Based on the data presented by the United Nations, the open defecation rates in low-income countries are four times higher in the world, which illustrates the existence of even more severe imbalances in access to sanitation among the poorest groups.
In low-income nations, open defecation (OD) is an important health issue that causes already-existing inequalities, especially for women, children, and those with limited resources. The issue is exacerbated by elements such as poverty, insufficient resources, and deeply rooted customs of culture.This phenomenon of open defecation in the low-income or poor countries is a true challenge to the global public health and development systems, even as the world has gone ahead in water, sanitation, and hygiene (WASH) provisions. United Nations recent reports show that the open defecation rates in the areas are four times higher than the global average, highlighting dramatic inequalities in terms of access to the basic sanitation. Despite the tremendous positive returns realised in the expansion of safe drinking water and sanitation systems across the globe, there has been a skewed distribution of these initiatives, with the poorest and most marginalised groups always being left out in the development. Such inequality goes against the very principle of human rights, and it impedes the work to meet Sustainable Development Goal 6, universal access to clean water and sanitation by 2030. Systemic barriers detected by the report such as poverty, poor governance and sociocultural norms are some of the factors that make unsafe sanitation practises persist. It is a critical analysis of the causes and effects of open defecation in low-income settings, critique of the inefficacy of existing policy measures, and suggest inclusive, community-based policies that will speed up change. The article aims to tell more informed and effective interventions in global sanitation policy by pre-empting the realities that underserved populations’ lives.
Global Progress vs. Local Realities
Although there are significant international achievements in the sphere of sanitation and access to drinking water, the gains are not evenly shared. The 2025 Joint Monitoring Programme (JMP) report by the United Nations signifies that there is an increasing disparity between the international and the domestic.
Global Gains in Sanitation Infrastructure
In the last 20 years, the global community has made a tremendous step to increase access to better sanitation. The JMP report asserts that over 75 percent of the world population currently accesses the safely managed sanitation services (WHO & UNICEF, 2025). This has been contributed by technological advancements, programmes initiated by the donors, as well as investments in urban infrastructure. However, the benefits are not spread equally and are in fact more dominant in middle and high income countries where institutional capacity and finance can support the long term implementation.
Persistent Inequities in Low‑Income Regions
In sharp contrast, low-income nations still have to face a systemic challenge. The report emphasises that open defecation rates in the areas are fourfold above the average worldwide with rural and marginalised populations being the most affected negatively. Poor government funding, weak government, and social cultural restraints are some of the challenges on the growth of sanitation services. In addition, informal settlements and remote locations are not usually part of national planning, which continues to exclude them.
Disparities in Drinking Water Access
Even though the availability of basic drinking water has been measured to have improved globally, according to the Joint Monitoring Programme (JMP) data, more than two billion people still do not receive safe access to the water. Cases in low-income situations are very common such that the sources of water either are contaminated or are extremely long distances thus a greater burden to both young children and women. These imbalances thus provide not only infrastructural shortcomings, but shortcomings in participatory policy formulation and surveillance systems.
Bridging the Divide
The clash between the evolution of the world the living of locals is characterised by stagnation and devolution, understandably, this necessitates interventions directed towards equity. Without specific measures that explicitly formulate a policy focusing on the poorest and the most vulnerable groups, potential achievement of the Sustainable Development Goal ‛6 will be impossible. In this regard, the urgent need is to stop focusing on the aggregate terms and switch to localised resources, focusing on communities and their needs.
Who Is Left Behind?
In spite of the global sanitation achievements, millions of people do have no access to sanitation. According to the 2025 JMP report, systemic neglect continues to face the 2025 poorest and most marginalised cohorts.
Rural Populations and Geographic Isolation
In the low-income countries the rural communities are more than necessary burdened by poor sanitation. Infrastructure funding is biased towards urban centres therefore the remote villages are left vulnerable without the most basic amenities. Geographic distortion also makes logistical operational challenging due to its costly and periodic nature of service delivery. It is said that over 60 percent of open defecation is in rural areas where the coverage of sanitation is at threat of extinction (WHO and UNICEF 2025).
