitation
services but often can ill-afford even the most basic of their sanitation needs.
“The common practice of ignoring differences among the urban
poor casts a stark silence on the most basic of practical needs for the
elderly. A poignant example from Kibera slum in Kenya points out
the need for ‘warm water for bathing’ by the elderly. A solar panel
installed on the community toilet block, with bathing sites, resulted
50. See reference 16, page 118. in a noticeable increase in the number of elderly users.”(50)

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Cleaning relates both to the availability of adequately clean (yes, this is

basic, yet often unavailable) water to bathe and wash clothes, the ability to
pay for water as well as cleaning goods, and equally the privacy required
for these activities, especially for women. Nasiruuddin, the rickshaw puller
sums it all up: “We can bathe anywhere, wherever we find water. This is not so for
women. When I marry, my wife will not live on the pavement and be exposed to
everybody. I will find a house or keep her in the village.” Young girls in Beguntila
explained: “We bathe in the dirty pond, with our clothes on. Then we go home,
change our clothes and then come back to wash the ‘changed’ clothes. This is so
difficult when we are bleeding (menstruating). We also need to wash the rags we
use during this period, but there is no space [private enough] to dry them.” They
spoke of the “smell” of these poorly washed rags, dried in dingy corners
of their homes. Looking clean is not only a basic, universal “feel-good”
issue; certain religions and cultures demand a fair amount of cleaning and
washing. In Bangladesh and India, both men and women remain “unpure”
and unfit for prayers without a ritualistic cleansing after sex. Women often
mentioned the need to find and store this water for themselves and their
husbands; few husbands reported doing the same for their wives. Women
have additional cleansing needs during and after menstruation and
childbirth – and remain entirely responsible for finding this water.
“Women in the Lingojigudem squatter settlement in Hyderabad go
to the ‘Muslim’ graveyard nearby to meet their water needs, despite
the ‘polluted and inauspicious’ taboo it holds in Hindu culture. If
access is denied or the hand pump is not working, the women travel
a kilometre each way to fetch water. Women mentioned how each
household contributes a container of water to ritually clean the
mother and the home after childbirth. Ritualistic requirements aside,
appropriate water-based hygiene is a basic post-natal need. Yet for a
vast majority of urban poor women, adequate water, hygiene and
privacy during childbirth and menstruation are a luxury.”(51) 51. See reference 16, page 112.

Some men reported that “providing” privacy and the basics for sanitation
(tel-saban (oil-soap) in Bangla) was a man’s job. Yet, a challenged masculinity
and poverty among some men results in letting go of these gendered
responsibilities. Unfortunately, women’s sanitation responsibilities, difficult as
they are, are practical and not as easy to let go. They include cleaning activities
in the home, including sanitary care of young children, the disabled and
elderly in the family. Even in harsh urban settings, good women are considered
to be those who diligently keep the house clean, provide clean clothes for the
family, keep their children clean and perform their personal sanitation needs
in private. If the realities defy the innate, self-regulatory gendering, there are
other means of policing patriarchy. Anowara, in Modher Bosti, the wife of a
home-owning municipality worker claims that she does not bathe in the open
like other shameless women. Of course a hand pump in her courtyard greatly
helps. She speaks of how the mastaans have warned women (the poorest who
lack access to a privately owned tap) not to bathe in public.
“Anowara (aged 37) is an educated wife of a Dhaka municipal
corporation worker, living in Modher Bosti. She gives tutorials to
local children and also ‘keeps’ the rent collected from three rooms
they have built in their compound. She has a tap and a toilet in her
compound and does not like to mix with the ‘others’ in the slum,
whom she finds ‘not respectable’.”(52) 52. See reference 16, page 98.

