The study, spanning a decade from 2011 to 2020, analysed data from 35 Indian states and 640 districts. Researchers focused on two key indicators: the infant mortality rate (IMR) and the under-five mortality rate (U5MR), both measured per 1,000 live births.

On Thursday, Prime Minister Narendra Modi took to X (formerly Twitter) to highlight a recent study underscoring the success of India’s Swachh Bharat Mission (SBM).

“Happy to see research highlighting the impact of efforts like the Swachh Bharat Mission. Access to proper toilets plays a crucial role in reducing infant and child mortality. Clean, safe sanitation has become a game-changer for public health. And, I am glad India has taken the lead in this,” he posted.

The study published in the journal, Nature, earlier this week, reveals that India’s Swachh Bharat Mission (SBM) has made a significant impact on reducing infant and child mortality rates across the country.

The study, spanning a decade from 2011 to 2020, analysed data from 35 Indian states and 640 districts. Researchers focused on two key indicators: the infant mortality rate (IMR) and the under-five mortality rate (U5MR), both measured per 1,000 live births. The study revealed that districts with over 30 per cent toilet coverage under SBM experienced reductions of 5.3 in the infant mortality rates and 6.8 in the U5MR per thousand live births. In absolute numbers, this co-efficient would scale to at least 60,000 and even up to 70,000 infant lives annually, the study says. 

Conducted by researchers from the International Food Policy Research Institute, University of California, and Ohio State University, the examined the effects of SBM on infant and under-five mortality rates. Analysing data from 35 states and 640 districts over a decade (2011-2020), the research reveals significant improvements in child health linked to increased access to sanitation facilities under the SBM.

The study, which utilized a quasi-experimental design, provides evidence linking increased toilet access under SBM with improved child survival outcomes. SBM is one of the largest national behavioural change sanitation programs in the world, aimed at eliminating open defecation by providing household toilets across the country. This unique programme has now metamorphised into ensuring Sampoorna Swachhata in the country.

Key Findings

By employing a quasi-experimental design, the study provided robust evidence linking increased access to toilets under SBM with improved child survival outcomes.

Inverse Association Between Toilet Access and Child Mortality: Historically, there has been a strong inverse relationship between access to toilets and child mortality in India. The SBM has intensified this trend. Data show that in districts with more than 30% toilet coverage, there was a reduction of 5.3 in IMR and 6.8 in U5MR per 1,000 live births. This translates into a significant impact, potentially saving 60,000 to 70,000 infant lives each year.

Scale of Impact: The SBM led to a dramatic increase in toilet availability, with over 117 million toilets built since its inception. For every 10 percentage point increase in district-level toilet access, there was a corresponding reduction in IMR by 0.9 points and U5MR by 1.1 points. This correlation underscores the program’s effectiveness in enhancing child health.

Comprehensive Approach: Unlike previous sanitation efforts, SBM combined extensive toilet construction with substantial investments in Information, Education, and Communication (IEC) campaigns, capacity building, and community engagement. This holistic approach has been pivotal in achieving the observed health improvements.

Broader Public Health Benefits: The study also highlighted that improved toilet access likely reduced exposure to fecal-oral pathogens, contributing to lower incidences of diarrhea and malnutrition—key drivers of child mortality in India.

Implications for Public Health

As one of the world’s largest sanitation initiatives, SBM aims to eliminate open defecation by providing household toilets to millions of Indian families. Since its launch, the program has seen the construction of over 117 million toilets across the nation, with a total public investment exceeding 1.4 lakh crore rupees. The mission’s multifaceted approach, which includes toilet construction, educational campaigns, and community engagement, represents a significant departure from previous sanitation efforts in India.

The study’s results underscore the critical role of sanitation in improving child health and reducing mortality. The SBM’s success offers a powerful case for expanding similar programs globally, particularly in low- and middle-income countries facing high rates of infant and child mortality.

As India continues to address public health challenges, the SBM’s experience provides valuable insights into the effectiveness of large-scale sanitation initiatives. The study suggests that future efforts should focus not only on expanding toilet access but also on sustaining behavioral changes and ensuring the effective utilization of sanitation facilities.

Novel Evidence of Impact

The study provides novel evidence of reductions in infant and child mortality following SBM’s comprehensive national sanitation program, indicating its transformative role in improving public health outcomes.

SBM’s impact on child health in India highlights the transformative potential of large-scale sanitation programs. The substantial reduction in infant and child mortality rates reported in this study demonstrates the critical importance of addressing sanitation and hygiene in public health efforts. As the world continues to confront health challenges, the lessons learned from SBM offer a hopeful path forward, showing that targeted investments in sanitation can deliver life-saving benefits to millions.

The study emphasizes the need for ongoing investment in sanitation programs as part of broader public health strategies. Ensuring that constructed toilets are used effectively and that behavioral changes are sustained will be crucial for maximizing the health benefits of such initiatives.

SBM’s approach, which integrates infrastructure development with community engagement and education, could serve as a model for similar programs worldwide. By addressing the root causes of poor sanitation and focusing on comprehensive, evidence-based strategies, countries can make significant strides in improving child health and reducing mortality.