India’s Swachh Bharat Mission (SBM) may have contributed to averting 60,000–70,000 infant deaths annually, as per a study published in the prestigious international science journal Nature. Five researchers have conducted the study and the article in Nature is titled ‘Toilet construction under the Swachh Bharat Mission and infant mortality in India’.
SBM was launched by Prime Minister Narendra Modi on October 2, 2014, as the world’s largest sanitation programme aimed at turning India open-defecation free by 2020. The government built over 100 million household toilets in these six years and over six lakh villages were declared open-defecation free.
Five researchers, Suman Chakrabarti, Soyra Gune, Tim A Bruckner, Julie Strominger, and Parvati Singh, have authored the article which says a quasi-experimental study was done to investigate the association between SBM and infant mortality rate and under five mortality rates (U5MR) in India. Data from 35 Indian states and 640 districts was analysed spanning 10 years (2011–2020).
What the Study Found
“The post-SBM period in India exhibited 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 article has mentioned. Results from the study suggest every 10-percentage point increase in district-level toilet access following SBM corresponds with a reduction in district-level IMR by 0.9 points and U5MR by 1.1 points, on average.
Improvement of water and sanitation conditions may reduce infant mortality, particularly in countries like India where open defecation is highly prevalent, the article says.
“Our study provides evidence of the benefits of India’s national sanitation campaign, the Swachh Bharat Mission or Clean India Mission, for infant and child mortality reduction. Our findings add to the growing body of evidence linking national sanitation campaigns to improved child health outcomes and emphasises the need for similar interventions in other low- and middle-income countries,” the article mentions.
The study found evidence of a threshold effect wherein the district-level toilet coverage of 30 per cent (and above) corresponds with substantial reductions in infant and child mortality. “Our study provides novel evidence of reductions in infant and child mortality following a comprehensive national sanitation program in India, potentially indicating the transformative role of SBM,” the article says.
Why Deaths Happened Earlier
The article says that Infant and child mortality due to faecal pathogen-based infections (diarrhoea, in particular) and malabsorption of nutrients may decline following improved access to toilets and elimination of open defecation.
It adds that it is essential to interpret these findings in light of India’s existing primary health care infrastructure, which provides a considerable portion of the population with preventive and curative health services that address various diseases stemming from inadequate sanitation and resulting in child mortality.
“Consequently, the effectiveness of the SBM may have been influenced by the availability of universal health services. We contend that that the benefits of improved sanitation measures may vary based on availability of comprehensive healthcare access and synergistic programming aspects of the SBM campaign, above and beyond toilet construction, in relation to behaviour change and oral-faecal exposure to contaminants,” the article says.
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