Sustaining latrine use: Peers, policies, and sanitation behaviors.

• Latrine adoption and use among peers increases household latrine use. • Peer effects are consistently strong influences on latrine use behavior over time. • Female latrine use is influenced by latrine use among other women. • Male latrine use is influenced by latrine use among women. • Policy efforts increase latrine adoption, but use behavior is not always sustained. One third of the world's population lacks access to improved sanitation facilities with ramifications for health, human well-being, and economic development. Although household latrines offer a relatively cheap technological solution, initiatives for universal coverage have fallen short of their goals. In this paper, we analyze a unique panel dataset to examine policies and peer effects as drivers of household sanitation behaviors over time. Our data include nearly 1000 rural Indian households across 39 villages surveyed at five time points over a 14-year period during which two distinct sanitation policy interventions occurred. Using spatial data on household locations to define peer reference groups, we estimate how the sanitation behaviors of neighbors influence latrine use, both at the household level and by gender. We find evidence that, while external interventions can be effective in increasing latrine use in the short term, sustained household latrine use consistently depends on neighbors' behavior. We also examine within- and across-group peer influences by examining patterns of latrine use among adult women and men. We find clear evidence that latrine use by neighboring women positively influences sanitation behaviors for both women and men, while latrine use among neighboring men has imprecisely estimated and small positive effects on men's behaviors and no effect on women's behaviors. These finding suggest that peer influences represent an important mechanism underlying household sanitation behavior, and policies that leverage these social effects, such as investments expanding women's access to sanitation and other drivers of behavior change, may be more effective and sustainable. [ABSTRACT FROM AUTHOR]