Effects of Rural Sanitation on Infant Mortality and Human Capital: Evidence from India’s Total Sanitation Campaign

Open defecation without a toilet or latrine is among the leading global threats to health, especially in India. Although it is well-known that modern sewage infrastructure improves health, it is unknown whether a sanitation program feasible for a low capacity, poor country government could be effective. This paper contributes the first causally identified estimates of effects of rural sanitation on health and human capital accumulation. The Indian government’s Total Sanitation Campaign reports building one household pit latrine per ten rural persons from 2001 to 2011. The program offered local governments a large ex post monetary incentive to eliminate open defecation. I use several complementary identification strategies to estimate the program’s effect on children’s health. First, I exploit variation in program timing, comparing children born in different years. Second, I study a long difference-in-differences in aggregate mortality. Third, I exploit a discontinuity designed into the monetary incentive. Unlike many impact evaluations, this paper studies a full-scale program implemented by a large government bureaucracy with low administrative capacity. At the mean program intensity, infant mortality decreased by 4 per 1,000 and children’s height increased by 0.2 standard deviations (similar to the cross-sectional difference associated with doubling household consumption per capita). These results suggest that, even in the context of governance constraints, incentivizing local leaders to promote technology adoption can be an effective strategy. ∗[email protected]. Sneha Lamba provided valuable research assistance. I appreciate conversations with staff at the Ministry of Drinking Water & Sanitation, UNICEF, and the World Bank WSP and with district and village officials. Thanks to Farzana Afridi, Radu Ban, Robert Chambers, Tom Classen, Janet Currie, Angus Deaton, Taryn Dinkelman, Josephine Duh, Sebastian Galiani, Jacob Goldin, Raymond Guiteras, Avinash Kishore, Susanna Makela, Doug Miller, Mushfiq Mobarak, Abhiroop Mukhopadhyay, John Papp, Manisha Shah, Yaniv Stopnitzky, Tom Vogl, Alix Zwane; to seminar participants at ISI Delhi, Princeton, the Gates Foundation, and the World Bank; and especially to Anne Case, Diane Coffey, Michael Geruso, and Jeff Hammer. Remaining errors are my own.