The Swachh Bharat Mission, a national cleanliness programme, launched in 2014 by Prime Minister Narendra Modi, may have reduced infant mortality through the construction of toilets and improved sanitation, a new study published in Nature journal suggests.
The study conducted by the US-based International Food Policy Research Institute was published in Nature, a leading scientific journal in the world, and estimates that 60,000-70,000 infant deaths a year were averted by the construction of toilets under the Swachh Bharat Mission (SBM).
The study investigated the association between the initiative and infant mortality rate and the Under Five Mortality Rate (UFMR) in India. Data was analysed from thirty-five states and 640 districts spanning 10 years (2011-2020).
The study says “Toilet access and child mortality have a historically robust inverse association in India. Toilets constructed increased dramatically across India following the implementation of SBM in 2014,” adding that “The post-Swachh Bharat Mission period in India exhibited accelerated reductions in infant and child mortality compared to the pre-SBM years.”
“In 2003, toilet coverage remained relatively low across districts, with less than 40% coverage on average. This coverage showed minimal improvement from 2003 to 2008, and some districts even witnessed a decline in access. However, by 2015, toilet coverage had substantially improved nationwide. In 2020, the majority of districts boasted toilet coverage exceeding 60%,” the study said.
The results suggested that on average, improving district-level toilet access by 10 percentage points corresponded to a lowering of death rates in infants by 0.9 points and those in under-5 by 1.1 points. The study’s observational data strongly support the notion that improved sanitation practices in India lead to reductions in child mortality, growth faltering, and incidence of diarrheal disease.
The authors concluded by saying “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 emphasising the need for similar interventions in other low- and middle-income countries.”
Speaking with NDTV, Dr Suneela Garg, chairperson of the Programme Advisory Committee on the National Institute of Health and Family Welfare, explained the link between toilets and infant mortality. Dr Garg said “Under the Swachh Bharat Mission, India has built 117 million toilets which means children and their families will be using it leading to a behavioural change. Naturally, infections like Feco-Oral infections will be less and if more toilets are built then fewer children will suffer from diarrhoea and gastrointestinal diseases and accordingly infant mortality will be low.”
“This is a landmark study which highlights that behaviour-change communication and changing toilet habits is a game-changer in reducing infant mortality,” Dr Garg added.
“This is a change in action. Swachh Bharat Mission is different from other cleanliness campaigns because it is a public support initiative. We told the people about the advantages of defecating safely. Information, education and communication were effectively delivered…This is just the beginning, we have to work toward the 100% mark. In the last 14 years, there has been a development in the mindset of people and the study shows the impact of investment,” Dr Zakaria Abbas, a public health expert said.
The study highlights the broader benefits of increased toilet access, including women’s safety, financial savings from reduced medical expenses, and overall improvements in quality of life.
Officially launched on October 2, 2014, by the Government of India, the national campaign is aimed at cleaning the country’s streets, roads and infrastructure. One of the objectives of the campaign is to address open defecation in villages by providing access to toilets in all rural households.
Since 2014, NDTV-Dettol has been at the forefront of a ‘Swasth’ change. For the last ten years, the campaign has emerged as one of India’s longest-running public health campaigns. In its first season, the NDTV-Dettol campaign raised Rs 280 crores to build and maintain toilets across India’s villages.
