The dirty business of eliminating open defecation: The effect of village sanitation on child height from field experiments in four countries

Changes in child height and open defecation in rural India: Understanding improvements between the two most recent demographic surveys

Rural Indian children are exceptionally short by international standards. However, between 2015-16 and 2019-21, the average rural child's height increased by about one-fifth of a standard deviation, a more rapid increase than previous years. Over this same period of time, reported open defecation in rural India reduced dramatically from 55% of households to 27% of households, in part because of a large government program that subsidized the construction of latrines. This paper studies the extent to which the reduction in open defecation can statistically account for the increase in child height over this period of time. Using a linear decomposition similar to Blinder-Oaxaca, that controls for fixed differences across districts and changes in other environmental exposures and economic status within districts, we find that the reduction in open defecation accounts for about one-fifth of the improvement in child height over this period of time. The improvement in the disease environment contributed to a small but important increase in child height, yet children in India are still short by international standards and much open defecation remains.

To use financial incentives or not? Insights from experiments in encouraging sanitation investments in four countries

We conduct a systematic re-analysis of intervention-based studies that promote hygienic latrines and evaluate via experimental methods. We impose systematic inclusion criteria to identify such studies and compile their microdata to harmonize outcome measures, covariates, and estimands across studies. We then re-analyze their data to report metrics that are consistently defined and measured across studies. We compare the relative effectiveness of different classes of interventions implemented in overlapping ways across four countries: community-level demand encouragement, sanitation subsidies, product information campaigns, and microcredit to finance product purchases. In the sample of studies meeting our inclusion criteria, interventions that offer financial benefits generally outperform information and education campaigns in increasing adoption of improved sanitation. Contrary to a policy concern about sustainability, financial incentives do not undermine usage of adopted latrines. Effects vary by share of women in the household, in both positive and negative directions, and differ little by poverty status.

Water pollution and sanitation in Indonesia: a review on water quality, health and environmental impacts, management, and future challenges

As an archipelagic tropical developing country, Indonesia is characterized by vast expanses of rural and isolated areas. This review aims to discuss water pollution and sanitation's existing condition, health, and environmental impacts, alongside its management and challenges in Indonesia. The systematic review approach was utilized to ensure transparency and replicability, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Many water sources in Indonesia are contaminated by various pollutants such as heavy metals, microplastics, pesticides, and endocrine-disrupting chemicals (EDCs). Moreover, the existing water and wastewater treatment plants cannot completely remove pollutants, including bacteria that cause waterborne diseases. The lack of proper sanitation facilities, including toilets and latrines, is not only reported in rural areas but also in peri-urban regions of Indonesia. This situation forces many to rely on unimproved water sources, such as river water, for their daily use and engage in open defecation, which may increase the risk of direct exposure to waterborne contaminants. Insufficient sanitation has been linked to significant public health issues in Indonesia, including maternal health complications, childhood stunting, and an increased incidence of waterborne diseases such as diarrhea. Based on the findings of this review, Indonesia still needs to improve its sanitation and water treatment facilities, as well as reduce pollution of the aquatic environment. This condition not only illustrates the condition of water and sanitation in Indonesia but can also be used as an illustration of how developing countries face various pollution and sanitation problems during the massive development and industry.

Evidence on designing sanitation interventions

Sanitation is a public good, the responsibility for which is shared between households and the government. Interventions in the sector, therefore, must be designed with an eye toward reducing crowd out. We discuss the new findings on sanitation provision from the 12 papers in this special issue in the context of a simple model of household choice of levels of sanitation investment in the face of joint responsibility between the government and households over sanitation. The model provides micro-foundations for understanding when we should be particularly concerned about the potential for crowd-out together with intuition for the implications of the choice of intervention design between information, in-kind transfers, cash transfers, and subsidies. We use the framework of the model to discuss the findings of the papers in this special issue.

Financial incentives for sanitation take-up: A randomized control trial in rural Vietnam

This study assesses the impact of financial incentives on hygienic latrine ownership by poor/near-poor households in Vietnam. Rural communes were randomly assigned to a control group and three treatment arm groups: (T1) a rebate for households that installed a hygienic latrine; (T2) a financial reward for commune governments if the proportion of hygienic latrines in their commune increased by 30 percentage points; (T3) both a household rebate and a commune reward. We find a strong and positive effect from the household rebate (treatment arms 1 and 3) but an insignificant effect from the commune reward (treatment arm 2) on household ownership of a septic tank latrine. Our analysis provides suggestive evidence that microcredit is a channel through which a rebate encourages the installation of septic tank latrines. We also find that treatment arm 3 increases people's knowledge regarding sanitation and the availability of water and soap for handwashing within households.

The impact of welfare on maternal investment and sibling competition: evidence from Serbian Roma communities

Siblings compete for limited parental resources, which can result in a trade-off between family size and child growth outcomes. Welfare incentives may improve parental circumstances in large families by compensating for the additional costs of an extra child and increasing the resources available to a family. The improvements in conditions may influence parents to increase their investment, expecting greater returns from the investment in child survival and development, while in turn increase sibling competition for the investment. This study assessed whether welfare benefits have influenced parental investment trade-offs and competition between siblings among Serbian Roma, a population largely dependent on welfare. Using data from the UNICEF Multiple Indicator Cluster Survey 6, this study assessed the associations between maternal investment, child cash benefits, sibship size, and child anthropometry, as an indicator of health, among 1096 Serbian Roma children aged 0 to 59 months. Living in a small family benefited Roma children, while the incentives increased competition between siblings. Maternal investment was negatively associated with incentives, as the improvements brought about were insufficient to influence a change in maternal perceptions about the local setting uncertainty and thus promote an increase in investment.