© 2023 The Authors Water Policy Vol 25 No 10, 980 doi: 10.2166/wp.2023.

083

Determinants of access to improved drinking water and sanitation in India:

evidence from India Human Development Survey-II (IHDS)

Rajiv Gurung a, *, Christopher Tirkeyb, Kishore Kumar Takrib, Nimesh Diyalic, Manesh Choubeyb
and Runa Rai b
a
Department of Economics, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam Campus, Puttaparthi, Andhra Pradesh, India
b
Department of Economics, Sikkim University, Gangtok, Sikkim, India
c
Centre for the Study of Regional Development, JNU, New Delhi, India
*Corresponding author. E-mail: [email protected]

RG, 0000-0002-4974-8541; RR, 0000-0001-6618-4752

ABSTRACT

Access to improved drinking water and sanitation has been declared a fundamental right by the UN General Assembly. How-
ever, around 25 and 50% of the global population lacked access to safely managed drinking water and improved sanitation in
2020, respectively. India, the second most populous country in the world, has around 3.7 and 31% of its population without
access to improved drinking water and sanitation, respectively. This paper explores the factors determining a household’s
access to improved drinking water and sanitation in India, using India Human Development Survey (IHDS) II data. The results
indicate that urban households with bigger family sizes, with fewer rooms, married but uneducated household heads, belong-
ing to forward castes, were more likely to have access to improved drinking water. Similarly, households with married female
heads, belonging to forward castes, small household sizes, older aged heads with primary education, from Non-EAG (Empow-
ered Action Group) states, located in urban areas, earning higher incomes and having more rooms were more likely to have
access to improved sanitation. Findings suggest subsidized improved water and sanitation services and an increase in public
investment to make these facilities affordable for poor rural households.

Key words: Access, Drinking water, Health, IHDS-II, Improved sanitation, India

HIGHLIGHTS

• A considerable share of the global population remains deprived of safe drinking water and sanitation.
• There is an urgent need to understand the factors influencing their access as any policy intervention aiming to improve
sanitation and drinking water problem must first identify the population at risk.
• Studies on the determinants of access to improved drinking water and sanitation in the Indian context are limited.

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 Water Policy Vol 25 No 10, 981

GRAPHICAL ABSTRACT

1. INTRODUCTION
Improved drinking water and sanitation access are crucial to public health and sustainable development.
Acknowledging the importance of clean drinking water and sanitation, the UN General Assembly declared it
as a fundamental human right in 2010 (United Nations, 2010). It also significantly impacts a household’s socio-
economic status, living standards, and life expectancy. However, it remains a major developmental challenge,
especially in developing countries. In 2020, around 25 and 50% of the global population lacked safely managed
drinking water and sanitation. Furthermore, approximately 6% of the world’s population still defecated in the
open in 2020, whereas 2.3 billion people lacked basic handwashing facilities in the same year (WHO/
UNICEF JMP, 2021). Furthermore, the World Health Organization (WHO) estimates that around 2 billion
people consume water contaminated with human faeces.
Unsafe drinking water and sanitation are the most common causes of sickness and deaths in developing
countries (Bartram et al., 2005). It also increases health costs, decreases worker productivity, and drops school
enrolment. The lack of access to safe drinking water and improved sanitation is the world’s second-largest
cause of child deaths (Watkins, 2006). According to the WHO Report 2015, children living with unimproved
drinking water and sanitation facilities face mortality risk and nutritional deficiency. Diarrhoeal diseases due
to poor sanitation, poor hygiene, or unsafe drinking water were responsible for 9% of the deaths of children
under five (UNICEF, 2022). Prüss-Ustün et al. (2019) estimated that around 60% of all diarrhoeal deaths and
5.3% of all deaths among under 5-year-old children in 2016 were due to inadequate drinking water, sanitation,
and hygiene. On the other hand, adequate access to improved sanitation and safe drinking water can signifi-
cantly reduce water-borne infections, and diseases like cholera, typhoid, and diarrhoeal deaths (Wolf et al.,
2018; Li & Wu, 2019). Adopting good sanitation and hygiene practices is a cost-effective, easy-to-practice,
and most effective public health intervention in preventing infectious diseases like diarrhoea, cholera, hepatitis,
etc. (Fewtrell et al., 2005).

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 Water Policy Vol 25 No 10, 982

