Utilization of improved sanitation facilities: Does socioeconomic inequality still persist in India?

Abstract

Background Despite the significant improvement in sanitation coverage, utilization of improved sanitation still does not reach the optimal level across all socioeconomic groups in India. Given this backdrop, this study examines the socioeconomic status-related inequality in the utilization of improved sanitation facilities among Indian Households. Methods The study utilized fifth round of National Family Health Survey (NFHS); a national representative cross-sectional survey of India conducted in 2019-21. Logistic regression was applied to estimate the effect of various predictors on utilization of improved sanitation facilities. We also used decomposition analyse to identify the factors responsible for utilization of improved sanitation. Results The results indicate that 69% of Indian households utilized improved sanitation facilities. The study highlights that young and unmarried household heads, lower education, poor wealth status of household, living in rural areas, and marginalized castes had lower access to improved sanitation facilities. The multivariate regression analysis suggested that households belonging to richer [AOR: 13.99; 95%, CI: 13.64–14.34] and richest [AOR: 46.73; 95%, CI: 45.00–48.52] wealth quintiles have 14 and 47-times higher odds of having sanitation facility than households which belong to poorest quintile respectively. The decomposition analysis suggested that 11 to 18% of inequality was explained by the geographical region of household and caste of household head. The concentration curve of utilization of improved sanitation was more concentrated in Central and East India households (Concentration Index: 0.51 and 0.47), which has reduced to 0.17 and 0.22 during NFHS-4 to NFHS-5. We also found that 68 districts in India had less than 50 percent utilization of improved sanitation facilities. Conclusion The study concludes that households with a better socioeconomic status were more able to access improved sanitation. Thus, inclusive strategies are needed to reduce socioeconomic inequality at the micro level and strengthen ongoing policies.