India’s toilet-building plan saves thousands of babies, report says

NEW DELHI — A government-backed sanitation project has resulted in the building of more than 117 million toilets in India, which a science journal has attributed to possibly having saved the lives of up to 70,000 babies.

Prime Minister Narendra Modi made it his government’s mission to create an “open defecation-free” (ODF) India under the “Clean India” campaign launched on Oct. 2, 2014.

The mission was mainly focused on rural areas in the South Asian nation, with a public investment of more than 1.4 trillion rupees ($16.7 billion), according to government data. Authorities say the rural sanitation coverage increased from 39% in 2014 to 100% in 2019 during the program’s first phase. The second phase running up to 2025 is aimed at sustaining the ODF status and managing solid and liquid waste.

The mission is the largest behavioral change program globally. The age-old practice of defecating in the open has stubbornly endured as patriarchal Indian families objected to having latrines inside houses — despite numerous hardships faced by women of going to the toilet in open areas outside the home. This was rooted in a centuries-old cultural resistance to installing a toilet alongside a prayer room or kitchen, and it was considered cleaner to defecate in the open regardless of its contribution to the spread of diseases.

“Toilet access and child mortality have a historically robust inverse association in India,” says the study published in September in science journal Nature, pointing out that the post-Swachh Baharat Mission (SBM) period in India showed accelerated reductions in infant and child mortality compared to the pre-SBM years.

“Based on our regression estimates, the provision of toilets at-scale may have contributed to averting approximately 60,000-70,000 infant deaths annually,” the report noted. “Our findings show that the implementation of transformative sanitation programs can deliver population health benefits in low- and middle-income countries,” it added.

The study analyzed the infant mortality rate (IMR), or the number of children dying before reaching the age of one out of 1,000 live births, and the under-five mortality rate in 35 states and 640 districts spanning 10 years from 2011 to 2020.

According to Abhishek Kumar Sinha, a medical doctor who is state program officer working to strengthen the health system in India’s eastern state of Bihar, the SBM has contributed to reducing both the IMR and the maternal mortality rate (MMR).

“Improved sanitation reduces the spread of infectious diseases like diarrhea, cholera, and typhoid, which disproportionately affect infants, children, and pregnant women. Reducing waterborne diseases directly lowers IMR and improves maternal health,” he told Nikkei Asia.

“The Swachh Bharat Mission, through its focus on sanitation, hygiene, and clean water, has had a positive effect on public health, contributing to reductions in both MMR and IMR across India, especially in rural areas,” Sinha added.

However, some argue that toilets that were constructed under the SBM are not being properly utilized. “Many of these [toilets] in rural areas have no water supply and are being used as granaries or storage,” Duru Arun Kumar, a New Delhi-based professor of sociology, said.

A photo of Indian Prime Minister Narendra Modi is displayed outside a public toilet in New Delhi during the G20 summit in 2023. The leader launched the “Clean India” campaign in 2014. (Photo by Ken Kobayashi)

On Oct. 2, 2019, India claimed that it was open defecation free, coinciding with the 150th anniversary of the birth of Mahatma Gandhi, who also propagated cleanliness, hygiene and sanitation.

Nevertheless, Kumar said, “there are very strong cultural reasons” which still prevent many people in villages from using household toilets even if they have constructed them. “They, especially men, still go outside [their houses] to relieve themselves.”

“Besides, there is a serious water problem due to lack of direct supply [in several places in rural India] and people are still drawing water from the wells for drinking,” she told Nikkei. “How can they have water in toilets then?”

In August 2019, the Modi government launched another program to provide a safe and potable tap water supply to rural households in partnership with the country’s states.

When the project was announced, about 32.3 million, or just 17%, of rural households were reported to have tap water connections.

An additional 110 million rural households had been provided with tap water connections as of Feb.4, bringing the total coverage to about 74%, according to an official statement. However, 26% of the total of more than 192.7 million rural households in India have yet to be connected.

source : asia.nikkei