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The above discussion provides a glimpse of the many issues that are
beyond the commonly held notions of gender and urban sanitation:
of the constraints of poverty and a failing masculinity for some urban,
poor men, which puts sanitation services and goods out of reach and/
or requires their wives and daughters to step out and violate gendered
boundaries; how age and practical necessities intertwine to influence
the social compulsions to stay and feel clean; of the enormous burdens
on women to be continually responsible for sanitation in the most
compelling situations; of additional burdens on women to cope with the
biological and social pollution attached to the female body in the absence
of adequate water; and last, but not least, the social demand to hide the
female body from public view in crowded urban spaces.
The indiginity due to a lack of privacy is indeed crucial to women –
but to assume this is only for defecation needs is evidently untrue. The
above observations do not imply that appropriate defecation facilities are
not important. When toilets (or latrines) are appropriate and accessible
they result not only in improved health but, equally, in moral, social and
emotional gains. The local residents of Kibera, in Nairobi, report that
the sanitation block has increased their social standing: “We are proud
to invite friends and family now.” What we observed was that as far as
possible in crowded urban settings, nobody would prefer to defecate in
the open than in a functioning toilet. Women living on the streets in
Dhaka said they preferred “domestic household work”, which pays less
than construction activities, because it offers privacy for bathing and
defecating. In the informal settlements in Nairobi the poorest households
opt to share latrines, even in the most constraining circumstances, often
compensating their neighbours or landlords through help in construction
or cleaning activities when they cannot pay.
“In Nairobi, Grace Wanjiku, a single mother with six children, shares
the latrine with several other tenants living on the landlord’s plot
in Maili Saba. Her children use the latrine as well, and Grace spends
considerable time trying to clean it before the children use it. Without
adequate water it is an incredibly difficult task to clean the platform
53. See reference 16, page 117. of rough wooden planks which covers the pit.”(53)
In Beguntila, in Dhaka, the long queues in front of the community latrine
are evidence of people’s need to uphold their dignity as best they can. Yet
the dysfunctionality of what is provided is serious evidence of the lack of
ethical considerations. The latrines are dilapidated, with broken doors, no
lights and “shit” lying all around. “I hold my breath all the time I am there. It
is an effort to go there, yet where else does one go?” says 60 year-old Gul Bano.
Kuddoz, who cannot see, says it’s impossible to go there to defecate; if he
does, he ends up all soiled around his feet.
When services and investments are stretched and stripped of human
dignity, attempts to promote hygiene awareness appear unethical. Yet
Safia, a young woman in the zeal of her first pregnancy, is eager to try
and apply what she had heard and learnt: “Hands are one’s ultimate enemy;
if hands can be taken care of [by washing with soap] much can be controlled.”
Her husband, Jamal, and his neighbour are less convinced of such given
wisdom: “The poor have a natural immunity to disease. Hygiene is for the
upper classes. The smell of hair oil takes everything away – both the smell and
anything else harmful. I know of one who after defecating washes his hands
with water, smells his hand and if the smell persists, rubs his hands on his

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thighs and then his hair. It’s all taken care of.” Safia might get her way –
and convince Jamal to buy soap for her. Khadiza (aged 28) had no such
luck: “When I used soap to wash my hands after defecation, my mother-in-law
remarked: ‘The landlord’s zamindarer [daughter] has come to the wrong house.”
That the urban poor, especially the poorest among them, make do
with the absence of some or all of these services is not indicative that
they have different sanitation needs from others or that they have a
low demand for sanitation. Despite decades of exclusion and services
that compromise human dignity, the urban poor have a clear idea of
what constitutes appropriate sanitation. Accepting the universal need
for sanitation services that are holistic and humane would go a long
way to bridging the mismatch between basic needs and programme
interventions.
“70 year-old Margaret Wangui in Maili Saba in Kenya eloquently
summarized what should really be the common sense yardstick in
delivering sanitation: ‘Clean toilets; not having to lift raw sewage and
dump it into the Mwengenye River [which we also use for bathing and
cleaning]; bathing spaces with warm water for us [elderly] and the young
children; water to clean clothes and homes; roads [outside her home] that
are not always filled with [human and animal] wastes; roads, homes
and toilets that don’t flood in the rainy months – that is what I think is
appropriate.’”(54) 54. See reference 16, page 125.

