Why Sanitation Matters for Children’s Health and Development

Sanitation rarely makes for exciting dinner-table conversation, yet for millions of children, it is a matter of life, growth, and learning. A clean toilet, a bar of soap, and safe drinking water might seem like ordinary things, but their absence shapes whether a child survives infancy, grows to her full height, or finishes school. Understanding why sanitation matters so deeply for children means looking past the infrastructure and seeing how it touches every stage of a child’s development, from the gut to the classroom.

How poor sanitation affects child health 🔗

Children, especially those under five, are biologically more vulnerable to the bacteria, viruses, and parasites that thrive in unsanitary environments. Their immune systems are still developing, their bodies are smaller, and even a short bout of illness can have lasting consequences. When toilets, clean water, and handwashing facilities are missing, the result is a cycle of infection that quietly erodes both health and potential.

Diarrhoeal disease: a preventable killer 🔗

Diarrhoea remains one of the leading causes of death among young children in India. The pathway is well documented: human waste contaminates soil and water, which then enters a child’s body through food, fingers, or drinking water. The result is repeated episodes of diarrhoea that drain the body of nutrients and fluids. UNICEF has noted that poor sanitation contributed to nearly 100,000 diarrhoeal deaths among children under five in India in earlier years, a number that reflects how lethal a preventable condition can become when basic facilities are unavailable.

The hidden link to malnutrition and stunting 🔗

For a long time, child stunting in India was blamed almost entirely on food shortage. But researchers began to notice something odd: Indian children were shorter on average than children in sub-Saharan Africa, even though sub-Saharan households were often poorer and less well-fed. This puzzle, sometimes called the “Asian Enigma,” pointed to sanitation as a missing piece. Researchers gathered in New Delhi to make the case that diseases from poor sanitation, not diet alone, were driving stunted growth.

The mechanism is straightforward but cruel. The World Health Organization estimates that around 50 per cent of malnutrition is associated with repeated diarrhoea or intestinal worm infections linked to unsafe water and poor hygiene. Repeated infection inflames the gut lining, a condition known as environmental enteropathy, which prevents the body from absorbing nutrients even when food is plentiful. A child can eat enough calories and still grow up stunted because her gut is too damaged to use what she eats.

Intestinal worms and chronic infection 🔗

Open defecation introduces tonnes of faecal matter into the environment every day, exposing children to parasites such as roundworms, hookworms, and whipworms. These worms feed off the nutrients in a child’s intestine and cause chronic anaemia. A spatial study of under-five diarrhoea in India found that children living in homes with unsafe stool disposal practices had significantly higher rates of stunting and mortality, a finding that confirms what paediatricians have observed for years: sanitation is not separate from nutrition, it is part of it.

Hygiene in schools: where health meets learning 🔗

Schools are where the impact of sanitation becomes most visible in everyday life. A child who is sick cannot attend class. A child without a clean toilet at school may simply stop coming. For girls especially, the absence of private and functional toilets can quietly end an education long before any exam is failed.

The state of school sanitation 🔗

Even after years of investment, gaps remain. UNICEF reports that nearly half of all schools in India still lack adequate water and sanitation facilities, particularly in rural areas. Earlier surveys found that 22 per cent of schools did not have appropriate toilets for girls, and a striking 58 per cent of preschools had no toilet at all. The national norm of one toilet for every 50 students is far from being met in many districts.

Why attendance rises when sanitation improves 🔗

The connection between toilets and attendance is not theoretical. When schools install functional, separate toilets for boys and girls along with handwashing facilities, attendance climbs and dropout rates fall. A case study from a middle school in Jharkhand described how children, especially girls, regularly missed school due to waterborne illness and the lack of usable toilets. After WASH facilities were upgraded, school attendance rose and absenteeism due to illness dropped sharply. The principle is simple: a school that protects its students’ dignity and health is a school they want to attend.

The girl child question 🔗

For adolescent girls, sanitation is intertwined with menstrual hygiene. Without private toilets, water for washing, a place to change, and a way to dispose of sanitary pads, girls often stay home for several days each month, fall behind in class, or drop out altogether. Studies from India and Nepal indicate that when girls have access to clean toilets and water at school, they are less likely to miss classes during menstruation. The presence of safe, girl-friendly toilets is therefore not a comfort but a precondition for gender equality in education.

