Relationship between water and sanitation and maternal health: Evidence from Indonesia

Abstract

• The effects of unsafe water and sanitation on maternal and newborn health has been largely ignored. • Our findings support the role of poor hygiene and fecal disposal in maternal health. • Access to at least basic sanitation at home substantially decreases overall risk during pregnancy and birth. • No access to at least basic sanitation at home is a strong determinant of fever/infection during delivery. • Access to at least basic water has no systematic association with maternal and newborn outcomes. Poor household water supply and sanitation can affect maternal and newborn health outcomes through several pathways, including the quality of drinking water consumed by pregnant woman and exposure to harmful fecal pathogens in the environment due to poor quality sanitation. Using data on 14,098 pregnancies across four rounds of the Indonesian Family Life Survey (IFLS), we investigate the relationship between water and sanitation and outcomes along the course of a pregnancy - health and complications during pregnancy, probability of a miscarriage, complications during child birth, probability of live birth, and neonatal outcomes including birth weight and newborn survival rates. After controlling for confounding factors, we find that access to at least basic household sanitation is strongly associated with substantially decreased overall risk during pregnancy and birth. Whether or not a household has access to at least basic sanitation is strongly significantly associated with a lower probability of miscarriage and is a strong predictor of high fever during labor (an indicator of infection). We find no systematic association between household access to basic water and maternal and newborn outcomes. We also find no evidence of herd protection resulting from high levels of sanitation within the community.