Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep:146:102277.
doi: 10.1016/j.jdeveco.2018.08.003.

Exposure to open defecation can account for the Indian enigma of child height

Dean Spears  1   2   3   4
Affiliations

Exposure to open defecation can account for the Indian enigma of child height

Dean Spears. J Dev Econ. 2020 Sep.

Abstract

Physical height is an important measure of human capital. However, differences in average height across developing countries are poorly explained by economic differences. Children in India are shorter than poorer children in Africa, a widely studied puzzle called "the Asian enigma." This paper proposes and quantitatively investigates the hypothesis that differences in sanitation - and especially in the population density of open defecation - can statistically account for an important component of the Asian enigma, India's gap relative to sub-Saharan Africa. The paper's main result computes a demographic projection of the increase in the average height of Indian children, if they were counterfactually exposed to sub-Saharan African sanitation, using a non-parametric reweighting method. India's projected increase in mean height is at least as large as the gap. The analysis also critically reviews evidence from recent estimates in the literature. Two possible mechanisms are effects on children and on their mothers.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
The enigma: Height in India and Africa.
Fig. 2
Fig. 2
Within-region sanitation gradients can account for India-Africa gap.
Fig. 3
Fig. 3
Empirical and reweighted CDFs of child height-for-age, by sex.
Fig. 4
Fig. 4
Empirical and reweighted average height-for-age, by mother's fertility.
See this image and copyright information in PMC

References

    1. Alderman Harold, Linnemayr Sebastian. Anemia in low-income countries is unlikely to be addressed by economic development without additional programs. Food Nutr. Bull. 2009;30(3):265–269. - PubMed
    1. Alsan Marcella, Goldin Claudia. National Bureau of Economic Research; 2015. Watersheds in Infant Mortality: the Role of Effective Water and Sewerage Infrastructure, 1880 to 1915. working paper. - PMC - PubMed
    1. Arnold Benjamin F., Null Clair, Luby Stephen P., Unicomb Leanne, Stewart Christine P., Dewey Kathryn G., Ahmed Tahmeed, Ashraf Sania, Christensen Garret, Clasen Thomas. Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ Open. 2013;3(8) - PMC - PubMed
    1. Baird Sarah, Hicks Joan Hamory, Kremer Michael, Miguel Edward. 2011. Worms at Work: Long-run Impacts of Child Health Gains. working paper, Berkeley. - PMC - PubMed
    1. Barcellos Silvia Helena, Carvalho Leandro S., Lleras-Muney Adriana. Child gender and parental investments in India: are boys and girls treated differently? Am. Econ. J. Appl. Econ. 2014;6(1):157–189. - PMC - PubMed

References cited in the online Appendix A. Supplementary data

    1. Black Sandra, Paul Devereux, Salvanes Kjell. NBER; 2015. Healthy(?), Wealthy, and Wise: Birth Order and Adult Health. working paper 21337. - PubMed
    1. Duflo Esther, Greenstone Michael, Guiteras Raymond, Clasen Thomas. National Bureau of Economic Research; 2015. Toilets Can Work: Short and Medium Run Health Impacts of Addressing Complementarities and Externalities in Water and Sanitation. Technical report.
    1. Fink Günther, Günther Isabel, Hill Kenneth. “The effect of water and sanitation on child health: evidence from the demographic and health surveys 1986–2007. Int. J. Epidemiol. 2011;40(5):1196–1204. - PubMed
    1. Humphrey Jean H., Jones Andrew D., Manges Amee, Goldberg Mangwadu, Maluccio John A., Mbuya M.N., Moulton Lawrence H., Ntozini Robert, Prendergast Andrew J., J Stoltzfus Rebecca. The sanitation hygiene infant nutrition efficacy (SHINE) trial: rationale, design, and methods. Clin. Infect. Dis. 2015;61(Suppl. 7):S685–S702. - PMC - PubMed
    1. Kumar Santosh, Vollmer Sebastian. Does access to improved sanitation reduce childhood diarrhea in rural India? Health Econ. 2013;22(4):410–427. - PubMed

LinkOut - more resources