metadata: authors: 0: author: Adukia,Anjali
1: author: Alsan,Marcella
2: author: Babiarz,Kim
3: author: Goldhaber-Fiebert,Jeremy D.
4: author: Prince,Lea
count: World
docna: 0: docna: Religion and Sanitation Practices
docty: Policy Research Working Paper
subtopic: Town Water Supply and Sanitation,Water Supply and Sanitation Economics,Sanitary Environmental Engineering,Environmental Engineering,Health and Sanitation,Water and Human Health,Engineering,Small Private Water Supply Providers,Health Care Services Industry,Hydrology,Educational Sciences,Sanitation and Sewerage
teratopic: Industry,Water Supply and Sanitation,Environment,Science and Technology Development,Health, Nutrition and Population,Education,Water Resources
abstracts: cdata!: Infant mortality among Hindus is higher
            than among Muslims in India, and religious differences in
            sanitation practices have been cited as a contributing
            factor. To explore whether religion itself is associated
            with differences in sanitation practices, this study
            compares sanitation practices of Hindus and Muslims living
            in the same locations using three nationally-representative
            data sets from India. Across all three data sets, the
            unconditional religion-specific gap in latrine ownership and
            latrine use declines by approximately two-thirds when
            conditioning on location characteristics or including
            location fixed effects. Further, the estimates do not show
            evidence of religion-specific differences in other
            sanitation practices, such as handwashing or observed fecal
            material near homes. Household sanitation practices vary
            substantially across areas of India, but religion itself has
            less direct influence when considering differences between
            Hindus and Muslims within the same location.
repnme: repnme: Religion and Sanitation Practices
display_title: Religion and Sanitation Practices
listing_relative_url: /research/2020/01/31738773/religion-sanitation-practices
topicv3: Sanitation m1326453 2000,Water m1326522 137,Education m1327048 470,Health m1504661 3480,Latrines m1505177 3454
publishtoextweb_dt: 2020-01-29T00:00:00Z
dois: 10.1596/40776
historic_topic: Industry,Water Supply and Sanitation,Environment,Science and Technology Development,Health, Nutrition and Population,Education,Water Resources
origu: DEC-Knowledge and Strategy (DECKS)
no_of_pages: 29
author_keys: 0: author_key: 1046692
1: author_key: NA
2: author_key: NA
3: author_key: NA
4: author_key: NA
model_extractions: Policy Research Working Paper 9131

# Religion and Sanitation Practices

_Anjali Adukia Marcella Alsan Jeremy D. Goldhaber-Fiebert Lea Prince_ Development Economics Knowledge and Strategy Team January 2020
Policy Research Working Paper 9131

# **Abstract**

Infant mortality among Hindus is higher than among Muslims in India, and religious differences in sanitation practices have been cited as a contributing factor. To explore whether religion itself is associated with differences in sanitation practices, this study compares sanitation practices of Hindus and Muslims living in the same locations using three nationally-representative data sets from India. Across all three data sets, the unconditional religion-specific gap in latrine ownership and latrine use declines by approximately two-thirds when conditioning on location characteristics or including location fixed effects. Further, the estimates do not show evidence of religion-specific differences in other sanitation practices, such as handwashing or observed fecal material near homes. Household sanitation practices vary substantially across areas of India, but religion itself has less direct influence when considering differences between Hindus and Muslims within the same location.

This paper is a product of the Knowledge and Strategy Team, Development Economics. It is part of a larger effort by the World Bank to provide open access to its research and make a contribution to development policy discussions around the world. Policy Research Working Papers are also posted on the Web at http://www.worldbank.org/prwp. The authors may be contacted at adukia@uchicago.edu.

