Child malnutrition and mortality are critical public health challenges in India, exacerbated by inadequate sanitation infrastructure. This study examines the effects of sanitation and sewage systems on malnutrition indicators (stunting, underweight, and wasting) and child mortality in India. Utilizing data from the NFHS-4 and NFHS-5 across 28 states and one union territory, the analysis investigates how access to improved sanitation, specifically private and shared toilets with sanitation and sewage systems, influences child health outcomes and indirectly impacts mortality through malnutrition.

The findings demonstrate that use of toilet facilities significantly reduces stunting and underweight prevalence, with shared toilets having a greater effect than private toilets. In contrast, open defecation is associated with increased malnutrition, particularly affecting stunted and underweight children under five. The study also highlights female education as a vital factor in reducing child mortality, suggesting that maternal education contributes positively to child health and sanitation awareness. Additionally, the indirect pathway of sanitation’s impact on mortality—through reduced malnutrition—emphasizes the broader public health benefits of sanitation improvements.

These results underscore the potential of sanitation initiatives, such as the Swachh Bharat Mission, to improve child health by reducing malnutrition and mortality risks. The study calls for integrated public health policies focusing on sanitation infrastructure, public health education, and female education to address malnutrition and mortality comprehensively. This research provides evidence supporting policies that prioritize sanitation improvements as a foundational element in enhancing child health outcomes in India.