More than 1,16,000 infants in India did not survive their first month due to air pollution in 2019, according to the State of Global Air 2020 report published on Wednesday. This was the highest among the 116 countries that were surveyed.

The report released by the Health Effects Institute said long-term exposure to outdoor and household air pollution – which led to strokes, heart attacks, diabetes, lung cancers, chronic lung diseases and neonatal diseases – contributed to a total of 16,67,000 deaths in India in 2019.

In a first, the report analysed the impact of air pollution on infants’ health and survival in their first month, and found that there was growing evidence to link mothers’ exposure to air pollution during pregnancy with an increased risk of their infants being born underweight or pre-mature, which lead to neonatal deaths.

The report estimated that a total of 4,76,000 infants died due to air pollution in 2019, out of which 1,16,000 deaths were recorded in India.

Total deaths among newborns attributable to air pollution in 2019

Corroborating the study’s observations, Kalpana Balakrishnan, Director of Indian Council of Medical Research told Hindustan Times that over 70 studies show that exposure to household and ambient air pollution is associated with adverse pregnancy outcomes. She said air pollution must be included alongside these risk factors to address the burden of low-birth weight and preterm births.

“We don’t totally understand what the mechanisms are at this stage, but there is something going on that is causing reductions in baby growth and ultimately birth weight,” Katherine Walker, Principal Scientist at the Health Effects Institute, told The Guardian. “There is an epidemiological link, shown across multiple countries in multiple studies.”

PM 2.5 exposure

The report said that in 2019, more than 4.1 million people died due to long-term PM 2.5 exposure. India recorded 9,80,000 deaths, second only to China, due to the micro particles. The report also noted that in 2019, on an annual average basis, people in India experienced the highest exposure to PM 2.5 – particles with a diameter of less than 2.5 micrometres.

Population-weighted annual average PM 2.5 concentrations in 2019

The report also showed that over the past decade, India was among five of the 20 most populous countries that witnessed a deterioration in terms of PM 2.5 exposure.

Nigeria and Bangladesh were the only countries that were worse than India. The top five also included Pakistan and Japan.

Change in population-weighted annual average PM 2.5 exposure in the 20 most populous countries, 2010–2019

In terms of ozone exposure too, India recorded the highest number of deaths in 2019, according to the report. As many as 1,68,000 people died due to ozone exposure.

However, India and China vastly improved their household air pollution levels – a trend that the report attributed to the shift towards cleaner fuel. In the last decade, India witnessed 2,08,000 fewer deaths due to household air pollution, the report said.

Numbers of deaths attributable to ozone in 2019

The report concentrates on data from 2019, so does not include the impacts of the lockdown policies around the world this year. The authors said the Covid-19 pandemic would have had an impact on air quality and deaths from air pollution, but these effects were not yet clear.