_The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent._ Produced by the Research Support Team
# **Religion and Sanitation Practices**<sup>_∗_</sup>

Anjali Adukia, University of Chicago and NBER Marcella Alsan, Harvard University and NBER Kim Babiarz, Stanford University Jeremy D. Goldhaber-Fiebert, Stanford University Lea Prince, Stanford University JEL Classification Codes: I12, O15, Z12 Keywords: Sanitation, urbanization, religion, culture

> _∗_ Authors: Anjali Adukia (corresponding author) is an assistant professor at The University of Chicago and a faculty research fellow at NBER; her email address is adukia@uchicago.edu. Marcella Alsan is a professor of public policy at Harvard Kennedy School of Government and a faculty research fellow at NBER; her email address is marcella ~~a~~ lsan@hks.harvard.edu; Kim Babiarz is a social science research scholar at Stanford University; her email address is babiarz@stanford.edu; Jeremy D. Goldhaber-Fiebert is an associate professor at Stanford University; his email address is jeremygf@stanford.edu; Lea Prince is a research analyst at Stanford University; her email address is lcprince@stanford.edu. Acknowledgments: The authors thank the editor, Eric Edmonds, two anonymous reviewers, Latika Chaudhary, and Richard Hornbeck for helpful feedback. The authors also thank Morgan Foy, Jack Landry, and Anlu Xing for their excellent research assistance. This work was supported by the U.S. National Institutes of Health (K01-AG037593-01A1); the Stanford Freeman Spogli Institute for International Studies; the UChicago Becker-Friedman Institute Development Economics Initiative; Tata Centre for Development at UChicago; the Stanford Woods Institute for the Environment; and the Bill and Melinda Gates Foundation.
Worldwide, one billion people practice open defecation and an estimated 2.5 billion people do not have improved sanitation facilities, such as flush toilets (UNICEF/WHO, 2014a).<sup>1</sup> The limited availability and use of such facilities, the pervasiveness of fecal material, and inconsistent handwashing all contribute to the transmission of infections with severe negative consequences for child health and educational attainment.<sup>2</sup> India faces particularly daunting sanitation challenges, with 597 million individuals practicing open defection and 450,000 deaths attributed to diarrheal illness per year (UNICEF/WHO, 2014b).

In response to this sanitation problem, India has expended substantial resources to subsidize latrine construction.<sup>3</sup> Government construction of latrines has been central to improvements in sanitation practices, and especially reducing the costs of latrines for poorer households (Gertler et al., 2015; Guiteras, Levinsohn and Mobarak, 2015). There has been mixed evidence on health improvements following Indian sanitation initiatives (Patil et al., 2013, 2014; Spears, 2014), however, which has given rise to an argument that deeply rooted cultural beliefs may limit improvements in sanitation practices.

Recent attention has been drawn to substantial differences in latrine use between Hindus and Muslims in India (BBC, 2012, 2014; The Economist, 2014). Geruso and Spears (2018) attribute a lower infant mortality rate for Muslims, relative to Hindus, to a higher rate of latrine use among Muslims that they conclude is due to differences in religious beliefs. Hindus are more likely to live in rural areas with less access to sanitation infrastructure, however, and so lower rates of latrine use and higher rates of open defecation may reflect differences in household locations rather than religion itself.

> 1“Improved sanitation facilities” refers to facilities that reliably separate human fecal material from human contact, and may include: flush toilets, piped sewer systems, septic tanks, ventilated improved pit latrines, or composting toilets (UNICEF/WHO, 2014a).

> 2See Nandy et al. (2005), Chambers and Von Medeazza (2013), Hueso and Bell (2013), UNICEF/WHO (2014b), and Adukia (2017).

> 3In the 1980s, the Central Rural Sanitation Program (CRSP) was directed towards improving access to sanitation facilities and associated changes in sanitation behaviors. These policy efforts evolved into India’s Total Sanitation Campaign (TSC), implemented in 1999, which included the building of latrines in poorer households (WSP, 2011; Spears, 2014). This Total Sanitation Campaign was absorbed into the broader Swachh Bharat Mission Program, which emphasized an educational component intended to drive behavioral changes in latrine use, handwashing, and other sanitation practices (AFC, 2005).

1
This paper explores the religious divide in sanitation practices in India, considering in particular the role of location-specific factors in driving observed differences between Hindus and Muslims. To do so, the analysis uses data from three nationally-representative surveys: the Indian Human Development Survey (IHDS), the District Level Household and Facility Survey (DLHS-3), and the National Family Health Survey (NFHS-3). Each data set provides detailed information on latrine ownership or latrine use at the household level.

