A recent study showed that the Swachh Bharat Mission initiated by Prime Minister Narendra Modi has been instrumental in saving the lives of 60,000 to 70,000 infants annually.
“Toilet construction under the Swachh Bharat Mission and infant mortality in India,” a study conducted by Suman Chakrabarti, Soyra Gune, Tim A. Bruckner, Julie Strominger and Parvati Singh has been published in the Nature magazine. It underlined that toilet construction under the Swachh Bharat program brought down the rates of infant and under-five mortality in the country.
Swachh Bharat: A landmark public health initiative
In 2014, soon after assuming office, Prime Minister Narendra Modi launched the Swachh Bharat Mission initiative to eliminate open defecation through the construction of over 100 million household toilets across India. Data on all Indian states and Union Territories, covering 640 districts, from 2011 to 2020, has been used in the recently published study.
This study aims to assess the impact of this mega sanitation program on the health of children. The authors have concentrated on district percentage share of households receiving toilets under the program, showing a clear-cut association between improved access to sanitation and reduced infant mortality.
The study identified Swachh Bharat as an exception because it integrated toilet construction with community engagement, hygiene education, and robust monitoring mechanisms. The approach thus provided greater access not only to toilets but also encouraged people to change their lifestyles to reduce their exposure to harmful pathogens, which resulted in a drop in infant and child mortality.
Key findings: The sharp fall in infant mortality
This paper estimates the impact of toilet construction on Infant Mortality Rates (IMR) and Under-5 Mortality Rates (U5MR) using a two-way fixed-effects regression model. It found that districts where 30% of households received toilets under Swachh Bharat Mission had a reduction of 5.3 infant deaths and 6.8 under-5 deaths per 1,000 live births, reflecting the consequence of improved sanitation on child survival rates.
In addition, open defecation exposes people in the open to a wide range of faecal pathogens that bring about infections such as diarrhoea, which is fatal for infants and young children. Access to toilets under the program reduced these health risks, showing the importance of sanitation to public health, especially in low-income and middle-income countries.
Robust findings supported by several tests
Various robustness checks were performed to test the reliability of the study’s findings such as placebo and falsification tests which were conducted to determine that the observed mortality reductions were related to the sanitation improvements, not unrelated factors. For example, when separating interventions such as antenatal care visits or maternal education, the study did not find a significant impact on mortality.
It also found evidence of the threshold effect on infant and child mortality rates which were much lower when at least 30% of households in a district had toilets. These findings supported other recent studies indicating critical thresholds for the health gains of sanitation improvements.
Broader implications for public health
The study recommended that programs such as Swachh Bharat Mission hold transformative potential to bring equity in health outcomes among children. Similar initiatives might prove to be enormously useful in several other low-income and middle-income countries with high rates of infant mortality caused by unsanitary conditions.
The researchers indicated that the success of the program was not restricted to infrastructure provisions; it manifested community participation and changing behaviour. Similarly, continuous monitoring also made this scheme unique from earlier initiatives in this country.
Challenges and Future Directions
The study also acknowledged several challenges, such as concerns about the actual utilisation of the toilets built and the sustainability of the behaviour changes over the long term. Several such reports pointed out that socio-economic and cultural factors affected toilet adoption, influencing the gross impact of the program.
There is also the continuing need to maintain the level of sanitation and extend access further, particularly to those disadvantaged areas.
The research established that the Swachh Bharat Mission has saved approximately 60,000 to 70,000 infant lives every year in India. This drastically cut down on the infant and child mortality rates, and underlining large-scale sanitation drives improving results on public health parameters. Its success, with it being among the largest such sanitation programs around the world, accrues key lessons for other similarly placed countries.
