Status of drinking water, sanitation facilities, and hygiene in West Bengal: evidence from the National Family Health Survey of India (NFHS), 2019–2021

Access to WASH (water, sanitation, and hygiene) is a powerful tool for improving people's quality of life. Poor and vulnerable groups, particularly children under the age of five and adolescent girls, have less access to improved WASH services (Hutton & Chase 2017). The UN General Assembly has declared that access to better water and sanitation is a fundamental right for all people. To live a dignified life, everyone should have access to sanitary facilities and clean water. Besides, poor WASH services are harmful to human health (UN-Water n.d.; WHO WASH Strategy 2018-2025 2018, pp. 2018–2025). It is estimated that more than 2.6 billion people lack access to adequate sanitation, resulting in an estimated 10% disease burden (Mara et al. 2010). A lack of improved drinking water and sanitation facilities places children in the neonatal age group at an increased risk of death. Due to improved WASH services, the life expectancy of newborns (0–28 days) and under 5 year olds (0–4 years) increases significantly (Ezeh et al. 2014). Moreover, improved drinking water and sanitation facilities contribute to the decline of maternal mortality rates (MMRs) (Cheng et al. 2012).

Lack of access to WASH services kills many people in low- and middle-income developing countries. Children under the age of five are particularly at risk due to poor handwashing habits (Dery et al. 2019; Mourad et al. 2019). In India, regional disparities exist between states, and sanitation facilities are extremely limited, especially in states such as Assam, Bihar, and Madhya Pradesh. Although Haryana has made significant progress over the years, Assam, Rajasthan, and Maharashtra are still struggling to meet their targets (Agarwal & Saha 2021). About 90% of urban households in India have improved access to drinking water facilities, and 77% of them have access to drinking water on their premises. Meanwhile, 90% of households have improved sanitation facilities, and 60% have improved garbage collection systems (Patel et al. 2020). The cluster of districts in central and eastern India has a higher level of WASH poverty (Ghosh et al. 2022).

Sabud et al. (2020) reported that in West Bengal, stunted and underweight children are highly associated with families with low WASH scores. According to Mukhopadhyay et al. (2020), the groundwater in Murshidabad Lalbagh Municipality is highly contaminated with arsenic and iron, posing serious health concerns. Furthermore, the groundwater in Murshidabad district is heavily contaminated with arsenic (As) and iron (Fe), which have a direct impact on human health (Das et al. 2021). A lack of access to safe drinking water, inadequate sanitation facilities, and improper handwashing practices in the home can have serious health implications. Despite this, many districts of West Bengal suffer from contaminated drinking water, containing various substances, posing a serious health risk to people. The diseases like diarrhea, skin diseases, anemia, water-related diseases, and fever are highly correlated with unimproved water and unhygienic sanitation facilities, as well as poor handwashing habits. In addition, previous studies show that people living in the district located in the Gangetic delta are at particularly high risk of drinking arsenic-contaminated water, creating a major public health concern in the long run (Chakraborti et al. 2018). Therefore, it is critical to provide clean drinking water, access to improved sanitation facilities, and awareness of hygiene at the household level. This will enable us to achieve SDG 6 by 2030.

Data were gathered from the fifth round of NFHS (NFHS-5). This is a two-stage cross-sectional stratified sampling survey that uses a probability proportional to size (PPS) method. Similarly, CAPI (computer-assisted personal interviews) were used in the survey to collect information about women, men, children, couples, and households. This survey involves 636,699 households across the country. However, the authors only considered 18,161 households of West Bengal (after exclusion of missing variables) for the study.

Improved access to water sources and sanitation facilities were considered experimental variables. In addition, improved water sources and sanitation facilities were coded as 1, and unimproved water sources and sanitation facilities were coded as 0 (Table 1).

The gender of the household head, educational level, Wealth Index, household members, place of residence, current marital status, time to fetch water (round trips), house types, and house structure were the main explanatory variables for this study. In addition, some variables were classified/coded into different categories. The household members variables (hv009) were coded into four groups: 1 member households coded as 0, 2–5 members households coded as 1, 6–10 members households coded as 2, and >10 members households coded as 3. Similarly, marital status (hv115_01) was coded as: 0 for unmarried, 1 for married, 2 for widowed, 3 for divorced, and 4 for separated. Moreover, the time to fetch water in a round trip (hv204) was coded as 1 for less than 30 min and 0 for more than 30 min.

