Associations between quality of water and sanitation and access to maternal and child health services in South Asia

Abstract

Background/Aim: Globally unsafe drinking water/sanitation facilities affect women and children who also frequently lack access to appropriate health care. We examined potential associations between unsafe water and sanitation and access to maternal and child health services in South Asia. Methods: We utilized representative data from the Demographic and Health Surveys (DHS) for Bangladesh, India, Nepal and Pakistan. Using WHO recommendations for improved/unimproved water sources/sanitation facilities we examined associations with women’s access to health-services including adequate antenatal visits, whether a skilled attendant was present at delivery and child’s up-to-date immunizations. Logistic regressions were conducted adjusted for country- and individual-level covariates, and stratified by wealth index. Results: We included data from 145,262 women ages 15-49 who had a singleton birth with a living child 0-36 months of age. For women in the lower wealth index, access to improved water sources was associated with having a child with up-to-date immunizations (OR: 1.30; 95% CI: 1.20, 1.40) and with having a skilled attendant at delivery (OR: 1.28; 95% CI: 1.19; 1.39). Access to improved sanitation facilities was positively associated with child’s up-to-date immunizations (OR: 1.26; 95% CI: 1.18, 1.34 and OR: 1.14; 95% CI: 1.07, 1.22) and adequate ANC visits (OR: 1.59; 95% CI: 1.48, 1.71 and OR: 1.11; 95% CI: 1.04, 1.18) among women in lower and higher wealth indexes, respectively. Among women in the lower wealth index without improved water sources, those without access to water on premises were less likely to have had a skilled attendant at birth. Conclusion: Our results indicate that improvements in access and quality of water and sanitation may have positive implications for access to maternal/child health services in South Asia. This may indicate that programs that integrate addressing water/sanitation and maternal/child health services may be beneficial and associations should be further explored.