Recognizing its importance, the governments in developing countries are making serious efforts to meet Sus-
tainable Development Goal 6 (SDGs 6.1 and 6.2) of the United Nations adopted in 2015. SDGs 6.1 and 6.2
aim to ensure access to improved water, sanitation, and hygiene for all by 2030. According to the WHO-
UNICEF Joint Monitoring Programme (JMP), an enhanced source of drinking water includes water piped
(into the dwelling, yard, or plot), water from a public tap or standpipe, a tubewell or borehole, a protected dug
well, a protected spring, and rainwater. Similarly, an improved sanitation facility includes a flush-to-piped
sewer system, septic tank, pit latrine, pit latrine with slab, and composting toilet.
India is the world’s second most populous country, accounting for 17.76% of the world’s population. Out of its
total population, around 91 million people do not have access to clean water sources, and more than 746 million
people still lack access to safely managed household sanitation facilities (Water.org, 2023). The poor water and
sanitation in India have serious health implications, resulting in cholera, dysentery, and typhoid diseases. A study
by Mallick et al. (2020) finds that poor sanitation and unsafe water are responsible for most of the diarrhoeal
deaths in India. Nevertheless, the Indian government has undertaken several measures to address these issues.
The Swachh Bharat Abhiyan (Clean India Mission), launched in 2014, aims to eliminate open defecation and pro-
mote cleanliness and hygiene. The programme has led to the construction of millions of toilets in rural areas and
reduced open defecation. Despite India being declared Open Defecation Free in 2019, the NFHS Report 2019–
2021 showed that 19% of households do not use any toilet facility and still defecate in the open. Open defecation
is still prevalent in India due to religious beliefs, untouchability, casteism, illiteracy, and lack of proper toilet infra-
structure. The Jal Jeevan Mission,1 launched in 2019, aims to provide access to piped water to all households by
2024. The programme has set an ambitious target of delivering 55 litres of water per person per day, focusing on
water-stressed areas and marginalized communities. Besides them, several non-governmental organizations and
private sector entities have also taken up the cause of improving water and sanitation in India. However, the pro-
blem of ensuring access to improved drinking water and sanitation remains a significant challenge in India.
It is to be noted that any policy intervention aiming to improve sanitation and drinking water problems must
first identify the population at risk of inadequate water and sanitation services. Therefore, there is an urgent need
to understand the essential factors influencing access to safe water and improved sanitation. Globally, many
studies have explored determinants of access to safe drinking water and sanitation (Adams et al., 2016; Abubakar,
2019; Behera & Sethi, 2020; Adil et al., 2021; Dongzagla, 2022; Rahut et al., 2022). However, studies on the
determinants of access to improved drinking water and sanitation in the Indian context are limited. Existing
studies are limited to state-level analysis (Tiwari & Nayak, 2013), urban households (Poonia & Punia, 2019),
and rural households (De, 2018). Therefore, this study extends the analysis to the national level to address this
literature gap and add to the burgeoning scholarship on the socioeconomic determinants of access to safe
water and sanitation.

2. LITERATURE REVIEW
Several studies have highlighted the determinants of households’ choice of drinking water and sanitation.
Abubakar (2019) demonstrated that gender and education of household head, household wealth, place of resi-
dence, geopolitical zone, access to electricity, water collection time, and number of rooms in the house are
positively significant predictors of access to drinking water. Similar findings were reported by Mulenga et al.

1
Jal Jeevan Mission is a national-level programme launched by the Government of India in 2019 to provide safe and adequate drinking water to
all rural households in the country by 2024. The mission is a part of the larger goal to ensure access to clean water, improve public health, and
promote sustainable development in rural areas. As on 24 July 2023, around 194,660,082 rural households have been covered.

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 Water Policy Vol 25 No 10, 983

(2017) who used data collected from a survey of 5,558 households from the 2013/2014 Zambia Demographic and
Household Sanitation dataset. They discovered that household wealth, gender, region, and locality of residence
were major determinants of better water and sanitation. Using a large survey dataset of 11,619 households in
Ghana, Adams et al. (2016) revealed that urban areas have better access to safe drinking water and sanitation.
Supporting this study, Angoua et al. (2018) found that rural households with lower incomes and lower levels
of education were less likely to access improved water and sanitation facilities. In Ethiopia, Gebremichael
et al. (2021) identified several significant variables, including access to water sources, water quality, sanitation
facilities, and hygiene perceptions. They found that access to improved water sources and sanitation facilities
was limited, with a high reliance on unimproved sources and open defecation.
In the case of Bhutan, Rahut et al. (2015) identified several significant variables, including the water source
type, the distance to the source, household income, and education level. Using primary data collected from a
survey of 600 urban households in Nepal, Behera & Sethi (2020) recorded that households’ access to drinking
water was significantly influenced by household income, distance to the water source, and the presence of a
water point in the neighbourhood. Adil et al. (2021) examined the determinants of improved drinking water
and sanitation in Pakistan. They discovered that household exposure to media, household head’s educational
attainment, household wealth, and ethnicity were important predictors. Along with these factors, social norms
and place of residence were important predictors of improved sanitation practices. In line with this finding,
Singh (2009) reported that the marginalized and the lower-caste households in India are deprived and prevented
from accessing improved drinking water sources. In some communities, even the concept of shared toilets is often
considered impure (Dwipayanti et al., 2019). Similarly, a regional study conducted by Tiwari & Nayak (2013) in
India discovered that factors like caste, household income, education level, and location significantly affected
access to improved water and sanitation. They discovered significant disparities based on income and caste.
The review highlights socioeconomic and demographic predictors including household size, age, gender, edu-
cation, income, wealth, location, marital status, region and caste, and social norms as important predictors of
access to clean drinking water and improved sanitation. However, it indicates that the critical determinants
are still unknown as the findings of the studies are contradictory and inconsistent. For instance, studies by
Dongzagla (2022) and Mulenga et al. (2017) show a significantly strong correlation between access to improved
water and income, while Yang et al. (2013) have not found it to be a significant predictor. Although studies have
been conducted globally to identify the determinants, studies exclusively focused on India are limited. Further-
more, existing studies focus separately on urban or rural areas, necessitating a nationwide study. Many of
them have used smaller sample sizes collected from the primary survey.

