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Child Undernutrition Following the Introduction of a Large-Scale Toilet Construction Campaign in India

27 Pages Posted: 28 Oct 2019

See all articles by Parvati Singh

Parvati Singh

University of California, Irvine - Program in Public Health

Manisha Shah

UCLA Department of Public Policy; NBER

Tim Bruckner

University of California, Irvine



Background: Lack of toilets and the wide-spread practice of open defecation contributes to India's large burden of child undernutrition. We examine whether a large national sanitation campaign launched in 2014, the Swachh Bharat Mission (SBM), corresponds with reduction in stunting, underweight, and wasting among under five year-old (u5) children in India.

Methods: We used district-level data from before (2013-14) and after (2015-16) SBM from three national surveys to derive, as our outcomes, the percentage of u5 children per district who are stunted, wasted, and underweight. We defined our exposures as (i) binary indicator of SBM and (ii) percentage of households with toilets per district. Our analytic sample comprised nearly all 640 Indian districts. Linear fixed effects regression analyses controlled for baseline differences in districts, linear time trends by state, and relevant covariates.

Findings: Relative to pre-SBM, u5 stunting declines by 0.07% with every percentage increase in households with toilets post-SBM. Districts with higher pre-SBM toilet availability show greater decline in u5 stunting post-SBM. Post-SBM reductions in u5 undernutrition concentrate in rural areas, and among the two to five year-old age group.

Interpretation: Increase in toilet availability and usage on a national scale, precipitated by the sweeping national SBM sanitation campaign, appears to reduce under nutrition among u5 children in India.

Funding Statement: Funding for this research was provided by the National Institute of Allergy and Infectious Diseases: 1R03AI135322-01.

Declaration of Interests: The authors declare no conflicts of interest.

Ethics Approval Statement: The authors stated: "This study used publicly available secondary data and was IRB exempt."

Keywords: child undernutrition, sanitation, open defecation, India, stunting, quasi-experiment

Suggested Citation

Singh, Parvati and Shah, Manisha and Bruckner, Tim, Child Undernutrition Following the Introduction of a Large-Scale Toilet Construction Campaign in India (10/17/2019 13:03:45). Available at SSRN: or

Parvati Singh (Contact Author)

University of California, Irvine - Program in Public Health ( email )

Anteater Instruction& Research Offices (AIRB)
653 E. Peltason Dr., 2nd Floor
Irvine, CA 92697-3957
United States

Manisha Shah

UCLA Department of Public Policy ( email )

Box 951656
Los Angeles, CA 90095-1656
United States


NBER ( email )

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

Tim Bruckner

University of California, Irvine ( email )

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