The study examines the role of household religion in predicting differences in household sanitation practices. If differences in household sanitation practices are being driven by religion itself, then household sanitation practices should continue to differ substantially by religion when comparing Hindus and Muslims within the same geographic areas.<sup>4</sup> The estimates show unconditional differences between Hindus and Muslims in latrine ownership and latrine use, similar in magnitude to Geruso and Spears (2018), but these differences are reduced by approximately two-thirds after controlling for measures of urbanization and other location characteristics. When replacing these location characteristics with location fixed effects, the analysis estimates a similarly large reduction in the HinduMuslim gap. Latrine ownership remains 5.3 percentage points lower in Hindu households than in Muslim households, using IHDS data in the preferred specification (95% confidence – interval: 1.5pp lower 9.1pp lower). This estimate is similar across specifications, once controlling for local characteristics or location fixed effects, and are similar in DLHS-3 data and NFHS-3 data. While there remains some difference in latrine ownership and latrine use, the unconditional differences by household religion largely reflect differences in household location.

> The analysis then extends to consider other sanitation practices and does not find differences between Hindus and Muslims in reported handwashing or observed fecal material near

> 4Note that religion may influence average sanitation practices in locations, which would be absorbed into location fixed effects, whereas the main analysis focuses on how religion differentially affects households of that religion. Using a machine learning technique (LASSO), this paper also estimates that average sanitation practices in locations are more predicted by locations’ rural status and female literacy than by locations’ religion shares.

2
homes. It estimates that Hindus are 1.1 percentage points more likely to report washing hands after defecating (95% confidence interval: 1.7pp less likely – 3.9pp more likely). There is also a 1.7 percentage point lower chance of the surveyor observing fecal material near – Hindu households (95% confidence interval: 2.3pp more likely 5.7pp less likely).

Finally, differences in latrine use are not estimated between Hindu and Muslim households that have migrated from rural to urban areas. The point estimate implies that Hindu migrant households are 2.7 percentage points less likely to use a latrine than Muslim migrant households, though the estimated precision is lower due to a decreased sample size (95% con– fidence interval: 12.2pp less likely 7.0pp more likely). These estimates focus on migrant households only, which may differ in religiosity from non-migrant households. The estimated difference is statistically smaller than the unconditional difference between all Hindu households and all Muslim households, but would not reject the estimated differences controlling for household location.

Understanding sanitation practices of Hindus and Muslims is part of a broader literature seeking to understand differences in outcomes more generally between Hindus and Muslims in India. An Indian government report noted that Muslim identity was associated with higher poverty rates (Sachar et al., 2006), which followed a period of lower intergenerational mobility among Muslims relative to Hindus (Asher, Novosad and Rafkin, 2018) and lower educational achievement among Muslims (Maitra and Sharma, 2009; Azam and Bhatt, 2015). By contrast, there is a lower infant mortality rate among Muslims (Bhalotra and van Soest, 2008; Deolalikar, 2010; Kumar et al., 2013), which has raised the suggestion that religion and associated practices may be important factors for infant mortality (Bhalotra, Valente and van Soest, 2010). Differences in child height and weight among Hindus, relative to Muslims, have also been attributed to cultural differences (Jayachandran and Pande, 2017). Muslim women have more children in India (Moulasha and Rao, 1999), though Jeffery and Jeffery (2000) emphasize that fertility differs substantially across geographic areas in India and that differences between Hindus and Muslims are exaggerated by not comparing Hindu 3
households and Muslim households within geographic areas.<sup>5</sup> This paper estimates that, while there is a substantial unconditional association between religion and sanitation practices, a comparison of Hindu households and Muslim households within similar locations finds more similar sanitation practices. The estimates suggest that household religion itself has less influence on sanitation practices, as compared to characteristics of household location. Sanitation practices are substantially better in urban settings, with better access to sanitation infrastructure, for both Hindus and Muslims.

The paper proceeds as follows. Section I describes the data, and Section II presents descriptive statistics. Section III describes the estimating equations, and Section IV presents the results. Section V concludes.

