Today’s era is the most modern and resourced by any measure, but when it comes to taking care of the health and nutritional well-being of our infants, we have yet to attain the standard that we should. Worldwide, 149.2 million children under 5 years of age are stunted, 45.4 million are wasted, and 38.9 million are overweight (Global Nutrition Report, 2021).

Surprisingly, undernutrition is responsible for 45% of all child mortality, with the majority of cases occurring in poor and middle-income countries (WHO Factsheet, 2021). According to estimates, recurrent diarrhoea or intestinal nematode infections as a result of tainted water, inadequate sanitation, or poor hygiene are to blame for 50% of this underweight or malnutrition. The total number of deaths directly and indirectly caused by malnutrition because of contaminated water, inadequate sanitation, and insufficient hygiene in children under the age of five is thus 8,60,000 every year (WHO: Safer Water, Better Health).

WASH measures during childbirth have been shown to improve overall recovery and reduce mother and child mortality, sepsis, and tetanus. The first 1,000 days of an infant’s life play a crucial role in determining their long-term development, including factors such as the microbiome, linear growth trajectory, cognitive abilities, sensorimotor skills, and socioemotional brain pathways. Poor hygiene during this critical period can substantially impact a child’s growth.

Linear growth failure, or stunting, is the most common type of undernutrition, developing gradually from conception and especially during the first two years of life. Stunting has severe consequences for a child’s development and is caused by a variety of complex circumstances, including poor WASH conditions in the home. Stunting is linked to WASH through both direct and indirect mechanisms, including recurring diarrheal illnesses, soil-transmitted infections, and Environmental Enteric Dysfunction (EED). Due to constant exposure to faecal microbes caused by inadequate domestic environmental conditions, EED, in particular, contributes to stunting (BabyWASH & the 1000 Days, Action Against Hunger, 2017).

To address these issues, the babyWASH concept was developed, which integrates WASH facilities with the maternal, neonatal, and child health and early childhood development sectors. The goal is to have a more profound impact on child health outcomes, particularly during the first 1,000 days of life. Many community-based humanitarian organizations around the world advocate for the babyWASH strategy for stunting prevention, which includes a bundle of activities centred on the household level. These activities supplement existing WASH, health centres, and school-based programs. The strategy is intended to limit faecal-oral exposure and transmission, thereby reducing stunting and increasing overall child health and nutrition.

Action Against Hunger, a pioneering voice for babyWASH, advocates for the implementation of a practical package of babyWASH activities at the household and individual levels to supplement traditional WASH, nutrition, and health programs. These activities attempt to alleviate chronic undernutrition in children throughout their first 1,000 days of life and can be adapted based on contextual needs.

The proposed BabyWASH activities include:

1. Household water treatment: Implementing boiling, solar disinfection, and filtration methods to ensure safe drinking water. Providing water containers, jerry cans, and child-friendly cups exclusively for use by infants and young children.
2. Reusable cloth nappies: Promoting the use of reusable cloth nappies to improve hygiene and reduce waste.
3. Baby-friendly toilets or potties: Creating appropriate and safe sanitation facilities for infants and toddlers and, supplying scoops for hygienic waste disposal.
4. Handwashing stations: Installing handwashing stations in kitchens and toilets, providing soap (or ash, if available), and domestic cleaning kits. Separating domestic animals using corrals and fences, and improving overall domestic hygiene conditions.
5. Safe and clean play spaces: Providing mats or plastic sheets to create safe play areas for children. Using pacifier chains and clips to prevent contamination.
6. Food protection: Using boxes or lids to protect food from flies, rats, and other animals. Organizing dishes and cooking utensil racks for hygienic food preparation.
7. Waste management: Introducing trash bins or incineration pits to manage waste effectively.
8. Handwashing stations with soap or ash: Ensuring access to handwashing facilities with soap or ash and safe water. Distributing mosquito nets and oral rehydration solutions for disease prevention and management.
9. Calm and clean breastfeeding spaces: Creating peaceful and hygienic spaces for breastfeeding, especially in crisis scenarios like internally displaced people or refugee campuses.

The impact of BabyWASH is demonstrated through various studies, (Meta-analysis- Dangour et al) found a modest but significant effect of different interventions that aimed to improve water quality and handwashing in the height-for-age Z-score (HAZ) of children under 5, and this effect was greater in children under 2 years of age.

The impact of BabyWASH is demonstrated through various studies, (Meta-analysis- Dangour et al) found a modest but significant effect of different interventions that aimed to improve water quality and handwashing in the height-for-age Z-score (HAZ) of children under 5, and this effect was greater in children under 2 years of age.

• Goal 2 – End hunger, achieve food security, and improve nutrition: BabyWASH intends to contribute to this goal by increasing access to safe and nutritious food for all, especially infants and those in vulnerable situations.
• Goal 3 – Ensure healthy lives and well-being: BabyWASH strives to improve overall health outcomes in order to reduce maternal and neonatal mortality. The strategy helps to prevent deaths of infants and children under the age of five by preventing undernutrition throughout the first 1000 days.
• Goal 6 – Ensure availability and sustainable management of water and sanitation: BabyWASH is critical to attaining universal and equitable access to safe drinking water, appropriate sanitation and hygiene facilities, and adequate sanitation and hygiene facilities for all.

The BabyWASH strategy, by addressing these SDGs, not only addresses the immediate concerns of stunted growth and undernutrition but also creates long-term sustainable solutions. BabyWASH aims to interrupt the cycle of faecal-oral transmission, improve child health, and contribute to a healthier and more prosperous future for disadvantaged communities by integrating with current programs and focusing on household-level treatments.

Abhishek Kumar Gupta – Abhishek Kumar Gupta is an alumnus of BHU and TISS. Currently, Abhishek is a WASH-CCES consultant for UNICEF Odisha and is stationed at the Panchayat Raj and Drinking Water Department, Govt. of Odisha. He is passionate about Indology, awakening civilizational consciousness, and the growth journey of the land of Bharat. Sukirti Chandra – Sukirti Chandra is an ambitious individual currently pursuing her Masters of Public Health at Indian Institute of Public Health, Gandhinagar. With a keen interest in Public Health Nutrition, WASH, and Child Health, she is committed to leveraging her knowledge and skills to contribute significantly to the betterment of communities.

Disclaimer: The information in this blog reflects the author’s research, and personal experiences. Youth4Water Plus neither endorses, nor is responsible for the views expressed by the author.