The overlooked sanitation challenge: where do children’s feces go?

India has reduced adult open defecation through the Swachh Bharat Mission, but unsafe disposal of children’s feces remains common. Our study identifies district hotspots and key social inequalities.
The overlooked sanitation challenge: where do children’s feces go?
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Mapping spatial inequality: unsafe child feces disposal practices across 707 districts in India - BMC Public Health

Background Unsafe child feces disposal is a recognized public health concern linked to adverse child health outcomes. While previous studies have examined its impact, the spatial heterogeneity and determinants of unsafe child feces disposal in India remain underexplored. This study addresses this research gap by investigating the spatial distribution and key factors influencing unsafe disposal practices across Indian districts. Method This study utilized data from the National Family Health Survey-5 (2019–2021) to conduct a comprehensive spatial analysis. Univariate and Bivariate Local Indicators of Spatial Association (LISA) clustering were employed to identify spatial patterns of unsafe child feces disposal. To examine the determinants, a Spatial Error Model (SEM) was applied, while Fairlie decomposition was used to quantify the contribution of various factors to regional disparities. Results The Univariate LISA analysis identified 170 hotspot districts characterized by high levels of unsafe child feces disposal, primarily located in Odisha, Jharkhand, Bihar, Assam, and Tamil Nadu. The SEM analysis revealed that maternal education, household wealth, sanitation access, and religious affiliation are significant determinants. Hotspot districts demonstrated a 22% higher likelihood of unsafe disposal compared to cold spots. Decomposition results indicated that household wealth accounted for 65.3% of the observed disparity, followed by sanitation (17.1%), religion (7.4%), media exposure (4.5%), and education (3.2%). Conclusion This study underscores the pronounced spatial disparities in unsafe child feces disposal across Indian districts. Addressing these disparities requires targeted interventions focusing on improving sanitation, enhancing maternal education, and leveraging media outreach to promote safe disposal practices.

Over the last decade, India has made remarkable progress in improving sanitation. With the launch of the Swachh Bharat Mission in 2014, millions of household toilets were constructed across the country. As a result, open defecation among adults has declined substantially and more families now have access to improved sanitation facilities.

But an important question often goes unnoticed: what happens to the feces of young children?

Many people assume that children’s feces are harmless. In reality, they can carry dangerous germs that spread diarrheal diseases and other infections. “Unsafe disposal” happens when a child’s feces are left in the open, thrown into garbage, or washed into drains instead of being disposed of in a toilet or latrine.

Our recent research, published in BMC Public Health, examined these practices across 707 districts in India using national survey data. The findings show that the problem is not evenly spread across the country. Around 177 districts emerged as hotspot areas, where unsafe disposal of children’s feces is particularly common. Many of these districts are located in central and eastern India.

The study also found that unsafe practices are more common among poorer households, families with limited education, and those without reliable sanitation facilities.

India’s sanitation mission has made impressive progress in reducing adult open defecation. However, safe disposal of children’s feces has not received the same attention. Addressing this gap is important because improving sanitation is not only about building toilets—it is also about ensuring safe hygiene practices for every member of the household, including young children.

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