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Effects of Rural Sanitation on Infant Mortality and Human Capital: Evidence from India's Total Sanitation Campaign

Research, Sanitation1 min read

Author: Dean Spears

Published by: Princeton University

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Over a billion people worldwide defecate openly without a toilet or latrine, with profound health consequences: over two million children under 5 die from diarrheal disease each year; chronic infection prevents surviving children from reaching human capital potentials. Although it is well-known that modern sewage infrastructure improves health, it is unknown whether a sanitation program feasible for a low capacity, poor country government could be effective. This paper contributes the first causally identified estimates of effects of on-site rural sanitation on health and human capital accumulation.

The Indian government’s Total Sanitation Campaign reports building one household pit latrine per ten rural persons from 2001 to 2011. The program offered local governments a large ex-post monetary incentive to eliminate open defecation. I use several complementary identification strategies to estimate the program’s effect on children’s health. First, I exploit variation in program timing, comparing children born in different years. Second, I study a difference-in-differences in aggregate mortality. Third, I exploit a discontinuity designed into the monetary incentive.

At the mean program intensity, infant mortality decreased by 4 per 1,000 and children’s height increased by 0.2 standard deviations (similar to the cross-sectional difference associated with doubling household consumption per capita). Importantly, unlike many impact evaluations, this paper studies a full-scale program implemented by a large government bureaucracy with low administrative capacity. Nevertheless, the program prevented an average infant death for $2,000-$3,000, a very low cost compared with other programs in the literature. This estimate includes all administrative costs and losses to corruption.


r.i.c.e. is a non-profit research organization focused on health and well-being in India. Our core focus is on children in rural north India. Our research studies health care at the start of life, sanitation, air pollution, maternal health, social inequality, and other dimensions of population-level social wellbeing.

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