# **I. Introduction**

In this paper, the impact of exposure to unimproved sanitation in Bangladesh on early childhood primary school enrollment is analyzed, using a pseudo-panel data for children ages 6 to 9 for the years 2007, 2011, and 2014. There is growing evidence that ill-health and poor nutrition in the early years of childhood have a lasting impact on later in life outcomes. This is especially true for the first 1,000 days of life. Failure to maximize a child’s development during this phase could have negative impact later in life in areas such as education, earnings, as well as mental health (Walker et al., 2007). Evidence indicates that poor health conditions early in life are associated with higher mortality (Bengtsson & Lindstörm, 2000) and poor adult cognitive development (Rong et al., 2017; Vogl, 2014). Children who are healthy early in life have better educational outcomes (Case & Paxson, 2010) and subsequently better economic outcomes (Lawson & Spears, 2016; Vogl, 2014; Cutler et al., 2010).

Unsanitary conditions during childhood are likely to result in poor health and nutrition both in the short and long-run. Exposure to fecal matter and bacteria because of unsafe disposal of feces, poor sanitation, and subsequently contaminated water and soil cause environmental enteropathy (George et al., 2018; Kosek et al., 2013), stunting (George et al., 2015; Spears et al., 2013), as well as diarrhea (Cronin et al., 2016), and a host of other water-borne diseases among young children (Mertens et al., 1990; Daniels et al., 1990). Although Bangladesh has substantially reduced its open defecation rates, its continued lack of improved sanitation facilities<sup>3</sup> (World Bank, 2018) could adversely affect children’s health, both early on and throughout their lives.

Bangladesh has made significant progress towards addressing the problem of poor sanitation. In line with the SDG goal of achieving access to adequate and equitable sanitation and hygiene for all and end open defecation, the country has reduced open defecation among its population from 35 percent to 2 percent by 2015 (World Bank, 2018). Rural households are more likely to openly defecate compared to urban households (DHS, 2015). Access to improved sanitation has also increased from 34 percent to 63 percent by 2015 (World Bank, 2018). Rural households are about twice as likely to have access to unimproved sanitation compared to their urban counterparts (DHS, 2014).<sup>4</sup> Sixty-five percent of the households in the country have access to a private sanitation facility in 2014 (DHS, 2016). However, the figure dramatically declines if we consider whether the facility is improved or not. In 2014, only 45 percent of the households had a private improved sanitation facility – an increase from 39 percent in 2011 (DHS, 2016). Interestingly, rural households are more likely to use

> 3 The World Bank (2018) estimates that 40 percent of Bangladeshis, or 58 million people, do not have access to a private improved sanitation facility in their home. This lack of access is associated with poverty: the vast majority of these 58 million people are in the bottom 50 percent of the national wealth distribution.

> 4 <u>https://dhsprogram.com/pubs/pdf/FR311/FR311.pdf</u>

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