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From what I remember reading, a lot of this tended to be cultural more than anything. Free++ and clean public restrooms are readily available but many residents in rural villages don't use them for various reason. The most attention-garnering reason was an article where a local sanitation worker reported that people were superstitious about toilets, believing them to have witches. [1]

In a less supernatural but similar vein, many still prefer open defecation in fields, as they traditionally have done.

It's not just a matter of infrastructure, it's a societal change for many people.

[1] http://www.bbc.com/news/health-33980904

++ Edit: added "and clean" after Free.




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