Views and experiences of people practicing open defecation: Evidence from riverside inhabitants of an Indonesian village

Currently, about 4.2 billion people, or more than half of the world's population, do not have access to proper sanitation, and 673 million people practice open defecation (OD) (UNICEF & WHO 2019). In Indonesia, nearly 7.6% of households continue to practice OD (BPS-Statistics Indonesia 2020). In 2008, the Indonesian government established a national program called Sanitasi Total Berbasis Masyarakat (STBM), or Community-Based Total Sanitation, to address sanitation and hygiene problems. The program was adopted from Community-led Total Sanitation (CLTS), an approach to persuade people to stop OD by using a triggering method to ignite a collective shame and disgust within the community to trigger behaviour change (Kar & Chambers 2008). The adoption of STBM resulted in varied outcomes in each district, highlighting one of the issues connected with Indonesian cultural diversity (Dwipayanti et al. 2019). Malang is one of the districts with low performance, wherein 88 of 390 villages, representing 22.56%, are occupied by individuals engaged in OD (Utami et al. 2019).

The Malang District of East Java Province is traversed by 44 rivers and more than 83 tributaries (BPS-Statistics of Malang Regency 2018). According to the Environmental Health Risk Assessment (EHRA), 7.6% of inhabitants in Malang District defecated in the river (The Government of Malang District 2016). A study conducted in 20 districts of East Java Province showed that OD practised by communities living near water bodies (rivers, seashores, and lakeshores) was difficult to intervene in since the communities had low motivations to change their behaviour (Mukherjee 2011). Three factors were identified as contributing to the low motivation of near-water communities to change their OD behaviour. First, emotional aspects include preferences, conveniences, and pleasantness. Second, socio-cultural determinants include societal norms and traditions (Mukherjee 2011; Mazaya 2016), socio-cultural customs, practices, beliefs (Sample et al. 2016), and household incomes (Sample et al. 2016). Third, physical environment factors include water body characteristics, seasonal changes (Sample et al. 2016), and proximity to water (Mazaya 2016).

In Sumberjaya village, Gondanglegi Sub-district, Malang District, 103 of 659 households, or 15.6%, lack access to a latrine (Ketawang Primary Health Centre 2019). Moreover, observations indicate that the percentage of village inhabitants engaging in OD exceeds 15.6%, as a significant number of individuals possessing access to a latrine persist in their OD practices. The theory of social construction of reality posits that a frequently repeated action can be cast into a pattern that can be accepted and repeated by members of society and performed again by the next generation in the same manner and with the same economic effort through habituation (Berger & Luckmann 1966).

Using a triggering method, the Puskesmas STBM team has collaborated with local leaders and village health cadres to promote OD behavioural change and latrine growth since 2018. As low income emerged as a major barrier to the latrines' growth, the local government subsidised latrines for 19 of the poorest and most vulnerable households. However, after 3 years of STBM implementation, this study found that OD habits are still prevalent in the village. Few studies have investigated the underlying reasons for OD habits from an individual perspective, although these factors are essential to be considered when developing a tailored sanitation promotion strategy. Using a constructivist perspective, this study investigated the views and experiences of riverside inhabitants engaging in OD from an individual perspective. The aim was to determine the underlying reasons why the practice of OD persists in the community and evolves into an accepted habit or even a community culture. The findings can then be used to evaluate the implemented sanitation promotion and create a tailored sanitation promotion strategy that matches the needs of the community.

Using a phenomenological design (Creswell 2014), the study employed a semi-structured interview to investigate the phenomena of OD experienced by individuals in their daily lives. Field notes were also used to support the interview data. The gathering process took 3 months, from June to September 2019.

All participants were interviewed separately based on their preferences, including their homes, riverbanks, traditional coffee booths, and rice fields. Each interview lasted between 1 and 2 hours. The national language, Bahasa Indonesia, was used along with two regional languages, Javanese and Madurese. All interviews were audio taped and transcribed, but they were not translated into English to avoid differences in perception and meaning. The translation was made while the paper was being developed.

The Ethics Committee of the Faculty of Social and Political Sciences at Universitas Brawijaya approved the project. A study authorisation was also received from the Public Health Office of Malang District, Malang. Because the first author was familiar with some community leaders and villagers from a prior project, she was able to establish a good rapport with participants from the start of the study and attend community activities to learn about and familiarise herself with local customs.