The statistical analysis was performed using Stata V. 14.1 software. Data were arranged in a categorical rank-ordered cluster or hierarchical structure. An ordered logistic model was used for the analysis (Grilli & Rampichini 2021). The lower values from Model II and Model I indicated that adding new variables continued to improve the goodness of fit for the combined model (Model III). Deviance was used to calculate the total variations caused by different types of variables. An adjusted odds ratio (AOR) has been calculated with a 95% confidence interval (CI). The first dummy variable in each group was considered a reference category. For the statistical significance test, the Likelihood Ratio Test (syntax: lrtest) was used to compare each model to the final model (Model III). The results of the lrtest showed that all models were statistically significant at p < 0.001. In addition, the Pearson chi-square (syntax: chi2) test was applied to test the statistical significance of the analysis.

The availability of safe drinking water, the location of water sources, sanitation facilities, and wastewater drainage facilities are all key indicators of WASH services. In West Bengal, access to and coverage of improved drinking water sources within household premises were observed in 33.93% of households. Furthermore, 74.35% of households have access to improved sanitation within their premises, while 14.88% of households have access to improved sanitation facilities outside of their dwellings. Besides, 43.78% of households have drinking water sources inside their premises, whereas 56.22% have drinking water sources outside their premises (elsewhere). 35.40% of households have access to sanitation facilities within their dwellings, however, 6.81% have access to a sanitation facility elsewhere (outside their premises). Moreover, 37.41% of households have access to drainage facilities (both open and closed) in their dwellings (Table 2).

Household access to drinking water, sanitation facilities, and shared sanitation are presented in Table 3. Purba Barddhaman (97.69%) had the highest access to improved drinking water, followed by Bankura (97.36%) and Birbhum (97.17%), while Darjeeling (86.98%) had the lowest access to improved drinking water. Kolkata (95.96%) had the highest access to improved sanitation facilities, however, Purulia (34.68%) had the lowest access to improved sanitation facilities. Maldah had the highest access (25.26%) to water within dwellings, followed by Koch Bihar (24.62%) and Jalpaiguri (19.98%). The results showed that water fetching time was less than 30 min in 12 districts. Besides, Hugli (98.48%) had the largest number of households that had access to improved water in less than 30 min, followed by Kolkata (97.87%) and Paschim Medinipur (97.84%). Furthermore, it was noted that Purulia (21.20%) had the highest prevalence of open defecation, followed by Bankura (11.89%) and Birbhum (11.53%). However, North 24 Parganas (0.40%) had the lowest prevalence of open defecation, followed by Darjeeling (1.00%) and Purba Medinipur (1.16%). Kolkata (6.73%) had the highest share of sanitation facilities, followed by South 24 Parganas (8.01%) and Haora (6.73%). The district of North 24 Parganas (96.02%) had the highest availability of water at handwashing facilities, followed by Koch Bihar (94.65%) and Nadia (96.22%). But Purulia (37.77%) had the lowest availability of water at handwashing facilities. Additionally, the availability of soap or detergent in households was the greatest in Kolkata (78.50%), followed by North 24 Parganas (70.99%) and Darjeeling (68.84%), whereas Purulia had the lowest facilities in terms of all WASH key indicators.

In West Bengal, 93.30% of households have access to improved sources of drinking water (Table 4). The results showed that female-headed households were 6% less likely to have access to improved sources of drinking water in comparison to male-headed households. Compared with households with no education level, primary 30%, secondary 31%, and higher educational status 28% were less likely to have access to improved sources of drinking water. Furthermore, in comparison with the poorest households, poorer 11%, middle-income 47%, richer 70%, and richest households 68% were less likely to have access to improved sources of drinking water. Compared with 1-member households, the likelihood of access to improved sources of drinking water was 1.06 times for 2–5-member households, 1.22 times for 6–10-member households, and 1.69 times for more than >10-member households. The households in urban areas were 1.37 times more likely to have access to improved sources of drinking water in comparison to rural households. As compared with unmarried-headed households, married households were 1.21 times more likely to have access to improved drinking water, widowed households were 1.35 times more likely, and separated households were 1.10 times more likely to have access to improved sources of drinking water. Female-headed divorced households were 29% less likely to have access to improved sources of drinking water. Compared with households with access to improved sources of drinking water within 30 min, those with access to improved sources of drinking water after 30 min were 89% less likely to have improved sources of water. Households that were semi-Pucca and Pucca were 1.43 times, and 1.40 times more likely to have access to improved sources of water than Kachha households. Moreover, non-nuclear households were 1.14 times more likely to have access to improved sources of drinking water compared with nuclear households (Table 5).

