Poor Sanitation in India May Afflict Well-Fed Children with Malnutrition, by Gardiner Harris, in Monday’s New York Times, discusses something that has been puzzling health and sanitation experts for a while: why are so many children in India with improved food quality and quantity not thriving?  Why are patterns of growth stunting so persistent?

If this emerging hypothesis is correct, then it would seem the clue to the disturbingly high rates of stunting is sanitation, not food.  The large percentage of the population in India who defecate in the open may be the cause; the theory is that the bacterial invasions children suffer in early years are too overwhelming to permit optimum brain and body development.  Many poorer countries – Somalia, the Democratic Republic of the Congo – experience lower rates of stunting.  Economists and health officials do not like such aberrant fact patterns.

It’s still a hypothesis but definitely one I’ll be following.  Something mentioned briefly but not dwelt upon is the gender differential.

The absence of latrines disproportionately affects women and girls.  There is virtually no stigma for public male urination and men have fewer incentives to devote resources to latrines.  Yet in villages, females are vulnerable when they seek remote places with a modicum of privacy.  In schools, which frequently have no functioning toilets, girls have increased dropout rates especially after puberty when menstruation begins.  And in public arenas and markets, women’s economic options are more limited simply because of the barriers to spending hours in transport or in public places with no toilets.  While the toll of childhood stunting and malnutrition is huge, women feel the absence of sanitation facilities throughout their lives.