"Sanitation is not on the political agenda, because it impacts poor people and not decision makers," Sanjines said. "The other problem is that people do not want to talk about excreta and human waste. It is taboo."
Those issues put women in many countries at particular risk.
"For women who become 'prisoners of daylight,' having a safe place to defecate and urinate is a priority," said Belinda U. Calaguas, a policy expert at WaterAid, a London-based nongovernmental organization. "Lack of sanitation affects women's reproductive health and exposes them to physical risks of sexual assault."
Some experts say an attitudinal change is necessary.
"Until we can talk about toilets comfortably, recognizing that dealing with human waste is a key priority of public health and hygiene the world over, we are not going to even get close to achieving the Millennium Development Goals," said Lauren Gelfand, media advisor for the nonprofit Oxfam GB in West Africa.
Promise to Help
Completing the UN development goals means moving people up what the report calls the "sanitation ladder," a progressive technology hierarchy that begins with open defecation and advances from "lower rung" technologies such as basic pit latrines to "pour-flush facilities" that operate with septic tanks.
The top rung is the developed world's model of pipe-fed flush toilets with adjoining sinks. But if this model is counted as the benchmark, the report says, the global sanitation deficit "would soar from 2.6 billion people to about 4 billion."
Improvements are expensive—it costs 20 times more to connect a household to a modern sewer system than to purchase a basic pit latrine.
But public health experts say the payoffs will be enormous.
"The transition from unimproved sanitation is accompanied by a more than 30 percent reduction in child mortality," the report says.
In urban areas of Peru, for instance, having a pit latrine in the home lowers diarrhea rates by half. Having a flush toilet drops the risk by 70 percent, the study says.
Poverty, however, remains a big impediment.
Though clean water, hygiene, and sanitation are intertwined components of public health, experts say, sanitation lags behind water services.
"For people in poverty, their first priority is to get access to reliable, clean water," WaterAid's Calaguas said. "Sanitation is a distant demand when compared to the top demands of food, livelihoods, and water."
More than 660 million people without sanitation live on less than two U.S. dollars a day, and some 385 million get by on a dollar or less, according to the UN.
Even when basic upgrades such as pit latrines begin to move waste out of homes, poor nations oftentimes lack the infrastructure to move and process the waste safely.
Some 13 percent of latrines in Kibera, Nairobi, for example, can't be used because they are too full, the report says (Kenya map).
In Brazil and Mexico large numbers of the population are connected to the sewage systems, but low treatment capacity means less than a fifth of the wastewater is treated. (Related video: "Sewer Diver in Mexico City, World's Worst Job?".)
In Delhi, India, a city with "the trappings of a modern sanitation system," less than a fifth of the city's waste is treated before being dumped into the Yamuna River, the report says (India map).
Experts say meeting the UN sanitation goal with the cheapest technologies would cost $10 billion (U.S.).
"The $10 billion price tag for the [Millennium Development Goals] seems a large sum, but it has to be put in context," the report authors write. "It represents less than five days' worth of global military spending and less than half what rich countries spend each year on mineral water."
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