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Usage and Health Impact of Toilets: Evidence from a Nationwide Sanitation Program in India

Author

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  • Dar, Shahid Majeed
  • Vellakkal, Sukumar

Abstract

Uptake of toilets has long been a challenge in India, where 60% of households practice open defecation, affecting the environment, health, and well-being. We study the impact of India’s Swachh Bharat Mission (SBM), a nationwide sanitation program launched in 2014, on the practice of open defecation and sanitation-related diseases using national-level representative data. Exploiting the political alignment of locally elected representatives in close elections as an instrumental variable, we find that the SBM reduced household open defecation by 8.5 percentage points and lowered the prevalence of sanitation-related diseases by 4.3 percentage points. The possible mechanisms driving our results are changes in the personnel preferences for toilet usage and hygiene habits. Our results are robust to other identification approaches and choice of controls.

Suggested Citation

  • Dar, Shahid Majeed & Vellakkal, Sukumar, 2025. "Usage and Health Impact of Toilets: Evidence from a Nationwide Sanitation Program in India," Economic Analysis and Policy, Elsevier, vol. 88(C), pages 1652-1669.
    • Handle: RePEc:eee:ecanpo:v:88:y:2025:i:c:p:1652-1669
    DOI: 10.1016/j.eap.2025.10.048
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    References listed on IDEAS

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    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • O18 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Urban, Rural, Regional, and Transportation Analysis; Housing; Infrastructure

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