3. MATERIALS AND METHODS

IHDS is a nationally representative survey in India jointly administered by researchers from the University of
Maryland and the National Council of Applied Economic Research (NCAER), New Delhi. It is a multi-topic
survey that collected information on income, consumption, employment, education, and health. So far, two
survey waves have been conducted: IHDS-I in 2004–2005 and IHDS-II in 2011–2012. The present study has
used data from IHDS-II (2011–2012) as the most recent round. The IHDS-II selected and surveyed 42,152 house-
holds using stratified random sampling. It provided information on 27,579 rural and 14,573 urban households
across 35 states and union territories of India.
The IHDS dataset is considered one of the most extensive and comprehensive datasets available for studying
various aspects of human development in India. It represents the country’s rural and urban populations ade-
quately such that the findings can be generalized to the broader Indian population. It is a longitudinal survey
that provides data from the same households and individuals at multiple points in time allowing researchers to

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 Water Policy Vol 25 No 10, 984

track changes over time and study the dynamics of various human development indicators. It provides detailed
socioeconomic data, enabling researchers to explore relationships between different variables and gain insights
into the factors influencing human development outcomes. This extensive coverage allows for in-depth analysis
of multiple dimensions of human development.

3.1. Measures
The India Human Development Survey-II (IHDS) dataset provides information on types of household drinking
water sources and toilet facilities. Sources of drinking water include (i) piped (public supply), (ii) tubewell, (iii)
hand pump, (iv) open well, (v) covered well, (vi) river, canal, and streams, (vii) pond, (viii) tanker truck, (ix) rain-
water, (x) bottled water, and (xi) others. Similarly, toilet facilities are of four broad types: (i) no facility belonging
to the household (or open fields), (ii) traditional pit latrine, and (iii) semi-flush (septic tank) latrine. The present
study has used two primary outcomes as the two significant dependent variables: ‘source of drinking water’ and
‘type of toilet used’. Based on the WHO-UNICEF JMP categorization, the dependent variables were dichoto-
mized into improved sources (1) and unimproved sources (0). Improved drinking water sources included
piped (public supply), tubewell, hand pump, covered well, and rainwater. On the other hand, unimproved sources
had open wells, unprotected springs and surface water (like rivers, canals, and streams), ponds, tanker truck
bottled water, and others. Similarly, sanitation was also dichotomized into (1) improved sanitation and unim-
proved sanitation (0). Improved sanitation facilities included flush and semi-flush toilets or latrines with septic
tanks, whereas unimproved sanitation comprised no facility in households (including open fields) and traditional
pit latrines.
Various theoretically relevant socioeconomic explanatory variables were included in the analysis, such as
gender, age, education, marital status, religion, caste category, number of household members, and total
annual household income. Place of residence (urban/rural) and Empowered Action Group (EAG)2 status were
included to examine the regional effects. EAG states comprise Bihar, Chhattisgarh, Rajasthan, Uttarakhand,
Assam, Odisha, Madhya Pradesh, and Uttar Pradesh. These states together account for about 46% of the coun-
try’s population and 61% of the poor (Chandramouli, 2011). EAG is considered the group of the most
backward and deprived states.

3.2. Data analysis

Analyses were based on weighted data to account for the complexity of the survey design. First, descriptive stat-
istics (frequency and percentage) were generated for all dependent and independent variables. Then, the Pearson
Chi-square test was used to test whether there is a statistically significant relationship between the dependent vari-
ables (i.e., drinking water source and sanitation type) and household socioeconomic, demographic, and
geographic factors. Lastly binary logistic regressions were used to identify the key determinants of household
drinking water source and sanitation type since the outcome variables were binary, as found in similar studies
(Adams et al., 2016; Abubakar, 2019; Dongzagla, 2022). The results were presented as tables and summary stat-
istics in odds ratios and p-values. The analyses were conducted using Stata 14 statistical software.

2
The Empowered Action Group (EAG) are eight socioeconomically backward states of India including Bihar, Chhattisgarh, Jharkhand, Madhya
Pradesh, Orissa, Rajasthan, Uttaranchal, and Uttar Pradesh. They face various developmental challenges, including poverty, healthcare,
education, infrastructure, and economic growth. They are disadvantaged in almost all socioeconomic indicators. Around 45% of the Indian
population lives in these states. These states were identified by the Government of India to receive special attention and focused
developmental efforts.

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 Water Policy Vol 25 No 10, 985

