The Beatles song, “Why Don’t We Do It in the Road?” may actually describe the experience of much of the world when it comes to bodily elimination habits. That’s because, according to UNICEF and the World Heath Organization, the astounding fact is that fully 2.5 billion people — 40% of the world’s population — engage in open defecation. In India alone, people leave 100,000 tons of excrement on the ground every day. This leads to more than two million preventable deaths per year because human fecal matter enters the food or water supply and is ingested by people, most of whom are kids. The result is that they develop intestinal ailments that kill them. This is particularly poignant when you consider that the flush toilet was actually invented in India over 4,600 years ago.

Here in the U.S. and throughout Europe, the discovery in the 1800s that contact with fecal matter could lead to the spread of cholera, diarrhea, typhoid, and parasites resulted in the creation of sanitation systems to keep water supplies and human waste separate. But in the most of the rest of the world, people don’t have access to these improved sanitation systems. According to a report by the United Nations Development Programme (UNDP), as many as 1.1 billion people use water supplies contaminated by human and animal feces, and 1.8 million children die of diarrhea each year as a result. All of these deaths could be prevented if these kids had a clean place to go to the bathroom. As Jamie Bartram, head of the United Nations water sanitation group says, “If you’ve got feces all around you, it will find its way into your mouth.”

This is largely an issue that affects the poor. UNDP Outreach Advisor Marisol Sanjines said, “Sanitation is not on the political agenda, because it impacts poor people and not decision makers. The other problem is that people do not want to talk about excreta and human waste. It is taboo.”

And that taboo is bolstered by the peculiar way the habit of open defecation becomes invisible, suggests LA Timesreporter Mitchell Koss. “Having worked in 68 countries, I can vouch that it’s certainly not invisible if you’re not used to seeing human fecal matter in the streets or fields. But you can quickly get used to it.” Koss gives the example of his time in Delhi, India, filming a documentary. At first, he was shocked to experience the presence of large amounts of human fecal matter in the Yamuna River, on the river banks and in the streets of a Delhi slum.

“In a week and a half, we had gone through the entire cycle from revulsion to acceptance, thereby illustrating the crux of the problem,” he says. “It had become invisible. When people don’t see the problem, they don’t push for solutions. That means there’s little incentive for governments to provide sewer systems and septic tanks to city dwellers, or for people in the country to dig and maintain outhouses.”

Of course, there’s also the fact that old habits die hard. Koss mentions two poignant examples. In the first, the World Bank donated outhouses to people in rural India. But the locals found them much more useful as storage sheds than as places to defecate. He also describes his visit to “a two-story brick home where the owner had a washing machine, a stove and a television set, yet in the predawn and again after sunset, she walked a mile with her teenaged daughter to use a field as a toilet.”

This last example points to another important fact. Among the poor who are affected by the lack of sanitation, women are affected disproportionately. According to Belinda U. Calaguas, a policy expert at WaterAid, a London-based nongovernmental organization, women become ‘prisoners of daylight.’ “Lack of sanitation affects women’s reproductive health and exposes them to physical risks of sexual assault.”

Part of the solution seems simple. Provide toilets and sanitation systems that keep human fecal matter out of the food and water supply. In so doing, you create the kind of privacy that reduces the danger to women. This isn’t expensive to do and it doesn’t require new or exotic technology. What it does require is that governments care. The second part of the solution may be harder, though. People need to be educated enough about the dangers of open defecation that they become willing to alter their habits.

Health organizations around the world are trying to raise awareness and overcome the taboos so that there is a demand for toilets. Put simply, to end the dangers that accompany “doing it in the road,” people need to be able to talk about poop and realize that they have the power to do something about it.

:hc