Swachh Bharat Mission averted 70,000 infant deaths a year, finds global study

Toilets built under the Prime Minister Narendra Modi government’s flagship Swachh Bharat Mission (SBM) may have helped in averting 60,000-70,000 infant deaths annually, a study published in Science journal Nature has found.
Launched in October 2014 by Prime Minister Modi, SBM is one of the largest national behavioral change sanitation programs in the world, aimed at eliminating open defecation by providing household toilets across the country.
The Nature study titled, ‘Toilet construction under the Swachh Bharat Mission and infant mortality in India’, has been authored by Suman Chakrabarti, Soyra Gune, Tim A Bruckner, Julie Strominger and Parvati Singh and published on September 2.
The researchers from the International Food Policy Research Institute in the United States took into account the infant mortality rate (IMR) and the under-five mortality rate (U5MR) in 35 states and 640 districts between 2011 and 2020. IMR is the number of deaths of children under one year of age per 1,000 live births.
Among the key findings, the study noted that historically, toilet access and child mortality have shown a robust inverse association in India. Toilets constructed increased dramatically across India following the implementation of the SBM in 2014. Over 117 million toilets have been constructed since 2014 with a public investment of over 1.4 lakh crore, it said
“Based on our regression estimates, the provision of toilets at-scale may have contributed to averting approximately 60,000–70,000 infant deaths annually. Our findings show that the implementation of transformative sanitation programs can deliver population health benefits in low- and middle-income countries,” reads the abstract of the report.
Prime Minister Narendra Modi shared the Nature report hailing it.”
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.”
Inverse Association Between Toilet Access and Child Mortality: Historically, toilet access and child mortality have shown a robust inverse association in India.
Scale of Impact: Toilets constructed increased dramatically across India following the implementation of the SBM in 2014. Over 117 million toilets have been constructed since 2014 with a public investment of over 1.4 lakh crore. Results from the analyses suggest that for every 10 percentage point increase in district level access following SBM corresponds with a reduction in district level IMR by 0.9 points and U5MR by 1.1 points on average.
There is further evidence of a threshold effect wherein the district level toilet coverage of 30% (and above) corresponds with substantial reductions in infant and child mortality. The study revealed that districts with over 30% toilet coverage under SBM experienced reductions of 5.3 in the IMR and 6.8 in the U5MR per thousand live births. In absolute numbers, this co-efficient would scale to 60,000 – 70,000 infant lives annually. This finding was supported by robustness checks and falsification tests, confirming the validity of the results.
SBM’s Unique Approach: SBM’s approach of combining toilet construction with substantial investments in IEC (Information, Education, and Communication) and community engagement represents a marked departure from prior sanitation efforts in India, which often lacked such comprehensive strategies.
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.
Broader Public Health Benefits: The study also highlights that expanded access to toilets under SBM likely reduced exposure to fecal-oral pathogens, contributing to lower incidences of diarrhea and malnutrition, which are key drivers of child mortality in India.