How Water and Sanitation Drive Development: Links to Poverty, Education, and Health

Turn a tap and water flows. Flush a toilet and waste disappears. For millions across the country, these two simple acts remain out of reach, and that absence quietly shapes almost every other measure of human development. Access to clean water and decent sanitation is not just a public health issue. It influences how much a family earns, whether a girl finishes school, whether a child survives past the age of five, and whether women can step beyond the daily grind of household survival. Understanding this web of connections is essential for anyone studying development today.

Why water and sanitation sit at the heart of development
From the MDGs to the SDGs: a quick journey
Water, sanitation, and poverty
The classroom effect: how water and sanitation drive primary education
Why girls suffer disproportionately
The Right to Education link
Water, gender equality, and the silent burden on women
The opportunity cost of carrying water
Safety, dignity, and toilets
Child and maternal health: the survival link
Maternal mortality and unclean births
Putting the pieces together

Why water and sanitation sit at the heart of development

When the United Nations launched the Millennium Development Goals (MDGs) in 2000, water and sanitation were placed under Goal 7 on environmental sustainability. Target 7C specifically called for halving the proportion of people without sustainable access to safe drinking water and basic sanitation by 2015. On paper, this looked like one isolated environmental target. In practice, it turned out to be a hinge that swung open progress on almost every other goal.

Researchers studying the MDGs found that access to water and sanitation was crucial to reducing poverty and infant mortality, improving maternal health, advancing gender equality, and expanding educational opportunities for girls. The same pattern carried over to the Sustainable Development Goals that replaced the MDGs in 2015. Experts on water, sanitation, and hygiene (WASH) now openly state that without progress on SDG 6, none of the other goals can be fully achieved. Clean water touches food security, health, dignity, and economic productivity all at once.

To see why, it helps to look at what unsafe water and poor sanitation cost a society. Globally, more than 300,000 children under five die every year from diarrhoeal diseases linked to poor sanitation, unsafe water, or weak hygiene, amounting to over 800 deaths each day. That is not a small public health blip. It is a developmental drag that pulls down household incomes, school enrolment, and women’s wellbeing all at the same time.

From the MDGs to the SDGs: a quick journey

The MDG framework set the baseline. Between 1990 and 2015, hundreds of millions of people gained access to improved drinking water sources, and many countries managed to halve the unserved population. India was central to this story. According to research published by the Global Water Forum, a large developing country like India was critical to meeting the MDG water and sanitation target simply because of its population size.

However, progress was uneven. The MDG indicator measured “improved” sources rather than truly “safe” ones, and several scholars have argued that this overstated the real gains. The Sustainable Development Goals tried to fix this. SDG 6 now demands universal and equitable access to safely managed water and sanitation by 2030, not just halved deprivation. SDG 6 is recognised as essential because it directly affects SDGs on poverty eradication, hunger, healthy lives, quality education, gender equality, sustainable cities, and ecosystems.

Water, sanitation, and poverty

Poverty is rarely caused by one factor, but lack of water and sanitation worsens every other deprivation. Households without piped water spend money buying water from vendors, lose work hours to illness, and pay medical bills for preventable infections. A UNICEF study estimated that for Indian households with access to a toilet under the Swachh Bharat Mission, the aggregate annual time saved on travel for defecation and reduced illness was valued at around USD 382 per household per year. That is a meaningful sum for low-income families.

When children stay healthy, parents miss fewer workdays. When women do not spend hours fetching water, they can take up paid work, run small enterprises, or care for younger children. The poverty-WASH link runs both ways: poor households are more likely to lack services, and lacking services keeps them poor.

The classroom effect: how water and sanitation drive primary education

One of the most striking development links is the one between school toilets and learning outcomes. The relationship is simple. If a child has to walk an hour to fetch water for the family before school, she arrives late or not at all. If her school has no functioning toilet, she stays home, especially after puberty. If she falls sick from contaminated water, she misses class. Multiply this across millions of students and the impact on a country’s education statistics becomes enormous.

Why girls suffer disproportionately

Research on Indian schools has been unambiguous on this point. According to UNICEF India, water, sanitation, and hygiene in schools contributes to more children attending school and learning, while preventing the transmission of communicable diseases. The effect is most pronounced for girls.

A detailed field study published by Ideas for India found that teenage girls cited privacy, safety, and menstrual hygiene as reasons for skipping school, sometimes missing so many days each month that they were eventually expelled. The same research traced the impact of the School Sanitation and Hygiene Education programme launched in 1999, which built latrines in rural schools and produced an immediate jump in girls’ attendance.

Menstrual hygiene management is the often-unspoken driver. A girl who has no private, safe, lockable toilet at school will skip several days every month during her period. Over a year, that adds up to weeks of missed lessons. Over the course of secondary school, it can mean dropping out altogether. The UN Department of Economic and Social Affairs notes that WASH programmes in schools have profound impact on the learning interest of children, especially girls, who are otherwise vulnerable to dropout.

The Right to Education link

This is why the Right to Education Act of 2009 explicitly mandates basic WASH facilities, including separate toilets for girls and boys, in every school. The Swachh Bharat Swachh Vidyalaya initiative under the Ministry of Education built on this, pushing schools to upgrade toilets and handwashing facilities. The evidence from these programmes is consistent: better WASH in schools means better enrolment, better attendance, and lower dropout rates.

