Health and nutrition returns to clean cooking fuel access across the rural-urban divide

Abstract

Access to clean cooking fuels is central to advancing health, equity, and environmental sustainability worldwide. However, despite sustained policy efforts, a substantial share of households, especially in developing countries, still rely on polluting fuels, with adverse effects on health, environmental quality, and economic well-being. This paper draws on a panel dataset of 102 developing countries spanning 2000–2022 to assess the relationship between access to clean cooking fuels and human well-being. Using fixed-effects and instrumental-variable estimators, we address potential endogeneity concerns. We further explore heterogeneity across rural and urban settings and show that improvements in access are associated with larger gains in health and nutrition outcomes in urban areas. Focusing on sub-Saharan Africa, we conduct scenario-based simulations to quantify the potential benefits of expanding access to clean cooking fuels. Increasing rural access from 10% to 25% is estimated to prevent around 84,000 infant deaths and reduce child stunting by approximately 1.68 million cases. In urban areas, achieving universal access from a baseline of 35% coverage could avert up to 377,000 infant deaths and generate more than 11 million disability-adjusted life years saved, reflecting a substantial reduction in disease burden linked to household air pollution. These results point to the need to accelerate progress toward universal access to clean cooking fuels through targeted, context-specific policies. While rural populations remain underserved and require continued attention, the magnitude of potential gains in urban areas underscores the case for a balanced strategy in clean energy policy design.