Publication: Effects of Early-Life Exposure to Sanitation on Childhood Cognitive Skills : Evidence from India's Total Sanitation Campaign
Loading...
Date
2013-10
ISSN
Published
2013-10
Author(s)
Editor(s)
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 or latrine 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.
Link to Data Set
Citation
“Spears, Dean; Lamba, Sneha. 2013. Effects of Early-Life Exposure to Sanitation on Childhood Cognitive Skills : Evidence from India's Total Sanitation Campaign. Policy Research Working Paper;No. 6659. © World Bank. http://hdl.handle.net/10986/16872 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Publication The Future of Poverty(Washington, DC: World Bank, 2025-07-15)Climate change is increasingly acknowledged as a critical issue with far-reaching socioeconomic implications that extend well beyond environmental concerns. Among the most pressing challenges is its impact on global poverty. This paper projects the potential impacts of unmitigated climate change on global poverty rates between 2023 and 2050. Building on a study that provided a detailed analysis of how temperature changes affect economic productivity, this paper integrates those findings with binned data from 217 countries, sourced from the World Bank’s Poverty and Inequality Platform. By simulating poverty rates and the number of poor under two climate change scenarios, the paper uncovers some alarming trends. One of the primary findings is that the number of people living in extreme poverty worldwide could be nearly doubled due to climate change. In all scenarios, Sub-Saharan Africa is projected to bear the brunt, contributing the largest number of poor people, with estimates ranging between 40.5 million and 73.5 million by 2050. Another significant finding is the disproportionate impact of inequality on poverty. Even small increases in inequality can lead to substantial rises in poverty levels. For instance, if every country’s Gini coefficient increases by just 1 percent between 2022 and 2050, an additional 8.8 million people could be pushed below the international poverty line by 2050. In a more extreme scenario, where every country’s Gini coefficient increases by 10 percent between 2022 and 2050, the number of people falling into poverty could rise by an additional 148.8 million relative to the baseline scenario. These findings underscore the urgent need for comprehensive climate policies that not only mitigate environmental impacts but also address socioeconomic vulnerabilities.Publication Exports, Labor Markets, and the Environment(Washington, DC: World Bank, 2025-07-14)What is the environmental impact of exports? Focusing on 2000–20, this paper combines customs, administrative, and census microdata to estimate employment elasticities with respect to exports. The findings show that municipalities that faced increased exports experienced faster growth in formal employment. The elasticities were 0.25 on impact, peaked at 0.4, and remained positive and significant even 10 years after the shock, pointing to a long and protracted labor market adjustment. In the long run, informal employment responds negatively to export shocks. Using a granular taxonomy for economic activities based on their environmental impact, the paper documents that environmentally risky activities have a larger share of employment than environmentally sustainable ones, and that the relationship between these activities and exports is nuanced. Over the short run, environmentally risky employment responds more strongly to exports relative to environmentally sustainable employment. However, over the long run, this pattern reverses, as the impact of exports on environmentally sustainable employment is more persistent.Publication The Macroeconomic Implications of Climate Change Impacts and Adaptation Options(Washington, DC: World Bank, 2025-05-29)Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.Publication The Asymmetric Bank Distress Amplifier of Recessions(Washington, DC: World Bank, 2025-07-11)One defining feature of financial crises, evident in U.S. and international data, is asymmetric bank distress—concentrated losses on a subset of banks. This paper proposes a model in which shocks to borrowers’ productivity dispersion lead to asymmetric bank losses. The framework exhibits a “bank distress amplifier,” exacerbating economic downturns by causing costly bank failures and raising uncertainty about the solvency of banks, thereby pushing banks to deleverage. Quantitative analysis shows that the bank distress amplifier doubles investment decline and increases the spread by 2.5 times during the Great Recession compared to a standard financial accelerator model. The mechanism helps explain how a seemingly small shock can sometimes trigger a large crisis.Publication Impact of Heat Waves on Learning Outcomes and the Role of Conditional Cash Transfers(Washington, DC: World Bank, 2025-07-14)This paper evaluates the impact of higher temperatures on learning outcomes in Peru. The results suggest that 1 degree above 20°C is equivalent to 7 and 6 percent of a standard deviation of what a student learns in a year for math and reading tests, respectively. These results hold true when the main specification is changed, splitting the sample, collapsing the data at school level, and using other climate specifications. The paper aims to improve understanding of how to deal with the impacts of climate change on learning outcomes in developing countries. The evidence suggests that conditional cash transfer programs can mitigate the negative effects of higher temperatures on students’ learning outcomes in math and reading.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Impacts of Interventions during Early Childhood on Later Outcomes(World Bank, Washington, DC, 2015-03-31)In an effort to bridge the evidence gap, the Independent Evaluation Group (IEG) prepared a systematic review that gathers and analyzes the available impact evaluation evidence in developing countries from 1990 to 2013 on whether early childhood interventions shape future outcomes. Its purpose is not to supplant existing evidence but rather to help practitioners understand how evidence from impact evaluations supports or challenges beliefs about interventions and can be used to inform development policy. This review aims to answer two questions: (1) What is the evidence of attributable effects on outcomes in primary school and beyond from interventions in low- and middle-income countries that occur during the early childhood period? and (2) How do the post-early childhood effects of early childhood interventions vary by socioeconomic status, gender, age at intervention, and age at evaluation, particularly during the first 1,000 days from conception to the childs second birthday and from age three to primary school enrollment at age five to six? This report reviews all interventions from developing countries that occur during early childhood for which impact evaluation estimates