# **I Databases on Indian Households: IHDS, DLHS-3, NFHS-3**

The analysis uses data from three nationally-representative surveys of households in India: the first wave of the Indian Human Development Survey 2004–05 (IHDS), the third wave of the District Level Household and Facility Survey 2007–08 (DLHS-3), and the third wave of the National Family Health Survey 2005–06 (NFHS-3). These data sets each contain different information on sanitation practices, and provide complementary insights on the relationship between sanitation practices and religion. The IHDS includes the most data on various sanitation practices, but is a smaller sample. The DLHS-3 has more households, but has fewer detailed questions on sanitation practices. The NFHS-3 provides an opportunity to follow migrants’ behaviors, though district-level identifiers are not available.

Three sanitation practices are studied: (1) whether an individual or household owns or uses a latrine, (2) whether the respondent washes hands with soap after defecation, and (3) whether the interviewer observed fecal matter (human or animal) around the dwelling of the respondent at the time of the survey.<sup>6</sup> The analysis is limited to households in which the

> 5There is also evidence of differences in contraceptive use among Muslim women and Hindu women who report not wanting additional children (Dharmalingam and Morgan, 2004; Dharmalingam, Navaneetham and Morgan, 2005), though other evidence suggests similar female autonomy within the household for Muslim women and Hindu women (Jejeebhoy and Sathar, 2001; Desai and Temsah, 2014).

> 6In the analysis, “latrine” refers to all types of latrines or toilets. The IHDS and DLHS-3 ask the

4
household head is either Hindu or Muslim, which covers between 86% and 92% of surveyed households in each data set.

The Indian Human Development Survey (IHDS) collected data from 41,500 households across 384 districts in 33 states and union territories from 2004 to 2005 (Desai, Vanneman and NCAER, 2005). These data cover three sanitation practices: latrine ownership, handwashing, and observed fecal material.

The third wave of the District Level Household and Facility Survey (DLHS-3) collected data from 720,000 households across 601 districts in 34 states and union territories from 2007 to 2008 (IIPS, 2010). DLHS-3 includes data on whether the household reports owning a latrine but does not report data on other sanitation practices.

The third wave of the National Family Health Survey (NFHS-3) collected data from 109,000 households in 29 states and union territories from 2005 to 2006 (IIPS, 2007). NFHS-3 includes data on whether the household reports typically using a latrine but does not report data on other sanitation practices.

The analysis explores the cross-sectional relationship between religion and sanitation practices, and so it uses three data sets from a similar time period that each provide similar but complementary data on sanitation practices (latrine ownership, latrine use, observed fecal material, and handwashing).<sup>7</sup> The data sets each include information about households, which are used to define a set of household characteristics: caste of household head, occupation of household head, education of household head, household size, age of survey respondent, number of female members of the household, whether the household has piped water, and proxies for household wealth (an indicator variable for whether the household owns their house; indicator variables for the presence of electricity, a cell phone, television, bicycle, car, and motorcycle; and distance to

> respondent about the type of latrine that her family “has,” while the NFHS-3 asks the respondent about the type of latrine that her household “uses.” Note that Geruso and Spears (2018) define “open defecation,” using NFHS data, as when the household reports not using a latrine.

> 7As a robustness check, the analysis was run on later waves of the data sets (IHDS-II in 2011-12, DLHS-4 in 2012-13, and NFHS-4 in 2015-16) and similar results are found.

5
fuel source).<sup>8</sup> Each data set observes the household’s “primary sampling unit” or PSU, which corresponds to the household’s village, town, or neighborhood as designated in each survey’s sample design. The analysis also merges in data at the district level from the 2011 Indian Census, reported separately for urban and rural areas of each district. These data provide detailed information about a household’s location. For each data set, each household is weighted using the provided household-level sample weights.

