Lack of toilets and other proper sanitation facilities costs India nearly 54 billion dollars a year, a World Bank study has found, mainly through premature deaths, especially of young children.
Asia's third-largest economy loses 53.8 billion dollars or 6.4 percent of its gross domestic product through hygiene-related illnesses, lost productivity and other factors stemming from poor sanitation, according to World Bank.
"For decades we have been aware of the significant health impacts of inadequate sanitation in India," said Christopher Juan Costain, leader for the World Bank's South Asia Water and Sanitation Program.
"This report quantifies the economic losses to India, and shows that children and poor households bear the brunt of poor sanitation," he said in remarks posted on the group's website on Tuesday.
The lack of proper sanitation creates major health risks, raising the threat of potentially fatal illnesses such as typhoid and malaria.
The study in East Asia showed annual per person losses from poor sanitation in the range of 9.3 dollars in Vietnam, to 16.8 dollars in the Philippines, 28.6 dollars in Indonesia to a high of 32.4 dollars in Cambodia, said Costain.
"In contrast, India lost 48 dollars on a per capita basis, showing the urgency with which India needs to improve sanitation," he said.
Earlier this year, a UN study found far more people in India have access to a mobile phone than to a toilet.
India's mobile subscribers totalled around 700 million at the last count, enough to serve more than half of the country's 1.2 billion population. But just 366 million people - around a third of the population - had access to proper sanitation, said the study.
The World Bank report said early deaths and other health-related impacts of inadequate sanitation such as cost of treatment for illnesses such as diarrhoea, malaria and intestinal worms, cost India 38.5 billion dollars.
This was followed by productive time lost, as people seek out proper sanitation facilities or places to defecate, at 10.7 billion dollars.
India's government calculates fewer than 30 percent of villagers in rural areas have access to toilets.