How India’s Swachh Bharat Abhiyan is Quietly Saving Thousands of Lives Every Year: The Hidden Impact of Toilet Access

Introduction

Sanitation is one of the most crucial determinants of public health, especially in developing countries like India, where the lack of proper sanitation facilities has historically led to serious health issues, including child and infant mortality. When Prime Minister Narendra Modi launched the Swachh Bharat Abhiyan (Clean India Mission) on October 2, 2014, the primary objective was to make India open defecation-free (ODF) by improving access to toilets across the country. What started as a sanitation initiative has evolved into a life-saving mission. According to research published in Nature and Scientific Reports, this national initiative may have saved between 60,000 and 70,000 infant lives annually from 2014 to 2020 by significantly reducing open defecation and its associated risks.

This article delves into how Swachh Bharat Abhiyan has made a life-saving impact, particularly for infants and children, and what the future holds for this transformative mission.

The Swachh Bharat Abhiyan: A Brief Overview

The Swachh Bharat Abhiyan was launched in 2014 with an ambitious target: to eliminate open defecation by 2019, which marked the 150th birth anniversary of Mahatma Gandhi. The mission focused on constructing toilets in rural and urban areas, creating sanitation awareness, and instilling behavioral changes to ensure long-term sustainability. By 2019, the government declared that over 600,000 villages and 109 million household toilets had been built, helping India reach open defecation-free status.

This large-scale movement involved not just government initiatives but also active participation from the public, celebrities, and NGOs. It quickly became a mass movement for a cleaner India. But behind the symbolic brooms and the rhetoric of cleanliness, the mission has quietly transformed public health, particularly for infants and young children.

How Poor Sanitation Contributes to Infant Mortality

Before Swachh Bharat Abhiyan, India struggled with a high rate of open defecation, especially in rural areas where about 60% of the population practiced it. Open defecation is linked to numerous health risks, primarily because it contaminates water sources and the environment, increasing exposure to harmful pathogens. These pathogens lead to the spread of diseases such as diarrhea, cholera, and other infections, which are particularly fatal for infants and young children whose immune systems are still developing.

One significant aspect of poor sanitation is its role in child stunting. Stunting, or reduced growth rate in children, is often caused by chronic malnutrition exacerbated by infections related to poor sanitation. This phenomenon, known as the “Asian Enigma,” was particularly evident in India, where child stunting rates were higher than in other countries with similar economic conditions. Researchers attributed this to widespread open defecation, which exposed children to repeated bouts of diarrhea, leading to malnutrition and inhibited growth.

Swachh Bharat Abhiyan’s Life-Saving Impact

A detailed study by public health researchers from the International Food Policy Research Institute (IFPRI), University of California, and The Ohio State University analyzed data from 35 Indian states and 640 districts over a 10-year period (2011–2020). The findings were remarkable:

1. Reduction in Infant Mortality Rate (IMR): Districts that constructed more than 30% of their toilets under the Swachh Bharat Mission saw 5.3 fewer infant deaths per 1,000 births. On a national scale, this translated to 60,000–70,000 infant lives saved annually. The study indicated that for every 10% increase in toilet coverage, the infant mortality rate dropped by 0.9 points.
2. Reduction in Child Mortality Rate: The campaign also contributed to reducing under-five mortality rates, with 6.8 fewer deaths per 1,000 births in districts that embraced the toilet construction initiative.
3. Accelerated Decline in Mortality: During the post-SBM period (2014–2020), the annual decline in infant mortality was 8%–9% higher than in the pre-SBM period (2000–2014). This means that SBM drastically accelerated the decline in both infant and child mortality rates.
4. Access to Toilets: There was a twofold increase in toilet availability, and open defecation dropped from 60% to 19% in just five years of the campaign. This massive improvement in sanitation infrastructure played a direct role in reducing disease exposure, particularly for children who are more vulnerable to infections and diarrhea caused by poor sanitation.

The Public Health Benefits of Improved Sanitation

The success of the Swachh Bharat Mission underscores the crucial link between sanitation and public health. Improved sanitation leads to:

• Better water quality: Reduced contamination of drinking water sources.
• Reduction in waterborne diseases: Preventing the spread of diseases like cholera, diarrhea, and dysentery, which are often fatal for infants.
• Decreased malnutrition rates: As children face fewer infections, their bodies can absorb nutrients more efficiently, reducing rates of malnutrition and stunting.

Addressing the “Asian Enigma” and Child Stunting

The “Asian Enigma,” which refers to higher child stunting rates in India despite economic growth, has been a perplexing issue for researchers. The Swachh Bharat Abhiyan provided a concrete solution to this problem. With reduced open defecation, there were fewer instances of diarrheal infections among children, which in turn improved their overall health and nutrition absorption. By addressing the root cause—sanitation—the program helped mitigate one of the most stubborn challenges in child development.

The Road Ahead: Swachh Bharat Abhiyan Phase II

Although India was declared open defecation-free in 2019, the journey of the Swachh Bharat Abhiyan is far from over. Phase II of the mission, also known as “Swachh Bharat Mission (Grameen) 2.0,” focuses on ensuring that the gains made are sustainable. This phase emphasizes:

• Solid and liquid waste management in rural areas.
• Promoting ODF Plus villages, which means not just eliminating open defecation but also improving overall cleanliness through waste management practices.

By ensuring that villages maintain their open defecation-free status and manage their waste effectively, the government aims to cement the public health benefits of improved sanitation for the long term.

Conclusion

The Swachh Bharat Abhiyan is much more than a campaign for a cleaner India. It is a life-saving mission that has directly contributed to reducing infant and child mortality by tackling one of the root causes—poor sanitation. With estimates suggesting that 60,000–70,000 infant lives are saved each year due to this mission, it is clear that the initiative has had a transformative impact on public health. As the mission enters its second phase, the focus on sustainability and waste management will be crucial in ensuring that these life-saving benefits continue for future generations.

The story of Swachh Bharat Abhiyan is a powerful example of how focused government policies can save lives and improve health outcomes on a national scale.