Baby WASH is a comprehensive approach that creates an enabling environment for improved household hygiene behaviours. It facilitates the adoption of optimal care practices during pregnancy, childbirth and infancy with the aim of improving child health outcomes in the first years of life.

Faecal ingestion and prolonged exposure to faecal microorganisms due to poor water and sanitation conditions at the household level have a significant impact on malnutrition and stunting in children under two years of age. This is primarily because babies spend time crawling and putting things in their mouths, increasing their risk of exposure to pathogens. The Baby WASH approach aims to prevent stunting through a reduction of environmental enteric dysfunction (EED) and other WASH-related diseases. Because infants under two years of age spend most of their time at home with their mothers or caregivers, the focus is on households. In addition, the approach aims to promote maternal health and avoid infections following childbirth by ensuring access to water and sanitation (P.3 and P.4) in health facilities, delivery rooms and postpartum rooms including bathing shelters. For women who do not remain in the health facility, postpartum hygiene can be supported with hygiene promotion and hygiene kits to use at home. To prevent infants from ingesting contaminants several actions are required: regular handwashing, exclusive breastfeeding, correct disposal of infant faeces, effective water storage, reduction of open defecation in the community and clean play spaces and toys. The burden of household chores, childcare and water collection often falls to women and girls. It is important to integrate gender sensitivity E.3 into interventions to ensure that this burden is not increased and that gender-transformative approaches can be harnessed to e.g. create a more equitable distribution of childcare and domestic responsibilities and to allow for mothers’ greater involvement in decision making.

Tools and Methods used

This is not an exhaustive list as the Baby WASH approach should be adapted to the context. Overall, any activity that can be applied at a household level is relevant for Baby WASH.

• Gender Analysis T.16
• Care Groups T.5
• Demonstration, Show and Tell T.10
• Exchange Visit T.12
• Institutional Checklist (e.g. in postnatal wards) T.20
• Stakeholder Mapping T.49
• Three-Pile Sorting T.51
• IEC Materials T.19

Applicability

The Baby WASH approach is more relevant if it is endorsed and integrated into the national health programmes (particularly Maternal, Newborn and Child Health programmes and policies) as it ensures a coherent approach from pregnancy onwards. However, a focus on children under two years old and their particular needs can be integrated into any hygiene promotion programme from the acute to the development phase. 

Main Requirements / Investments Needed

Working with pregnant women and new parents requires specific skills and should be considered when recruiting team members. It may require the production, improvement or adaptation of existing guidelines, training materials and manuals as well as the capacity strengthening of key stakeholders. Financial support and resources for Baby WASH may need mobilising via different sectors such as education, health, nutrition and WASH.

Evidence of Effectiveness

Evidence is available from various contexts. Some studies show that children who live in ‘cleaner’ (e.g. more sanitary and hygienic) households have reduced parasitic infections, less severe EED and greater linear growth. Limited research suggests that the correct disposal of faeces (both human and animal) in the immediate household environment can reduce diarrhoeal disease in children by more than 30%. 

Do

• Conduct a Stakeholder Mapping [T.49] across all sectors to ensure that Baby WASH activities work with existing initiatives [P.9] and maximise efficiencies

• Coordinate at minimum with the health and nutrition sectors [P.9]: Baby WASH is an integrated approach, not a stand-alone intervention

Don't

• Do not focus exclusively on women but include other caregivers such as young girls and older people

• Do not forget the fathers in the design of the approach 

Practical Example

In 2017, Ethiopia’s Ministry of Health developed national Baby WASH guidelines, supported by UNICEF. The guidelines detail how Ethiopia’s National Programme provides a platform for mainstreaming Baby WASH through the country’s WASH structure. It brings together four ministries – Education, Finance, Health and Water Resources – and, in some regions, Agriculture and Rural Development and Women, Children and Youth Affairs. Baby WASH sits at the intersection of critical interventions for childhood health; the guidelines illustrate simple entry points and possible approaches to programming in Eastern and Southern Africa.