Marginalized Social Groups
Structural exclusion of ethnic minorities, indigenous peoples, and displaced groups of people by sanitation programmes is very common. The barriers to their access to the government services include discrimination, lack of legal awareness and consideration, and lack of sufficient political representation. Such groups are very likely to remain outside of national datasets and planning thus becoming invisible in policy frames. JMP report verifies that lack of sanitation is the greatest in socially marginalised people.
Women and Girls: gendering burdens
The female gender as well as girls is largely affected through unsafe sanitation. Lack of privacy toilets infringes dignity, safety and management of hygiene during menstruation. In many places, girls are out of school during their menstrual period because there were no sufficient facilities. The 2025 JMP also underlines that gender-sensitive sanitation is critical in ensuring the nation attains equitable conditions, although this is not given much priority in most national plans.
Persons with Disabilities and the Elderly
Sanitation facilities are often incapable of serving persons with disabilities and the elderly. Exclusions take place due to inaccessible designs, lack of assistive technology and general social stigmas. Universal commitments to inclusive WASH are small despite efforts to implement universal WASH for everyone in the world. The report supports disability inclusive practises in order to avoid the exclusion of any individual.
Causes of Persistent Open Defecation
However, open defecation remains strong in many of the low-income countries despite decades of concerted international campaigns to promote sanitation. This constitutes a complex constellation of structural, cultural, andpolicybased determinants that perpetuate this practise that are outlined in the 2025 UN JMP report.
Inadequate Infrastructure and Financial Constraints
The major setback is the long term lack of proper sanitation equipment. The presence of fiscal constraints common in most low-income regimes means that they face no real alternatives of investing heavily in toilets and sewage systems and their upkeep. A report published by WHO and UNICEF (2025) reveals that in sub-Saharan Africa alone, more than 400,000 people cannot access basic sanitation since the number of people seeking such services is quite low and the outreach of donors denotes its limited numbers with great harshest details in the remote areas. Communities lack the option of demonstrating continuity in the capital input and therefore they revert to unsafe practises.
Governance Deficits and Policy Fragmentation
The problem is worsened by weak institutions and disjointedpolicy execution. Sanitation work also cuts across many ministries and leads to lack of proper coordination and accountability. City officials might be not technically savvy or have the political motivation to implement standards of the sanitation. According to JMP report, those nations where the governance frameworks are highly decentralised may find it difficult to provide homogeneous sanitation services especially in rural and peri-urban regions.
Cultural Norms and Behavioural Resistance
Open defecation also thrives because of other deep rooted culturalbeliefs and habits. To some societies, open defecation is okay or even better than going to common or inadequately maintained latrines. Campaigns based on behavioural change have not been winning much where they do not consider the power of local values and social dynamics. UNICEF (2025) and WHO emphasise that interventions associated with sanitation should be culturally contextualised to become more effective.
Lack of Awareness and Education
The flies in the minuscule levels of sanitation literacy hamper the adoption of hygienic practises. Most people do not know of the health hazards attached to open defecation such as diarrhealdisease and child stunting. Behavioural shift in the absence of a challenge to targeted education through the infrastructure is impossible.
Policy and Programmatic Gaps
Even where international commitments to universal sanitation address policy and programmatic gaps persist, the low-income countries remain undone by these policy and programmatic gaps. Illustrated in the 2025 JMP report issued by the UN, there are serious gaps in planning, funding, and inclusiveness.
Fragmented Governance and Weak Institutional Coordination
Sanitation policy is always penalised by lack of coherence in the governing authority with tasks being allocated to a plethora of ministries and agencies. This disintegration causes lack of coordination, duplication of work, and end up in a patchy implementation. In most low-income settings, local governments do not have the technical ability and autonomy to effectivelyrun sanitation programmes. WHO and UNICEF (2025) observe the decentralised systems though they can be empowering just have very little institutional coherence to offer equitable services.
