air pollution

How air pollution impacts the health of pregnant women and foetuses

A health ministry panel has recommended that pregnant women stay away from polluting cooking stoves to ensure babies born are not underweight.

In September, a group of researchers studying the effects of air pollution on human health recommended to the Union Health Ministry that polluting cooking stoves, which are commonly used in Indian villages, be removed from the homes of pregnant women.

The group wants to reduce the exposure of pregnant women to air pollutants emitted from biomass-burning stoves to ensure that the children born to them are not low in weight.

This is perhaps the first time that the role of pollutants in adversely impacting pregnancy has been acknowledged for a policy intervention.

These recommendations were made by a steering committee formed by the Union Ministry of Health and Family Welfare last year to draft a report looking at the impact of air pollution on human health.

“India has a difficult air pollution system,” said Kirk Smith, professor Global Environmental Health, University of Berkeley, who is part of the steering committee formed by the health ministry. “About 30% of outdoor air pollution is a result of using chulhas.”

(Click to see larger image.)
(Click to see larger image.)

Health risk

Contrary to the popular belief that air pollution is responsible for triggering and worsening respiratory ailments, a growing body of evidence has linked air pollution to heart disease, strokes and cancer.

Thus, the risk that air pollution poses to the health of unborn children is another challenge for policy makers already struggling to improve child health.

Sutapa Neogi from the Public Health Foundation of India conducted a study on household air pollution that was published in 2015 where she found a strong association between household air pollution and neonatal mortality and still births.

The steering committee had looked at several studies, including Neogi’s, before making its recommendations to the government.

“We don’t know the mechanism,” said Neogi. “The assumption is that prolonged exposure to air pollution affects the oxygen supply to the foetus.”

In her study, Neogi analysed the health indicators of nine large states in India using data from the Annual Health Survey – a population-based survey conducted by the Central government.

Child specialists say that the foetus receives oxygen from the mother, and if she is breathing polluted air, it is bound to impact the development of the unborn child.

This, in turn, has a cascading effect on the child’s future development. For instance, children whose weight is low at birth are at a higher risk of contracting illnesses, say doctors. In fact, babies with low birth weight also tend to be malnourished as they grow older. Some studies have found that a low birth weight baby is more likely to develop diabetes, heart conditions and blood pressure later in life.

(Click to see larger image.)
(Click to see larger image.)

Low vitamin D levels

Studies have also found that high air pollution levels can have an impact on the body’s absorption of vitamin D, which promotes calcium absorption, is vital for bone growth and also plays an important role in boosting immunity.

In 2002, doctors from St Stephens Hospital in Delhi conducted a study into the impact of air pollution on vitamin D levels in children.

“We oversimplified it but more the pollution, the lesser is the absorption of ultraviolet radiation in children which is major source of vitamin D,” said Dr Jacob M Puliyel, a paediatrician, one of the authors of the study.

Puliyel and his colleagues looked at the vitamin D status of children living in Mori Gate in central Delhi and Gurugram in neighbouring Haryana. Mori Gate has high air pollution levels as compared with Gurugram. The study found that children living in Mori Gate had low levels of vitamin D as compared with those living in Gurugram. They concluded that children living in polluted areas should be provided with vitamin D supplements to avert their risk of developing rickets, a skeletal disorder that is caused by the lack of that crucial vitamin in the body.

In 2012, another group of researchers from France linked air pollution with low vitamin D levels in newborns. During their study, they tested cord blood and found low levels of vitamin D among mothers who were exposed to high pollution levels. The group concluded that gestational exposure to ambient urban air pollution, especially during late pregnancy, may contribute to lower vitamin D levels in babies.

Puliyel said that India needed to conduct a similar study especially because there was an unexplained rise in the number of children with low calcium levels.

“I am definitely seeing too many children coming with convulsions which are a result of low calcium levels,” said Puliyel.

(Click to see larger image.)
(Click to see larger image.)

Doctors, governments clueless

Public health experts said that despite the growing body of evidence linking air pollution with pregnancy outcomes, little has been done to inform the community at large.

“Air pollution has not been a part of the medical curriculum,” said Smith, who conducts research on environmental and health issues caused by pollution in developing countries, including India.

The reasoning here is that if doctors are not educated on the problems of air pollution they will be unable to pass the message to their patients.

“A doctor in the village has to tell a pregnant woman that cooking on the traditional stove can damage her child,” said a senior doctor working with a medical college in Maharashtra. “We have observed that even if women are provided with non-polluting stoves, they will still use the traditional stove to cook some items.”

Associating low birth weight with air pollution is a challenge as it is caused by multiple factors. For instance, small babies are also routinely born to mothers with poor nutritional status, and to young mothers.

