Sanitation and Health Externalities: Resolving the Muslim Mortality Paradox

Michael Geruso, University of Texas at Austin
Dean Spears, Delhi School of Economics

In India, Muslims face significantly lower child mortality rates than Hindus, despite Muslim parents being poorer and less educated on average. Because observable characteristics would predict a Muslim disadvantage relative to Hindus, previous studies documenting this robust pattern have called it a "puzzle" of Muslim mortality. This paper offers a simple solution to the puzzle in an important sanitation externality. Most of India's population defecates in the open, without the use of toilets or latrines, spreading fecal pathogens that can make children ill. Hindus are 40% more likely than Muslims to do so, and we show that this one difference in sanitation can fully account for the large (18%) child mortality gap between Hindus and Muslims. We show that latrine use constitutes an externality rather than a pure private gain: It is the open defecation of one's neighbors, rather than the household's own practice, that matters most for child survival.