Study estimates that Swachh Bharat Mission toilets have helped reduce infant mortality by 60,000 to 70,000 per year

New Delhi: Toilets built under the Swachh Bharat Mission – India's national cleanliness programme – may have helped prevent around 60,000 to 70,000 infant deaths every year, according to a study.

A team, including researchers from the International Food Policy Research Institute (USA), examined data from nationally representative surveys covering 35 states/union territories and more than 600 districts over a 20-year period.

The study, published in the journal Scientific Reports, examined the link between improved access to toilets under the Swachh Bharat Mission and the decline in deaths among infants and children under five between 2000 and 2020.

The results suggest that a 10 percentage point improvement in toilet access at the district level corresponds, on average, to a 0.9 percentage point reduction in mortality rates among young children and 1.1 percentage points in mortality rates among children under five.

In India, there has historically been an inverse relationship between access to a toilet and child mortality rates, the authors said.

They also found that improving toilet coverage in a district by 30 percent or more was associated with a significant reduction in infant and child mortality.

“In absolute terms, this coefficient would equate to an estimated 60,000 to 70,000 infant lives lost each year,” the authors write.

They said the “novel evidence” of a reduction in infant and child mortality as a result of a comprehensive national sanitation programme potentially points to the transformative role of the Swachh Bharat Mission.

The findings are consistent with evidence from around the world and in South Asia. Several studies analyzing population-level survey data have indicated that improved sanitation has the potential to reduce child mortality rates by 5 to 30 percent, the researchers said.

They added that recent studies have highlighted the broader benefits of improved access to toilets, including women's safety, financial savings due to reduced medical expenses and an overall improved quality of life.

Despite these benefits, however, inequality in the provision and use of toilets persists due to discriminatory practices based on caste and religion, the authors say.

“Our findings add to the growing body of evidence linking national hygiene campaigns with improvements in child health and underscore the need for similar interventions in other low- and middle-income countries,” the authors write.

They said studies have also shown that local authorities resort to coercive measures and discrimination to achieve the campaign's goals, violating the rights of individuals, particularly garbage workers and lower castes.

“These practices pose a challenge to the effective and equitable implementation of the Swachh Bharat Mission and raise legitimate concerns about the long-term sustainability of hygiene-related behavior change,” the authors write.

Officially launched by the Government of India on October 2, 2014, the national campaign aims to clean the country's roads, streets and infrastructure. One of the objectives of the campaign is to solve the problem of open defecation in villages by providing access to toilets to all rural households.

According to a statement by Union Minister Hardeep Puri, nearly 1.2 million toilets have been built across rural and urban India in the last nine years up to July 2024.

The United Nations Economic and Social Headquarters praised the progress of the campaign, saying that by 2019, 500 million people in 630,000 villages had benefited from the campaign.

In addition, households in villages where open defecation is not allowed – all households are equipped with a toilet – saved up to Rs 50,000 every year, with the benefits to members exceeding the costs by 4.7 times, it said.