How much international variation in child height can sanitation explain?

Abstract Physical height is an important economic variable reflecting health and human capital. Puzzlingly, however, differences in average height across developing countries are not well explained by differences in wealth. In particular, children in India are shorter, on average, than children in Africa who are poorer, on average, a paradox which is often called “the Asian enigma.” The primary contribution of this paper is to document that cross-country variation in sanitation statistically explains a large and important fraction of international height differences. Over a billion people worldwide – and more than half of Indian households – defecate openly without using a toilet or latrine, introducing germs into the environment that cause disease and stunt children’s growth. I apply three complementary empirical strategies to Demographic and Health Survey data to identify the fraction due to sanitation: country-level regressions using collapsed DHS surveys; within-country analysis of differences between India’s first and second DHS surveys; and econometric decomposition of the India-Africa height difference in child-level data. Open defecation, which is exceptionally widespread in India, accounts for much of the excess stunting in India.