exist for effects observed at primary school age and older. From an initial search of thousands of studies, the search process which included database searches, hand searches, and snowballing identified more than 500 relevant impact evaluations written from 1990 to 2015. This review covers six areas or domains of human development: physical development, cognitive development, language development, socio-emotional development, schooling outcomes, and employment and labor market outcomes. These domains are commonly included in evaluations of early interventions targeting poor children because they are negatively affected by early poverty, can benefit from early intervention, and are important for overall well-being or adult productivity. Some outcomes can be measured repeatedly starting from early childhood (i.e., height and weight) while others are only measurable later in life (i.e., cognition, schooling, and employment and labor market status).Publication Investing in Young Children : An Early Childhood Development Guide for Policy Dialogue and Project Preparation(World Bank, 2011)Investing in young children is the responsible thing to do. All children deserve a chance to grow into healthy, educated, and competent people, no matter where and when they were born. While parents bear most of the responsibility for raising their children, especially in the early years of life, governments also have an important role during this critical time of human capital accumulation. For example, governments can ensure that all expectant mothers and young children have access to quality health services and nutrition. They can support parents and other caregivers in providing a positive and stimulating environment for children from birth on by promoting parenting information programs, investing in direct services such as home-based visits, funding daycare centers and preschools, or providing financial incentives to access good quality programs for infants and children. This Early Childhood Development (ECD) guide presents lessons and experiences that have been useful in informing the policy debate about ECD interventions and the design of such programs across the world. Whether the user of this guide is at the initial stage of deciding whether to expand an ECD portfolio or already in the program design stage, the content offers a range of evidence- based options to inform policy and investment choices.Publication From Early Child Development to Human Development : Investing in Our Children's Future(Washington, DC: World Bank, 2002)Investing in every child at an early age is an investment in human, and economic development for all. Children born in poverty are far more likely to grow undeveloped in both body, and mind. Science tells us that early child development (ECD) is critical, and marks a child for life, and, young children who are well nurtured, do better in school, and develop the skills to compete in a global economy. It is in this context that the Bank hosted a conference to review the state of knowledge on brain development, the link between ECD and human development, the standards of care to improve children's educational outcomes, the qualitative and quantitative measures of effective programs, and elements of quality in ECD programs. This book contains the proceedings of the Conference on Investing in our Children's Future, which brought together leading experts, academicians, and practitioners from nongovernmental organizations, civil society, governments, and international organizations. The conference featured the benefits of investing in young children, and measuring ECD standards of care, to ensure a fair start for all based on case studies. It further evaluated the effectiveness of ECD programs, with presentations focused on the role of private initiatives in influencing public policy. Conclusions include the pursuit of a continued evaluation on the effectiveness of ECD programs, and, a deliberately planned global coalition to fund ECD initiatives.Publication Environmental Health and Child Survival : Epidemiology, Economics, Experiences(Washington, DC : World Bank, 2008)This report complements Repositioning Nutrition as Central to Development by looking at environmental health issues that affect child health broadly, while also exploring the links through malnutrition. This report argues that environmental health interventions are preventive measures that are imperative to improve child survival with sustainable results in the long term. Preventive measures, such as improving environmental conditions are effective in reducing a child's exposure to a disease agent and thereby averting infection. The overall aim of this report is to provide information to decision-makers on the optimal design of policies to help reduce premature deaths and illness in children under five years of age. To protect the health, development, and wellbeing of young children, decision-makers must identify and reduce environmental risk factors by providing appropriate interventions that prevent and diminish exposures. This study is intended to advance the understanding of what those risk factors are, when and how to reduce children's exposure to them, and how to mitigate their consequent health impact.Publication The Impact of Expanding Access to Early Childhood Services in Rural Indonesia(World Bank, Washington, DC, 2015-07)This paper uses three waves of longitudinal data to examine the impact of expanding access to preschool services in rural areas of Indonesia on two cohorts of children. One cohort was children aged 4 at the start of the project and was immediately eligible for project-provided services when they began operation in 2009. The other cohort was children aged 1 at the start of the project and became eligible for project-provided services two years later. The paper presents intent-to-treat estimates of impact in the short term (first year of the project) and medium term (three years after the project started), using experimental and quasi-experimental methods. For the cohort of 4-year-olds, while the magnitude of the enrollment impact is similar across children from different backgrounds, the impact on child outcomes is larger for children from more disadvantaged backgrounds in the short and medium terms. However, for this cohort of children, it seems that project-provided playgroups encouraged substitution away from existing kindergartens, suggesting that future interventions should incorporate such possibilities into their design. For the average child in the younger cohort, the project led to improvements in physical health and well-being as well as language and cognitive development. For this cohort, there is little evidence of differential impact. This can be explained by the fact that children who enrolled soon after the centers opened (the older cohort) were generally poorer, compared with children who enrolled later (the younger cohort). This may be because of fee increases in project centers as project funding ended.
