At the deadline for meeting the Millennium Development Goals (MDGs), 2.1 billion (109) people had gained access to improved sanitation and 95 countries were able to meet the MDG sanitation target. However, 2.4 billion still lacked improved sanitation facilities. India is among those countries where open defecation stubbornly persists. Despite decades of government spending on the construction of toilets, and the recent Swachh Bharat Mission (SBM) to eradicate open defecation, toilet use remains a challenge. To draw attention to the deep deficits in sanitation services in smaller Indian cities, we explore what motivates sanitation uptake by the urban poor. Household survey data from 13 low-income settlements combined with interviews, focus-group discussions, and transect walks in three cities in central India allowed us to examine factors that influenced resource-constrained households' toilet ownership and toilet use versus open defecation. Our findings indicate that in urban settings, toilet ownership could, in fact, deter open defecation given the presence of other key conditions. Programs to build toilets under the SBM could, therefore, see favorable outcomes in cities provided there is a broadening of access to sanitation to include fecal sludge management. Our findings also underscore the importance of coproducing basic services.

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