More than 600 million people in India lack access to a proper toilet. With no other option they either defecate in the open or in unhygienic and unmaintained facilities. The problem is vast and increasing in urban slums where more than half of slum dwellers are forced to resort to open defecation within or around densely populated areas. Often this means traveling long distances or only going late at night or early morning before dawn when darkness provides some degree of privacy - in turn placing women and girls at risk of sexual assault.

An undignified existence, this also results in high morbidity, especially for children who suffer severely from potentially life threatening diarrhea and intestinal worm infestations. Other serious diseases which are present in slums and resulting from poor hygiene include cholera, malaria, and typhoid fever. Resulting malnutrition negatively affects school attendance and learning abilities, with life-long consequences, and detrimentally affects the urban economy.