# **II Descriptive Statistics and Preliminary Evidence**

To explore the relationship between religion and sanitation, the analysis begins with descriptive statistics that are separated by religion and urban/rural status. Specifically, the data are split by whether the head of household is Hindu or Muslim, as well as by whether the household is in a rural or urban location.<sup>9</sup> Using data from the IHDS, Hindu households are on average 18 percentage points less likely to have a latrine than Muslim households (Table 1). Yet this overall difference masks significant heterogeneity across urban and rural areas. In urban areas, the gap between Hindu and Muslim latrine ownership is 4 percentage points, whereas in rural areas the gap is 18 percentage points.<sup>10</sup> The large overall difference in latrine ownership between Hindu and Muslim households is similar to the rural gap between Hindu and Muslim households, which reflects several features of the data. Latrine ownership is substantially lower in rural areas, and Hindus live disproportionately in rural areas as compared to Muslims.<sup>11</sup> Further, a majority of both

> 8The availability of these variables vary slightly across data sets: the IHDS data do not include information on homeownership, and only the IHDS data include the occupation of the household head and the distance to the closest fuel source.

> 9“Urban” is defined in the 2011 India Census, which is based on total population, population density, and non-agricultural labor activity.

> 10In equilibrium, urban areas and rural areas differ on several dimensions. For example, urban areas have higher wages and higher returns to education than rural areas (Adukia, Asher and Novosad, 2020). Other notable differences between the two group means include the following: family size is slightly smaller among Hindus, and there are fewer Hindus in urban areas that have less than or equal to 5 years of education. The main regression analysis will control for family size and education, along with other characteristics.

> 11Note that the overall difference between Hindus and Muslims is not a weighted average of the difference

6
Hindu and Muslim households live in rural areas. In the 2011 Indian Census, the Hindu rural share was 71% compared to the Muslim rural share of 60%. These demographics align with those in IHDS-sampled households, for which approximately 68% of Hindu households resided in rural areas compared to 56% of Muslim households. Figure 1 plots the share of Indians and Muslims living in urban areas over time, which shows longstanding differences in urbanization between Hindus and Muslims and the (predominantly Hindu) Indian population. In each decade, Muslims are more urbanized than the overall Indian population.<sup>12</sup> The differences between Hindus and Muslims in latrine ownership reported in the IHDS data (Table 1) are similar to the differences in latrine ownership reported in the DLHS3 data (Appendix Table 1) and differences in latrine use reported in the NFHS-3 data (Appendix Table 2). The analysis calculates large unconditional differences between Hindus and Muslims, between 18 and 23 percentage points, which are similar to the 25 percentage point difference reported by Geruso and Spears (2018) using NFHS data pooled across 199293, 1998-99, and 2005-06. This overall difference is similar to the rural difference between Hindus and Muslims, with smaller differences between Hindus and Muslims in urban areas.

Table 1 also includes other sanitation practices: whether household members wash their hands after defecating, and whether the surveyor did not observe fecal material near the home. Hindu households report slightly higher handwashing than Muslim households in urban areas (row 2, column 6) and slightly lower handwashing in rural areas (row 2, column 9). Surveyors are less likely to observe fecal material near the homes of Hindus, and this between Hindus and Muslims in urban areas and the difference between Hindus and Muslims in rural areas. The overall difference also reflects lower latrine ownership in rural areas than in urban areas, along with a greater share of Hindus living in rural areas than the share of Muslims living in rural areas. For example, there could be no difference between Hindus and Muslims in both rural areas and urban areas and there could still be an overall between Hindus and Muslims.

> 12According to Gayer and Jaffrelot (2012, p. 10), Muslims represent the most “urbanized religious community of any significant size in India” and more than “50% of Indian Muslims are living in towns and cities in seven states, which, otherwise are predominantly rural.” Muslims historically dominated Indian Ocean trade routes, and were more likely to settle along pilgrimage routes and in urban areas, which is a pattern that has persisted (Jha, 2013). In addition, according to the 2011 Indian Census, Muslims were less likely to own land than other religious groups, and hence may move toward urban centers and out of the agricultural sector. Traditionally, Muslims worked in industries such as silk, hand and power looms, the leather industry, automobile repairing, and garment making (Sachar et al., 2006).

7
gap is roughly the same in rural and urban areas (8% vs. 7%, respectively). These other measures of sanitation practices do not mechanically track differences in latrine ownership.

