NEW DELHI/GADOJ, India -- Sharmila, a 40-year-old mother of four, waited most of her life to achieve her dream of having a toilet inside her house. Until a little over a year ago, she and her two daughters, who live in the village of Gadoj in India's northwest, had no option but to take a lengthy walk to a field to answer nature's call. These trips often were made either before sunrise or after sunset in order to have a modicum of privacy.

"Life was one big struggle,'' said Manisha, Sharmila's 20-year-old daughter. "We used to go out in the dark [in groups] and look for a place to go where no one could see us in that position. It's a sea change now."

Her elder sister Nisha, 21, added: "It was highly unsafe to venture out as there was often unwanted [male] attention on the streets and fear of assault, apart from the danger of snake and poisonous insects' bites."

Sharmila and her daughters are among the millions of people across Asia's third-largest economy who have benefited from Prime Minister Narendra Modi's ambitious Swachh Bharat, or Clean India, mission. The campaign, launched in October 2014, aims to make the country open defecation free (ODF) by Oct. 2 this year -- the 150th anniversary of the birth of Mahatma Gandhi, who also propagated cleanliness, hygiene and sanitation.

A staggering 111 million toilets are being built under the program, mainly in rural India, at a cost of more than 1 trillion rupees ($14 billion). It is the largest toilet-building project in the world, and is expected to dramatically improve the nation's health and economy. Funding is split 60:40 between the central and state governments, bolstered by a $1.5 billion loan from the World Bank.

Women in Guti village still have limited access to toilets. (Photo by Kosaku Mimura)

An official statement issued on Jan. 9 said more than 90 million toilets have been built across rural India since the launch of the mission, taking the national rural sanitation coverage up from 39% four years ago to over 98% now.

"That's remarkable progress that has been made," Parameswaran Iyer, who heads the Swachh Bharat Mission, told the Nikkei Asian Review in December. "We have been very fortunate that we have had the prime minister lending his weight to this program -- he announced [the scheme and] in many ways he's our communicator-in-chief, and that has made a big difference in the momentum of the program."

Modi, who is seeking a second term in elections to be held by May, is expected to tout the country's progress under the Swachh Bharat program on the campaign trail. "We in India take pride at the remarkable speed with which sanitation cover has increased in the last four years," the prime minister tweeted on Nov. 19, World Toilet Day. Yet the national elections will not be a walk in the park for Modi, whose Bharatiya Janata Party was dealt a crushing defeat in recent regional polls.

According to a study by the World Health Organization, the Swachh Bharat Mission in rural India is expected to prevent over 300,000 deaths from diarrhea and protein-energy malnutrition between 2014 and October 2019. Unsafe sanitation caused an estimated 199 million cases of diarrhea annually before the start of the toilet-building push.

Improving the health of rural Indians should also help them save money. Fewer workdays will be lost to illness, and less money will have to be spent on medicines -- allowing households in ODF villages to save up to 50,000 rupees annually, according to a UNICEF study.

A 2011 World Bank report estimated that lack of sanitation cost India over 6% of its gross domestic product, based on 2006 figures, and a 2016 report by Lixil Group, Water Aid and Oxford Economics put losses at 5.2% of the economy in 2015.

The Swachh Bharat Mission is the largest behavior change program in the world. The age-old open defecation practice has stubbornly endured as patriarchal Indian families objected to having latrines inside houses -- despite numerous hardships faced by the women. This was rooted in a centuries-old cultural resistance to installing a toilet alongside a prayer room or kitchen, and it was considered cleaner to defecate in the open despite its contribution to the spread of diseases.

There was also a stigma attached to cleaning latrine pits, a job considered to be suitable only for the lowest caste groups -- the Dalits -- who were once regarded as untouchable.

Women in Gadoj village, where 90% of households now have indoor toilets. (Photo by Kosaku Mimura)

Ishwar Singh, Sharmila's husband, said it took him two months to start using the toilet in their house; he was much more comfortable defecating "in the company of nature." There are still some men, mostly middle-aged and older, who prefer open fields as they feel that they are doing the right thing culturally, he said.

To help shift such attitudes, top Bollywood actors such as Amitabh Bachchan and Akshay Kumar were enlisted as the campaign's brand ambassadors. Kumar starred in the popular 2017 Bollywood movie "Toilet: Ek Prem Katha (Toilet: A Love Story)," in which his character's newlywed wife, played by actress Bhumi Pednekar, refuses to stay with him unless he builds a toilet in their house. The film, which earned over 3 billion rupees at the box office, was a huge boost for Swachh Bharat.

"The whole security and dignity of women is hugely enhanced by [this mission]. It also helped in [generating] employment" for women, said Iyer. He pointed out that in Jharkhand State, many women have become masons and have started building toilets themselves. "There are 30,000-40,000 woman masons who have taken it up as employment," he said.

When the Swachh Bharat program started, there were roughly 1 billion people in the world who practiced open defecation, of which about 600 million were in India. Of those, 550 million were in rural parts of the country.

Iyer said that about 450 million people in rural India have moved away from open defecation in a little over four years. "There has been tremendous progress and we are very confident of meeting the Prime Minister's goal of making India open defecation free by Oct. 2, 2019."

The biggest challenge, he said, will be to keep people from returning to old habits. "So, all the ODF [villages] need to remain ODF for a long time," Iyer said, adding they will also focus on ODF-plus, which is solid and liquid waste management.

Tough choices for the poorest

Sharmila, who belongs to a family of farmers, received a government incentive of 12,000 rupees to build her toilet, though the actual cost was three times that, she said.

Prior to the launch of the SBM, village elders say, fewer than 30% of the village's 1,050 households had toilets, but this has now gone up to 90%.

