News Release

Poor sanitation practices in pregnant women linked to adverse pregnancy outcomes in India

Peer-Reviewed Publication


Poor sanitation practices, such as open defecation, in pregnant women are linked to adverse pregnancy outcomes in two rural areas of Odisha state, India, according to a study published by Bijaya K Padhi from the Asian Institute of Public Health, Bhubaneswar, and colleagues in this week's PLOS Medicine.

The researchers enrolled 670 women during the first trimester of their pregnancy, recorded information about toilet access and sanitation practices for each woman at enrollment, and followed them through pregnancy until birth. They observed that nearly two-thirds of the women practiced open defecation, and a quarter experienced an adverse pregnancy outcome, most commonly a preterm birth and/or having a baby with low birth weight. After adjustment for potential confounding factors (factors that are related to poor sanitation and could themselves affect pregnancy outcomes, such as socio-demographic characteristics), they found that, compared with women who used a latrine, women who defecated in the open had a significantly greater risk of adverse pregnancy outcomes overall and preterm birth, but not low birth weight.

Although the researchers adjusted for numerous confounding factors in their analysis, including poverty, social class, and caste, the women who defecated in the open may have shared other unknown characteristics that were actually responsible for their increased risk of an adverse pregnancy outcome.

Pinaki Panigrahi, senior author of this paper at University of Nebraska, College of Public Health said: "This study indicates that, in the context of maternal and child health prevention research, sanitation is an important dimension of women's health and distinct from social class and caste."


Research Article

Funding: This work was made possible with UK aid from the Department for International Development (DfID), as part of the SHARE research programme, and support from the Water Supply and Sanitation Collaborative Council (WSSCC). However, the views expressed do not necessarily reflect DfID's official policies or the policies of WSSCC. The funders of the study had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The first and corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Competing Interests: The authors have declared that no competing interests exist.

Citation: Padhi BK, Baker KK, Dutta A, Cumming O, Freeman MC, Satpathy R, et al. (2015) Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study. PLoS Med 12(7): e1001851. doi:10.1371/journal.pmed.1001851

Author Affiliations:

Asian Institute of Public Health, Bhubaneswar, India
College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America


Dr Pinaki Panigrahi

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