Over 50 million people in India, especially children, are exposed to arsenic-contaminated water. Yet demand for safe drinking water remains low. An experiment in Assam by researchers Rashmi Barua, Deboshmita Brahma, and Prarthna Agarwal Goel demonstrates how increasing awareness and simplifying access to government benefits can address this issue.
India, along with Bangladesh, has the largest population globally exposed to arsenic poisoning from groundwater. More than 50 million people across 35 districts in India, mainly in Assam and West Bengal, are affected by arsenic-contaminated water. Nearly half of this population are children, significantly contributing to India’s high infant mortality rate of 30 per 100 live births. Children are particularly susceptible to arsenic poisoning due to their lower immunity and higher water content in their bodies compared to adults. Exposure to arsenic during pregnancy is also linked to stillbirths and poor child growth outcomes. However, extended breastfeeding can protect infants since breast milk contains negligible arsenic levels regardless of maternal exposure
Demand for private water connections remains low
To tackle the problem of unsafe drinking water, the Government of India launched the Jal Jeevan Mission (JJM) in 2019, aiming to provide rural households with a regular supply of safe, affordable drinking water. However, as a demand-driven scheme, JJM relies on local village water user committees and households to apply for and maintain private tap water connections. While this approach may work in many states, the demand for private water connections remains low in rural Assam due to the abundance of alternative water sources—Assam being a water-surplus state—and a strong cultural preference for groundwater.
The low demand for government-supplied tap water in rural Assam can be attributed to several factors:
- Insufficient information: Households make choices based on their knowledge; if this is incomplete, they may make suboptimal decisions. For instance, a study in Bangladesh observed that households were 37% more likely to switch to safer water sources when informed about arsenic contamination.
- Financial constraints: Poor households might lack the financial means to invest in household infrastructure, such as private water connections, despite being aware of the benefits.
- Complex government schemes: Government initiatives that provide essential services like water, electricity, and gas often involve complex application processes. This complexity can deter households from accessing these benefits.
Financial constraints often drive the demand for better water quality in regions where accessing water is challenging, but this is not the case in Assam. According to the 76th round of the National Sample Survey (NSS), 10% of rural households in India spend more than 30 minutes collecting water, compared to an average of just 10 minutes in Assam, which has the shortest collection times in India. Therefore, the study focuses on the remaining factors: information gaps and transaction costs.
4-10 times higher concentrations of arsenic
In November 2021, the researchers collaborated with the National Health Mission (NHM), the Government of Assam, and the Public Health Engineering Department (PHED) to carry out a randomized controlled trial in Titabor block, Jorhat district, Assam. Government data shows that Titabor has arsenic concentrations ranging from 194 to 491 micrograms per liter, significantly above the WHO safety limit of 50 micrograms per liter, with most residents relying on tube wells and borewells for their water supply.
Divided into three groups
The NHM provided a list of households with young children (0-6 years) and pregnant women in Titabor, based on data from Accredited Social Health Activists (ASHA[i]). The villages were randomly assigned to one of three groups: a control group (no intervention), an information-only treatment group, and an 'information plus transaction costs' treatment group, encompassing a total of 2,064 households across over 80 villages.
The information group viewed a video in the local language detailing the presence of arsenic in groundwater, its health impacts on children and pregnant women, alternative sources of safe drinking water, and the importance of breastfeeding to reduce arsenic exposure for young children.
The second treatment group received this video and was also provided with comprehensive information on how to apply for a private government water connection. Additionally, they received assistance in filling out and submitting the application form.
Combined interventions by far most effective
The intervention increased awareness about arsenic and improved knowledge, even two years after the intervention. The information-only treatment led to a 12-percentage point rise in the use of community tap water, rainwater harvesting, or bottled water. However, the combined treatment, which included both informational and administrative support, resulted in a significant 128% increase in self-reported demand for piped water compared to the control group. This suggests that while providing information is important, it must be accompanied by streamlined paperwork and simplified administrative procedures to significantly boost household demand for safe water. In the long run analysis of administrative data, conducted two years after the intervention, the increased demand also translated to increased supply as treatment households were more likely to receive government-supplied water.
Breastfeeding increased
Mothers and pregnant women in the combined treatment group showed a greater increase in both the likelihood and frequency of breastfeeding after the intervention. The probability of breastfeeding rose by 4 percentage points, and the planned duration of breastfeeding increased by 2.6 months. While both treatment groups recognized the benefits of breastfeeding, the combined treatment had a more pronounced effect. This was because it not only highlighted the advantages of breastfeeding but also made women more aware of the time and effort required to access safe drinking water, which influenced their decision to breastfeed for a longer period.
More willing to pay for water
The findings reveal that female-headed and low-income households were more likely to report illness in their children after the information intervention. Moreover, the intervention led to an increased willingness among poorer households to pay for safe drinking water.
Policy implications
The findings reveal a cost-effective strategy for enhancing the adoption of government water supply schemes. It is crucial to pair water quality awareness with measures that reduce transaction costs to increase participation. This involves simplifying paperwork, streamlining application processes, and removing administrative barriers. Implementing these changes can boost demand for public water schemes and significantly improve the health and well-being of the communities served.
[i] ASHAs are community health workers – usually women – instituted by the Ministry of Health and Family Welfare as part of the National Rural Health Mission.
By: Ishita Datta
EfD India