Insufficient and Uneven Funding Allocation
A major challenge to the scaling of sanitation interventions is finance constraints. The national budgets that are dedicated to Water, Sanitation and Hygiene (WASH), is often not sufficient and is mostly biased towards infrastructure in the urban regions therefore, excluding the rural or marginalised groups. Externally donor funding is large but tend to be project-based and only temporary thus limiting sustainability. As pointed out in the Joint Monitoring Programme (JMP) report, without the availability of predictable and long-termed financing mechanisms, gains in sanitation cannot be sustained.
Lack of Inclusive and Data Driven Planning
Many sanitation programmes do not include requirements of the vulnerable groups such as women, personswith disabilities or ethnic minorities. Planning processes tend to isolate communities and to base their plans on old-fashioned or partial data which leads to a lack of priority. The report proposes the gathering of disaggregated information and application of participatory methods, thus ensuring interventions meet on-ground reality and enhance social inclusion.
Monitoring and Accountability Deficits
That is because poor monitoring schemes and insufficient accountability measures hinder the tracking of progress and the refinement of the policies. The poor evaluation tools make governments unaware of the gaps and modify measures. The JMP (2025) emphasises that the purpose of having a well-developed surveillance mechanisms is to ensure transparency, efficiency and accountability in sanitation governance.
Path Forward
The challenge of open defecation that is resistant to change in low-income nations requires a radical change in sanitation policy, funding, and involvement of the community.
Prioritizing Equity in National Sanitation Strategies
Equity is a principle that governments need to instil in the sanitation planning. This involves engaging underserved populations, i.e., rural communities, informal settlements and marginalised communities in specific interventions. In the report presented by World Health Organisation and UNICEF (2025), it is clear that it is impossible to reach universal access using similar solutions; solutions that are specific to the situation should be prioritised in order to be more inclusive and sustainable.
Strengthening Community Led Approaches
Participatory planning and CommunityLed Total Sanitation (CLTS) have shown to be effective at changing behaviour and building ownership. Powering local stakeholders to plan, execute and oversee the sanitization programmes will increase cultural apprehensiveness and adoption. Such models are advocated in the JMP report, especially in areas where the top-down programmes have not made inroads.
Sustainable Financing
Development partners and governments ought to go beyond funded short-term projects and set sustainable financial systems. Bridginginfrastructures gaps can never be avoided without blended finance, public-private-partnerships, and targeted subsidies to vulnerable households. WHO and UNICEF (2025) insist the focus should be on the fact that sanitation is a production good, and people should proceed to invest in it.
The inclusion of Monitoring and Accountability Systems
A sanitation programme cannot do without robust data systems to monitor progress and transparency in the programme. Breaking down data based on income, gender, and geography helps the policymakers to act with specificity to needs that arise. The report addresses the need to develop more sophisticated monitoring tools and citizen-feedback mechanisms that could make institutionsaccountable and mechanisms where strategies are improved in real-time.
Conclusion
The 2025 UN JMP report highlights the persistence of open defecation in low-income nations as a setback to achieving equitable improvements in global sanitation. In spite of significant improvements in infrastructure and policy on international levels, the most marginalised and poor groups are still left out of the basic services. Unsafe sanitation practises have continued to be perpetuated by structural barriers such as poor financing and fragmented governance, sociocultural resistance, and lack of data, which erode human dignity and health. To address these disparities, it is required to carry out a paradigm shift with recommendations that focus on inclusive andcommunity-based interventions that emphasise equity. Participatory planning, prioritised on long-term investing by the government, development helpers and the civil society, and strong monitoring are necessary by guaranteeing that no one is left behind. The attainment of Sustainable Development Goal 6 will require expansion of coverage as well as transformation of systems that fail the most vulnerable in diverse ways. The way ahead needs to be urgent, innovative, and unremitting in social justice regarding policy of sanitation.