World Bank Structural Adjustment, Water, and Sanitation: A Cross-National Analysis of Child Mortality in Sub-Saharan Africa

Abstract

The authors conduct a cross-national analysis that seeks to accomplish two important goals. First, they test dependency theory’s hypotheses that World Bank structural adjustment adversely affects child mortality in Sub-Saharan Africa. Second, they empirically evaluate the effect of access to clean water and basic sanitation on child mortality. In doing so, they use two-way fixed effects regression models to analyze child mortality using data on 31 nations and four time points (1990, 1995, 2000, and 2005). They find substantial support for their first goal relating to dependency theory that when a Sub-Saharan African nation is under a World Bank structural adjustment loan, then it tends to have higher levels of child mortality. They also find support for their second goal concerning the importance of including environmental variables in cross-national research on health. Specifically, they find that higher levels of access to an improved water source and an improved sanitation facility are associated with lower levels of child mortality within Sub-Saharan African nations. The authors conclude by discussing the findings, theoretical implications, methodological implications, policy suggestions, and possible directions for future research.