Sanitation (itself a euphemism for defecation) as a subject can be likened to sex; it is taboo to discuss it in polite society and is often a great source of humour. If anything, defecation is spoken about even less than sex. At the same time poor defecation practices can be a source of great embarrassment and indignity, leading to strongly held feelings of discomfort and dissatisfaction. Problems relating to defecation remain hidden and rarely make it on to the community or political agenda. Without such bottom up pressure, excreta disposal remains in the political backwater. The elevation of sanitation to an MDG target has had a significant impact on the political will for sanitation change in the global development sector. It is slowly beginning to gain political credence at national level but it would be a brave (but astute) politician who attempted to be elected on a “latrines for all” policy rather than “clean water for all”, or “free health care for all”.