The link between poor sanitation and stunting in India


  • Stunting among children, or low height for age, is common in developing countries with poor sanitation, as per the recent research finding by the Lancet Global Health research findings.


  • The two studies were well designed and conducted in contexts where the burden of malnutrition is high and water quality, sanitation, handwashing, and nutrition practices are inadequate
  • The study aimed to assess whether water, sanitation, handwashing, and nutrition interventions reduced diarrhoea or growth faltering

What is stunting?

  • India has the highest number of stunted children worldwide.
  • Stunting is a serious form of malnutrition or chronic undernutrition during the most critical periods of growth and development of children.
  • It is characterised by low height for age and is caused mainly due to insufficient nutritional intake often triggered by recurrent infections such as diarrhoea.

Consequences of stunting:

  • An estimated 156 million children worldwide suffer from stunting and are unlikely to reach their full potential as adults.
  • Stunting can have serious consequences and can lead to long-lasting harmful effects such as diminished mental ability and learning capacity and poor performance at school.
  • This results in poor earnings in adulthood; they are also at increased risks of nutrition-related chronic diseases such as diabetes, hypertension, and obesity.
  • Stunning is the most apparent sign of chronic undernutrition and is the physical manifestation of combined physiological and developmental insults.
  • Early-life stunting leads to poor cognitive development in childhood, reduced economic productivity in adulthood, and increased risk of morbidity and mortality.
  • Stunting leads to disease like Diarrhoea, which is the second leading cause of death in children aged 1–59 months, contributing to almost 500000 deaths in children younger than 5 years in 2015.
  • Frequent diarrhoea is also associated with linear growth faltering.
  • India registers the third highest proportion of child deaths caused by diarrhoea in South Asia  and diarrhoeal diseases are the most prevalent of all waterborne diseases in the country.

What are the causes of stunting?

  • Nutritional status of the mother before and during pregnancy and chronic hunger among children during their growing years are primary determinants of stunting in children .
  • Environmental factors such as lack of availability of clean water and poor sanitation and hygiene practices also play a part because they could lead to infections such as diarrhoea.

The link between poor sanitation and stunting

Poor sanitation, lack of availability of clean water and hygiene practices is one of the major reasons for stunting in India.

  • Household water, sanitation, and hygiene (WASH) practices play a huge role in stunting in India.
  • Open defecation is an important factor influencing stunting among children in different districts, preceding factors such as maternal education, calorie intake, socio-economic status, etc. More than 650 million people in this nation practice open defecation.
  • Poor nutrition and exposure to faecal contamination are associated with diarrhoea and growth faltering, both of which have long-term consequences for child health.
  • Poor quality and availability of water can have a significant impact on sanitation and hygiene behaviour in populations, affecting handwashing practices and toilet use.
  • Although the coverage of safe drinking water has increased according to government figures, only 43.5 percent of this is tap water of which only 32 percent is treated, according to the Census 2011 figures.
  • India is the worst performer in terms of sanitation coverage as compared to other countries with almost half of the households in the country not having access to toilets.
  • At 49.8 percent, India has the highest number of people practising open defecation in the world according to Census 2011 figures.
  • In sanitation, India lags behind South Asian countries like Bangladesh and Pakistan, which have not progressed as much in economic terms.
  • Poor sanitation leading to open defecation practices in increasing the risk of frequent infections and poor growth among children in low-income settings.

Way ahead:

  • WASH interventions may need to be very widespread to make a difference.
  • There is need to look beyond toilet numbers to deal with stunting
  • Not just toilet numbers but poor toilet use and hygiene behaviour too need urgent redressal at the policy level to reduce stunting.
  • Improved conditions of sanitation and hygiene such as access to toilets and hygiene behaviour such as handwashing practices after defecation will help in reduction of stunting among children in India.


India has identified sanitation as one of its important priorities in recent years. The Swachh Bharat Mission is a good step in this direction. However putting all the responsibility for poor sanitation on people’s behaviour will not help unless broader poverty and infrastructure-related issues like access to water, poor sewage disposal mechanisms, and availability of user-friendly and appropriate technologies are dealt with while addressing poor sanitation outcomes in the country.”

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