“There are enough reasons to act,” said K Srinath Reddy, president of Public Health Foundation of India and co-chair of the steering committee set up by the health ministry.

Though officials at the health ministry said that very little has been done to act on the recommendations, Reddy and his colleagues are optimistic. “India is the only country where the health ministry is acting,” said Smith. “Usually the environment ministries take a lead in most countries.”

However, public health experts say that India has a long history of forming committees, but does not always effectively implement their recommendations.

India’s commitment (or lack of it) to the problem of air pollution is evident from an incident early this year, when a funds crunch at the Indian Council of Medical Research led to the derailment of a multi-level study on air pollution and its impact on human health in the country.

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“My body instantly craves chai and samosa”

German expats talk about adapting to India, and the surprising similarities between the two cultures.

The cultural similarities between Germany and India are well known, especially with regards to the language. Linguists believe that Sanskrit and German share the same Indo-Germanic heritage of languages. A quick comparison indeed holds up theory - ratha in Sanskrit (chariot) is rad in German, aksha (axle) in Sanskrit is achse in German and so on. Germans have long held a fascination for Indology and Sanskrit. While Max Müller is still admired for his translation of ancient Indian scriptures, other German intellectuals such as Goethe, Herder and Schlegel were deeply influenced by Kalidasa. His poetry is said to have informed Goethe’s plays, and inspired Schlegel to eventually introduce formal Indology in Germany. Beyond the arts and academia, Indian influences even found their way into German fast food! Indians would recognise the famous German curry powder as a modification of the Indian masala mix. It’s most popular application is the currywurst - fried sausage covered in curried ketchup.

It is no wonder then that German travellers in India find a quite a lot in common between the two cultures, even today. Some, especially those who’ve settled here, even confess to Indian culture growing on them with time. Isabelle, like most travellers, first came to India to explore the country’s rich heritage. She returned the following year as an exchange student, and a couple of years later found herself working for an Indian consultancy firm. When asked what prompted her to stay on, Isabelle said, “I love the market dynamics here, working here is so much fun. Anywhere else would seem boring compared to India.” Having cofounded a company, she eventually realised her entrepreneurial dream here and now resides in Goa with her husband.

Isabelle says there are several aspects of life in India that remind her of home. “How we interact with our everyday life is similar in both Germany and India. Separate house slippers to wear at home, the celebration of food and festivals, the importance of friendship…” She feels Germany and India share the same spirit especially in terms of festivities. “We love food and we love celebrating food. There is an entire countdown to Christmas. Every day there is some dinner or get-together,” much like how Indians excitedly countdown to Navratri or Diwali. Franziska, who was born in India to German parents, adds that both the countries exhibit the same kind of passion for their favourite sport. “In India, they support cricket like anything while in Germany it would be football.”

Having lived in India for almost a decade, Isabelle has also noticed some broad similarities in the way children are brought up in the two countries. “We have a saying in South Germany ‘Schaffe Schaffe Hausle baue’ that loosely translates to ‘work, work, work and build a house’. I found that parents here have a similar outlook…to teach their children to work hard. They feel that they’ve fulfilled their duty only once the children have moved out or gotten married. Also, my mother never let me leave the house without a big breakfast. It’s the same here.” The importance given to the care of the family is one similarity that came up again and again in conversations with all German expats.

While most people wouldn’t draw parallels between German and Indian discipline (or lack thereof), Germans married to Indians have found a way to bridge the gap. Take for example, Ilka, who thinks that the famed differences of discipline between the two cultures actually works to her marital advantage. She sees the difference as Germans being highly planning-oriented; while Indians are more flexible in their approach. Ilka and her husband balance each other out in several ways. She says, like most Germans, she too tends to get stressed when her plans don’t work out, but her husband calms her down.

Consequently, Ilka feels India is “so full of life. The social life here is more happening; people smile at you, bond over food and are much more relaxed.” Isabelle, too, can attest to Indians’ friendliness. When asked about an Indian characteristic that makes her feel most at home, she quickly answers “humour.” “Whether it’s a taxi driver or someone I’m meeting professionally, I’ve learnt that it’s easy to lighten the mood here by just cracking a few jokes. Indians love to laugh,” she adds.

Indeed, these Germans-who-never-left as just diehard Indophiles are more Indian than you’d guess at first, having even developed some classic Indian skills with time. Ilka assures us that her husband can’t bargain as well as she does, and that she can even drape a saree on her own.

Isabelle, meanwhile, feels some amount of Indianness has seeped into her because “whenever its raining, my body instantly craves chai and samosa”.

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This article was produced by the Scroll marketing team on behalf of Lufthansa as part of their More Indian Than You Think initiative and not by the Scroll editorial team.