Quantifying Water Supply, Sanitation and the MDGs


  • 2012•03•22

    June Cheng, Corinne Schuster-Wallace, Susan Watt, K. Bruce Newbold, Andrew Mente and Katherine Pizzacalla

    Quantifying water supply, sanitation and the MDGs

    Cité Soleil, Haiti. Photo: UN Photo/Logan Abassi

    To mark World Water Day, we feature a new study that demonstrates the necessity of bringing drinking water and sanitation to the forefront of the development agenda in order to achieve the Millennium Development Goals by the 2015 deadline. World Water Day was conceived at the 1992 United Nations Conference on Environment and Development in Rio de Janeiro. The Water for Life Decade 2005–2015 puts the spotlight on water-related programmes and the participation of women, and aims to boost efforts for achieving international water-related goals and the UN Millennium Declaration.

     • • •

    Water and sanitation are integral aspects of ensuring environmental sustainability, as per Millennium Development Goal (MDG) 7; additionally, their availability influences health, education, gender issues and the economy, making them central to achieving several of the other MDGs. A recent study by researchers from UNU-INWEH and McMaster University (Canada) explored this relationship, seeking  to quantify the role of water and sanitation in achieving all of the MDGs. The results of this study related to child and maternal health, recently published in Environmental Health, have generated considerable public interest.

    As the Millennium Development Goals were created as a global vision for the world by 2015, they provide a useful tool for assessing the role of water and sanitation in development more generally. Country-level data from 193 countries provided the basis to assess the influence of water and sanitation against indicators associated with MDGs 1 to 6 through linear and ordinal logistic regression models. The analysis found statistically significant relationships between access to an improved water source and indicators for Goals 1, 3, 4, 5 and 6.

    In addition, significant relationships were found between access to improved sanitation and indicators for Goals 4 and 5.

    Relationships were considered significant if the p-value was below 0.01. The p-value represents the probability that the relationship observed was by chance (random); the lower the p-value, the more likely the relationship is valid.

    Millennium Development Goal

    Statistically significant?

    Water supply Sanitation
    Poverty and hunger (MDG 1) Yes No
    Primary education (MDG 2) No No
    Gender equality (MDG 3) Yes No
    Child mortality (MDG 4) Yes Yes
    Maternal health (MDG 5) Yes Yes
    Diseases (MDG 6) Yes No

    Poverty and hunger

    Water availability, quality and quantity are closely linked with poverty. Water quality and quantity are central to agricultural productivity and, thus, hunger — particularly in subsistence farming. Water management is important in ensuring adequate access to safe food. Moreover, health problems associated with poor water quality and sanitation can often lead to malnutrition.

    These effects were demonstrated in the data, showing that the prevalence of underweight children under five years of age is related to increasing water access (p = 0.028). However, the relationship between access to improved sanitation and the prevalence of underweight children under five was not found to be statistically significant (p = 0.436).

    Primary education

    Children often share the burden of water collection. In cases where children need to spend hours every day collecting water, they may not have the opportunity to attend school as a result. Moreover, safe and separate sanitation facilities can prevent girls from dropping out of school after puberty. Children who are suffering from water-related diseases may be unable to attend school or may be unproductive in their studies.

    Despite these influences, a statistically significant relationship was not found between access to improved water and net enrollment in primary school (p = 0.098), nor was a significant relationship found in the case of sanitation (p = 0.469). In this case, it is likely that school absenteeism is a better indicator to use.

    Women collect water from the only well in Kuma Garadayat, North Darfur.

    Women collect water from the only well in Kuma Garadayat, North Darfur. Photo: UN Photo/Albert Gonzalez Farran

    Gender equality

    Women are primarily responsible for collecting water for the household. Without sustainable access to an improved water source, women may need to spend hours daily traveling to collect water for domestic use. This time limits their ability to participate in other economic activity and continue their education. Similarly, lack of sanitation facilities may force women to wait until nightfall to search for a place to relieve themselves, often compromising their safety.

    As a result of such conditions, the ratio of girls to boys in primary education was found to be related to access to an improved water source (p = 0.006). However, a relationship between primary education and access to sanitation was not found to be statistically significant (p = 0.45).

    Child mortality

    Children are the most vulnerable to water-related diseases. Diarrhoea, caused by unclean water, is a leading cause of child mortality. Although diarrhoea mortality has declined in recent years, it remains the second leading cause of death for children under five (after pneumonia), accounting for one-fifth of child deaths. This death toll is greater than that caused by AIDS, malaria and measles combined.