Figure 2 shows religion-specific differences at the state level, which complements the summary statistics by rural and urban status in Table 1 (IHDS) and Appendix Table 1 (DLHS-3). Figure 2 plots the difference between Hindu and Muslim households in latrine ownership (IHDS and DLHS-3) across states. In some states, Muslim households are more likely to own latrines than Hindu households; in other states, the converse is true. Much of the density is near zero, reflecting similar latrine ownership among Hindu and Muslim households. The variation shown in Figure 2 does not suggest that Hindu households have consistently lower latrine ownership once comparing Hindus and Muslims in more similar geographic locations.

Figure 3 explores the relationship between the Hindu-Muslim gap in latrine ownership and urbanization. The figure plots the difference in the state-level shares of Hindus and Muslims who report owning a latrine (y-axis) against the state-level difference in the shares of Hindus and Muslims living in urban areas (x-axis). The correlation between the two differences is 0.75. The states with large differences in latrine ownership between the two groups are also more likely to have considerable divides in the share of each group living in urban settings.

# **III Estimating Equation**

To further examine the differences in sanitation practices across Hindus and Muslims, now controlling for household characteristics and location characteristics, the following equation is estimated: where _i_ signifies household, _j_ denotes the household’s town/village/neighborhood (PSU), and _d_ is the household’s district. The outcome _Yijd_ represents one of the sanitation practices discussed above: whether the household owns or uses a latrine, whether the respondent 8
washes hands with soap after defecation, and whether human or animal fecal matter is observed near the home. _Hindu_ is an indicator variable equal to one if the head of household is Hindu.

Household characteristics are denoted by _Xi_<sup>_h_,forwhichsummarystatisticsarereported</sup> in Table 1 (IHDS), Appendix Table 1 (DLHS-3), and Appendix Table 2 (NFHS-3). The list includes sociodemographic characteristics that may influence latrine ownership and other sanitation practices in India, which are: caste, occupation, and education of household head; household size, number of female members in the household, and age of survey respondent; whether the household has piped water; and proxies for household wealth (indicator variables for whether the household owns their house; indicator variables for the presence of electricity, a cell phone, television, bicycle, car, motorcycle; and distance to fuel source).<sup>13</sup> Characteristics of the household’s location are denoted by _Xjd_<sup>_l_,whicharedrawnfrom</sup> the 2011 Census.<sup>14</sup> These variables include measures of urbanization and local demographic composition: an indicator for urban area; log population density; share of population working in agriculture; share of population that are minority religious groups (Jain, Sikh, Christian, Buddhist); share of population that is Muslim; share of population belonging to a Scheduled Caste (SC) or Scheduled Tribe (ST); fraction of women who report being literate; and the sex ratio. These control variables are included because urbanization affects the availability of sanitation infrastructure and the returns to improved sanitation practices.<sup>15</sup> Further, the average demographic composition of areas is associated with different economic environments.<sup>16</sup>

> 13The data sets vary slightly in which of these variables are available. The IHDS data do not include information on homeownership. Only the IHDS data include the occupation of the household head and the distance to the closest fuel source.

> 14These variables are measured at the district level, reported separately for urban areas of the district and rural areas of the district.

> 15Urbanization impacts the returns to hygienic behaviors since communicable disease is more easily transmitted in dense areas. By contrast, low population density might reduce the risk of infectious disease. A more agriculturally oriented area might also value the fertilizer content of human waste.

> 16Muslims live disproportionately in more urban areas, and the presence of other minority groups (Jain, Sikh, Christian, Buddhist) can also be associated with different economic environments. Note that in controlling for the Muslim share of districts, the analysis still compares Hindu and Muslim households but within locations that have similar demographic shares. Also included is the sex ratio, which varies

9
Some specifications replace the location-specific characteristics ( _Xjd_<sup>_l_) with fixed effects for</sup> household primary sampling unit (PSU) that corresponds to the household’s village, town, or neighborhood. These fixed effects capture unobservable local factors that may influence sanitation practices in a geographic area. PSU fixed effects absorb the control variables for household location, as the household location characteristics are homogeneous within a PSU.

All specifications limit the sample to households that are headed by a Hindu or Muslim. Standard errors are clustered at the PSU level (village, town, or neighborhood), which adjusts for the spatial correlation in sanitation practices within nearby areas.