4. RESULTS AND DISCUSSION

Access to improved drinking water and sanitation were the dependent variables in two binary logistic regressions.
Binary logistic regressions were used to identify the determinants of access to improved drinking water and
improved sanitation. Table 1 reports the descriptive statistics of the dependent and explanatory variables
employed in the present analysis.
Our descriptive statistics in Table 1 show that approximately 87.6% of the respondents used water from
improved sources, while 12.4% used non-improved sources. About 60% of the respondents were without
access to improved sanitation facilities, while 40% used improved sanitation facilities. About 86% of the house-
holds were headed by males. Households were evenly distributed across the income category, with 62.47% below
one lakh category and more than 10 lakhs only 0.7%. Most respondents were married (84.2%), and almost 25%
were educated at a minimum of secondary school level; the remaining 35% had at least primary education.
4.1. Association between households’ socioeconomic and demographic factors (independent variables)
and sources of drinking water and sanitation facilities (dependent variables)
The associations between households’ sources of drinking water and sanitation facilities (dependent variables),
gender of the household head, family size, and age of the household head, marital status of the household
head, region educational attainment, and household income (independent variables) are presented in Table 2.
Improved water coverage among female-headed households (87.7%) was similar to male-headed households
(87.6%). Conversely, improved sanitation coverage among male-headed households (40.5%) was slightly higher
than among female-headed households (39.6%). Whereas the association between the gender of the household
head and access to improved drinking water was statistically significant (p , 0.1), it was not significant for
access to improved sanitation. As expected, households where the heads lacked education (87.2%) had lower
access to improved sources of drinking water as compared to those with secondary education (88.5%) and gradu-
ate and above (91.1%). Surprisingly, households with heads with primary education (86.54%) had lower access
than households with heads without education. The association between HH’s educational level and household
access to improved water was statistically significant (χ 2(3) ¼ 62.9, p ¼ 0.001). The observed Chi-square distribution
is larger than expected by 62, thus signifying a significant difference in household drinking water source and edu-
cational level of the household head. A similar association was observed between improved sanitation coverage
and the educational level of HH. Households with higher educational levels had increased access to improved
sanitation facilities. Households with heads that had no formal education had lower access to improved sani-
tation (22.1%) as compared to households with heads who completed primary (38.2%), secondary (56.2%),
and graduate and above (72.8%) education. Table 2 indicates a significant positive relationship between the edu-
cational level of the household head and access to improved sanitation (χ 2(3) ¼ 4,400, p ¼ 0.001). The Chi-square
value indicates that the observed distribution is larger than expected by 4,400, thus signifying a vast difference
among various educational groups in access to improved sanitation. Thus, the likelihood of using improved sani-
tation increases with the educational level. The results also depict heavy reliance on unimproved sources of
sanitation by households headed by uneducated persons (78%), followed by those with primary (61.8%), second-
ary/higher secondary (43.8%), and graduation and above (27. 2%). These figures suggest that the difference
between education levels substantially impacts access to improved sanitation.
We find a statistically significant relationship between income levels and access to improved drinking water
(χ (3) ¼ 32.4, p ¼ 0.001) and sanitation (χ 2(3) ¼ 4,900, p ¼ 0.001). Households in the highest income bracket of
2

above 10 lakhs had higher improved sanitation coverage (79.7%) as compared to households with lower incomes:
5–10 lakhs (69.2%), 2–5 lakhs (52.7%), and less than or equal to 1 lakh (28.1%). Similarly, households with the
highest incomes had higher access to improved drinking water (86.9%) than households with a total annual

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 Water Policy Vol 25 No 10, 986

Table 1 | Descriptive statistics sanitation and drinking water (N ¼ 41,902).

Variables Categories Frequency Percentage

Source of drinking water Unimproved 5,210 12.41

Improved 36,785 87.59
Total 41,995 100
Sanitation facility Unimproved 25,049 59.67
Improved 16,929 40.33
Total 41,978 100
Gender of HH head Male 36,114 85.77
Female 5,994 14.23
Total 42,108 100
Caste General/Open/Brahmin 11,857 28.19
OBC 17,056 40.55
SC/ST/Others 13,153 31.27
Total 42,066 100
Family size Small 11,504 27.29
Medium 22,946 54.44
Big 7,702 18.27
Total 42,152 100
Age of HH head Below 30 3,121 7.41
30–39 6,962 16.53
40–49 11,393 27.06
50–59 9,655 22.93
60 and above 10,977 26.07
Total 42,108 100
Marital status HH head Married 35,455 84.2
Never married 439 1.04
Widowed/Separated/Divorced 6,214 14.76
Total 42,108 100
Education of HH head Illiterate 13,422 31.9
Primary 14,808 35.19
Secondary/Higher Secondary 10,477 24.9
Graduate and above 3,371 8.01
Total 42,078 100
EAG status EAG 15,904 37.73
Non-EAG 26,248 62.27
Total 42,152 100
Place of residence Rural 27,579 65.43
Urban 14,573 34.57
Total 42,152 100
Income Less than or equal to 1,00,000 26,331 62.47
Rs. 100,001–Rs. 200,000 8,924 21.17
Rs. 200,001–Rs. 500,000 5,546 13.16
Rs. 500,001–Rs. 1,000,000 1,055 2.5
More than Rs. 10,00,000 296 0.7
Total 42,152 100
No. of rooms Less than or equal to 2 23,149 55.17

(Continued.)