Research participants were selected purposefully for their ability to discuss their views and experiences with the OD phenomenon in the river. As a result, we recruited village inhabitants who had been defecating in the river since childhood as study subjects. The study included 15 participants aged 24–75 years, with 46% female and 54% male. Forty-nine percent graduated from junior high, 40% from elementary school, 13% never attended school, and 7% from senior high. They could be categorised as poor households since their monthly average income was IDR1,500,000 (USD107.991), whereas the regional minimum wage was IDR2,895,502 (USD208.459)/month (The Governor of East Java 2019).

The analysis of the data referred to the Miles & Huberman model for thematic analysis, a type of qualitative analysis used to analyse classifications and present themes (patterns) that relate to the data (Miles et al. 2014). To analyse the data, we used an interactive analysis (Miles et al. 2014), in which data collection and analysis were carried out simultaneously in three connected stages: data reduction, data display, data conclusion-drawing, and verification. The process of analysis began with reviewing, transcribing, and coding the recorded data. The collected data were then compared for similarities and differences in searching patterns and regularity. The similar codes were combined and categorised into a group of sub-themes and themes to get a broader sense.

To analyse the findings, we used the social construction of reality theory and the symbolic interaction theory. The social construction of reality theory assumes that what individuals understand and how they present themselves are influenced by their interactions with others and their previous experiences (Berger & Luckmann 1966). It further assumes that a frequently repeated action could be cast into a pattern that can be accepted and repeated by the members of a society and performed again in the same manner and with the same economic effort by future generations through habituation. On the other hand, the symbolic interactionist theory postulates that individuals' actions are based on the definition of a person, an object, or an environment they confront, and they may change their actions (Blumer 1969). The social construction of reality was applied to explore how open defecators looked at their practice based on their accounts, while the symbolic interactionist theory was to explore how they engaged in communication with people they met around the river.

The results of the interviews are presented in Table 1, which summarizes the subject's views and experiences in OD practice.

The participant viewed defecation in the river as part of daily routines that provided social communication experiences for keeping in touch with relatives and ethnic community members, sharing information, having fun, and maintaining social harmony.

Keeping in touch with relatives and ethnic community members: The village population consists of 99.26% Madurese migrants and their descendants. Most of them have kinship ties, as marriages among relatives or ethnic community members are still prevalent in the village.

Some participants saw OD in the river as part of daily routines allowing them to communicate with relatives and ethnic community members. Furthermore, they believed that the Madurese language they spoke while gathering by the river could strengthen their ethnicity.

Sharing and updating information: By defecating in the river, the villagers could meet their neighbours and share or update information, while occasional workers could receive job information or job offers.

Having fun: Some villagers had fun with their friends and neighbours while engaging in their daily routines in the river. A 50-year-old female participant, for instance, stated that she enjoyed her routines in the river because she had grown up with them. She was unable to completely abandon them, as they provided her with the opportunity to have fun with her friends and break up the monotony of working from home.

Maintaining social harmony: Some participants preferred face-to-face communication over mediated communication because they believed it was more intimate and practical. Daily activities on the river were viewed as a way to maintain harmony and engage in face-to-face communication.

Social norms: The practice of OD in the river was deemed acceptable within the community as it had been practised for generations without any reservations from the community members. Some participants stated that they were not disgusted or ashamed to defecate in the river because it had become a habit everyone was aware of.

Shared beliefs: Despite being informed about the dangers of OD in the river, some participants believed that OD was harmless because fish ate some faeces and the current flowed the rest into the fields to fertilize the crops. They also assert that no one within the village contracted illness as a result of the river water.

Religious beliefs: Some participants held the belief that the act of defecating in a well-flowing river did not contravene their religious beliefs. Its water remains to qualify for self-purification rituals, including bathing and ablution. They argued that many traditional Islamic boarding schools in their region have been using river water to supply students' needs for years. It is plausible that the religious practice of cleansing with water may have an impact on individuals' preference for accessing the river.

Negative attitudes: The negative attitude that hindered the modification of OD behaviour was a lack of awareness of health and the environment. Despite having access to latrines, some participants stated that they continued to defecate in the river because their neighbours also did so. Other participants did not use the latrine every day to reduce routine cleaning and the cost of emptying the septic tank.

