We want everyone to have the same chance of starting life in good health. Healthy Start is our campaign focused on improving the health and nutrition of newborn babies and children through clean water, decent sanitation and good hygiene.

310,000 children each year die before they reach five years from diarrhoeal diseases caused by poor water and sanitation. Many more suffer serious effects such as undernutrition and stunting that affect them well into adulthood. To end this crisis, we advocate integration of access to water, sanitation, and hygiene promotion into health policy and delivery locally, nationally and internationally.

The links between dirty hands, dirty water and infant mortality have been known for more than 150 years – this is not a puzzle waiting for an answer, but an injustice waiting for action. The time for change is now. We work with key partners and forge alliances to effect the changes that will make the difference nationally and internationally.

We are calling for:

  1. National governments to make water, sanitation and hygiene (WASH) services part of all plans to reduce infant mortality and improve nutrition.

  2. Every healthcare facility to have clean running water, safe, separate and accessible toilets for men and women, and functional sinks with soap in all treatment and birthing rooms.

  3. Healthcare workers to commit to practising and promoting good hygiene.

  4. Monitoring and assessment of progress towards universal health coverage to include data on the availability of WASH services in healthcare facilities and households.

  5. Joint cross-sector action to achieve the Sustainable Development Goals (SDGs), recognising that achieving Goal 6 – water and sanitation for all by 2030 – will be fundamental to ending malnutrition (Goal 2) and to ending preventable newborn and child deaths and achieving Universal Health Coverage (under Goal 3).

Coordinate, integrate, invest

Analysis by WaterAid and PATH’s Defeat Diarrheal Disease (Defeat DD) Initiative shows that major health gains and improved cost-effectiveness are possible if decision-makers act now to coordinate, integrate and invest in child health and WASH interventions.

WaterAid/Ernest Randriarimalala

Newborn survival

In 2016, over 2.6 million babies died in their first four weeks of life. The vast majority of them were born in low- and middle-income countries where hospitals and other healthcare facilities frequently lack access to water, sanitation and hygiene. The deaths of one in five of these babies could have been prevented by them simply being washed in clean water and cared for in a clean environment by people who had washed their hands.

A child in sub-Saharan Africa or in Southern Asia is nine times more likely to die in the first month than is a child in a high-income country. Far too often, these children are dying from highly preventable causes such as sepsis, meningitis or tetanus – all infections strongly linked to unhygienic conditions. Research shows that ensuring every baby has a healthy start would dramatically reduce their risk of contracting those infections. In one study, if both mother and birth attendant washed their hands before the birth and before handling the newborn child, a baby’s chance of dying in the first month more than halved.

It is hard to imagine that there is any medical professional, health department official or health minister who is unaware of the risks of exposing babies to infection through unclean birth conditions and poor hygiene practices. And yet, women are still giving birth in environments that do not have clean water, soap and sanitation, attended by carers who cannot or do not observe basic hygiene practices.

A WHO and UNICEF study of 66,000 health facilities across 54 low- and middle-income countries showed:

  • 38% did not have an improved water source
  • 19% did not have improved sanitation
  • 35% did not have water and soap for handwashing

The tragic consequences highlight shocking global inequality. For example, an analysis in 2014 showed that a woman in Sierra Leone has a one in 21 chance of losing a baby to sepsis at some point in her life; in the UK this risk is one in 7,518.

We want to end such inequalities, by making sure everyone, everywhere has access to clean water, sanitation and hygiene by 2030. Governments must ensure all healthcare facilities are equipped with water and sanitation facilities as a matter of urgency, and they must be held to account for ensuring these standards are met.

Find out more in our new 'Transforming health systems' report >

Child nutrition

Malnutrition is more than hunger. It is a global crisis that is hurting the most vulnerable people the most, undermining many areas of development such as expanding access to quality education, and every year reducing GDP by up to 11% across Africa and Asia. And it is closely linked to unclean water, inadequate sanitation and poor hygiene.

155 million children around the world are stunted, their physical, cognitive, social and emotional development irreversibly damaged by a lack of vital nutrients in the first thousand days of their lives, from conception to age two. Approximately 25% of all stunting is attributed to five or more episodes of diarrhoea before the age of two – and 88% of cases of diarrhoea are directly associated with inadequate water, sanitation and hygiene (WASH).

The World Health Organization (WHO) estimates that half of undernutrition is linked to chronic diarrhoea, intestinal worms and other infections caused by unsafe water, inadequate sanitation or insufficient hygiene. Considering how many people live without access to clean water, soap for handwashing, or a proper toilet, the scale of the malnutrition crisis is not surprising.

The new Sustainable Development Goals commit UN member countries to ending malnutrition and achieving universal access to safe water and sanitation and good hygiene by 2030. Governments can’t achieve these interconnected goals separately – urgent joint action is needed.

Our Healthy Start campaign calls on governments and donors to recognise that access to WASH is fundamental to ending malnutrition. WASH and nutrition need to be integrated in national strategies and plans, with joint multi-sector action, and increased domestic and international funding for WASH as a key ‘nutrition-sensitive’ intervention. By ensuring this, we can set every baby on the path to a healthier life.

For more information about Healthy Start please contact [email protected]


Explore our publications and resources.

News and blogs 

Opinion pieces and discussions relating to health.