A recent analysis in ScienceDirect on Indian states found that improved water access is associated with higher literacy and lower school dropout rates, particularly among girls. States that invested early in school WASH consistently outperformed others on basic education indicators.

Water, gender equality, and the silent burden on women

Few development issues capture gender inequality as starkly as the daily walk for water. In households without water on the premises, the responsibility of fetching it falls overwhelmingly on women and girls. A landmark UNICEF-WHO report in 2023 confirmed that women and girls aged 15 and older are primarily responsible for water collection in seven out of ten households without water on premises, compared with three in ten for their male peers.

The same report observed that girls under 15 are nearly twice as likely as boys to fetch water for their families. The consequences are measurable. Time spent collecting water is time not spent in school, on paid work, on caregiving, or on rest. The UN-Water briefing on gender notes that long journeys to fetch water often preclude women and girls from school or earning an income, while exposing them to risks of attack.

The opportunity cost of carrying water

The physical toll is real too. Public health researchers have documented spinal injury, neck pain, spontaneous abortion from heavy loads, and high caloric expenditure linked to women’s water-fetching responsibilities. A piped connection at home, therefore, is not just a convenience. It is a structural intervention that reshapes how a woman uses her time, protects her body, and participates in the economy.

India’s Jal Jeevan Mission, launched in 2019 with the aim of providing tap water connections to every rural household, is one of the most ambitious gender-equality interventions in the country, even though it is officially a water programme. By cutting collection time, it frees up hours for women that previously vanished into queues at handpumps.

Safety, dignity, and toilets

Sanitation access shapes gender equality in another, more sobering way. When women have no toilet at home, they wait until dark to relieve themselves outdoors, which exposes them to harassment and assault. A study cited in research on India’s progress on SDG 6 found that household toilets reduced the scope of sexual assaults on women by 65 percent in 2018, alongside major improvements in women’s self-reported sense of self-respect and stress reduction. A toilet, in other words, is a safety device, not just a sanitation facility.

Child and maternal health: the survival link

Where water and sanitation fail, children die. Diarrhoea remains one of the leading causes of death among children under five. It is also a major driver of chronic malnutrition and stunting, because repeated bouts of diarrhoea and gut infections prevent the absorption of nutrients during the critical first 1,000 days of life.

The World Bank notes that poor WASH is associated with under-5 mortality and childhood stunting, and that childhood stunting carries lifelong economic costs, including an estimated 22 percent loss in adult yearly income from being stunted in childhood. Stunting also propagates across generations: stunted women are more likely to have stunted children. This means inadequate WASH today shapes the productivity of the next generation.

Maternal mortality and unclean births

Maternal health is equally tied to water and sanitation. According to UN-Water, around 1 million deaths each year are associated with unclean births, with infections accounting for 26 percent of neonatal deaths and 11 percent of maternal mortality. A delivery room without running water or a clean toilet is a delivery room where preventable infections take lives. Investments in health facility WASH are therefore investments in maternal survival.

The relationship even extends to nutrition. When children are repeatedly sick, they cannot benefit from food programmes or supplements. This is why interventions like the Swachh Bharat Mission have positioned toilet construction not just as a hygiene effort but as part of a broader strategy to improve child nutrition and survival.

Putting the pieces together

The water-sanitation-development relationship is not a single line. It is a network. A girl who does not have to walk three kilometres for water goes to school. A school with a clean, private toilet keeps her enrolled through her teenage years. A literate woman with a tap at home and a household toilet earns more, has fewer sick days, and raises healthier children. Her children, in turn, attend school regularly because they are not constantly battling diarrhoea or skipping class to help fetch water. Twenty years later, the family is out of poverty.

This is why the global development community treats water and sanitation as foundational rather than peripheral. They are inputs into almost every other developmental outcome. Investments here pay dividends across health, education, gender equality, and economic productivity simultaneously. Cuts here, similarly, ripple outwards into worse health and weaker schools.

For students of population and family health, this is one of the clearest illustrations of how interconnected development really is. You cannot fix child mortality without fixing water. You cannot empower women without fixing sanitation. You cannot raise school completion rates for girls without fixing both. The textbook may treat these as separate units, but in the field they are inseparable.

What do you think? Looking at your own neighbourhood or hometown, which of these links between water, sanitation, and development do you see most clearly, and which one is most invisible? If you had to pick one intervention to fund first, would you build household toilets, install piped water at home, or upgrade school sanitation, and why?

References

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How Water and Sanitation Drive Development: Links to Poverty, Education, and Health

Table of Contents

Why water and sanitation sit at the heart of development 🔗

From the MDGs to the SDGs: a quick journey 🔗

Water, sanitation, and poverty 🔗

The classroom effect: how water and sanitation drive primary education 🔗

Why girls suffer disproportionately 🔗

The Right to Education link 🔗

Water, gender equality, and the silent burden on women 🔗

The opportunity cost of carrying water 🔗

Safety, dignity, and toilets 🔗

Child and maternal health: the survival link 🔗

Maternal mortality and unclean births 🔗

Putting the pieces together 🔗