The issue of open defecation is not a new point in any analysis of maternal and child health. What is wrong is reducing it all to the religious preferences of Hindus and Muslims.

Hindus may be trying to put some distance between themselves and Manusmriti, that age-old text on castes and codes from a different and distant past, but academics – especially ones descending from abroad to solve our problems – seem unwilling to let us rest in peace. They want to reconnect with Manu.

Most Indians may not have abandoned caste, but no one goes around with Manusmriti in his back pocket, seeking guidance on where to defecate. But if you were to read a recent research paper by Michael Geruso and Dean Spears seeking to explain why Muslim child survival and health rates are significantly better than those for Hindus, it is all boiled down to the difference between what Manusmriti prescribes and what Muslim religious texts do.

Other western media, The Economist and The New York Times among them, have quickly latched on to this religious theory to build their own assumptions on the importance of Manusmriti to Hindus. They don’t seem to know that Hindus have never reduced religion to one text or scripture that is unalterable and immanent. Cultural norms that evolved from many religious injunctions and experiences of the past may, however, not be easy to wish away.

Geruso and Spears’ key conclusion in a recent paper titled Sanitation and health externalities: Resolving the Muslim mortality paradox is this: “Hindus are 40 percent more likely than Muslims to do so (defecate in the open), and we show that this one difference in sanitation can fully account for the large (18 percent) child mortality gap between Hindus and Muslims.”

So far, so good. But they garnish this basic reality with religious overtones. They add: “Building on our finding that religion predicts infant and child mortality only through its association with latrine use, we show that latrine use constitutes an externality rather than a pure private gain: It is the open defecation of one's neighbors, rather than the household's own practice, that matters most for child survival.” (Italics mine)

Since the western academic preference is to look for the silver bullet – the one unique point that explains everything - they quote one line each from Manusmriti and a Muslim religious text to explain this Hindu preference for open defecation (OD).

The two texts quoted are the following:

Muadh reported God's messenger as saying, Guard against the three things which produce cursing: relieving oneself in watering-places, in the middle of the road and in the shade."

- Mishkat-al-Masabih, Muslim sacred text, P:76

The Manusmriti line quoted is this:

Far from his dwelling let him remove urine and excreta

- The Laws of Manu, Chapter 4 verse 151

A commonsense reading of both texts would suggest that hygiene is the basic point in both Hindu and Muslim texts. They may or may not explain the state-specific, community-specific, local preference or otherwise for OD, but to boil down the entire difference between mortality rates to these texts makes absolutely no sense.

Geruso and Spears have done good work to show that there could be strong causal link between OD and health (especially maternal and child health), but by trying to hang the blame on some stray lines in Manusmriti, they surely muddy the waters needlessly.

In a scathing indictment of this narrow approach and needless bunging in of an old text – which Hindus, at any rate, do not view as some kind of must-read-must-follow rulebook in their current lives – economists Vivek Dehejia and Rupa Subramanya tear this arguments to shreds (read their blog here). They point out that what the duo have done is reduce a complex explanation to such simplicity as to make it meaningless. They write: “…Careful as their primary statistical and economic analysis is, they’re extremely careless in offering what can best be described as an Orientalising (it's not just leftists who can draw on Edward Said), armchair cultural/religious explanation for the difference in OD rates between Hindus and Muslims.”

They add: “Coupled with these two quotes (from Muslim and Hindu texts) and a potted sociology of the caste system, pointing to notions of ritual impurity and the role of the "manual scavenger" class, with an inevitable little detour via a pearl of wisdom from Mahatma Gandhi thrown in, the authors appear to provide us with a simple (in reality, simplistic) cultural explanation for this difference.”

The issue of open defecation is not a new point in any analysis of maternal and child health. It is a commonsense hygiene and health issue. If you live in or near an area where a lots of people are defecating in the open, the resultant increase in disease due fecal matter getting into water and food sources will lead to infections, higher disease and sickness. What is wrong is reducing it all to the religious preferences of Hindus and Muslims.

Not only does this reductionism not take state-level and demographic differences between Hindus and Muslims into account, but it also boils down the entire explanation to one factor.

For example, if more Hindus are likely to indulge in OD than Muslims, a key factor could be that Muslims are more urbanised than Hindus. There are more toilet facilities in urban areas than rural areas. Also, defecating in the fields even in rural areas may have been more hygienic in the past when population densities were lower. Today, that may not be the case at all, but old habits are dying hard. A third issue could be the poor state of public toilet facilities (a look at our railway station toilets will tell us how terrible these facilities are, given their high usage). If public toilets are unhygienic and more likely to lead to infections (many women suffer from urinary tract infections due to the use of dirty public toilets), open defecation may seem like a better option.

Clearly, Geruso and Spears needlessly adopted an unnecessary religion-based explanation that may not be anywhere near the truth. Their explanation lacks nuance even as they flag OD as the real issue – which is correct.

In a 2009 paper titled The puzzle of Muslim advantage in child survival in India, authors Sonia Bhalotra, Christine Valente and Arthur van Soest have a more nuanced explanation for the difference. They summarise their findings thus: “We suggest that some of the Muslim advantage may stem from their lower degree of son-preference, their closer kinship, their more non-vegetarian diet, the better health of Muslim mothers and their lower propensity to work outside the home.”

What this paper highlights is that the difference in Muslim child survival rates is unrelated to their socio-economic status. They specifically examine whether religion can be an explanation for the Hindu-Muslim difference, and reject this hypothesis.

They conclude: “The essence of the paradox that this paper highlights is that, when we consider averages by religious community in India, then the commonly found positive association of socio-economic status (SES) and survival breaks down. Our decomposition of the community differential suggests that the effects of SES are overwhelmed by some unobservable trait owned by the lower SES group. Correlates of religion that may plausibly influence survival without exhibiting a strong positive correlation with SES include diet, attitudes to women’s work, personal hygiene, political clout or social norms and networks. Some of these effects may be better cast as historical, cultural or biological factors in that they are unrelated to religious belief per se even if they have gelled around a community that is identified by its religion.” (Italics mine).

Clearly, there is a cultural factor that could explain the child mortality and health differences. It may have little to do with Manusmriti and Muslim hadiths.