Sharmila's experience has been good, but not everyone in Gadoj is happy. Hitesh Kumar, a village council assistant, said that only about 150 households have received the 12,000 rupee incentive, which is directly transferred to residents' bank accounts.

As he spoke, a group of seemingly frustrated villagers gathered around his office and, in chorus, demanded to know when they would get their subsidy. To claim the incentive, an eligible beneficiary must build a toilet first -- a process that includes taking pictures at every key stage of construction and filling out some paperwork. "Many of these people are illiterate and don't follow due process to claim the incentive," said Kumar.

One such person is Digdev Singh, 66, who said the government should give the money before the toilets are built. There is no toilet in Singh's simple, single-story house, where he lives with his two sons and their wives, and three grandchildren.

Digdev Singh, right, wants the government to provide money for toilet construction up front rather than compensating households after they build them. (Photo by Kosaku Mimura)

"How can a poor man build a toilet on his own?" demanded Pawan, Singh's 34-year-old son, as his wife Laxmi, 30, tends to their buffalo. Pawan works as a teacher in a private school and gets a paltry salary of 4,500 rupees a month while his father gets the old-age pension of 500 rupees. A typical toilet costs around 15,000 to 20,000 rupees to build -- more than three months' income for Pawan.

Laxmi -- who has two sons aged 8 and 6 -- walks over a kilometer to relieve herself. "We don't own any farmland, and use someone else's fields. We have to ensure there's nobody watching us as it is shameful and people object to their plots being used for this purpose."

"The government should give us money to just dig an underground pit and put in a seat. We'll cover it with temporary tin shades or curtains," Pawan said.

"I'm now planning to sell my buffalo, which should fetch me 50,000 rupees, and then I'll build a toilet," he added, lamenting that those who can afford to construct a latrine are getting incentives while those living in abject poverty are not taken care of.

Despite such stories, the village has declared itself to be open defecation free. Critics say such ODF claims under Swachh Bharat need to be properly investigated.

Citing a report by the government's auditor for western Gujarat State, which has also declared itself ODF, Sumedh M. K., a medical doctor and public health professional, wrote for the Observer Research Foundation in October that nearly 30% of households in eight districts surveyed in the state "still did not have any access to toilets."

"Although the ODF statuses give the governments a lot to boast about, the reality seems much different. This reality [of people defecating in the open] can be observed all across India -- from the Mumbai local trains, during a drive through the coastal villages of Gujarat, and in hinterland Maharashtra and at many such places," he added.

In Marora, a poor village in northern Haryana State about 80 km from New Delhi, the nonprofit Sulabh International Social Service Organisation has built toilets for more than 100 families. Most of them belong to the minority Muslim community, which makes up about 15% of Hindu-dominated India's 1.25 billion population.

Mehboobi, an illiterate widow who lives with her son, his wife and two granddaughters, is one of the recipients. Her 24-year-old son is the only breadwinner in the house, earning around 5,000 rupees a month as a contract laborer, but the family now has a twin-pit toilet built for free by Sulabh two years ago.

"We used to go to the fields far away or places near the highway to relieve ourselves, but now life has become much easier," said Mehboobi.

Her daughter-in-law Akhlima, 23, is particularly happy. "In my parental house we have had a toilet for over 15 years now, but I got a shock here after I got married four years ago. There was no toilet and I felt so ashamed. I was always scared of being caught by someone in that embarrassing state," said Akhlima, a mother of two girls, aged 3 and 2. "I'm relieved that my daughters will not have to face this problem."

Sulabh International Social Service Organisation has built toilets for more than 100 families in Marora, a poor village about 80 km from New Delhi. (Photo by Kosaku Mimura)

Since the village has an erratic piped water supply, the family has built a 10,000-liter underground chamber -- like all other houses there -- that is filled with water they buy from private sellers for 800 rupees. The water is used for drinking, flushing the toilet and all other household chores, and lasts for over two months.

A lifelong sanitation advocate

Sulabh founder Bindeshwar Pathak is known for inventing the two-pit technology in 1968 when few villages in rural India had toilets.

The eco-friendly, self-composting twin-pit toilet allows safe disposal of human waste on-site. When one pit is full, the flow is diverted to the second. Within about two years, the sludge in the first pit turns into a dry, odorless, pathogen-free and safe manure which can be easily dug out and used in agriculture.

"This manure has nitrogen, phosphorus and potassium. It can also retain water," Pathak said.

He launched Sulabh in 1970 and built its first toilet in Bihar State in 1973. Since then he has built 1.5 million pour-flush toilets and 8,500 public toilet-cum-bath complexes. About 20 million people are using these facilities every day across India.

Bindeshwar Pathak, founder of Sulabh International Social Service Organisation, has dedicated his life to improving sanitation in India. (Photo by Kosaku Mimura)

The organization continues to build toilets in villages across India and is working with 110 companies such as Boeing, Maruti Suzuki India, Oil and Natural Gas Corp., and power company NTPC in the field of sanitation. Maruti Suzuki, majority owned by Japan's Suzuki Motor, has built over 3,500 individual household toilets across 26 villages it adopted in Haryana and Gujarat states.

Since 2015, it has spent about 170 million rupees of its corporate social responsibility funds to set up these toilets, and regularly undertakes awareness campaigns for the villagers and children to drive behavior change, according to Ajay Tomer, the company's executive director for corporate planning.

After a half century working to bring sanitation to his country, Pathak said the Modi government's Clean India Mission has given the cause real momentum across the nation.

"After Gandhi, Modi is the second person who has taken up the cause of sanitation and turned it into a people's movement. Today everybody is talking about cleanliness, everybody has become aware. The prime minister gets full marks for this," he said.