Sanitation and Stunting: How Much International Variation in Child Height can Open Defecation Explain?

January 2013

A child’s height is one of the most important indicators of his or her wellbeing. Height reflects the accumulated total of early-life health and diseases. Because problems that prevent children from growing tall also prevent them from growing into healthy, productive, smart adults, height predicts adult economic outcomes.

Researchers studying height have long been puzzled by a paradox: among developing countries, differences in average height are not very well explained by differences in income. In particular, children in India are shorter, on average, than children in sub-Saharan Africa, even though Indians are richer on average. What could explain this paradox?

Because addressing widespread stunting is a health and economic policy priority, understanding determinants of children’s height is important. This note explores evidence for one possible explanation: open defecation. More than a billion people worldwide defecate openly without using a toilet or latrine. India, with some of the world’s worst stunting, also has one of the very highest rates of open defecation.

Additional details

PublisherWorld Bank
RegionSouth Asia
ThemesHealth, Sanitation and health impacts

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