title: Multidimensional Measurement of Household Water Poverty in a Mumbai Slum: Looking Beyond Water Quality.
abstract: OBJECTIVE
  A focus on bacterial contamination has limited many studies of water service delivery in slums, with diarrheal illness being the presumed outcome of interest. We conducted a mixed methods study in a slum of 12,000 people in Mumbai, India to measure deficiencies in a broader array of water service delivery indicators and their adverse life impacts on the slum's residents.
  
  
  METHODS
  Six focus group discussions and 40 individual qualitative interviews were conducted using purposeful sampling. Quantitative data on water indicators-quantity, access, price, reliability, and equity-were collected via a structured survey of 521 households selected using population-based random sampling.
  
  
  RESULTS
  In addition to negatively affecting health, the qualitative findings reveal that water service delivery failures have a constellation of other adverse life impacts-on household economy, employment, education, quality of life, social cohesion, and people's sense of political inclusion. In a multivariate logistic regression analysis, price of water is the factor most strongly associated with use of inadequate water quantity (≤20 liters per capita per day). Water service delivery failures and their adverse impacts vary based on whether households fetch water or have informal water vendors deliver it to their homes.
  
  
  CONCLUSIONS
  Deficiencies in water service delivery are associated with many non-health-related adverse impacts on slum households. Failure to evaluate non-health outcomes may underestimate the deprivation resulting from inadequate water service delivery. Based on these findings, we outline a multidimensional definition of household "water poverty" that encourages policymakers and researchers to look beyond evaluation of water quality and health. Use of multidimensional water metrics by governments, slum communities, and researchers may help to ensure that water supplies are designed to advance a broad array of health, economic, and social outcomes for the urban poor.
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, India; Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America.
authors.forename: Ramnath
authors.initials: R
authors.lastname: Subbaraman
authors.affiliation: Office of Population Research, Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: Nolan
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, India.
authors.forename: Kiran
authors.initials: K
authors.lastname: Sawant
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, India.
authors.forename: Shrutika
authors.initials: S
authors.lastname: Shitole
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, India.
authors.forename: Tejal
authors.initials: T
authors.lastname: Shitole
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Nanarkar
authors.affiliation: Partners for Urban Knowledge, Action, and Research (PUKAR), Mumbai, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Patil-Deshmukh
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States of America.
authors.forename: David E
authors.initials: DE
authors.lastname: Bloom
mesh_terms: D006801:Humans; D007194:India; D011204:Poverty Areas; D060753:Water Quality; D014881:Water Supply / Q000191:economics* / Q000706:statistics & numerical data