# **IV Results**

# **IV.A Main Estimates**

Table 2 reports results from estimating equation (1), using the IHDS data set which observes three sanitation practices. Panel A reports estimated differences in latrine ownership for Hindus, relative to Muslims. Panel B reports estimated differences in handwashing. Panel C reports estimated differences in whether no fecal material was observed around the house.

Column 1, panel A, reports that Hindus are 17.9 percentage points less likely to own a latrine than Muslims, without adjustment for other covariates (95% confidence interval: – 13.0pp less likely 22.9pp less likely). Column 2 reports similar differences between Hindus and Muslims when controlling for household characteristics, such as household demographics and proxies for household wealth, though these controls do contribute substantial explanatory power (raising the adjusted R-squared from 0.014 to 0.341).

Column 3 reports that Hindus are 5.6 percentage points less likely to own a latrine than Muslims, after controlling for differences in household location (95% confidence interval: 1.2pp less likely – 10.0pp less likely). This estimate is statistically smaller than the unconditional difference between Hindus and Muslims, and represents a 68.7 percent decline in the unconditional difference (reported in column 1). Similarly, column 4 reports a difference of 6.8 percentage points when replacing these location controls with fixed effects for household across India along with differences in the local economy.

10
PSU (village, town, or neighborhood), such that the estimated differences between Hindus and Muslims are restricted to households in close geographic proximity. Column 5 reports a difference of 5.3 percentage points when jointly including controls for household characteristics, location characteristics, and PSU fixed effects (95% confidence interval: difference – of 1.5pp 9.1pp). The standard errors on the estimates are similar, or decreasing, as additional controls are added because the decrease in degrees of freedom is counterbalanced by the predictive power of the controls. Columns 6 and 7 report this difference separately for urban areas (3.2pp) and rural areas (5.6pp).

For other sanitation practices, panels B and C report little substantive difference between Hindus and Muslims after controlling for the same characteristics. There are some unconditional differences between Hindus and Muslims, with less handwashing and less observed fecal material around Hindu households, but these differences are attenuated when comparing households within similar locations. For handwashing, column 5 reports that Hindus are 1.1 percentage points more likely to report washing their hands after defecating (95% confi– dence interval: 1.7pp less likely 3.9pp more likely). For observed fecal material, column 5 reports that the surveyor is 1.7 percentage points more likely to not observe fecal material near Hindu households (95% confidence interval: 2.2pp less likely – 5.7pp more likely).<sup>17</sup> Table 3 reports estimated differences in latrine ownership for Hindus and Muslims, using data from the DLHS-3. There is an unconditional 22.9 percentage point difference in latrine – ownership between Hindus and Muslims (95% confidence interval: difference of 21.7pp 24.0pp), which is substantively similar to the unconditional difference in latrine ownership in the IHDS data. This unconditional difference is in large part attenuated in columns 3, 4, and 5 when controlling for household location characteristics and/or fixed effects for PSU. Comparing Hindus and Muslims within the same location, with similar access to sanitation infrastructure, Hindu households are 5.7 percentage points less likely to report owning a – latrine (95% confidence interval: 5.2pp less likely 6.3pp less likely). This estimate is

> 17Note that surveyor-observed fecal material near homes reflects that household’s sanitation practices and potentially those of nearby homes.

11
similar to that using IHDS data, but more precise given the larger samples in DLHS-3 data.

The main analysis focuses on how religion differentially affects households of that religion, but an important caveat is that religion may also influence average sanitation practices within locations. For example, Hindu religious customs could influence sanitation practices of nearby Muslims and Hindus, such that influence of religion becomes absorbed into location fixed effects. While the study focuses on whether Hindu households have different sanitation practices than nearby Muslim households, it also explores how religion influences average sanitation practices in locations (i.e., the location fixed effects). The analysis estimates using LASSO that average sanitation practices in locations are more predicted by locations’ rural status and female literacy than by locations’ religion shares.<sup>18</sup>

# **IV.B Analysis of Migrant Households**

The prior analysis found that religion-specific gaps in latrine ownership were smaller when controlling for characteristics of household locations or including fixed effects by household location. To further disentangle religion from the local economic environment, migrant households are now examined.

