New Delhi, India - Nobody liked the smell of truth, more so since it concerned the tetchy aspect of toilets in India.

India's Federal Minister of Rural Development Jairam Ramesh was accused last year of hurting Hindu religious sentiments by the opposition Bharatiya Janata Party for saying the country needed "more toilets than temples".

Cleanliness may be next to godliness, but India - with 1.2 billion people - is far from achieving it. As World Toilet Day is marked on November 19, India's sanitation and toilet statistics continue to raise a stink.

Less than one-in-three households in Indian villages have toilets. Urban areas have more toilets but nevertheless suffer from poor sanitation and disposal mechanisms.

The lack of public toilets for the urban poor and in rural areas leads to alarming rates of water-borne disease and affects women and children most, campaigners say.

India also carries the shame of having manual labourers, mostly marginalised people who belong to a community formerly called "untouchables" or Dalits, to clean human excreta from open lavatories, even today in the 21st century.

You can find public urinals for men, but women suffer most as Indian cities and villages do not make space for women's basic needs. Gender gets the worse off in this shitty business. - Inder Salim, Delhi-based artist

While a 1961 census by the government said there were more than 3.5 million "faeces scavengers", recent reports have said the number is down to 64,000. This is contested by NGOs saying these workers still suffer the ignominy of cleaning human excreta, suffer illnesses and social ostracisation.

A few years ago, "Shit of the Other" - a show by Delhi-based artist Inder Salim - displayed human faeces in a bottle. Some contended it was not scatological but a telling artistic statement of the state of the poor and disadvantaged, who are compelled to defecate in public in Indian cities.

"Toilets are not just confined to sanitation in India," Salim says. "They contain layers of oppressed people, Dalits, our inability to deal with this basic human need."

Mahatma Gandhi, India's "Father of the Nation", had in the early part of the 20th century branded the practice of engaging manual scavangers to clean latrines as a social evil. Gandhi preferred to clean his own toilet to set an example - something that shocked many.

Gandhi's call to make sanitation a hygienic issue 65-years ago seems to have gone down the drain.

Consider these facts:

- Only 46.9 percent of India's 24.66 million households have toilets, 49.8 percent defecate in the open, and 3.2 percent use public toilets, according to 2011 census figures.

- The economic impact of inadequate sanitation is about 2.4 trillion rupees ($38.4 million), or 6.4 percent of India’s gross domestic product, according to the Water and Sanitation Programme.

- The states of Jharkhand and Odisha rated lowest with 78 percent of households lacking toilet facilities.

- More people in India have mobile phones than toilets.

Right to dignity

"We need to view services – such as the availability of functional toilets – as a part of the right to live a life of dignity and equality," says Subhadra Menon, director of Health Communication at the Public Health Foundation of India.

But she adds: "Having said that, the provision of toilets to 1.2 billion people is far more complex than making mobile phones available, so in a sense, it isn't right to compare apples and oranges.

"But yes, the kind of social and other marketing that can be utilised to influence choices and behaviours is not being done optimally in the case of the use of toilets."

Sulabh International is an NGO promoting sanitation across the country. Its founder, Bindeshwar Pathak, bemoans that "India lacks a culture of sanitation."

The royal rajas - erstwhile rulers - might have had slaves to evacuate their "thunder boxes", but much of India has had a late start to "toilet training", Pathak says.

"Even the rural rich in the 1950s did not have toilet facilities in their mansions. Women went to the open for their ablutions as did the men."

While he says India has made progress from a no-toilet scenario to providing nearly half of its population with latrines, "implementation of rural sanitation must be made priority and speeded up", says Pathak.

Sulabh is seeking ways to accelerate the installation of toilet facilities. These programmes include training youth in both rural and urban areas on health and sanitation; pressing the government for fund allocation, and encouraging alternative livelihoods for caste groups that manually scavenge toilets.

'No toilets, no marriage'

It's easier for modern Indian women in the metros to walk into a shopping mall and find a loo. But it is not so for their underprivileged sisters who are poor or live in villages with no toilet facilities.

Women and girls often defecate in public, harming their health and also inviting molestation and unwanted attention from men in both rural and urban areas.

Priyanka Bharti returned to her husband's home only when a proper toilet was built [AFP]

Police in the state of Bihar have admitted violence against women could be contained if more public toilets were provided.

As Salim points out, "You can find public urinals for men, but women suffer most as Indian cities and villages do not make space for women's basic needs. Gender gets the worse off in this shitty business."

Ramesh, who has campaigned zealously for the need for toilets, last year invoked a "no toilet, no bride" campaign. He exhorted women to not marry men whose family homes did not come equipped with toilets.

Some instances have occurred where brides have left the home of the groom after finding the household did not have a proper toilet. It has forced some men to pose in photos beside toilets in their home before seeking a bride in their villages.

A "right to pee" campaign was also launched in April 2012 by a group of non-profit organisations in Mumbai. They fought for the use of free toilets for women who were until then charged a fee to use toilets, while men could use them for free.

India's Supreme Court ruled in 2011 that every government school must provide toilets, especially for girls. Inability to do so would mean closing the schools down.

"Once political support – across party lines – builds up for an issue, chances are it gets addressed satisfactorily," says Menon. "Therefore, it is more about how all our politicians and elected representatives can take up the issue of toilets being provided.

"The critical issue is this – each and every day, young, adolescent girls and young adult women [and men actually] need to expose themselves to multiple vulnerabilities," Menon says. "This makes even more serious the ignominy that these girls and women face – including not having a clean and functional toilet that they can use with a guarantee of privacy."