Linking WASH and MNCH

WASH and Child Health – Fact Sheet

  • Diarrhoea is the second leading cause of death in children under five in developing countries, and the leading cause in Sub-Saharan Africa. Globally about 760,000 children die each year from diarrhoeal disease. (WHO, 2013; UNICEF and WHO, 2009)
  • There are an estimated 1.7 billion cases of diarrhoea each year. Frequent bouts of diarrhoea weaken children, making them more vulnerable to the effects of malnutrition and of other serious diseases such as malaria and pneumonia. (ibid)
  • The only way to prevent diarrhoea is through better access to water and sanitation services, and through improved hygiene practices, especially hand-washing with soap. However, there are still 2.5 billion people worldwide without improved sanitation and 768 million without improved water. And over one billion people are still forced to engage in the dangerous practice of open defecation, making them particularly susceptible to disease. (JMP, 2013)
  • There is new evidence directly linking WASH to the physical (and mental) stunting of children, with researchers finding that children living in unhygienic environments, and especially where open defecation is common, are even more vulnerable than previously thought. (Ngure et al, 2014; Spears et al, 2013)

WASH and Maternal Health

  • There is a growing body of evidence showing significant links between inadequate water and sanitation in communities and maternal mortality. The burden of hauling water from distant sources is linked to poor weight gain during pregnancy, faecal contamination of the environment and of drinking water disproportionally affects pregnant women, poor personal hygiene (due in part to lack of water) is a major contributing factor to high levels of obstetric fistula, and hookworm infestations (caused by poor sanitation) is linked to anaemia and the risk of haemorrhage. (Simavi, 2012).
  • A recent meta-analysis of studies from Sub-Saharan Africa (where almost 90% of maternal deaths occur) indicated that women in households with poor sanitation and lack of water have a significantly higher risk of maternal mortality. (Benova et al, 2014).
  • The critical need for good hygiene in midwifery is well recorded, and there is a strong association between birth attendants’ hand-washing practices and neonatal survival rates. (Rhee et al, 2008).
  • The lack of adequate water supplies and sanitation facilities in health centres is a basic prerequisite for good care (and to prevent hospital-acquired infections), especially in maternal health and obstetric units. However, a recent estimate indicates that fewer than half of hospitals and health centres in the developing world have functional water and sanitation systems (WHO, 2014). A recent study in Tanzania found that only 24 percent of actual delivery rooms have adequate WASH conditions (Benova, 2013).
  • Adequate menstrual hygiene management is only possible where private washing facilities and adequate water supplies are present. The majority of schools in least developed countries do not have adequate WASH facilities; a factor linked to poor attendance and performance rates among girls.(Sommer & Sahin, 2013; UNICEF, 2013).


Benova, Lenka. “What Has Sanitation and Hygiene Got to Do with Maternal Health?” Global Maternal Health Conference, Arusha, Tanzania. Jan 15–17, 2013.

Benova, Lenka, Oliver Cumming, and Oona M. R. Campbell. “Systematic Review and Meta-Analysis: Association between Water and Sanitation Environment and Maternal Mortality.” Tropical Medicine & International Health, 2014, n/a–n/a. doi:10.1111/tmi.12275.

JMP (Joint Monitoring Programme on Drinking Water Supply and Sanitation, WHO and UNICEF). Progress on Sanitation and Drinking-Water, 2013. Geneva: World Health Organization, 2013.

Ngure, Francis M., Brianna M. Reid, Jean H. Humphrey, Mduduzi N. Mbuya, Gretel Pelto, and Rebecca J. Stoltzfus. “Water, Sanitation, and Hygiene (WASH), Environmental Enteropathy, Nutrition, and Early Child Development: Making the Links.” Annals of the New York Academy of Sciences 1308, no. 1 (2014): 118–28. doi:10.1111/nyas.12330.

Rhee, Victor, Luke C Mullany, Subarna K Khatry, Joanne Katz, Steven C LeClerq, Gary L Darmstadt, and James M Tielsch. “Maternal and Birth Attendant Hand Washing and Neonatal Mortality in Southern Nepal.” Archives of Pediatrics & Adolescent Medicine 162, no. 7 (July 2008): 603–8. doi:10.1001/archpedi.162.7.603.

Simavi. Getting It Right, WASH and Maternal Health Evidence 2012, Haarlem: IRC and Royal Tropical Institute, 2012.

Sommer, Marni, and Murat Sahin. “Overcoming the Taboo: Advancing the Global Agenda for Menstrual Hygiene Management for Schoolgirls.” American Journal of Public Health 103, no. 9 (September 2013): 1556–59. doi:10.2105/AJPH.2013.301374.

Spears, Dean, Arabinda Ghosh, and Oliver Cumming. “Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts.” PLoS ONE 8, no. 9 (September 16, 2013): e73784. doi:10.1371/journal.pone.0073784.

UNICEF. UNICEF WASH 2012 Annual Report. New York: United Nations Children’s Fund, 2013.

UNICEF and WHO. Diarrhoea: Why Children Are Still Dying and What Can Be Done. New York: United Nations Children’s Fund, 2009.

WHO. “Diarrhoeal Disease WHO Fact Sheet April,” 2013.

WHO. Landscape report on the status of water, sanitation, and hygiene and environmental conditions in health care facilities. Unpublished draft. Geneva: World Health Organization, 2014.

Click for a Knowledge Summary on Water Sanitation and Hygiene, highlighting the impact of WASH investments on reproductive, maternal, newborn and child health.