Household Sanitation, Social Norms, and Public Policy in India

Abstract

Female bargaining power in rural Haryana, as in much of northern India, is constrained by widespread discrimination against women. In recent years, however, women successfully demand private sanitation facilities from potential husbands as a precondition for marriage. I study this manifestation of bargaining power by modeling latrine adoption as an investment that males can make to improve their desirability on the marriage market, and I show that increasing proportions of females with strong sanitation preferences drive male investment in toilets. Moreover, I demonstrate women's ability to secure latrines increases when they are relatively scarce in a marriage market. I test these predictions empirically by studying a sanitation program in Haryana, India, known colloquially as "No Toilet, No Bride". Using a triple difference empirical strategy based on households with and without marriageable boys, in Haryana and comparison states, before and after program exposure, I provide evidence that male investment in sanitation increased by 15% due to the program. Further, the program effect is four times larger in marriage markets where women are scarce (26%) as compared to marriage markets where women are abundant (6%). These results suggest the relative scarcity of women in Haryana has, conditional on women surviving to marriageable age, improved the ability of the remaining women to secure valuable goods. Building on this work, I turn to an analysis of the impacts of latrine adoption in rural India on child diarrhea. I use a variety of fixed effects and instrumental variables approaches to address concerns about the potential endogeneity of latrines. The evidence suggests that household-level unobservables are not a serious concern in the context of latrine adoption and child diarrhea. Village-level unobservables, however, both time-invariant and time-varying, appear to be much more important. I then turn to an instrumental variables strategy that exploits the "No Toilet, No Bride" campaign in Haryana, which, I argue, generates exogenous pressure on rural households with boys of marriageable age to construct an improved latrine. I provide two-stage least squares and limited information maximum likelihood estimates of the causal impact of household latrine adoption on reported child diarrhea, and I find limited evidence that household latrine ownership causes any improvement in child health. Both ordinary least squares and fixed effects regressions suggest that latrine ownership is associated with an 8% to 15% decline in reported diarrhea. Instrumental variables estimates, on the other hand, are inconclusive due to imprecision, but provide suggestive evidence of a positive association between presence of latrine and child diarrhea. This dissertation goes on to evaluate the impact of the Total Sanitation Campaign's subsidy program on household latrine adoption. This investigation sheds light on a central debate in contemporary sanitation policy: whether social drivers or subsidies are more effective measures for increasing sanitation coverage. My analysis of the subsidy program uses three distinct and complementary approaches to identify the effects of subsidy eligibility on latrine ownership. The first uses linear regression with fixed effects that address unobserved heterogeneity in capacity and corruption across Indian administrative units. The second approach uses propensity score matching at the household level to estimate the causal effect of access to the subsidy program on latrine ownership. Finally, I again utilize the successful "No Toilet, No Bride" information campaign, which focused exclusively on social drivers of latrine ownership, to test whether the information campaign was differentially effective for BPL cardholders. Results from all three empirical strategies suggest negligible or very small increases in latrine ownership due to the costly subsidy program, yielding new insights into the sanitation debate regarding the relative importance of social pressure versus subsidies. (Abstract shortened by UMI.