Population Research Center

Anemia—defined by low levels of the protein hemoglobin in the blood—is a widespread problem in many developing countries. Anemia in children impairs their physical and cognitive development. While large bodies of literature have studied the relationships between poor nutrition and anemia and malaria and anemia, little research has focused on the impact of poor sanitation on anemia. The authors look specifically at the practice of open defecation, or defecating outside on open ground without a toilet or latrine. When people defecate in the open, they often spread intestinal parasites that are known to cause anemia. The medical literature also suggests that exposure to fecal germs can lead to environmental enteropathy, a disease which decreases the intestines’ ability to absorb the nutrients that are important for preventing anemia. Over one billion people practice open defecation, and it is especially common in South Asia. In 2006, half of Nepali households practiced open defecation, but this number declined dramatically—to about 35 percent—by 2011. The authors explore the causal relationship between open defecation and anemia in Nepal using the 2006 and 2011 Demographic and Health Surveys (DHS) for that country.