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A basic need to help children

A man exits a public toilet on Koh Pich in Phnom Penh
A man exits a public toilet on Koh Pich in Phnom Penh. New research in Cambodia shows that young children living in communities with access to toilets are generally taller than their less fortunate counterparts. Pha Lina

A basic need to help children

Did you know that in communities where a high proportion of people defecate outdoors, children are on average shorter than children living in communities where most people use toilets.

New research in Cambodia conducted jointly by the World Bank’s Water and Sanitation Program and the Research Institute for Compassionate Economics (RICE) shows that open defecation contributes significantly to stunting of children.

In layman’s term, the study led by Dean Spears, a researcher on health and needs of young children in poor countries, found that a 5-year-old child living in a community where everyone uses a toilet would on average be 2cm to 3.6cm taller than the child living in a community where no one uses a toilet.

More importantly, open defecation not only affects one’s own health, but it also affects the health of one’s neighbours. In other words, when almost an entire community is defecating in the open, even the children in families that use a toilet are almost as short as the children in families that do not use a toilet. Simply put: toilets make good neighbours.

Does this small difference in height matter? Yes it does, because children are not making up for this height loss in their early years and as a result will not achieve their full cognitive potential.

Long-term research studies following individuals in the US and the UK have shown that taller children are more likely to become taller adults, and taller adults are more likely to earn more income, as pointed out by professors at Princeton University Anne Case and Christina Paxson in their research.

Another study by Dean Spears highlights that in places like India, taller children are much more likely to be able to read and do mathematics.

Therefore, any linkage between sanitation and child height reveals that exposure to open defecation can be a serious barrier for children growing into tall, smart and ultimately productive adults.

This means that tackling open defecation deserves the focused attention of policy makers to address malnutrition, like other essential interventions such as breast-feeding, nutrition intake and basic access to health care services for mother and child.

Although Cambodia’s economic growth has been impressive, averaging 8.2 per cent during the period 2000 to 2010 – the 15th fastest in the world – the country is still among those with the highest rates of open defecation.

In 2010, 57 per cent of Cambodian families still defecated openly, and this rate is even higher in rural areas at 66 per cent. At the same time, malnutrition indicators, such as stunting among under-five-year-olds remain high at 40 per cent in 2010.

The situation is even worse among poor families which are three times less likely to have access to good sanitation facilities than the average, according to the forthcoming Cambodia Poverty Assessment 2013.

The Royal Government of Cambodia recognises this challenge and has set itself the goal of reaching universal rural sanitation coverage by 2025, a target that, to be achieved, requires a rate at least six-times higher than past annual progress.

By declaring November 13 National Sanitation Day, the government aims to garner support for the sanitation sector and to promote sanitation awareness, particularly among rural communities.

The theme for this year was “Better Sanitation Starts with You”, recognising the importance of empowering communities and local leaders to take action and improve everyone’s sanitation situation.

The celebration of National Sanitation Day in Cambodia is in tandem with the first United Nations designated World Toilet Day on November 19.

Appreciating the importance of reducing open defecation to improve a child’s nutritional status, more needs to be done to accelerate access to sanitation in the country, in close collaboration with nutrition-specific interventions.

Research shows us that sanitation policies would best prioritise community-wide behaviour change to stop open defecation. Incentives, policies and targets that encourage villages and communes to become “open defecation free” are needed.

To this end, the following must be developed: sanitation policy guidelines, a sector monitoring system, local implementation capacities, local private sector capacities and appropriate incentives, and financing arrangements, especially for reaching the poor.

Equally important, integration of sanitation interventions as part of broader national nutrition programs could offer important synergies.

We, as development partners, are ready to support the government with solutions that help to achieve better sanitation and nutritional outcomes for Cambodian families and children.

Alassane Sow
Country Manager,
The World Bank

Rana Flowers
Country Representative,


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