An open toilet sits in a field in Gorba in the eastern state of Chhattisgarh, India, on Nov. 16, 2015. (Adnan Abidi/Reuters)

Today we celebrate World Toilet Day to promote awareness about the global sanitation crisis. Toilets have been around for more than 5,000 years, but many people around the world still do not have one.

No. 6 on the list of U.N. Sustainable Development Goals (SDG) is to achieve universal access to adequate sanitation and end the practice of open defecation by 2030, recognizing the dangers of waterborne disease. But 61 percent of the global population still lacked safely managed sanitation services in 2015. Why has progress toward this goal been so hard to achieve?

Rural Africa and South Asia are where the sanitation problems are concentrated — and India has one of the worst sanitation records. More than half of the rural population still practices open defecation. Here are three things my research on India’s sanitation progress suggests:

1. The answer is not just constructing more toilets.

In 2014, Prime Minister Narendra Modi began the Clean India Mission (Swachh Bharat Mission) to install 111 million household toilets by the end of 2019 at an estimated cost of about $20 billion.

Although this mission includes communicating hygiene awareness, the focus has overwhelmingly been on installing toilets — and families can get subsidies to install private toilets. Although microfinancing helps, my study shows that information is a greater motivator in encouraging households to install latrines in rural areas.

Using the India Human Development Survey, a nationally representative panel survey conducted in 2004 and 2011, I find that households with women who regularly consume mass media through newspapers, radio or television are more likely to install a private toilet in their home. Several types of publicly reported information, such as government-sponsored public health campaigns, reports on the health risks of open defecation, or learning about sanitation facilities, may help explain this finding. Therefore, beyond the infrastructure drive to supply toilets, promoting toilet access and use through mass media is an effective strategy — particularly for women in hard-to-reach rural areas.

2. Having more women in leadership roles helps improve sanitation.

SDG 6 also specifically targets women and girls. Women are more heavily affected by the negative consequences of poor sanitation because they are at higher risk of violence and stress when practicing open defecation after sunset. They are also usually the primary caregivers to children, who are most susceptible to sanitation-related diseases. In a recent article in Comparative Politics, I explore the possibility that having more women in leadership roles helps address the burdens of poor sanitation that disproportionately affect women.

Using Indian census data about the availability and types of latrine facilities, I find that areas represented by female politicians are more likely to have “safely managed toilets,” which remove waste in a sanitary manner by avoiding human contact. These latrines also provide other benefits, such as greater privacy and reduced exposure to physical and sexual violence. This research is a reminder that not all latrines are equal — maximizing the intended health benefits of latrines means considering safe disposal methods of waste.

3. Promoting latrine use is key.

Although increasing the number of toilets and improving their quality is important, the larger challenge is how to ensure that they actually will be used. Surprisingly, many people with access to latrines do not use them. In our survey of 810 households in Delhi’s slums, where private toilet ownership is rare, we found that many people do not regularly use nearby public toilets, known as community toilet complexes, built specifically for slum dwellers. Although almost all of our survey respondents acknowledged that open defecation presents health risks and is embarrassing, people find places to defecate in public or wait until they go to work to use a toilet instead.

Our survey reveals that interactions among community members may be an important motivator to get people to use public toilets because these networks help spread norms that discourage the practice of open defecation. In particular, we find that frequent interactions with community leaders can help promote daily use of public latrines. A possible explanation is that local community leaders, who often help solve everyday problems, motivate collective behaviors of public latrine use by communicating their work on fixing sanitation problems, perhaps to claim credit for their work. Our survey results suggest that using these channels to promote latrine use may be key.

Poor sanitation causes waterborne diseases, such as diarrhea, which is one of the leading causes of child mortality worldwide. If the goal is to improve global public health through sanitation, these research findings suggest looking not just at achieving universal toilet access but also paying more attention and resources to efforts to encourage their use.

YuJung Julia Lee is an assistant professor at the Department of Political Science at Colorado State University. Her research interests include political economy of development, basic service provision, gender issues in development and Asian politics.