Explaining the shortfall in India’s universal hygiene coverage through decomposition of socio-economic inequality based on recent MIS 2020-21 data

Universal access to handwashing facilities with soap and water (HSW) at home forms a core mandate of SDG 6.2, yet globally it continues to stand as a major unfinished priority in realizing equitable sanitation and hygiene for all. Although recent evidence indicates that India has made rapid progress in the proportion of households reporting a home HSW, understanding what hinders the achievement of universal coverage remains critical. The current study pursues two objectives: first, it examines and estimates the extent to which the socioeconomic and demographic inequalities are shaping the HSW prevalence. Second, using decomposition analysis, it seeks to estimate the contributions of each of these structural inequalities to the overall shortfall in universal coverage for remedial policy interventions. The present study is based on the nationally representative household-level data from the Multiple Indicator Survey (MIS) 2020-21 in India. Analyses of total and differential prevalence in HSW practices among various socioeconomic and demographic subpopulations were carried out using design weighted Horvitz-Thompson and non-linear estimators. Binary logistic regression-based generalized concentration-index decomposition analysis was carried out to assess the potential socio-economic and demographic contributors to inequality and further the percentage contributions of these factors were estimated. The study has revealed a stark disparity in rural (76%) and urban (92.1%) basic HSW facilities. Prevalence of HSW had increased significantly with the UMPCE quintile class, level of education of the household head (p = 0.000), upper-caste social groups, access to improved water sources, and exclusive household toilets. The results of the adjusted logistic regression validate these findings. Household’s wealth index was responsible for about 35% of the overall inequality in access to HSW, followed by the educational level of the household head (22%), the household’s exclusive access to a toilet (21%), and social groups (6%). Despite significant gains, large socio-economic and demographic disparities still impede universal household access to HSW in India. Bridging this gap requires equity-focused policies that prioritize the poorest households, strengthen rural infrastructure, promote universal education, and integrate inclusive hygiene promotion with sanitation programs for the marginalized groups to realize SDG 6.2.