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 Water Policy Vol 25 No 10, 987

Table 1 | Continued

Variables Categories Frequency Percentage

3–5 rooms 16,279 38.8

More than 5 rooms 2,532 6.03
Total 41,960 100
Source: IHDS-II (2011–2012).

income of 5–10 lakhs (90.1%), 2–5 lakhs (89.2%), and less than or equal to 1 lakh (86.9%). Quite unexpectedly,
households in the highest annual income bracket (above 10 lakhs) had lower coverage of improved drinking
water (87.8%) than those with lower income levels.
Coverage of improved drinking water was the highest (90.1%) among the households belonging to forward
castes (General/Open/Brahmin). Households from reserved caste categories such as OBC (86.5%) and SC/
ST/Others (86.8%) had less access to improved drinking water. Similarly, households from forward castes also
had the highest level of access to improved sanitation (54.5%). In contrast, only 27.8% of the SC/ST/Others
households and 40% of the OBC households used improved sanitation. A significant statistical difference is
found between caste category and household’s access to improved drinking water (χ 2(2) ¼ 92.23, p ¼ 0.001) and
sanitation (χ 2(2) ¼ 1.8, p ¼ 0.001) were statistically significant.
Households headed by a never-married person had lower access to improved drinking water (85.2%) than
households headed by a married person (87.5%) or a widowed/separated/divorced person (88.3%). In contrast,
households with heads who were never married had slightly higher access to improved sanitation (43.9%) than
households with heads who were married (40.5%), widowed/divorced/separated (39.1%). The association
between marital status and households’ access to improved drinking water (χ 2(2) ¼ 5.76, p ¼ 0.057) and sanitation
(χ 2(2) ¼ 6.6, p ¼ 0.037) was statistically significant.
The association between the age of the household head and the level of access to improved sanitation (χ 2(2) ¼
533.41, p ¼ 0.000) was statistically significant but was otherwise with the improved drinking water (χ 2(2) ¼ 4.76,
p ¼ 0.313). Coverage of improved drinking water ranged between 86.7 and 88% for all age groups, and a slight
disparity was observed across age groups. However, the results indicate a wide disparity in improved sanitation
coverage across age groups. Households from the age group 50–59 years had the highest coverage (45.3%), fol-
lowed by the age groups above 60 (43.4%), 40–49 years (40.6%), 30–39 years (35.1%), and below 30 years (24.
8%). Household size was significantly related to access to improved drinking water (χ 2(2) ¼ 4.83, p ¼ 0.089) and
sanitation (χ 2(2) ¼ 33.01, p ¼ 0.000) in India. Table 2 indicates that the difference between big, medium, and
small family sizes does not substantially matter in the level of access to improved drinking water. However,
medium-sized households (41.6%) have higher levels of access to improved sanitation compared to small
(38.9%) and big (38.7%) households.
Table 2 presents a statistically significant difference in access to improved drinking water (χ 2(1) ¼ 48.394,
p ¼ 0.000) and sanitation (χ 2(1) ¼ 2,000, p ¼ 0.000) between EAG states and Non-EAG states. The results indicate
that households in Non-EAG states (88.5%) had higher coverage of improved drinking water than EAG states
(86.2%). The results also reveal a wide disparity between the households in EAG states (26.5%) and Non-EAG
states (48.8%) regarding access to improved sanitation facilities.

4.2. Determinants of access to improved drinking water and sanitation

The logistic regression results in Table 3 report the key determinants of a household having access to improved
water and sanitation. The significant determinants of access to improved drinking water are caste category, house-
hold size, marital status, educational level, place of residence, and the number of rooms.

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 Water Policy Vol 25 No 10, 988

Table 2 | Bivariate analysis of variables modelling access to improved water and sanitation (N ¼ 14,315).

Source of drinking water Source of sanitation

Variables Unimproved Improved Unimproved Improved

Gender
Male 4,470(12.4%) 31,514(87.6%) 21,418(59.6%) 14,550(40.5%)
Female 737(12.3%) 52,309(87.7%) 3,604(60.4%) 2,362(39.6%)
Pearson Chi-square statistics χ 2 ¼ 0.0237; df ¼ 1; p ¼ 0.087* χ 2 ¼ 1.578; df ¼ 1; p ¼ 0.209
Caste
General/Open/Brahmin 1,170(9.9%) 10,650(90.1%) 5,375(45.5%) 6,437(54.5%)
OBC 2,298(13.5%) 14,681(86.5%) 10,179(60%) 6,793(40%)
SC/ST/Others 1,733(13.2%) 11,377(86.8%) 9,464(72.2%) 3,644(27.8%)
Pearson Chi-square statistics χ 2 ¼ 96.228; df ¼ 2; p ¼ 0.000*** χ 2 ¼ 1.800; df ¼ 2; p ¼ 0.000***
Family
Small 1,480(13%) 9,952(87%) 6,979(61.1%) 4,447(38.9%)
Medium 2,773(12.1%) 20,110(87.9%) 13,361(58.4%) 9,511(41.6%)
Big 957(12.5%) 6,723(87.5%) 4,709(61.3%) 2,971(38.7%)
Pearson Chi-square statistics χ 2 ¼ 4.835; df ¼ 2; p ¼ 0.089* χ 2 ¼ 33.013; df ¼ 2; p ¼ 0.000***
Age
Below 30 years 414(13.3%) 2,691(86.7%) 2,333(75.2%) 768(24.8)
30–39 years 870(12.5%) 6,067(87.5%) 4,503(64.9%) 2,435 (35.1%)
40–49 years 1,362(12%) 10,003(88%) 6,751(59.4%) 4,615(40.6%)
50–59 years 1,212(12.6%) 8,414(87.4%) 5,260(54.7%) 4,357(45.3%)
Above 60 years 1,349(12.4%) 9,569(87.6%) 6,175(56.6%) 4,737(43.4%)
Pearson Chi-square statistics χ 2 ¼ 4.760; df ¼ 2; p ¼ 0.313 χ 2 ¼ 533.414; df ¼ 2; p ¼ 0.000***
Marital status
Never married 64(14.8%) 369(85.2%) 243(56.1%) 190(43.9%)
Married 4,422(12.5%) 30,915(87.5%) 21,014(59.5%) 14,305(40.5%)
Widow 721(11.7%) 5,460(88.3%) 3,765(60.9%) 2,417(39.1%)
2 2
Pearson Chi-square statistics χ ¼ 5.746; df ¼ 2; p ¼ 0.057* χ ¼ 6.606; df ¼ 2; p ¼ 0.037**
Education
Illiterate 1,716(12.8%) 11,646(87.2%) 10,401(77.9%) 2,960(22.1)
Primary 1,988(13.46%) 12,780(86.54%) 9,126(61.83%) 5,634(38.17%)
Secondary/Higher 1,198(11.5%) 9,236(88.5%) 4,570(43.8%) 5,859(56.2%)
Graduate 300(8.9) 3,059(91.1) 912(27.2%) 2,445(72.8%)
Pearson Chi-square statistics χ ¼ 62.997; df ¼ 3; p ¼ 0.000***
2
χ ¼ 4,400; df ¼ 3; p ¼ 0.000***
2