Users also downloaded
Showing related downloaded files
Publication Governance Matters IV : Governance Indicators for 1996-2004(World Bank, Washington, DC, 2005-06)The authors present the latest update of their aggregate governance indicators, together with new analysis of several issues related to the use of these measures. The governance indicators measure the following six dimensions of governance: (1) voice and accountability; (2) political instability and violence; (3) government effectiveness; (4) regulatory quality; (5) rule of law, and (6) control of corruption. They cover 209 countries and territories for 1996, 1998, 2000, 2002, and 2004. They are based on several hundred individual variables measuring perceptions of governance, drawn from 37 separate data sources constructed by 31 organizations. The authors present estimates of the six dimensions of governance for each period, as well as margins of error capturing the range of likely values for each country. These margins of error are not unique to perceptions-based measures of governance, but are an important feature of all efforts to measure governance, including objective indicators. In fact, the authors give examples of how individual objective measures provide an incomplete picture of even the quite particular dimensions of governance that they are intended to measure. The authors also analyze in detail changes over time in their estimates of governance; provide a framework for assessing the statistical significance of changes in governance; and suggest a simple rule of thumb for identifying statistically significant changes in country governance over time. The ability to identify significant changes in governance over time is much higher for aggregate indicators than for any individual indicator. While the authors find that the quality of governance in a number of countries has changed significantly (in both directions), they also provide evidence suggesting that there are no trends, for better or worse, in global averages of governance. Finally, they interpret the strong observed correlation between income and governance, and argue against recent efforts to apply a discount to governance performance in low-income countries.Publication Governance Matters VIII : Aggregate and Individual Governance Indicators 1996–2008(2009-06-01)This paper reports on the 2009 update of the Worldwide Governance Indicators (WGI) research project, covering 212 countries and territories and measuring six dimensions of governance between 1996 and 2008: Voice and Accountability, Political Stability and Absence of Violence/Terrorism, Government Effectiveness, Regulatory Quality, Rule of Law, and Control of Corruption. These aggregate indicators are based on hundreds of specific and disaggregated individual variables measuring various dimensions of governance, taken from 35 data sources provided by 33 different organizations. The data reflect the views on governance of public sector, private sector and NGO experts, as well as thousands of citizen and firm survey respondents worldwide. The authors also explicitly report the margins of error accompanying each country estimate. These reflect the inherent difficulties in measuring governance using any kind of data. They find that even after taking margins of error into account, the WGI permit meaningful cross-country comparisons as well as monitoring progress over time. The aggregate indicators, together with the disaggregated underlying indicators, are available at www.govindicators.org.Publication Government Matters III : Governance Indicators for 1996-2002(World Bank, Washington, DC, 2003-08)The authors present estimates of six dimensions of governance covering 199 countries and territories for four time periods: 1996, 1998, 2000, and 2002. These indicators are based on several hundred individual variables measuring perceptions of governance, drawn from 25 separate data sources constructed by 18 different organizations. The authors assign these individual measures of governance to categories capturing key dimensions of governance and use an unobserved components model to construct six aggregate governance indicators in each of the four periods. They present the point estimates of the dimensions of governance as well as the margins of errors for each country for the four periods. The governance indicators reported here are an update and expansion of previous research work on indicators initiated in 1998 (Kaufmann, Kraay, and Zoido-Lobat 1999a,b and 2002). The authors also address various methodological issues, including the interpretation and use of the data given the estimated margins of errors.Publication Breaking the Conflict Trap : Civil War and Development Policy(Washington, DC: World Bank and Oxford University Press, 2003)Most wars are now civil wars. Even though international wars attract enormous global attention, they have become infrequent and brief. Civil wars usually attract less attention, but they have become increasingly common and typically go on for years. This report argues that civil war is now an important issue for development. War retards development, but conversely, development retards war. This double causation gives rise to virtuous and vicious circles. Where development succeeds, countries become progressively safer from violent conflict, making subsequent development easier. Where development fails, countries are at high risk of becoming caught in a conflict trap in which war wrecks the economy and increases the risk of further war. The global incidence of civil war is high because the international community has done little to avert it. Inertia is rooted in two beliefs: that we can safely 'let them fight it out among themselves' and that 'nothing can be done' because civil war is driven by ancestral ethnic and religious hatreds. The purpose of this report is to challenge these beliefs.Publication Design Thinking for Social Innovation(2010-07)Designers have traditionally focused on enchancing the look and functionality of products.