research and policy advocacy for health & wellbeing in India.

Sanitation

Exploring the causes and consequences of widespread open defecation in India

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Sanitation

Social Inequality

Understanding how social discrimination impacts child and maternal health in rural India

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Social Inequality

Maternal Health

Exploring challenges and policy responses to adequate nutrition in motherhood to improve child health

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Maternal Health

Bus ko rasta do

16THOPEDBRT_2374964f (Part of the Bus Rapid Transit Corridor in Sheikh Sarai in Delhi.  Photo: RV Moorthy) If you haven't already seen it, do check out Aashish and Karthik's wonder op-ed on public transit in today's Hindu.  It talks about how lack of willingness on the part of rich Delhites to sacrifice road-space for the convenience for poorer commuters, and for better air quality, rather than any intrinsic problem with BRT technology, gets in the way of a functioning bus rapid transit system in Delhi.  My favorite line in the op-ed is the last one: "Many commentators seem to believe that the involvement of international expertise in the design of Delhi’s BRT will solve its woes, but experts in physical design will have no remedy to offer for this deeper malaise of indifference." As with open defecation, the problem here is not with the technology.  ...Read More..

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We don’t clean toilets!

Anil K. Rajvanshi, an Indian academic and the Director of an agricultural institute in Maharastra, recently wrote an article titled ‘The Un-Swachh Truth’ in the Huffington Post. The points which the author takes up in the article resonate with our findings from the “switching study” that one reason people defecate in the open rather than use latrines is because they don’t want to deal with feces. In the article Dr. Rajvanshi reflects on one of the most difficult aspects of his job as director of the institute: trying to keep the toilets clean. Despite his efforts, the educated scientists in the institute remained reluctant to taking turns and cleaning the toilets themselves. In fact Dr. Rajvanshi said that even when he made it mandatory for people to clean the toilet, if they wanted to use it, most of his staff members chose to use the fields for almost two years. Though the incident which Dr. Rajvanshi talks about is an anecdote, it is an important and meaningful one. In fact most people in rural north India have attitudes towards emptying their latrine pitsthat are similar to those of Dr. Rajvanshi’s staff towards cleaning toilets. Villagers similarly think it is not...Read More..

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SQUAT in USA Today!

P1030163 The government's plans to monitor toilet building as a part of the Swacch Bharat Mission were highlighted this week in USA Today.  The article quotes from the SQUAT report to make the point that simply building toilets will not be enough, and that without building awareness and changing preferences for sanitation, efforts to end open defecation are unlikely to work.  While it is true that official policy envisions public education as a part of the government's efforts, we have yet to see a true campaign to change people's minds on the ground.  Check out the article here!...Read More..

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optimal guidelines: a pain in the gluteal region

Diane got bit by a dog a little the other day.  She's really quite fine, it was nothing.  There is every reason to believe this dog doesn't have rabies, but we decided to get Diane the post-exposure prophylaxis (she already had the pre shots, so she only needed the two follow-up shots).  Things have much progressed from the horrifying shots into the belly that I remember seeing pictures of in a library as a little boy: now it is just a shot in the arm. Surprisinly often, people tell me that we shouldn't be complaining about the improbability of India's Swatch Bharat Mission eliminating open defecation in the next 4.5 years, because the government has formulated such perfect, optimal guidelines.  But I'm increasingly persuaded that writing optimal guidelines is a deeply suboptimal approach: instead, we should be attempting to design robust policies, doing our very best to admit challenges at the outset and design systems to fail well and to achieve something valuable in a wide range of realistic scenarios. Anyway, apparently both nurses, at two separate facilities, very much wanted to give Diane her rabies shot in what the WHO guidelines delicately call the gluteal region.  It turns out, this...Read More..

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Sanitation in the new IFPRI Global Food Policy Report

GFPR14-15_ch03_fig01_744 This afternoon in Washington DC, IFPRI will release its new 2014-2015 Global Food Policy Report.  The report covers an impressive range of important topics.  Among them, is a chapter that I was honored to be asked to contribute, in collaboration with Lawrence Haddad: our chapter reviews the accumulating new evidence for the old observation that sanitation policy can be -- and should be -- part of nutrition policy. Much of the new evidence that has emerged in the last year or so is from careful observational studies, such as Derek Headey and John Hoddinott's work about Nepal, or Audrie Lin and coauthors in Bangladesh.  But a new -- and surprising large -- set of intervention studies is also emerging. One of the central points of our chapter is a reflection on a special challenge for intervention studies: you can only learn about the anthropometric consequences of a change in open defecation if you succeed in changing open defecation.  That is what the arrow diagram above is about: even if all you care about is the "second stage" effect of open defecation on child height, your ability to learn about it depends on your ability to achieve a "first stage" effect on open defecation.  Put...Read More..

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big numbers

states I'm often asked why I work in India rather than other places.  When I answer that it is substantially because there are so many people here, people sometimes react as though that is bafflingly irrelevant. I'm thinking of this today because I have been editing our paper that uses joint rural households to identify an effect of women's social status and empowerment on their children's health (that old draft will be replaced soon, with any luck).  This is a very important question: many development programs are built on the belief that empowering moms is a good way to improve their children's outcomes, but it turns out to be very difficult to conclusively show. In our paper, we were resisting the urge to apologize and wring our hands over the fact that, of course, not every Indian child lives an a joint rural household.  We are zooming in on a special case that we think we can learn from.  However, I stopped feeling apologetic when I realized that the number of children under 5 living in joint rural households in India is over 7 million -- approximately the total number of people of all ages living in Diane's and my home states...Read More..

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More articles covering Diane’s PNAS paper on maternal health in India

Dean posted yesterday about Diane's new paper in the PNAS, which showed that maternal nutrition in India was much worse than previously thought. As the abstract of the paper says, 42.2% of Indian women are underweight when they begin pregnancy compared with 16.5% of African women. In both regions, women gain little weight during pregnancy, but because of prepregnancy deficits, Indian women end pregnancy weighing less than African women do at the beginning. Apart from the New York Times, The Hindu and the Business Standard, the article was also covered by The Economic Times, NDTV, Deccan Chronicle and LiveMint. We imagine that more newspapers will follow through. We usually post news articles covering rice research in the news section, but since there are so many of them for this paper, we will just be posting the articles that have the most information on the news tab. Do share this important paper with your friends and colleagues. Update:  The article has also been covered now in the Reuters,  HuffPost India, British Medical Journal, and Quartz!...Read More..

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