EAG status
EAG 2,198(13.8%) 13,682(86.2%) 11,676(73.5%) 4,202(26.5%)
Non-EAG 3,012(11.5%) 23,103(88.5%) 13,373(51.2%) 12,727(48.8%)
Pearson Chi-square statistics χ 2 ¼ 48.394; df ¼ 1; p ¼ 0.000*** χ 2 ¼ 2,000; df ¼ 1; p ¼ 0.000***

(Continued.)

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 Water Policy Vol 25 No 10, 989

Table 2 | Continued

Source of drinking water Source of sanitation

Variables Unimproved Improved Unimproved Improved

Place of residence
Rural 3,965(14.4%) 23,513(85.6%) 20,259(73.8%) 7,204(26.2%)
Urban 1,245(8.6%) 13,272(91.4%) 4,790(33%) 9,725(67%)
2 2
Pearson Chi-square statistics χ ¼ 299.497; df ¼ 1; p ¼ 0.000*** χ ¼ 6,600; df ¼ 1; p ¼ 0.000***
Income
Less than or equal to 100,000 3,426(13.1%) 22,798(86.9%) 18,839(71.9%) 7,375(28.1%)
1 lakh–2 lakhs 1,044(11.7%) 7,855(88.3%) 4,204(47.3%) 4,689(52.7%)
2–5 lakhs 600(10.9%) 4,928(89.2%) 1,701(30.8%) 3,827(69.2%)
5–10 lakhs 104(9.9%) 945(90.1) 245(23.4%) 803(76.6)
Above 10 lakhs 36(12.2%) 259(87.8%) 60(20.3) 235(79.7%)
Pearson Chi-square statistics χ 2 ¼ 32.443; df ¼ 4; p ¼ 0.000*** χ 2 ¼ 4,900; df ¼ 4; p ¼ 0.000***
Source: IHDS-II (2011–2012).
Percentages are computed as rows.
*p  0.1, **p  0.5, and ***p  0.01.

First, female-headed households are 46% more likely to access improved sanitation facilities than male-headed
households. One reason for this could be that in many developing countries, women are responsible for managing
water, sanitation, and hygiene. Women could pay more attention to such issues than their male counterparts,
especially when women are the household heads. Also, females place more attention on privacy and personal
hygiene than males. As a result, they would strive to have their toilets at home for better privacy and reduce infec-
tion risk. This finding is consistent with Agbadi et al. (2019), Armah et al. (2018), Adams et al. (2016), and
Mulenga et al. (2017) but disagrees with the work of Akpakli et al. (2018). However, gender did not significantly
influence the odds ratio of access to improved drinking water.
Households headed by older persons (more than 30 years) were at least 31% more likely to have access to
improved sanitation facilities than the ones headed by younger persons (less than 30 years). Older people
could afford more basic services compared to young ones, possibly because of their higher economic status.
Also, older household heads are more concerned about their health and try to utilize services that improve
their and their family’s health and quality of life (Agbadi et al., 2019). It may also be possible that a majority
of household heads above 30 years of age might have been working and could afford improved sanitation facili-
ties compared to younger household heads who are at risk of being unemployed. This finding is in line with
Dongzagla (2022), Agbadi et al. (2019), and Akpakli et al. (2018). However, the age category has no statistically
significant impact on the odds ratio of using improved drinking water.
The results showed that households with literate heads were more likely to have access to improved sanitation
than those with illiterate heads. Also, respondents with primary education were 17% less likely to have access to
an improved water source than those with no education at all. Perhaps, household heads with formal education
are more informed regarding improved water and sanitation health benefits than uneducated household heads.
This is in line with Agbadi et al. (2019), Adams et al. (2016), and Dongzagla (2022). However, the educational
level of the household head has no significant impact on the odds of access to drinking water. Compared to
households with heads who were never married, households with married heads were 57%, and widowed/
divorced/separated heads were 70% more likely to have access to improved drinking water. This contradicts

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 Water Policy Vol 25 No 10, 990

Table 3 | Multivariate analysis of variables modelling access to improved water and sanitation (N ¼ 41,902).

