The Government of India’s NFHS–4 offers the best new data on open defecation in rural India to be eleased in over a decade. Although open defecation has become less common than it was 10 years ago, it is still highly prevalent, with more than half of rural households reporting open defecation. On average, change has been slow, even during the period of the Swachh Bharat Mission.

This World Bank 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.

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.

Poor sanitation remains a major public health concern linked to several important health outcomes; emerging evidence indicates a link to childhood stunting. In India over half of the population defecates in the open; the prevalence of stunting remains very high. Recently published data on levels of stunting in 112 districts of India provide an opportunity to explore the relationship between levels of open defecation and stunting within this population.