Swachh Bharat Mission averted 60,000-70,000 infant deaths annually: Study

The report, ‘Toilet construction under the Swachh Bharat Mission and infant mortality in India’, by Suman Chakrabarti, Soyra Gune, Tim A. Bruckner, Julie Strominger and Parvati Singh, published on September 2, took into account the infant mortality rate (IMR, or the number of deaths of children under one year of age per 1,000 live births) and the under-five mortality rate (U5MR) in 35 states and 640 districts between 2011 and 2020.

While the study noted an overall decline in infant mortality during 2003-2020, it said the fall was particularly noteworthy from 2015 onwards. For instance, the study said, in 2003, the average toilet coverage in a district was below 40 per cent and by 2020, this went up to over 60 per cent. Establishing an inverse relation between access to toilets and infant mortality, the study stated that even districts with 30 per cent toilet coverage had managed to reduce the infant mortality rate by a substantial number. In absolute numbers, it amounted to averting 60,000-70,000 deaths annually across the country.

“Toilet access and child mortality have a historically robust inverse association in India. Toilets constructed increased dramatically across India following the implementation of SBM (Swachh Bharat Mission) in 2014… Based on our regression estimates, the provision of toilets at-scale may have contributed to averting approximately 60,000–70,000 infant deaths annually,” the report said.

Sharing the findings of the study on X, Prime Minister Narendra Modi said: “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.”

One of the the authors of the study, Suman Chakrabarti, an Associate Research Fellow for Nutrition, Diets and Health Unit at the International Food Policy Research Institute, told The Indian Express, “Deaths from preventable infectious diseases account for a large proportion of infant and under-5 deaths in India. Improvement in sanitation has been shown to reduce this burden. The Swachh Bharat Mission’s focus on toilet construction combined with intensive behaviour change communication increased toilet construction (and likely toilet usage) nationwide in India, and our results, along with prior research by our team members, show that these investments in India’s sanitation and public health infrastructure correspond with improved child health across multiple dimensions, including mortality and undernutrition.”

Chakrabarti said sustaining the momentum of SBM was crucial for public health. “While SBMs’ efforts are laudable, larger investments in clean water and disposal of municipal waste are needed for long-term health impacts,” Chakrabarti said.

The study used data from the Swachh Bharat Mission dashboard and the government’s National Family Health Survey data to draw its conclusions.

According to the report, in 2003, the infant mortality rate in a majority of the districts exceeded 60 per 1,000 live births with a district mean of 48.9. These included (based on colour-coded maps) districts in Rajasthan, Madhya Pradesh, Gujarat, Maharashtra, Odisha, Telangana, Tamil Nadu, West Bengal, Assam, Uttar Pradesh, Uttarakhand, Punjab, Haryana and Himachal Pradesh. But by 2020, the deaths had fallen below 30 per 1,000 live births with the district mean of 23.5. While many of these states still report infant mortality, their numbers have been significantly brought down, especially in Tamil Nadu, Telangana, Maharashtra, Gujarat, Uttarakhand and Rajasthan. However, some pockets of Uttar Pradesh, Madhya Pradesh, Odisha and Andhra Pradesh continue to report infant mortality of 45-60 per 1,000 live births as recorded in 2020, the study underscored.

In 2012, the infant deaths reported was 40 per 1,000 live births per district which fell to about 33 in 2016 and further dropped below 30 by 2019. Likewise, the deaths of children under the age of five in 2012 was about 44 per 1,000 live births per district. It dropped to below 40 in 2014, 35 in 2016 and in 2019, it was below 30.