V. APPROPRIATE FOR WHOM? SANITATION: WHAT IS PROVIDED

VERSUS WHAT IS REQUIRED

Margaret Wangui’s perception of sanitation needs does not match the

definitions of sanitation by expert others. In very simple terms, Mrs
Wangui is asking for too much. As Allen et al.(55) identify, the “urban poor” 55. Allen, Adriana, Julio Davila
(threshold, liminal citizens as they are) are considered eligible only for the and Pascale Hofmann (2006),
“The peri-urban water poor:
slimmest of even basic entitlements. Recent global events in relation to citizens or consumers?”
sanitation reiterate the fact that even defecation services are increasingly Environment and Urbanization
considered a personal responsibility. Vol 18, No 2, October, pages
333–351.
The 2010 UN resolution declaring the human right to “safe” water
and sanitation was acclaimed as a long-awaited victory by human rights
advocacy groups, albeit with concerns about issues related to the pricing of
56. O’Callaghan, D (2010),
“safe” water and the inclusion of non-state actors in water provision.(56) There
e-mail listserve communication.
has been no similar concern shown about the limited vision on sanitation,
still considered as “access to a safe and secluded space for defecation”, or
even on the pricing of provision for defecation.
There are many arguments as to why sanitation lags behind other
development priorities, including water supply. Penner(57) identifies that 57. See reference 7.
the failure of individual projects in low-income areas is usually blamed
on technology, scarce funding and even a lack of demand for sanitation,
even though as she observes in South Africa, the problem is deeply related
to inequitable politics. Many observers suggest that the lack of effective 58. See reference 4.
demand for private and public components of sanitation is an outcome of 59. Christoffers, T, C van Wijk
communities’ poor understanding of the links between sanitation, health and V Njugana (2005), “Making
and hygiene.(58) Such perceptions call for a new approach to sanitation – hygiene promotion cost-
effective”, WELL Briefing Note
i.e. promoting or marketing a demand for sanitation.(59) Closely tied to 14, WELL, WEDC, Loughborough
this approach are discourses around who pays for these excreta disposal University; also see reference 5.

106

60. See reference 1, page 1.
61. See reference 5.
62. See reference 7.
63. Bond, Patrick (2002),
Unsustainable South Africa:
Environment, Development and
Social Protest, University of
Natal Press, Scottsville, South
Africa, 449 pages.
64. See reference 55; also see
reference 12, pages 833–855;
and Satterthwaite, David (2003),
“The Millennium Development
Goals and urban poverty
reduction: great expectations
and nonsense statistics”,
Environment and Urbanization
Vol 15, No 2, October, pages
181–190.
H E A LT H , H Y G I E N E A N D A P P R O P R I A T E S A N I T A T I O N
systems and services: “Whose shit is it, how is it dealt with and who foots the
bill?”(60) We present below some excerpts from a preparatory document for
the MDG Task Force on Sanitation, which outline the reasoning around
the new approach to sanitation.(61)
“Fundamentally, we have to stop assuming that the situation (in the
poorest countries) is comparable to that experienced in countries
(in the North), where universal coverage is the norm; or even to
experiences in Victorian Britain, where municipalities had access to
funds that enabled them to establish a networked service available
universally and to finance operation and maintenance. We need a
new idea of sanitation.” (page 17)
“More money is clearly needed but little is available…” “…to
recognize the important role to be played by households themselves
in investing in sanitation and hygiene behaviour change.” “…new
approaches need to increase the focus on and influence of the citizen/
consumer…” “…a redirecting of direct public investments away from
household facilities towards explicit ‘public good’ elements of the
system (wastewater treatment and networks in the urban areas for
example).” “Public funds can be legitimately used for marketing
sanitation and promoting behaviour change…key areas in the re-
shaping of public sanitation programmes…” (pages 17, 21, 25)
Our research findings highlight serious misunderstandings in the concept
of marketing sanitation in the context of the situations presented in this
paper. These issues are discussed below as a concluding analysis.
First, the market-based approach draws a simplistic parallel between
the urban and rural poor, even though issues such as tenure security and
physical space, as well as a cash-only livelihood, are critical points of
difference. Second, a simplistic assumption is made that the urban poor
all live in “households” and have no constraints such as lack of tenure
security, hence making them willing and able to make investments in
household sanitation. Third, it is assumed that stand-alone investments
by these poor households – quick-fix, low-cost as they tend to be – will
have enormous health benefits and will eventually benefit from links to
explicit “public goods and services”. Penner(62) confirms what Patrick Bond
reported in his book,(63) that far from being temporary, basic sanitation
risks becoming permanent for poor communities as infrastructure gets
cemented in “at the lowest levels”. This research and numerous other
studies(64) prove this is indeed the case for a majority of the urban poor
living in excluded zones of the cities or as illegal residents in the legal
urban areas.
In crowded urban slums in Nairobi, completely de-networked from
the urban sewerage systems, the “provided” options are community
latrines, where communities pay to use the toilets. The fees include the
cost of periodic vacuum lifting of the sewage by private entrepreneurs.
The poorest, who cannot pay or are unwilling to pay, dig their own
shallow pit latrines: small holes in the ground covered with corrugated
tin or wooden planks with a squat hole. The stench from the numerous
shallow pit latrines permeates the surroundings, and the pits, being
shallow, need to be emptied frequently, manually. The faeces, still raw,
are carried in buckets and dumped into the nearby river. Those who do
not have even this option defecate in the open or in a plastic bag that
107
E N V I R O N M E N T & U R B A N I Z AT I O N Vol 23 No 1 April 2011

