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Revised NITI Working Paper_1.pdf
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Dr. Arvind Virmani
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Views expressed in the paper are personal 1
Child Malnutrition & Mortality:
Role of Sanitation & Sewage systems
By
Arvind Virmani & Shruti Sabharwal
1
Abstract
Child malnutrition and mortality are critical public health challenges in India, exacerbated by
inadequate sanitation infrastructure. This study examines the effects of sanitation and sewage
systems on malnutrition indicators (stunting, underweight, and wasting) and child mortality in
India. Utilizing data from the NFHS-4 and NFHS-5 across 28 states and one union territory,
the analysis investigates how access to improved sanitation, specifically private and shared
toilets with sanitation and sewage systems, influences child health outcomes and indirectly
impacts mortality through malnutrition.
The findings demonstrate that use of toilet facilities significantly reduces stunting and
underweight prevalence, with shared toilets having a greater effect than private toilets. In
contrast, open defecation is associated with increased malnutrition, particularly affecting
stunted and underweight children under five. The study also highlights female education as a
vital factor in reducing child mortality, suggesting that maternal education contributes
positively to child health and sanitation awareness. Additionally, the indirect pathway of
sanitation’s impact on mortality—through reduced malnutrition—emphasizes the broader
public health benefits of sanitation improvements.
These results underscore the potential of sanitation initiatives, such as the Swachh Bharat
Mission, to improve child health by reducing malnutrition and mortality risks. The study calls
for integrated public health policies focusing on sanitation infrastructure, public health
education, and female education to address malnutrition and mortality comprehensively. This
research provides evidence supporting policies that prioritize sanitation improvements as a
foundational element in enhancing child health outcomes in India.
1
Arvind Virmani is Member NITI Aayog and Shruti Sabharwal is a Young Professional in NITI
Aayog. Any views expressed in this Paper are those of the author(s) and should not be attributed to NITI Aayog
or Government of India.