The problem with ‘human waste’ is that it has become a much sanitised term and does not do justice to this story that follows. Even faeces, when used in connection with the digestive tract, somehow give the impression that a reference is being made about animals; or it may give a more scientific cover of putting the ugly issue well under wraps of medicine. On the other hand, the use of the more unsavoury four-letter word makes one look uncivilised.

So how does one talk about poop and pee without the glowers, grimaces, frowns and still make it a serious issue worth including in a conversation concerning sustainable development?

Singaporean businessman Jack Sim who founded the World Toilet Organization in 2001, to bring attention to the lack of sanitation in developing countries, said in TED Talk held in Taipei, in September, this year : “What we don’t discuss, we can’t improve”. Twelve years since, there has been a groundswell of global movement around the issue.

This year, on November 19, events will be taking place to break toilet taboos and highlight the struggle for dignified sanitation for a staggering 2.6 billion people without access to a clean, private toilet and 1.2 billion people (17 per cent of the global population) who practice open defecation. The theme of the campaign put together by the Water Supply and Sanitation Collaborative Council (WSSCC) and the World Toilet Organization (WTO) this year is: “I give a shit, do you?”

So how do we talk about this issue and break the silence? If we can get past our sense of disgrace, a dialogue can begin, say many.

Perhaps it would be best to tell the story as it is. People may begin to look at it differently, even seriously, if they are told that globally nearly 5,400 children die every day due to diarrhea, (second to pneumonia) preventable if they had soap, water and a clean place to perform their bodily functions, most basic of human rights.

In 2006, it was estimated that 2.5 billion people did not have access to proper sanitation; in 2008 there was an increase of 100 million people to that figure. That is one in every three people worldwide or nearly 40 per cent of the world’s population without a clean toilet.

In South Asia of the over a billion people who do not have access to improved sanitation, nearly 700 million defecate in the open according to the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation 2012. There is often an omission of mention of the plight of a vast majority of women, who also defecate in the open, but have to wait until it is dark or before sunrise to relieve themselves.

But really, who gives a shit (pardon the language)?

In television chat shows, so popular in Pakistan, where the politicians banter and cry themselves hoarse to be heard, not once has any one of them had the courage to talk about the yucky issue of latrines. But then it’s a topic not even on the minds of hosts of these shows.

In Pakistan – according to the WHO – of the 173.59 million people, 39.93 per cent defecate in the open. If this trend continues, Pakistan will be able to meet its target of reducing to half the number of people lacking sanitation by 2025, missing the MDG target of 2015 by a decade.

In addition, given other areas that the present government is fire-fighting on a daily basis, it seems highly unlikely that they could be persuaded to spend on latrines. Militancy, violence, lawlessness, power outages and rising food prices seem to have consumed everyone.

“It is not a politically attractive area for investment,” conceded Mustafa Talpur, regional advocacy manager (South Asia) of UK-based non-governmental organisation, WaterAid.

However, even in times of considerable peace, sanitation was never on the radar of politicians.

But to be fair, there is less demand for sanitation than water from those who have neither. Thus politicians always prefer to have water schemes than sanitation. “Politicians want visible things and sanitation pipes are laid underground, and not easily demonstrable,” Talpur told

Even for those media pundits, who may give some space or air time to development issues, toilets remain an even less sexy topic.

When the Code Pink decided to support Imran Khan and travel to South Waziristan, in October, little did they know all what the journey would entail.

The Guardian was the only newspaper that saw it fit to mention that the gruelling journey by these “hardened campaigners” was made all the more nightmarish because they had only “one toilet break in nine hours”. It was perhaps one important reason why the 35-strong team of Americans opted to discontinue into a “chaotic” situation.

What the writer failed to mention was that for millions of women in rural Pakistan, and in South Asia, nine hours curfew is a daily ordeal.

According to the World Health Organization, of the 692 million people defecating in the open in South Asia, India accounts for 90 per cent with 626 million defecating in the open. Compare that to 40 million Pakistanis relieving themselves in the open.

But this year India has decided to actually walk the talk and carried out a series of events to address its poop problem unabashedly. They have even involved Vidya Balan, the Bollywood star of “Dirty Picture” to talk dirty in real life and make sanitation fashionable.

The central government is carrying out the Nirmal Bharat Yatra, and talks about toilets, taps and yes, the unspoken sanitary pads. It even tackles the shame and suffering of the 300 million Indian women because of their menses.

It started from New Delhi, travelled 2,000 kilometres across five states between from October 2 on Gandhi’s birthday and will culminate on Nov 19 in Bettiah, in Bihar with the “World’s Longest Squat.” The participants will squat, like those 1.2 billion people around the world who defecate in the open every day, and see who can squat the longest with observers cheering on.

But it’s still not too late for Pakistan to join in.

For starters, it would be good to have people pledge to the case. It would be a great opportunity for many advocates like Talpur to clamour for governments to start thinking about how to interject the development discourse with sanitation.

Without proper sanitation, the country will not be able to achieve universal primary education, promote gender equality, empower women, or reduce child mortality.

And while there are many good policies and programmes and no dearth of political commitments at global and regional level, Talpur lamented these “promises are seldom kept.”

If nothing else, maybe hitting where it hurts most – the purse strings. In 2006, it was estimated that in Pakistan, the total economic impact of inadequate sanitation amounted to a loss of Rs 343.7 billion or about 3.9 per cent of Pakistan’s gross domestic product (GDP), according to a report by World Bank’s Water and Sanitation Programme.

For the moment, said Talpur, there are no clear and separate investment plans or budget for sanitation. “Sanitation budget is lumped with water when there is need for not just clear institutional responsibility but a clear sanitation budget line and increased allocation.”

What’s even more unfortunate, the civil society is far too weak to make decision makers accountable. Despite strong link of sanitation to other development areas including education, gender equality, nutrition, it is never considered a cross-cutting theme.

The missing link between sanitation and education, too, needs to be addressed. Despite enough evidence that inadequate sanitation brings major disease burden and child mortality, the health sector hardly talks about toilets. “They will talk about the curative while completely disregarding the preventive part of health care system,” said Talpur.

He said the education sector that should build the foundations of behaviour, designs schools with complete disregard for school toilets and where there are toilets, they are in a state of disrepair or not functioning.