Emotional preferences: Some participants associated their OD habit in the river with a feeling of comfort, freshness, and ease of defecation process.

Some participants associated OD practice with financial constraints stemming from their low income and land status. Other participants also linked it to the size of the household.

Low income: Despite being aware of the hazards of OD, some participants stated that they were compelled to defecate in the river because having a latrine was unaffordable. Moreover, the latrine arisan, a savings club formed to finance a household latrine building on a rotating basis, did not work well because some members could not afford the regular dues.

Land status: Some participants who lived on government land preferred to access the river rather than build a latrine. A participant claimed that building a latrine is a waste of money because the local authority can demolish her house at any time because it was built illegally.

Household size: Several participants related their defecation practice in the river to their household size. When some family members needed to use the latrine at the same time, such as in the morning, they were defecating in the river.

The proximity of rivers and river pollution were identified as physical environments that inhibited the use of latrines.

Proximity to the river: Several participants stated that they frequently defecated in the river while engaged in agriculture or outdoor activities in proximity to the river. However, others claimed that they defecated in the river because it was only a few steps from their residence.

River pollution: For centuries, an old sugar factory in the Malang district discharged waste into the river. During the sugar production season (May to December), the waste generated from the sugar production process polluted the river water. Otherwise, during the sugar cease-production season (January to April), the river water regains its clarity and cleanliness. Previously, villagers were required to access the river all year because it served as their primary water source. In 2008, following the availability of tap water facilities in certain village areas, individuals who have tap water have limited their access to the river to the cease-production season. As a side effect, during the sugar production season, many villagers disposed of waste into the river. Hence, individuals who defecate in the river contended that defecating in the river during the sugar production season was not detrimental as the villagers did not utilise its water for their daily needs.

The first identified theme revealed that OD in the river provided social communication experiences. Social communication refers to the process by which people establish connections with others through mutual contacts, actions, and influences (Chen et al. 2019).

Individuals who defecate in the river presented themselves as migrant community members who were required to uphold their collective culture, ethnic identity, and closeness with community members. They perceived the river as not only a public space that facilitates their daily activities but also as a venue to establish connections with relatives and demonstrate their ethnic identity. Furthermore, frequent contact and interactions among community members located along the river are intended not only to facilitate the exchange and update of information but also to maintain social relationships and harmony. This finding confirms previous references that a strong relationship can be measured by a high frequency of contact (Patil 2019), and that OD is associated with a mode of socialising with neighbours and friends (Coffey et al. 2014; Sample et al. 2016; Bhatt et al. 2019). The symbolic meaning of the river as a public space for gathering, and the collectivist cultural background of the migrant community which prioritised togetherness, harmony, kinship ties, and group bonding, had an impact on the persistence of OD habits. This finding emphasises the significance of recognising comprehensive details regarding the historical background and social communication experiences to ascertain the underlying reasons for current behaviours and devise appropriate interventions for latrine promotion.

The second identified theme revealed that OD in a riverside village was difficult to intervene with due to its association with socio-cultural factors such as social norms, shared beliefs, religious beliefs and practices, negative individuals' attitudes, and emotional preferences. As per social norms, individuals who grew up in a neighbourhood where family members, peers, and others defecate in the river did not perceive OD as a shameful or disgusting act. They continued and performed the practice of OD in the same manner and with the same economic efforts as their predecessors through habituation (Berger & Luckmann 1966). Thus, an intervention implemented based on the guiding principles of CLTS by stimulating a collective sense of shame and disgust to trigger behaviour change was unable to sustain the new behaviour. It confirms previous references that the use of shame and disgust in communities situated near water bodies frequently proved futile or yielded limited results (Mukherjee 2011; Sample et al. 2016). The features of water bodies were unable to trace the smells and visual effects of faeces to trigger collective disgust and shame (Sample et al. 2016). This finding indicates the importance of exploring the social norms and characteristics of regions to determine whether certain activities that diverge from the guiding principles of CLTS need to be applied to ensure their suitability and effectiveness for the target community. This finding indicates the importance of exploring the social norms and characteristics of regions to determine whether certain activities that diverge from the guiding principles of CLTS need to be applied to ensure their suitability and effectiveness for the target community.

