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BMC Pregnancy Childbirth. 2019 Oct 24;19(1):378. doi: 10.1186/s12884-019-2528-8.

Effects of sanitation practices on adverse pregnancy outcomes in India: a conducive finding from recent Indian demographic health survey.

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International Institute for Population Sciences, Govandi station Road, Deonar, Mumbai, 400088, India.
International Institute for Population Sciences, Govandi station Road, Deonar, Mumbai, 400088, India.



Several risk factors predisposing women and their live-borns to adverse outcomes during pregnancy have been documented. Little is known about sanitation being a factor contributing to adverse pregnancy outcomes in India. The role of sanitation in adverse pregnancy outcomes remains largely unexplored in the Indian context. This study is an attempt to bring the focus on sanitation as a factor in adverse pregnancy outcome. Along with the sanitation factors, few confounder variables have also been studied in order to understand the adverse pregnancy outcomes.


The study is based on the fourth round of National Family Health Survey (NFHS-IV) covering 26,972 married women in the age-group 15-49. The study variables include the mother's age, Body Mass Index (BMI), education, anemia, and Antenatal care (ANC) visits during their last pregnancy. The household level variable includes place of residence, religion, caste, wealth index, access to toilet, type of toilet, availability of water within toilet premises, and facility of hand wash near the toilet. Children study variables include Low Birth Weight (LBW), the order of birth (Parity), and the death of the children of the women in the last 5 years. The target variable Adverse Pregnancy Outcome (APO) was constructed using children born with low birth weight or died during the last pregnancy.


We calculated both adjusted as well as unadjusted odds ratios for a better understanding of the association between sanitation and adverse pregnancy outcomes. Findings from the study showed that women who did not have access to a toilet within the house had a higher risk of adverse pregnancy outcome. In the multivariable model, no association was observed for adverse pregnancy outcome among women who did not have access to toilet and women who used shared toilet. Teenage (15-19 years), uneducated, underweight and anemic mothers were more likely to face APO as compare to other mothers in similar characteristics group.


Our findings contribute to the decidedly less available literature on maternal sanitation behaviour and adverse pregnancy outcomes. Our results support that sanitation is a very significant aspect for women who are about to deliver a baby as there was an association between sanitation and adverse pregnancy outcome. Education on sanitation practices is the need of the hour as much as it needs to follow.


Access to toilet; Adverse pregnancy outcome; India; Low birth weight; National family health survey; Sanitation

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