Researchers in Ethiopia studied over 1,000 families to understand how access to clean water affects babies’ health and breastfeeding. They found that families without reliable, clean water were more likely to stop breastfeeding early and had babies with more stomach illnesses. When families had to spend more than 30 minutes getting water, or when their water had harmful bacteria, mothers were more likely to stop exclusive breastfeeding before their babies turned six months old. This research shows that improving water access in poor communities could help keep babies healthier and better nourished.

The Quick Take

  • What they studied: How problems with getting clean water affects whether mothers breastfeed exclusively and whether babies get sick with diarrhea
  • Who participated: 1,019 mothers and their children ages 6 months to 5 years living in farming communities in rural Ethiopia in 2019
  • Key finding: Families without reliable clean water were 40-107% more likely to have babies with diarrhea, and mothers were 42-54% more likely to stop exclusive breastfeeding early when water was hard to get or not clean
  • What it means for you: If you live in an area with water challenges, understanding this connection may help you find ways to maintain breastfeeding longer and protect your baby from stomach illnesses. However, this study was done in Ethiopia, so results may differ in other places

The Research Details

Researchers conducted a one-time survey in 2019 with 1,019 families in rural Ethiopia who grew crops on small farms. They asked mothers detailed questions about their water situation—including how long it took to get water, whether the water source was reliable, and whether the water was clean. They also tested water samples to check for harmful bacteria called E. coli. The researchers recorded information about whether mothers were exclusively breastfeeding (giving only breast milk, no other foods or drinks) and whether children had experienced diarrhea in the previous two weeks.

This type of study is called a cross-sectional survey, which means researchers collected all the information at one point in time rather than following families over months or years. The researchers used statistical methods to determine whether families with water problems were more likely to have the health problems they were studying.

Understanding the connection between water access and breastfeeding is important because both are critical for baby health in poor communities. By studying this relationship, researchers can help governments and organizations prioritize which problems to fix first. If water insecurity causes mothers to stop breastfeeding early, then improving water access might have even bigger health benefits than previously thought.

This study has several strengths: it measured water quality objectively by testing for bacteria, it included a reasonably large sample of over 1,000 families, and it examined multiple aspects of water insecurity rather than just one. However, because it was a one-time survey, researchers cannot prove that water problems actually caused the health issues—only that they were connected. The study was conducted in one specific region of Ethiopia, so the results may not apply everywhere. Additionally, the study relied on mothers’ memories of recent events, which can sometimes be inaccurate.

What the Results Show

Mothers in households with water quality problems (contaminated with E. coli bacteria) were 42% more likely to stop exclusive breastfeeding before six months compared to mothers with clean water. When water sources were unreliable—meaning families couldn’t count on water being available when they needed it—mothers were 44% more likely to stop exclusive breastfeeding early. The most dramatic finding was about time spent fetching water: when families had to spend more than 30 minutes to get water, mothers were 54% more likely to stop exclusive breastfeeding before their babies reached six months old.

For diarrhea, the results were also concerning. Children in households with moderate water insecurity (meaning some but not all water problems) were 54% more likely to have diarrhea in the previous two weeks. Children in households with high water insecurity (meaning many water problems) were more than twice as likely to have diarrhea—a 107% increased risk. These findings suggest that water insecurity affects children’s health through multiple pathways.

Interestingly, the study found no connection between water insecurity and stunting (when children don’t grow to their expected height). This was surprising because researchers expected water problems might affect growth. This could mean that water insecurity affects children’s immediate health (like diarrhea) more than their long-term growth, or it could mean that other factors beyond water are more important for growth in this population.

Previous research has shown that both exclusive breastfeeding and clean water are individually important for child health. This study is one of the first to examine how these two factors work together. The findings align with what researchers would expect: water problems make it harder for mothers to maintain exclusive breastfeeding, and water problems directly cause more diarrhea. The study adds important evidence that water insecurity should be considered when designing programs to improve child nutrition and health.

The study was conducted in one region of Ethiopia, so results may not apply to other countries or even other parts of Ethiopia. Because the study collected information only once, researchers cannot determine whether water problems caused the health issues or whether other factors were responsible. The study relied on mothers remembering whether their children had diarrhea in the past two weeks, which can be inaccurate. Additionally, the study didn’t measure some other important factors that might affect breastfeeding decisions, such as mothers’ education level or access to healthcare.

The Bottom Line

If you live in an area with water challenges: (1) Prioritize finding the cleanest water source available, even if it takes longer to access; (2) If possible, work with community members or local organizations to improve water access; (3) If you’re breastfeeding, understand that water problems may make exclusive breastfeeding more difficult, but it’s still worth pursuing for as long as possible; (4) Take extra precautions to prevent diarrhea by washing hands and keeping food clean. These recommendations are supported by this research but should be adapted to your specific situation.

This research is most relevant to families in rural areas with limited water access, public health organizations working in low-resource settings, and policymakers deciding where to invest in water infrastructure. If you live in an area with reliable clean water, these findings are less directly applicable to your situation, though they highlight why water access is a global health priority. Healthcare providers working with families facing water insecurity should be aware of these connections when counseling about breastfeeding.

If water access improves, benefits would likely appear relatively quickly. Diarrhea rates might decrease within weeks as families have access to cleaner water. Breastfeeding rates might improve over months as mothers face fewer barriers. However, long-term improvements in child growth and development would take longer to observe.

Want to Apply This Research?

  • Track daily water access quality by rating water reliability (1-5 scale) and noting time spent fetching water. Also track any diarrhea episodes in children and exclusive breastfeeding status weekly to identify patterns between water challenges and health outcomes
  • Users can set reminders to boil or treat water before use, log water collection time to identify efficiency improvements, and receive alerts if diarrhea episodes increase, prompting them to review water quality and handling practices
  • Establish a baseline of current water access challenges and health outcomes, then monitor weekly for changes. If water access improves, track whether diarrhea decreases and breastfeeding duration increases over the following months. Share data with healthcare providers to inform treatment decisions

This research describes associations found in one study of families in rural Ethiopia and should not be considered medical advice. Water insecurity is a complex issue with many health effects. If your child has diarrhea or you have questions about breastfeeding, consult with a healthcare provider who knows your specific situation. This study provides evidence that water access matters for child health, but individual circumstances vary. Always seek professional medical guidance for your child’s health concerns.