Open defecation linked to stunting in Indian children

Research finds 10 per cent increase in open defecation associated with a 0.7 per cent increase in stunting in 112 districts

By Kundan Pandey
Published: Monday 23 September 2013

Poor sanitation gives arise to a number of health problems, but now research shows that it is linked to stunted growth as well. A research published last week in journal PloS One has concluded that lack of sanitation is a potential contributor to stunting in the country. 

The study was carried out by Dean Spears from the Centre for Development Economics at the Delhi School of Economics along with Arabinda Ghosh, an Indian Administrative Service official, and Oliver Cumming of the London School of Hygiene and Tropical Medicine. The researchers found that a 10 per cent increase in open defecation was associated with a 0.7 per cent increase in both stunting and severe stunting.

The researchers used recently published data on levels of stunting in 112 districts of India to explore the relationship between open defecation and stunting within the population in these districts. They used information from the 2011 HUNGaMA (hunger and malnutrition) survey  for stunting data and 2011 Indian Census for the same districts was referred to for other indicators like open defecation. The HUNGaMA survey is the most recent large-scale data on malnutrition which evaluated 109,093 children under five years of age in 73,670 households.

The researchers carried out a statistical analysis after adjusting potential confounding factors such as socio-economic status, maternal education and calorie availability. They found that stunting figure of the districts where people defecate in the open is higher. In general, children in these districts were found unhealthy. “Over half of the children are stunted, and almost a third of children are severely stunted. The early-life disease environment is poor: over 70 per cent of households defecate in the open and 71 out of every 1,000 babies born alive die before they are one year old. Two-thirds of all adults, and slightly more than half of females, are reported as literate in the Census,” the research findings state.

Population density's compounding effect

The finding calls for immediate attention of and follow up by policy makers in India. Open defecation is a pressing problem because it is much more common in India than in many poor African countries. UNICEF and the WHO estimate that in 2010, 25 per cent of people in sub-Saharan Africa defecated in the open. Recent health surveys in the largest three sub-Saharan countries show that 31.1 per cent households in Nigeria, 38.3 households in Ethiopia, and 12. 1 per cent households in the Democratic Republic of the Congo defecate in the open. Consider the comparative data for India. The Planning Commission report on Evaluation Study on Total Sanitation Campaign, 2013, suggests that around 72.63 per cent of rural India still defecates in the open.

What's more worrying for India is that density of population in the country is very high which has the potential to compound the problem.

Spears has written on the subject in a research paper prepared for Public Health Foundation of India (PHFI) on February 15 this year. “If open defecation is indeed keeping children from growing to their genetic potentials–rather than merely being coincidentally correlated with height–we would expect open defecation to be more important for health outcomes where children are more likely to encounter whatever fecal germs are introduced into the environment. This means that population density should matter: living near neighbours who defecate in the open is more threatening than living in the same country as people who defecate in the open far away.”

He goes on to say that Indian children face the double threat of widespread open defecation and high population density, and that  stunting among Indian children is no surprise.  He stresses on proper efforts to motivate people to not only construct latrines but use them as well.

However, motivation and awareness have not received sufficient attention in the planning of the government. The Planning Commission evaluation report of Total Sanitation Campaign report  points out that the practice of open defecation was supposed to be stopped with all individual households being given access to the toilets by 2012; toilet facilities to all schools and anganwadi centres were to be provided by  2009 and Community Sanitary Complex/Women Sanitary Complex were to be provided in case of lack of space or financial constraints. Government of India gives Nirmal Gram Puraskar to push the sanitation campaign. But there is no significant progress as 72 per cent people  in rural India still defecate in the open.

Open defecation and childhood stunting in India: An ecological analysis of new data from 112 districts

Progress on sanitation and drinking-water: 2013 update

Does access to improved sanitation reduce childhood diarrhea in rural India? 

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