Improved Drinking Water, Healthier Children? Evidence from Pakistan

One of the United Nations' sustainable development goals is to ensure the availability of improved drinking water for everyone. In this study, we examine the association between access to improved drinking water at the district level and child nutritional outcomes in Pakistan. In this study, we employ district-level unbalanced panel data from Pakistan from various rounds of PSLM an MICS compiled by the Data4Pakistan, Pakistan District Development Portal. We examine the impact of the percentage of population in a given district with access to clean drinking water on the percentage of stunted, underweight and wasted children in the district. The analysis proceeds in two steps. In the first step, we explore the spatial distribution of improved drinking water coverage and child development outcomes across districts. In the second step, we study their relationship by employing standard panel estimation methods and controlling for district characteristics. Our spatial analysis reveals large disparity among districts and provinces in terms of improved drinking water coverage and child nutrition. The availability of improved drinking water varies between a low of 12% and nearly 100%, with districts in Balochistan and Sindh being the most affected. The estimation results indicate that there is a significant association between accessibility of improved drinking water and child development outcomes. The effect is significant for child stunting and underweight but not on child wasting. A 1% increase in the access to improved drinking water in the district is associated with 9 to 20% decrease in the prevalence of child stunting and underweight. The impact appears to be stronger in rural districts. These findings are robust to alternate empirical strategies. This is the first such study to examine the provision of improved drinking water at the district level in relation to child developmental outcomes in a developing country context.