Urban family ties and household latrines in rural India: A cross-sectional analysis of national data.

Anna Lunn,Madhavi Bhargava

doi:10.1371/journal.pone.0235677

Abstract

Access to toilets and latrines represents both a development indicator and a significant factor in child mortality and physical development. The lack of latrines in rural India therefore constitutes a major global health challenge. Given the urban-rural gap in latrine ownership across India, I investigated how family ties to major cities, which extend beyond the local community affected by neighbors’ defecation practices, shaped latrine ownership in rural India. Using the national Rural Economic & Demographic Survey 2006 (n = 7,949), I analyzed the geographies of family ties, types of exchange and rural latrine ownership. Receiving family visits from major cities increased the likelihood of having a latrine (33% higher odds). The relationship between family visitors from major cities and rural latrine ownership was stronger for wealthier households (.031 increase in average marginal effect of urban visitors for a .5 standard deviation increase in household assets at the mean). Material support from family also increased the likelihood of latrine ownership (7.8% higher odds for each additional $200USD) suggesting that family members not living in major cities may still contribute necessary resources. The importance of personalized connections beyond the village, particularly to major cities, suggests that linking geographically disparate sanitation interventions may produce synergies.

Highlights

Access to improved household sanitation, such as toilets or latrines, is crucial for population health
The vast majority of gifts from non-resident family members came from family that did not live in major cities—85% received gifts from family members not living in major cities, while only 16% of households received gifts from family living in major cities
Comparing AIC and BIC measures of model fit across models indicates that adding a product term in model 4 and separating the source of family gifts in model 5 does not improve model fit. These results reveal that rural Indian households with active family ties to major cities were more likely to have a latrine, which suggests that social status concerns motivate latrine construction

Summary

Introduction

Access to improved household sanitation, such as toilets or latrines, is crucial for population health. Development targets and policies related to improved household sanitation have focused on India because, of the 1.1 billion households around the world without access to latrines in 2015, 626 million (almost 60%) lived in India mostly in rural areas [1]. Households decide to construct and use private latrines, but this household-level decision impacts local health outcomes, such as diarrheal disease and physical stunting, through environmental pathways. Given the impact of latrine coverage on local population health, existing scholarship has examined how village-based interventions and local social dynamics impact rural Indian households’ decisions to install household latrines.

Results

Discussion

Conclusion