Handwashing: the smallest habit with the biggest return 🔗

Handwashing with soap is one of the cheapest and most effective public health interventions ever measured. A UNICEF-supported survey found that only 53 per cent of schoolchildren washed their hands with soap, a gap that translates into preventable illness, absenteeism, and lost learning days. When schools build group handwashing stations and make soap a daily ritual, rates of diarrhoea and respiratory infection fall. The habit, once learned, often travels home with the child and influences family behaviour.

The long-term benefits of better sanitation 🔗

Improvements in sanitation pay back over decades. A healthy childhood is the foundation for a productive adulthood, and the gains in survival, growth, and learning compound across generations.

Lives saved at scale 🔗

India’s Swachh Bharat Mission, launched in 2014, became the world’s largest sanitation drive. A study published in Nature analysed data from over 600 districts and found that the programme averted between 60,000 and 70,000 infant deaths annually, with districts where more than 30 per cent of toilets were built under the mission seeing 5.3 fewer infant deaths and 6.7 fewer under-five deaths per 1,000 live births. The World Health Organization separately estimated that improved sanitation under the mission prevented around 300,000 deaths and avoided 14 million Disability-Adjusted Life Years between 2014 and 2019.

Better growth, better learning, better futures 🔗

Children who escape repeated infection in their first thousand days grow taller, develop stronger immune systems, and perform better in school. A spatiotemporal study of malnutrition in India found a strong association between improved sanitation and reductions in stunting, wasting, and underweight. Cognitive development tracks closely with physical growth in early childhood, so a child spared from chronic gut infection is also a child better equipped to read, count, and reason.

Economic and social returns 🔗

The economic case for sanitation is equally striking. A UNICEF study found that families living in open-defecation-free villages reported annual health-related savings of approximately ₹50,000 per household through reduced medical expenses, fewer lost workdays, and higher property values. Multiplied across millions of households, this represents a quiet but enormous transfer of wealth from disease to development.

Behaviour change as a lasting legacy 🔗

Infrastructure alone is not enough. The most durable gains come from behaviour change: the habit of using a toilet, washing hands, treating drinking water, and managing menstrual hygiene safely. WASH programmes across South Asia have shown that even seven to nine years after a project ends, around four out of five women continued to use the practices they learned. Schools play a critical role here because children become messengers of hygiene, carrying lessons home to parents and younger siblings.

What still needs to change 🔗

Despite genuine progress, the work is far from over. Functionality, not just availability, is the next frontier. A toilet that exists but has no water, no door, or no maintenance staff is not really a toilet. Cleaning staff are absent in many schools, and broken handwashing stations are common. Urban slums, migrant settlements, and tribal areas still face acute gaps. Menstrual hygiene infrastructure, including incinerators and disposal systems for sanitary pads, remains uneven. The next decade of progress will depend on sustained operation and maintenance, behaviour change, and an honest acknowledgement that sanitation is not a one-time construction project but a continuous public service.

What do you think? If a single intervention could reduce child deaths, raise school attendance, and improve learning outcomes all at once, why does sanitation still struggle for political and household attention? And in your own community, which is the bigger gap today, the absence of facilities or the absence of habits that keep them clean and used?

References

1. https://www.unicef.org/india/what-we-do/water-sanitation-hygiene
2. https://world.time.com/2013/09/09/poor-sanitation-not-malnutrition-may-be-to-blame-for-indias-notoriously-stunted-children/
3. https://www.prb.org/resource/water-sanitation-hygiene-and-malnutrition-in-india/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC6597875/
5. https://www.unicef.org/india/what-we-do/clean-india-clean-schools
6. https://nirdpr.org.in/crru/docs/wash/WASHinSchoolsUNICEFBooklet_10212016112324AM.pdf
7. https://egov.eletsonline.com/2022/08/correlation-between-improved-sanitation-infrastructure-in-schools-and-girl-child-education-in-achieving-sdg-6-2/
8. https://varthana.com/school/10-facts-about-water-sanitation-and-hygiene-in-indian-schools/
9. https://www.newsecuritybeat.org/2024/12/swachh-bharat-mission-intended-and-unintended-consequences/
10. https://www.indiawaterportal.org/health-and-sanitation/sanitation/the-sanitation-child-malnutrition-nexus-in-india
11. https://www.unicef.org/india/media/1206/file/Financial-and-Economic-Impacts.pdf