An estimated 2.4 billion people worldwide lack access to improved sanitation. This includes nearly 1 billion people practicing open defecation, of which 60 percent reside in India. Open defecation is especially common among rural populations, and has been linked to health problems like the occurrence of diarrheal disease and malnutrition. Despite decades of efforts by the Indian government to improve sanitation, open defecation continues to be a common practice even in households possessing a functional latrine. The main aims of this research were 1) to understand the reasons for poor adoption (uptake) and use of government subsidized latrines, and 2) to identify the constraints causing latrine non adoption and use. From the constraints identified in the literature review, three constraints were selected for in-depth investigation in this dissertation :1) socio-cultural beliefs and customs around handling adult human faeces, 2) programmatic challenges in mobilising communities for latrine promotion, and 3) household level challenges with sanitation decision making, especially exploring inability of women to take decisions on sanitation installation. The study was conducted in rural areas of Odisha through a mixed methods approach. The research revealed that in this study population, latrine adoption and use by all family members is influenced by socio-cultural and behavioural rituals and restrictions on handling and containing adult human faeces close to the home. In some cases, study subjects expressed a preference for open defecation over latrine use and were able to articulate benefits and advantages. Diverse communities and lack of capacity and skill among implementers negatively impacted the implementation of sanitation campaigns. Power hierarchies, inter-generational and household dynamics prevented female family members from participating in household decisions, including latrine installation decision-making.