The analysis focuses on Hindu and Muslim migrants, who have moved from rural areas and converged in similar urban locations that allow the analysis to hold constant the available sanitation infrastructure and other features of an urban area. Another advantage to analyzing rural-to-urban migrants is that they have similar generational exposure to urban areas, which is important giving the long history of Muslim urbanization in India (see Figure 1). An important caveat to this analysis is that migrant households may be less religious, on average, than non-migrant households. Thus, differences between Hindu migrants and Mus-

> 18In practice, location fixed effects are estimated by regressing latrine ownership on household religion and PSU fixed effects. LASSO is then used to select which variables most predict variation in the fixed effects. Following the procedure suggested by Belloni, Chernozhukov and Hansen (2014), the analysis includes the household characteristics and location characteristics (from Table 2) along with their pair-wise interactions (including their squares). Out of this set of variables, 21 variable interactions are selected. The most commonly selected variables are distance from fuel source (selected 14 times), which proxies for the remoteness of rural areas, and female literacy (selected 7 times). A location’s Muslim population share is chosen once, in an interaction with female literacy.

12
lim migrants may be smaller than differences between Hindus and Muslims in the general population.<sup>19</sup> This analysis uses the NFHS-3 data that report migrant status and latrine use along with other household characteristics.<sup>20</sup> These migrants are moving from rural to urban areas, which could be within the same state or across state lines.

Table 4 reports that latrine use is similar among migrant Hindu and Muslim households, both unconditionally (column 1) and conditional on household characteristics (column 2). As a comparison, column 3 and column 4 report estimated differences in the NFHS-3 data using all households, which are similar to the estimated differences in Table 2 and Table 3. The sample size is substantially smaller when analyzing migrants only, and so there is less precision in estimating the difference in likelihood of latrine use between Hindu migrants and – Muslim migrants in the same locations (95% confidence interval: 12.2pp less likely 7.0pp more likely). This difference is not statistically different than the within-location difference for all households (column 4), but is statistically smaller than the unconditional difference between Hindus and Muslims (column 3).

# **V Conclusion**

Improvements in sanitation have the potential to dramatically improve child health and adult health (UNDP, 2006).<sup>21</sup> Substantial efforts have been made to improve sanitation infrastructure in India and reduce open defecation, where there are the largest number of children and adults exposed to uncontained fecal material, but there remain concerns that deeply ingrained religious beliefs and associated traditional practices will limit the improvements in sanitation practices following investments in sanitation infrastructure.

The estimates in this study suggest that the unconditional differences in sanitation prac-

> 19From a bias perspective, differences between migrants and non-migrants would bias the estimated differences between Hindu migrants and Muslim migrants if selection of migrants is differential by religion.

> 20The NFHS-3 survey asked about the location of migrants’ prior residence and current residence. The sample is limited to respondents who moved from the “countryside” to a “city,” “large city,” or “capital.”

> 21For evidence on the historical importance of water and sewerage infrastructure for health in the United States, see work by Alsan and Goldin (2019).

13
tices between Hindus and Muslims are driven largely by differences in their locations rather than by differences in household religion itself. The analysis shows large unconditional differences between Hindus and Muslims in latrine ownership and latrine use, but this difference falls by approximately two-thirds when controlling for characteristics of household locations or adding location fixed effects to compare Hindu and Muslim households within more similar geographic locations. Among a sample of migrants from rural to urban areas, there are no statistically significant differences in latrine use between Hindus and Muslims, though this analysis has less statistical power. When considering other sanitation practices, such as handwashing and observed fecal material near homes, the estimates do not show consistent between Hindus and Muslims.

This paper relates to a broader literature seeking to understand differences between Hindus and Muslims in India. It highlights that sanitation practices vary substantially across areas of India, and many areas of India have few Muslims, such that analysis of differences between Hindus and Muslims should compare Hindu and Muslim households that live in similar locations and economic environments. There is an important distinction between household religious beliefs determining differences in behaviors and differences in households’ locations generating differences across religious groups.

14