    These conditions were reflected in the data; decreased under-five mortality was found to be related to increased water access (p<0.001) and improved sanitation (p<0.001). Under-five mortality was found to decrease by 1.17 and 1.66 per 1,000 deaths for every quartile increase in water access and sanitation access, respectively.

    Similarly, increased access to an improved water source has also been found to be related to infant mortality rate (p<0.001). This relationship retains its significance with improved sanitation (p<0.001).

    Maternal health

    Improved health and nutrition, attributable in part to access to improved water and sanitation, can reduce susceptibility to other health risks that influence maternal mortality. Pregnant women are particularly vulnerable to water-related diseases such as vitamin deficiency, trachoma and hepatitis; thus, improvements in access to clean water are likely to also improve maternal health. In addition, clean water and sanitation, especially in medical facilities, are an integral part of preventing infection in pregnant women. Moreover, measures to help reduce pregnant women’s physical burdens, particularly in relation to collecting water, will result in safer pregnancies.

    Increased water access was found to be significantly associated with decreased maternal mortality ratio (p = 0.008). A similar relationship was found in the case of improved sanitation (p = 0.009).

    Contaminated water in Karial slum in Dhaka, Bangladesh.

    Contaminated water in Karial slum in Dhaka, Bangladesh. Photo: UN Photo/Kibae Park


    Safe water and improved sanitation lower the risk of many diseases. Improved health outcomes due to water and sanitation increase people’s capacity to combat HIV/AIDS, malaria and other diseases. People weakened by HIV/AIDS are more likely to be affected by a lack of safe water and sanitation; access to safe water can help to keep HIV positive people healthy.

    Increased access to water was found to be significantly associated with decreased percentage of mortality in children under five years of age due to diarrhoeal diseases (p<0.001). However, the relationship is not statistically significant for sanitation (p = 0.08).

    Partnership for development

    The provision of safe water and sanitation must be considered as an important part of a global development agenda. In areas that face significant challenges in relation to water and sanitation, these issues will create major obstacles to sustainable development. However, the data are not appropriate to measure against this goal.

    To the forefront

    This study has shown that changes in access to safe water and improved sanitation influence the indicators used to measure the MDGs. Water and sanitation are clearly cross-cutting issues not only affecting the targets in Goal 7, but also affecting targets related to health, poverty, education and gender equity.

    These findings demonstrate the necessity of bringing drinking water and sanitation to the forefront of the development agenda in order to achieve the MDGs by the 2015 deadline.

  • carol

    Bill, et al.

    This is the urgent INWEH thing. See my e-mail for the file if you prefer to work on the Word doc.

    • carol

      If you really can’t stand an acronym in the title, Water supply, sanitation and the Millennium Development Goals fits on 5 lines (if we cut “Quantifying”)

      • carol

        PS: “Primary author JJC was supported by the UNU-INWEH for a portion of this project. CSW is employed by the UNU-INWEH. AM is supported by a Research Early Career Award from Hamilton Health Sciences. JJC, SW, KBN, and AM are affiliated with McMaster University.”

  • carol

    Hi Curtis & Stephan.

    I don’t know when exactly this will run (they owe us a couple of answers, so maybe Thursday, maybe next Tues?) but they are anxious so could you please prepare the photo and Stephan, can you talk to Bill about the table he sketched out and if it will really work (note that they are supposed to add an explanation of p value on the first reference to it in the body text)? Also, there are icons for each MDG that might be good to use as bullets http://www.mdgmonitor.org/press.cfm if you guys find them acceptable style-wise?


  • carol

    Hi Curtis/Stephan. This is running Thursday so time to get the photo ready, onegai. Are we using the little icons or not? If not, maybe take of the asterixes and underline the Goal section titles?

    Stephan, can you also talk to Bill about that table he had jotted for this during a meeting several weeks back?


  • stephan


    I added the table and as we do already have a lot of visuals in the article, we spare out the icons.
    Ready to go? Handover to Bill.


  • bill

    Just FYI,

    One change I made in my final proofing, after recalling some conversations in the past. The article said “June Cheng … explored this relationship by …”. Since June is one of the authors, it seems awkward to mention her in the third-person within the article.So I rewrote the sentence as “A recent study … explored this relationship …”