Strengthening Child Survival in Urban Contexts: The Impact of WASH Infrastructure on Under-Five Mortality amid Rapid Urbanization

Abstract

This study examines the impact of Water, Sanitation, and Hygiene (WASH) infrastructure on under-five mortality within rapidly urbanizing environments. It explores how urbanization interacts with WASH access to influence child health outcomes, focusing specifically on under-five mortality as a core indicator of population health and sustainable development. Employing advanced quantitative techniques including Quantile Regression, System Generalized Method of Moments (System GMM), Bootstrap Resampling in Quantile Regression, and Feasible Generalized Least Squares (FGLS) the analysis captures heterogeneous effects across the distribution of under-five mortality rates while addressing endogeneity and methodological challenges. The findings reveal that improved WASH infrastructure significantly reduces under-five mortality, particularly in higher-mortality contexts. Although rapid urbanization can intensify pressures on health systems and basic services, robust WASH provision mitigates these adverse effects, functioning as a protective mechanism for child survival. Rather than urbanization and WASH operating in isolation, their interaction demonstrates potential synergies when infrastructure expansion keeps pace with urban growth. The results highlight the emergence of “urban child health resilience,” reflecting cities’ capacity to safeguard child survival when supported by effective sanitation, clean water access, and hygiene systems. The study underscores the critical importance of integrating WASH infrastructure into public health strategies. Cross-sectoral collaboration among urban planners, water authorities, sanitation agencies, and health policymakers is essential to optimize resource allocation and strengthen child survival outcomes. By focusing on under-five mortality within urban contexts, this research contributes to the literature on child health, sustainable development, and public health governance, offering policy-relevant insights for achieving Sustainable Development Goals related to child survival and resilient cities.