Abstract
Our study contributes to the understanding of key drivers of stunted growth, a factor widely recognized as major impediment to human capital development. Specifically, we examine the effects of sanitation coverage and usage on child height for age in a semi-urban setting in Northern India. Although sanitation – broadly defined as hygienic means of promoting health through prevention of human contact with the hazards of wastes, particularly human waste – has long been acknowledged as an indispensable element of disease prevention and primary health care programmes, a large number of recent impact evaluation studies on sanitation interventions in low income countries fail to find any health improvements. We address endogeneity of sanitation coverage through an instrumental variable approach, exploiting variation in raw material construction prices. Doing so, we find that sanitation coverage plays a significant and positive role in height growth during the first years of life and that this causal relationship holds particularly for girls. Our findings suggest that a policy that aims to increase sanitation coverage in a context such as the one studied here, is not only effective in reducing child stunting but also implicitly targets girls.
Highlights
The failure to reach linear growth potential early in life has been widely recognized as a major impediment to human capital development
We provide evidence on causal links between an improved sanitation environment and child health, proxied by height for age of children using two rounds of primary data collected for learning around a sanitation intervention in Northern India
We make use of primary data collected as part of an evaluation exercise of a sanitation intervention to investigate the impact of improvements in the sanitation environment, defined as the fraction of households using private or community toilets, on child height for age, an indicator for health
Summary
The failure to reach linear growth potential early in life has been widely recognized as a major impediment to human capital development. The general term for a child being short for its age, have been reducing over recent years, but 159 million children around the world are still estimated to be affected, more than half of these living in Asia (de Onis et al [2015]). Diseases have been linked to stunting (Checkley et al [2008]) but have shown direct associations with short (Nokes et al [1992], Nokes et al [1998], Walker et al [2011]) and long-term effects on human capital (Almond and Currie [2011], Bozzoli et al [2009]). Understanding the potential of improving the disease environment that children live in is of direct policy relevance
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