they throw away when no one is around or in the dark, resulting in what
is popularly known as the “flying latrine”. Fifty year-old Bernard Mutitso,
living in Kibera, speaks of the additional “…defecating and urinating in the
narrow alleys when it’s dark – creating an awful odour.” In his perception,
should this de-humanizing trend not be reversed? In technical terms,
this situation highlights the unintended health impacts of currently
promoted low-cost “manage your own” sanitation interventions for the
urban poor.

“It was commendable that UNICEF Bangladesh had provided

a 14-seater community pour–flush latrine in ‘illegal’ Beguntila.
However, at the time of the research, these toilets, just four years
old, were near-dysfunctional. Some 1,500 people were still using the
toilets daily: toilets with broken doors, no water, no lights to use
during the night. The on-plot septic tank had long filled up: ‘During
the monsoon, there is a slush of water and faeces. It is so dirty that I
lose my appetite. If only one could breathe calmly and not have to hold
one’s breath while defecating’, says 60 year-old Gul Bano, who pays a
monthly fee to use the toilet. Worse, the sludge and overflow from
the toilet flows downhill into a small pond that is the common source
of water for bathing, cleaning and even playing by young children.
The dysfunctional toilets will persist – Beguntila residents are unsure
of if, when and how they will be evicted, and for the authorities it is
still an illegal location.”(65) 65. See reference 16, page 120.

The argument for a new sanitation approach that targets users as

consumers has yet to catch the attention of the “human rights water
activists”. Indeed, the majority of the urban poor do provide and pay for
their own sanitation services; however, such self-investments only result
in success when the situation is enabling and when there is legitimate
space for local decisions and choices. The Orangi Pilot Project in Pakistan
is a successful example of planned, networked sanitation infrastructure
in urban poor settlements. Tenure security provided the enabling
environment for local residents to plan and design a locally appropriate
lane by lane sewage disposal system, which eventually prompted lateral
inputs by the city authorities.(66) However, solutions still need to be 66. Hasan, Arif (2006), “Orangi
explored for the significant number of urban poor who live on the streets Pilot Project: the expansion
of work beyond Orangi and
and in slums that face constant threats of eviction. To ask such insecure, the mapping of informal
illegal urban poor to bear the costs for household-only excreta disposal settlements and infrastructure”,
systems and/or to ignore other sanitation needs reflects both apathy and Environment and Urbanization
Vol 18, No 2, October,
an unrealistic belief that an eventual laddered “complete sanitation”
pages 451–480.
is waiting in some “policy plan” for these residents. However, another
complexity of urban poverty is that, even in slums with reasonably secure
tenure, there are owners, tenants and sub-tenants who are not equally
poor and not equally secure.
“In Modher Bosti, in Dhaka, we met a group of elderly women
who beg for a living and were living together in one rented room.
When a non-governmental organization offered no-interest, long-
term loans to residents to construct individual pour–flush toilets,
the landlords accepted the loan and passed on a part of the loan 67. See reference 16. NB. Text
fee to tenants like these women. The women, unable to pay has been moved around so it
is no longer possible to give
an increased rent, decided to move out to cheaper ‘no-latrine’ an exact page number for the
accommodations.”(67) quote.