Improved water source Improved sanitation

Explanatory variables OR SE OR SE

Gender of the household head

Female 0.952 0.082 1.462*** 0.098
Caste
OBC 0.758*** 0.039 0.856*** 0.032
SC/ST/Others 0.748*** 0.043 0.572*** 0.024
Family status
Medium 1.054 0.053 1.002 0.039
Big 1.235*** 0.081 0.796*** 0.042
Age of household head
30–39 0.955 0.082 1.167** 0.080
40–49 0.959 0.080 1.314*** 0.087
50–59 0.879 0.075 1.529*** 0.106
60 and above 0.984 0.085 1.604*** 0.113
Marital status of household head
Never married 0.636** 0.126 1.077 0.157
Widowed/Separated/Divorced 1.082 0.092 0.805*** 0.054
Educational status household head
Primary 0.829*** 0.042 1.692*** 0.071
Secondary/Higher Secondary 0.993 0.059 2.538*** 0.121
Graduate and above 1.156 0.113 3.109*** 0.224
EAG states
Non-EAG states 1.071 0.046 2.382*** 0.078
Place of residence
Urban 1.759*** 0.077 4.389*** 0.139
Income status of the family
Rs. 100,001–Rs. 200,000 0.938 0.051 1.573*** 0.062
Rs. 200,001–Rs. 500,000 0.954 0.069 2.007*** 0.106
Rs. 500,001–Rs. 1,000,000 1.013 0.153 2.297*** 0.276
More than Rs. 10,00,000 0.824 0.189 2.646*** 0.576
Rooms 0.925*** 0.011 1.288*** 0.017
Constant 10.231*** 0.996 0.045*** 0.004
Source: IHDS-II (2011–2012).
**p  0.5, and ***p  0.01.

the finding of Adams et al. (2016). Dongzagla (2022) also contradicts this further, arguing that households with
never-married heads are usually small-sized and thus can meet the cost of improved water. On the other hand,
households with widowed/divorced/separated heads were 26% less likely to have access to improved sanitation

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 Water Policy Vol 25 No 10, 991

than those with never-married heads. As compared to forward castes, households from OBC and SC/ST/Others
categories were 24 and 25% less likely to have access to improved drinking water, respectively. Similarly,
households from OBC and SC/ST/Others categories were 14 and 43% less likely to have access to improved
sanitation, respectively.
The household size is also an important determinant used in the analysis. Big households (above 7 members)
were 23.5% more likely to have access to improved drinking water than small families. This aligns with Irianti
et al. (2016) and Adams et al. (2016), who found that larger households had higher chances of using improved
drinking water sources in Indonesia and Ghana, respectively. However, this is in contrast to a study by Dongzagla
(2022) in Ghana, where medium- and big-sized households were less likely to use improved drinking water
sources than small households. On the other hand, big households were 21% less likely to have access to
improved sanitation, compared to small-sized (1–3 members) households. As the number of family members
increases, total household income and wealth may decrease. This eventually declines the household’s ability to
afford an improved sanitation facility.
Similarly, urban households were 76% more likely to access improved drinking water sources and 339% more
likely to have access to improved sanitation facilities than rural households. This suggests urban households are
spatially closer to facilities or services, whereas rural households are spatially dispersed. Installing a private facil-
ity is expensive in rural areas, whereas these are provided by local government or municipal bodies in urban
areas. This depicts the urban–rural disparities in access to improved drinking water and sanitation. This finding
aligns with the literature suggesting that urban households have a better chance of having access to improved
drinking water and sanitation facilities (Armah et al., 2018; Abubakar, 2019). Also, living in EAG and Non-
EAG states slightly differentiates households according to their access to improved sanitation. Households
who belong to Non-EAG states were 2.38 times more likely to use improved sanitation. No significant influence
of EAG status on the odds of access to drinking water has been observed.
We observed that the income level of households had a statistically significant impact on a household’s chances
of using improved sanitation facilities. Moving from a lower to a higher-income group increases the likelihood of
using improved sanitation. As compared to households with the lowest income level (below Rs. 1 lakh), house-
holds with higher income levels, i.e., Rs. 1–2 lakhs, Rs. 2–5 lakhs, Rs. 5–10 lakhs, and above 10 lakhs were 57,
100.7, 130, and 165% more likely to have access to improved sanitation facilities. It implies that access to
improved sanitation facilities improves with the rise in income levels, which agrees with several studies
(Adams et al., 2016; Dongzagla, 2022). This is expected because higher-income households can pay more for
improved sanitation facilities (Abubakar, 2019), even when the local government does not provide it. However,
income level did not significantly influence access to improved drinking water. The total number of rooms in the
house also significantly determines the odds of using improved drinking water and sanitation. One additional
room decreases the odds of using improved drinking water by 0.08% but increases the chances of using improved
sanitation by around 29%. The present study found that gender, age, EAG status, and income level have no sig-
nificant influence on the drinking water source of the household.

