The positive effects of improved sanitation in India

From a paper by Dean Spears & Sneha Lamba on a sanitation campaign in India 

The abstract 

Early life health and net nutrition shape childhood and adult cognitive skills and human capital. In poor countries -- and especially in South Asia -- widespread open defecation without making use of a toilet orlatrine is an important source of childhood disease. This paper studies the effects on childhood cognitive achievement of early life exposure to India's Total Sanitation Campaign, a large government program that encouraged local governments to build and promote use of inexpensive pit latrines. In the early years of the program studied here, the TSC caused six-year-olds exposed to it in their first year of life to be more likely to recognize letters and simple numbers. The results suggest both that open defecation is an important threat to the human capital of the Indian labor force, and that a program feasible to low capacity governments in developing countries could improve average cognitive skills.

From the conclusions

Our findings suggest that even a low capacity government can implement a relatively inexpensive program that will cause an important improvement in cognitive skills, given the context of widespread open defecation. The program we study was imperfect: much open defecation remains even after the end of a decade of the TSC. However, open defecation may be so harmful for early-life physical and cognitive development that even an imperfect and incomplete improvement in sanitation can have important effects.

Child Height and Sanitation (India)

From a very interesting paper by Dean Spears (January 2013).

Physical height is an important economic variable reflecting health and human capital. Puzzlingly, however, differences in average height across developing countries are not well explained by differences in wealth. In particular, children in India are shorter, on average, than children in Africa who are poorer, on average, a paradox called "the Asian enigma" which has received much attention from economists. This paper provides the first documentation of a quantitatively important gradient between child height and sanitation that can statistically explain a large fraction of international height differences. This association between sanitation and human capital is robustly stable, even after accounting for other heterogeneity, such as in GDP. The author applies three complementary empirical strategies to identify the association between sanitation and child height: country-level regressions across 140 country-years in 65 developing countries; within-country analysis of differences over time within Indian districts; and econometric decomposition of the India-Africa height differences in child-level data. Open defecation, which is exceptionally widespread in India, can account for much or all of the excess stunting in India.

“No Toilet, No Bride”

Female bargaining power in rural Haryana, as in much of northern India, is con- strained by widespread discrimination against women. In recent years, however, women successfully demand private sanitation facilities from potential husbands as a precondi- tion for marriage. I study this manifestation of bargaining power by modeling latrine adoption as an investment that males can make to improve their desirability on the mar- riage market, and I show that increasing proportions of females with strong sanitation preferences drive male investment in toilets. Moreover, I demonstrate women’s ability to secure latrines increases when they are relatively scarce in a marriage market. I test these predictions empirically by studying a sanitation program in Haryana, India, known col- loquially as “No Toilet, No Bride”. Using a triple difference empirical strategy based on households with and without marriageable boys, in Haryana and comparison states, be- fore and after program exposure, I provide evidence that male investment in sanitation increased by 15% due to the program. Further, the program effect is four times larger in marriage markets where women are scarce (26%) as compared to marriage markets where women are abundant (6%). These results suggest the relative scarcity of women in Haryana has, conditional on women surviving to marriageable age, improved the ability of the remaining women to secure valuable goods.

That is from the paper "The Bargaining Power of Missing Women: Evidence from a Sanitation Campaign in India" by Yaniv Stopnitzky March (2011).