108

68. See reference 3, page 548.
69. See reference 55, page 334.
70. See reference 7.
71. See reference 11, page 3.
72. See reference 64,
Satterthwaite (2003).
73. See reference 7.
H E A LT H , H Y G I E N E A N D A P P R O P R I A T E S A N I T A T I O N
Referring to the same project, Ahmed writes of “women willing but
unable to pay”. The British DFID-supported ASEH (Advancing Sustainable
Environmental Health) project document made well-meaning efforts
to link “ownership, sustainability and equity”, but in practice this was
difficult if not impossible to implement.(68)
In the various examples described above, it is clear that current excreta
disposal initiatives, promoted as sanitation, are based on three contentious
assumptions. First, they are designed for an “assumed” homogeneous
group of adult, able individuals who are, second, living in houses and have
secure tenure and hence are willing and able to pay for and manage the
infrastructure and, third, are able to eventually benefit from the networked
public and possibly complete sanitation services. Such assumptions meet
the realities of only a limited group of the urban poor. These interventions,
when technically sound and designed for long-term use might result
in significant health and social gains. However, even these limited
interventions exclude a large number of the urban poor both within and
beyond slums. As Allen et al. write, and as is evident in examples in this
paper, “…neither centralized public services nor the market are able to meet the
water and sanitation needs of the urban poor…who need to resort to a dizzying
array of non-conventional and officially unrecognized means.”(69)
Difficult political questions still remain in promoting sanitation.
As Penner asks: “When is provision good enough, dignified enough? And
who decides?”(70) The findings in this study identify serious flaws in
policy perceptions around appropriate sanitation. Current approaches
to promoting sanitation, “…approaches that will inspire and motivate
users to change their behaviour and adopt attitudes that promote hygienic
living”,(71) assume a lack of understanding of health and hygiene, or
a low prioritization of sanitation needs by increasing numbers of the
urban poor. Ethnographic analyses in the slums we visited for this study
indicate that the urban poor are no less human, no less aware of their
“complete” sanitation needs; and as in the case of the Orangi project,
no less enterprising in participating in the call for sanitation and health
when the conditions are enabling. However, what is currently packaged
and delivered as sanitation too often meets neither the health needs
nor the basic human rights of large sections of the poorest and most
vulnerable among the urban poor; this makes the policies, statistics
and development goal of sanitation for all, to echo Satterthwaite,(72) no
more than “nonsensical” rhetoric. The situation is unlikely to change if
global and national policy makers and the development community at
large continue to ignore the basic realities of a complex urban poverty.
The objective of the study reported in this paper was to assess what
is perceived as appropriate sanitation by a diverse group of urban poor. In
conclusion, our analyses indicate that lagging sanitation targets are not a
simple case of technical failures or lack of demand by users. It is a potent
reflection of wider social, cultural and political disparities. In the absence of
inclusive urban policies, the proposed approach to “promoting a demand
for toilets” grossly simplifies the complex social–environmental issue
that makes for appropriate sanitation. We conclude this paper with the
observation that such interventions, albeit well-intentioned, exacerbate
existing inequities and result in physical and social indignities rather than
health and development. As Penner argues, “…the question that emerges
is not, ‘How can we best sell this product [excreta-disposal]?’ but rather, ‘How
can we address the structural inequalities [inherent in] sanitation provision?’”(73)
109
E N V I R O N M E N T & U R B A N I Z AT I O N
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