5. CONCLUSION AND POLICY IMPLICATIONS

Using the data from India Human Development Survey-II (2011–2012), this study has identified the key deter-
minants of access to improved drinking water and sanitation in India. For access to improved drinking water,
caste, household size, marital status, education, place of residence, and the number of rooms were statistically
significant predictors. Urban households with larger family sizes (above 7), led by married but uneducated
heads from forward castes, were more likely to have access to improved drinking water. Regarding improved
sanitation access, all socioeconomic and demographic variables showed a statistically significant association.

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 Water Policy Vol 25 No 10, 992

Households with female heads who were married, belonging to forward castes, small household sizes (1–3),
older aged heads with at least primary education, from Non-EAG states, located in urban areas,
earning higher incomes, and having more rooms were more likely to have access to improved sanitation
facilities.
The findings of the present study have a few significant implications for water and sanitation policies in India.
We found that economically and socially backward households have less probability of having access to safe
drinking water and sanitation. Since access to these facilities is necessary to lead a healthy and disease-free
life, policies are required to improve the access of these sections of society. Despite several schemes such as
the Jal Jeevan Mission, rural households have lower access to safe drinking water. This illustrates the existing dis-
parity between urban and rural areas in terms of access. Thus, rural areas still need more focus.
In India, targeted support is essential for socially marginalized caste households, who often belong to the
poorer segments of the population and face lower access to improved amenities. To address caste-based inequal-
ities, allocating dedicated funds for their upliftment is crucial. Existing programmes such as the Jal Jeevan Mission
and the Swachh Bharat Mission3 should prioritize the needs of these marginalized and backward caste house-
holds to improve their access to clean drinking water and sanitation.
The impact of household income on access to water and sanitation in India is evident, highlighting the need for
government intervention to improve the well-being of the poor. As household income rises, households tend to
shift from unimproved to improved water and sanitation sources. Thus, household incomes should be enhanced
by creating more employment opportunities in both on- and off-farm sectors to improve the affordability of these
facilities thereby enhancing their health and overall well-being. Additionally, stakeholders involved in providing
sanitation and drinking water facilities can consider subsidizing the cost of improved services for rural house-
holds. Also, innovating low-cost products and technologies to make these facilities more affordable for the
poor is a valuable step.
Increased public investment should be directed towards improving education. The importance of water and
sanitation should be integrated into the school curriculum. For individuals with little or no education, awareness
campaigns using simple language, visuals, and local dialects are crucial to overcome social and cultural barriers.
Awareness about the harmful effects of poor sanitation, especially open defecation, is essential. Open defecation
is still prevalent in India due to religious beliefs, untouchability, casteism, illiteracy, and lack of proper toilet infra-
structure. It should be discouraged and its harmful effects on health should be propagated.
To empower female-headed households, it is essential to address their specific needs and challenges, including
privacy, security, and water availability while planning sanitation policies. Presently, schemes like Swachh Bharat
Mission and Housing for All 20224 prioritize female-headed households for allocation of funds for toilets and
houses, respectively. Similarly, other schemes also should prioritize female-headed households.
EAG states with the worst health outcomes in the country should be given high priority in providing improved
sanitation facilities. These states require substantial progress in terms of quality infrastructure to enhance access

3
Swachh Bharat Abhiyan, also known Clean India Mission, is a cleanliness and sanitation campaign launched by the Government of India on 2
October 2014. It aims to achieve the vision of a ‘Clean India’ by addressing issues related to sanitation and cleanliness, improving waste
management practices, eliminating Open Defecation, and promoting hygiene and sanitation across the country.
4
‘Housing for All by 2022’ is a flagship initiative of the Indian government, officially known as the Pradhan Mantri Awas Yojana (PMAY). It was
launched in June 2015 with the aim of providing affordable housing to all eligible beneficiaries in urban and rural areas of India by the year 2022.
The mission focuses on addressing the housing needs of the economically weaker sections, lower-income groups, and middle-income groups in
the country.

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 Water Policy Vol 25 No 10, 993

to safe drinking water and sanitation. Policy attention is crucial to address the challenges of poor access and
affordability in these regions.
Key lessons of this study’s findings include the need for formulating and implementing sanitation and water
policies with more focus on tackling the internal socioeconomic and regional variations in access to improved
water and sanitation facilities, as a significant step towards sustainable goal in India. Additionally, safe water
and sanitation need to be provided in public spaces too.

6. LIMITATIONS
The paper acknowledges some limitations. Firstly, it relies on a nationally representative dataset, which offers a
broad perspective on the topic but may not be suitable for drawing policy implications at the state or regional
level due to its general nature. To gain more context-specific insights and a deeper understanding of the issue
for regional-level policies, future studies should use primary data and consider the differences in water sources,
demographics, and water use patterns in different regions. Secondly, the paper has not incorporated multivariate
household analysis to cluster household types. Future research may conduct such analysis to provide clearer
insights that will help decision-makers to identify and prioritize specific target groups to achieve the greatest
impact of policy interventions.

FUNDING
No funding was received for conducting this study.

DATA AVAILABILITY STATEMENT

All relevant data are available from an online repository or repositories. The raw data is located in the public
repository of ICPSR: https://www.icpsr.umich.edu/web/DSDR/studies/36151.

CONFLICT OF INTEREST
The authors declare there is no conflict.

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First received 5 April 2023; accepted in revised form 13 September 2023. Available online 3 October 2023

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