The proportion of households that had access to improved sanitation facilities was 82.75% in West Bengal (Table 4). Female-headed households were 1.12 times more likely to have access to improve sanitation facilities compared with male-headed households. As compared with households having no education, households with primary education, secondary education, and higher education were 1.36, 1.41, and 1.39 times more likely to have access to improved sanitation, respectively. Compared with the poorest households, poorer 4.52, middle-income 13.57, richer 62.14, and richest 3.18 × 10⁺⁰⁸ times more likely to have access to improved sanitation facilities. Compared with households with 1 member, households with 2–5 members, 6–10 members, and more than 10 members were 0.97, 0.92, and 0.66 times less likely to have access to improved sanitation facilities. Urban households were 1.08 times more likely to have access to improved sanitation facilities compared with rural households. As compared with unmarried-headed households, married-headed households were 1.22 times more likely to have access to improved sanitation, and widowed households were 1.35 times more likely to have access to improved sanitation. Furthermore, divorced and separated households were 29 and 13% less likely to have an access to improved sanitation facilities. Compared with households with access to improved sources of drinking water within 30 min, those with access to improved sources of water after 30 min were 36% less likely to have access to improved sanitation. Households that were semi-Pucca and Pucca were 1.43 times, and 1.40 times more likely to have access to improved sanitation than Kachha households. In addition, non-nuclear households were 1.14 times more likely to have access to improved sources of sanitation facilities than nuclear households (Table 6).

The study showed that groundwater was the primary source of drinking water for the majority of households in West Bengal. Furthermore, access to improved sources of drinking water was the highest in Purba Bardhaman (97.69%) and the lowest in Purulia (88.12%). Meanwhile, 56.22% of households reported that their primary drinking water source was located ‘elsewhere’, and 59.36% reported that their premises lacked drainage facilities. According to the study, 14.60% of households in the state still practice open defecation. As a result, households need WASH services in order to maintain their overall health and well-being (Kanyangarara et al. 2021). In India, open defecation is very common, especially in the eastern part of the country including West Bengal; and rural households lack access to clean drinking water, both of which pose serious health risks (Chaudhuri et al. 2018). In the study, it was found that Kolkata city had better access to and coverage of combined WASH services. Therefore, the city ranked top in WASH services, and higher performance was observed in SDG 6 (Sau 2017). Moreover, future studies should focus on the urban poor in order to accurately portray the state of WASH services in the city.

This study examined how sociodemographic variables influenced access to WASH services in West Bengal, including access to drinking water, sanitation, and hygiene. It is observed that lack of access to WASH services is negatively affecting the health of people in the state. Therefore, this study will be useful in highlighting the current state of WASH services in West Bengal to formulate micro-scale policies and programs.

Furthermore, results showed that access to improved drinking water in the Nadia district was inadequate. A past study found that the majority of the area in Nadia district is contaminated with arsenic, which is affecting the quality of drinking water. Furthermore, the study also stated that prolonged exposure to arsenic causes skin lesions and adversely affects human health. Moreover, groundwater contamination with arsenic affects the quality of improved drinking water (Mazumder et al. 2010). In order to minimize the effects of arsenic in the district, the authors recommend the use of alternative sources such as potable water, rainwater harvesting, and deep tube wells.

In addition, results of the study revealed that Purulia ranked last in terms of access to water and soap for hand washing. In previous studies, it has been shown that access to water and soap is key to maintaining good health and preventing diarrhea and diarrhoeal diseases. Furthermore, these studies show that handwashing with plain water and soap reduced bacterial load by 8% (Burton et al. 2011). Therefore, handwashing awareness programs in the state are urgently needed. In order to address these issues, a micro-scale policy is necessary based on regional heterogeneity in West Bengal. As an additional measure, alternative sources of water (rainwater harvesting, potable water, and extra deep tube wells) can be used to minimize the effects of arsenic. On the other hand, the effects of arsenic on health can be minimized through public awareness and regular monitoring of shallow tube wells. Future studies should focus on access to and coverage of WASH services at a micro level in order to frame effective policies. Moreover, special attention is needed for Purulia district due to its low scores on combined WASH services.

Arsenic-contaminated drinking water, unhygienic sanitation facilities, and a lack of handwashing practices adversely affect human health. Therefore, improving access to WASH services is essential for people's health and well-being. The successful implementation of the Asian Development Bank's clean water project in arsenic, fluoride, and salinity-affected areas of West Bengal will help reduce health risks. The availability, affordability, and access to improved WASH services are all dependent on the successful and long-term implementation of various schemes. In order to achieve Sustainable Development Goal 6 (SDG 6) by 2030, it is imperative to effectively implement these ongoing schemes and collaborate with international and local authorities.

All relevant data are available from an online repository or repositories (https://dhsprogram.com/data/dataset/India_Standard-DHS_2020.cfm?flag=1).

The authors declare there is no conflict.