Several participants believed that human waste fertilised agricultural land. Although this study found that the latrine promotion improved knowledge of hygiene and sanitation, it was not enough to convince them to change their shared belief about OD. Previous studies found that health knowledge did not play a major role in changing OD behaviour (Lopez et al. 2019), while shared beliefs played a more essential role in perpetuating it (Mukherjee 2011). It implies that the latrine promotional approach in the study area should not solely concentrate on improving health and sanitation knowledge but also consider the shared beliefs that will enable novel knowledge to exert an influence on behaviour.

According to religious beliefs and practices, defecation in a well-flowing river was not against participants' beliefs. Concurring with this finding, studies conducted in Nepal and India have also revealed that OD behaviour is associated with spiritual and religious beliefs and norms (Coffey et al. 2014, 2017; Routray et al. 2015; Bhatt et al. 2019). The religious use of water for post-defecation cleansing also influenced participants' preference to defecate in the river. A similar finding was reported from India (Routray et al. 2015), Nepal (Bhatt et al. 2019), and Nigeria (Sample et al. 2016). Coping with these barriers, local religious leaders and places of worship could be used as agents in hygiene and sanitation promotion and eventually increase the result of the promotion in the community (Odagiri et al. 2017). In this study area, it is crucial to involve local religious leaders and teachers (Kiai and Ustadz), mosques, and religious forums in disseminating hygiene and sanitation messages and to persuade people to change their OD behaviour.

The third identified theme indicated that negative attitudes, such as a lack of awareness of the environment, a reluctance to maintain a latrine, and emotional preferences, were barriers to stopping OD. Similar attitudes were found in Nepal, where OD practice was influenced by a lack of awareness for cleaning and maintaining the latrine and by emotional preferences, such as convenience and feeling independent (Bhatt et al. 2019). In India, emotional preferences were influenced by convenience (Routray et al. 2015), happiness, freshness, and peacefulness (Coffey et al. 2017). These findings suggest the necessity of incorporating attitudes and emotional preferences into the design of health and hygiene messages in behavioural change interventions.

The fourth identified theme was that OD behaviour change was hindered by low income, land status, and household size. However, the study found that financial support mechanisms, such as the latrine subsidy and latrine arisan, were ineffective. Upon receiving a latrine subsidy, some low-income households reverted to their old practices. This implies that economic constraints were not a primary cause of OD, as evidenced by previous studies, but were a reason why participants continued to practice OD (Routray et al. 2015; Coffey et al. 2017; Yogananth & Bhatnagar 2018; Bhatt et al. 2019; Lopez et al. 2019). This suggests that strategies to support low-income households in funding latrine construction should be combined with a monitoring system to sustain latrine use and behavioural change.

The fifth identified theme indicated that physical environments emerged as barriers to behavioural change, including proximity to the river and river pollution. It confirms a previous finding that proximity to water bodies became a factor hindering latrine use (Mukherjee 2011). In the study area, river pollution from industrial waste caused participants to defecate in the river. Thus, it is important for policymakers to ensure the safety of the river from industrial activities that affect the environment and public health.

The practice of OD in a riverside area was socially constructed by community members adopting the practice. Exploring individuals' views and experiences of the riverside community on OD practice, this study found that the underlying reasons for OD emerged to be inhibiting factors for latrine promotion. Consideration of their social communication experiences, socio-cultural factors, household size and economic constraints, individual attitudes, and physical environment may help design customised OD behavioural change interventions for increasing the impact of latrine promotion. It is also recommended that policymakers protect rivers from industrial activities that impact the environment and public health.

As a phenomenological study, the findings of this study cannot be generalised to the wider community. However, the process and findings of this study could be an insight that could be applied to other riverside communities in the rural area, specifically in Indonesia.

The authors wish to thank the Faculty of Communication Science, Universitas Padjadjaran, for providing facilities and conducting the Ph.D. study of the first author. Gratitude also goes to Universitas Brawijaya for providing the study grant for the first author. The authors have no conflicts of interest to declare.

The data that support the findings are available in the appendices.

All relevant data are included in the paper or its Supplementary Information.

The authors declare there is no conflict.