Sanitation and Education

Worldwide, one in five children does not complete upper-primary school. I examine whether educational attainment is stymied by inadequate school-sanitation infrastructure that threatens children’s health and safety. Using an Indian national schoollatrine-construction initiative and administrative school-level data, I estimate that latrine construction encourages educational attainment. Boys and younger girls respond substantially, whether latrines are unisex or sex-specific. For older girls, however, sexspecific latrines become crucial. Safety considerations appear central for pubescent-age girls, whereas health factors may influence boys and younger girls. Understanding motivations behind educational decision-making is a natural precondition for influencing behavior and children’s educational and economic outcomes. ∗Contact: adukia@uchicago.edu, http://home.uchicago.edu/adukia. For their comments and suggestions, I thank Larry Katz, Michael Kremer, Bridget Long, and Dick Murnane, as well as Nava Ashraf, Raj Chetty, Ed Glaeser, Claudia Goldin, Simo Goshev, Rema Hanna, Andrew Ho, Rick Hornbeck, Asim Khwaja, Carla Lillvik, Susanna Loeb, Sendhil Mullainathan, Rohini Pande, Chris Robert, Martin Rotemberg, Jack Shonkoff, John Willett, and seminar participants at Harvard, Stanford, and the Comparative and International Education Society. For their help in understanding the context, I thank Jayeshbhai Patel, Ishwarkaka Patel, Roopal Shah, and staff members at Safai Vidyalaya, Environmental Sanitation Institute, Manav Sadhna, Indicorps, the Government of India, UNICEF, and IRC. For their help with data acquisition, I thank Arun Mehta, Shalender Sharma, Bonnie Burns, Steve Cicala, and staff members at the National University of Educational Planning and Administration in Delhi. For financial assistance, I thank the Harvard South Asia Institute, the Institute for Quantitative Social Science, the Harvard Sustainability Science Program, and the Julius B. Richmond Fellowship at the Harvard Center on the Developing Child. Worldwide, one in five children of upper-primary-school age are out of school, including one in four children in South Asia (UNESCO 2010). Girls in developing countries disproportionately drop out of school, particularly around puberty, which some have attributed to the absence of sanitation facilities in many schools worldwide (Herz and Sperling 2004, Moojiman et al. 2005, Sommer 2010). Indeed, even the standard World Bank-supported school does not necessarily include sanitation facilities. Education provides opportunities for upward economic mobility (Card 1999), and gender equality in education and economic opportunity has been associated with a broad range of social and economic benefits (Glewwe 1999, Duflo 2012). The Millennium Development Goals reflect a call from the international policy community to expand access to education and to address a gender gap in enrollment that is particularly pronounced among adolescents. Investments in child health can improve educational outcomes (Miguel and Kremer 2004), though the infrastructure needed to support child health often differs dramatically by gender and age. The “Menstruation Hypothesis” is that menstruation creates an obstacle to female schooling, contributing to high drop-out rates among pubescent-age girls. This belief has motivated efforts to provide sex-specific sanitation in schools, which could increase girls’ health, privacy, and safety (Leach et al. 2003, Kirk and Sommer 2006, Raising Clean Hands 2010, Sommer 2010, WHO 2010). Understanding children’s motivations to drop out from school is a natural precondition for influencing their behavior and subsequent educational and economic outcomes. Qualitative studies often indicate important impacts of school sanitation on girls’ enrollment (Birdthistle et al. 2011), yet there is little quantitative support for a narrow “Menstruation Hypothesis” (Oster and Thornton 2011). While the quantitative evaluation of menstruation-management technologies may show no benefits where school absences are rare during girls’ few menstrual days each month (Oster and Thornton 2011), a broader “Menstruation Hypothesis” might emphasize how girls are impacted every day by the physical, emotional, and societal changes that happen along with the onset of menstruation. Pubescent-age girls’ educational decisions may be more impacted by addressing every-day concerns for health, safety, and privacy, such as through the provision of sex-specific school latrines. In addition, a narrow focus on the “Menstruation Hypothesis” might neglect other “Upper-primary school” refers to grades six, seven, and eight. It is categorized as UNESCO’s International Standard Classification of Education (ISCED) Level 2 and is also known as middle school. 25 percent of girls do not complete primary school, compared with 15 percent of boys (UNICEF 2003). The Millennium Development Goals were established in 2000 by the World Bank, the United Nations, the 189 UN member states, and many international organizations (WHO 2004). Kremer (2012) expresses skepticism that school latrines impact girls’ enrollment, referencing Oster and Thornton’s (2011) finding of no impact on school attendance from providing menstrual cups to girls in four schools in Nepal, though Kremer mainly emphasizes the need for evidence from additional settings.