A number of studies have linked water, sanitation, and hygiene (WASH) interventions to improvements in health outcomes such as diarrhoeal diseases, helminth (parasitic worm) infections and childhood stunting. However, little work has been done to evaluate the effects of WASH interventions on adverse pregnancy outcomes (APOs) among women.

Poor sanitation can promote hookworm infestation, which is a risk factor for maternal anaemia as it is directly linked to adverse pregnancy outcomes. Exposure to unsafe water, unimproved sanitation, and poor waste management during pregnancy may increase the risk of infection, leading to adverse outcomes such as low birth weight and preterm delivery.

The paper titled 'Risk of adverse pregnancy outcomes among women practicing poor sanitation in rural India: A population based prospective cohort study' published in the journal PLOS Medicine, aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population based study in rural Odisha, India.

The study

670 pregnant women from coastal and inland areas of Odisha were interviewed to examine the relationship between maternal sanitation behaviour and adverse pregnancy outcomes. Socio-demographic and clinical information along with access to toilets and sanitation practices was obtained from pregnant women.

Observational checklists were used for latrine use that recorded presence of a functional water source or water storage container at the latrine, type of latrine, visible faecal contamination on latrine floors, and presence of a hand-washing station with soap, detergent, or ash at or near the toilet. Other information, such as hand-washing practice after defecation and source of bathing water, was also collected.

Findings of the study

• Women who reported poor sanitation practices in the early phase of pregnancy (10–12 wk of gestation) were more likely to experience adverse pregnancy outcomes such as preterm birth and low birth weight.
• Open defecation was found to be associated with total adverse pregnancy outcomes and preterm birth.
• Risk of adverse pregnancy outcomes were higher among women who used latrines only occasionally.
• Absence of water availability was associated with increased total adverse pregnancy outcomes and preterm birth. 
• The association between adverse pregancy outcomes and open defecation was independent of poverty and caste.
• Women who reported bathing or body washing with an open source of water such as pond, river or canal also reported higher cases of adverse pregnancy outcomes.

The paper ends by arguing that although this is one of the first studies that provides positive evidence of the relationship between poor sanitation and adverse pregnancy outcomes, further studies are needed to highlight the exact biological and behavioural mechanisms through which poor sanitation behaviour can affect poor pregnancy outcomes among women.

Please download a copy of the paper below.