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The construction of toilets at a national scale under India’s Swachh Bharat Mission (SBM) may have averted 60,000-70,000 infant deaths annually between 2011-2020, a new research has found.
SBM was launched by Prime Minister Narendra Modi on October 2, 2014 with an aim to ensure that India becomes Open Defecation Free (ODF).
From 2014 to 2020, the government constructed 109 million household toilets and declared that more than 600,000 villages were free from open defecation.
To investigate the association between SBM and infant mortality rate (IMR) and under five mortality rate (U5MR) in India, public health researchers from International Food Policy Research Institute (IFPRI), University of California and The Ohio State University analysed data from 35 Indian states and 640 districts over 10 years (2011–2020).
The research, published in the journal Scientific Reports, found that districts with over 30 per cent toilets constructed under SBM corresponded with 5.3 fewer infant deaths and 6.8 fewer child deaths per 1,000 births.
In absolute numbers, this coefficient would scale to an estimated 60,000–70,000 infant lives annually.
Further, every 10-percentage-point increase in district-level toilet access following SBM, corresponded with a reduction in district-level IMR by 0.9 points and U5MR by 1.1 points, on average.
Sanitation has been considered as one of the most important public health interventions of the past century, with dramatic declines in IMR following improved sanitation in the United States and other western countries in the early 1900s.
The current study observed that IMR reductions occurred more rapidly during the post-SBM period.
In the pre-SBM period (between 2000 and 2015), the IMR exhibited an annual decline of three per cent. This showed that the rate of IMR reduction in the post-SBM period was eight to nine per cent per year higher than the pre-SBM rate of reduction.
“The post-SBM period in India exhibited accelerated reductions in infant and child mortality compared to the pre-SBM years,” the study said.
After SBM started, there was a twofold increase in toilet availability and a decline in open defecation to 19 per cent from 60 per cent in the first five years of the campaign. Meanwhile, for the period spanning 2015–2020, SBM averaged an annual budget of around 1.25 billion USD.
Prior research in the field has documented a phenomenon known as ‘Asian Enigma’, wherein disproportionately higher growth faltering in early childhood resulted in child stunting (low height for age) rates in India, despite rapid economic progress, relative to other Low and Middle Income Countries (LMICs).
This, researchers had argued, presumably arises from the widespread practice of open defecation.
Currently, the government is implementing phase two of the mission, under which villages which have sustained its ODF status along with implementing either solid or liquid waste management systems, will be declared ODF plus.