To put some numbers on this, about 600 million Indians rely on open defecation. Some researchers think that this is a key to the &quot;Asian enigma&quot;--the problem of why Indian children are shorter on average than African children even though African children are on average poorer (which normally correlates well with height).<p>Researchers have found that open defecation leads to stunted growth, and also higher child mortality rates. The later could explain another puzzle of India--why Hindu children have higher mortality rates than Muslim children, even though Hindus are on average richer and more educated.<p>It turns out that Indian Muslims are about 20 percent more likely to use toilets than Indian Hindus, regardless of income level.<p>Here&#x27;s an article on this: <a href="http:&#x2F;&#x2F;arstechnica.com&#x2F;science&#x2F;2014&#x2F;06&#x2F;open-defecation-solves-the-child-mortality-puzzle-among-indian-muslims&#x2F;" rel="nofollow">http:&#x2F;&#x2F;arstechnica.com&#x2F;science&#x2F;2014&#x2F;06&#x2F;open-defecation-solve...</a><p>Here&#x27;s a research paper on the connection between open defecation and stunted growth: <a href="http:&#x2F;&#x2F;journals.plos.org&#x2F;plosone&#x2F;article?id=10.1371&#x2F;journal.pone.0073784" rel="nofollow">http:&#x2F;&#x2F;journals.plos.org&#x2F;plosone&#x2F;article?id=10.1371&#x2F;journal....</a>