A new study focused on Delhi’s migrant worker hubs calls for more investment in building awareness and campaigns to check the impact of toxic air on some of the city’s poorest, and youngest inhabitants
Monika Banerjee
As winter sets in across north India, in the poor neighbourhoods of New Delhi, largely home to migrant workers, young mothers bring their babies closer to the warmth of the kitchen fire, hoping to keep them snug as the temperature and air quality plummet outside. But the use of biofuels in these kitchens makes the indoor air as harmful for the child as that of the air outside.
The mother's thoughtfulness is often used to apportion blame for their children's illness. But effective mitigation requires policy to understand the constraints of the poorest as they battle a harsh winter and poor air quality, so the solutions are both mindful and aligned to their daily challenges.
These were some of our learnings as we set out on a qualitative study to map the impact of air pollution in Delhi on the first 1000 days of the young child, through a socio-economic lens - an overlooked, but a critical, parameter in gauging and responding to the annual air crisis.
While literature establishes that air pollution impacts everyone and both ambient and indoor air pollution is causing grave impact for all residents of Delhi, our study that we conducted at Mobile Creches established the many reasons why and how the poor, the marginalized and their young children are the worst impacted by the intense pollution that the city faces year after year during the winter months.
The study, supported by the Asia-Pacific Regional Network for Early Childhood (ARNEC), focused on understanding the perception of mothers and health professionals regarding the impact that air pollution has on young children and highlight mechanisms and strategies that are adopted by families from marginalized communities to deal with the issues.
We found the mothers to be quite aware of the levels of pollution in the city and its known impacts. But despite the awareness, none of them seemed to connect the increased air pollution during the winter months to the illnesses their children suffered from.
This made their response to tackling the dual challenges of winter and toxic air often misplaced, and in some cases, even harmful.
THE STUDY
The study that started in March and April this year involved interviews with mothers, from six low socio-economic localities of Delhi NCR which included, Dakshinpuri, Barola in Noida, Seemapuri, Bhalswa Dairy (Landfill), Shabad Dairy, and a construction site in Gurgaon. These locations are densely populated and face similar challenges of rapid and unplanned urbanization and industrialization.
Most residents of these areas are migrants from neighboring states, engaged in labor-intensive and often informal employment sectors., ranging from rag picking, domestic work, construction work and other forms of daily wage labour.
The geographical location and socio-economic context of these locations became a crucial factor for understanding the environmental conditions and potential sources of air pollution that the young children and other residents of the area are exposed to in these low-income group areas. We also learnt from interviews with health experts, researchers, doctors and care workers on the most prevalent form of illnesses among infants living in these areas.
Even though it is not possible to accurately establish a direct connect between increased air pollution and prevalence of infection or ill-health due to the multifactorial nature of various health conditions, the nature of infections has shifted over the years. The community highlighted persistent cough, cold, nasal blockage, and sneezing, which lasted for several days and, in some cases, a few weeks. Skin rashes, bloody diarrhoea, nosebleeds, and vomiting were other ailments they told the researchers about, among other ailments, some of them resulting in hospitalization.
Apart from the direct impact of air pollution in terms of prevalence of illness, we found several indirect impacts as well, such as delayed vaccination, disturbed sleep, inability to breastfeed due to nasal blockage that further compromises the immunity of the children.
The study notes that the socio-economic background of a family plays a significant role not only in determining the level of exposure and impact the child would have from air pollution but also in how the family tackles both direct and indirect impact of this toxic air.
THE MANY RISKS
Picture credit: Mobile Creches
The congested living conditions in Delhi’s poor neighbourhoods, poor access to clean environment and basic infrastructure as well as poor nutrition levels makes children here more susceptible to compromised immunity and illness than others.
The localities selected for the study had poor waste disposal and sanitation systems. One locality was a construction site where temporary provision was made for the migrant workers to stay. Roads were narrow and dusty with open drains with people living in makeshift houses packed against each other. Piles of waste was a common site in most places.
Houses comprised a room, part of which was also used as a kitchen. Lack of proper ventilation, overcrowding due to space crunch along with lack of sanitation and waste disposal mechanisms, made the poor residents of these localities and their children more vulnerable to the toxins and allergens present in the air. The high level of traffic, frequent waste burning to get relief from the cold weather and usage of biofuels for cooking also added to the problem. Apart from this, lack of awareness amongst the community in maintaining hygiene levels was also highlighted as a major problem.
Globally, 93% of all children live in environments with air pollution levels above the guidelines issued by the World Health Organisation, which it notes has a “vast and terrible impact on child health and survival”.
The WHO in a 2018 study on Air Pollution and Child Health noted that more than one in every four deaths of children under 5 years of age is directly or indirectly related to environmental risks. The study attributed 543,000 deaths under the age of 5 years in the year 2016 to both ambient air pollution and household air pollution that cause respiratory tract infections.
During our study, we found that families, and children in particular, were indeed vulnerable to the air pollution outside, and also inside their homes, a contributing factor to prolonged and frequent episodes of ill-health during the winter months.
More worrisome, however, is the disruption in vaccination schedules, disturbed sleep and feed patterns as other indirect impacts of poor air. Infants are not able to take breast feed due to nasal blockage and congestion, which has a grave impact on their immunity and has long-term implications for their overall health.
And then, there is the tendency among parents to consult local private doctors instead of government-run health centres or dispensaries, each time they or their child falls ill. They believe the medication given by the private doctors gives instant relief. Interviews with ASHA workers, public hospital doctors and the private doctors themselves revealed that most of the practicing local private practitioners are not qualified doctors; rather their practice is more of an extension of their pharmacy shops.
Even though there are clear guidelines by the government on cautious use of antibiotics, steroids and even cough syrups with children under the age of 5 years, most private doctors prescribe antibiotics and nebulize the child with steroid medicines. While this provides instant relief to the child, it is also leading to antibiotic resistance and compromised immunity. But for parents - most of them daily wage earners - a quick solution is not just an affordable option, but it also relieves them from taking care of the child so they can return to work so as to protect the family’s income.
POOR AWARENESS
Picture credit: Mobile Creches
Speaking to mothers, we also found that while they were trying to keep their child as protected as possible, their poor awareness was further compromising the child’s immunity.
Mothers told researchers that ‘cold had set into their bodies’ owing to their work with cold water while doing domestic chores or even at work as domestic helps or at construction sites. They feared passing on this cold to the child through breast feeding. This widely held belief prevents many women from breast feeding their babies during the winter months.
And while they would keep the child close to the kitchen, they were not mindful of the toxins in the air as they cooked using biofuels.
But there is very little that is seen in terms of awareness campaigns and policy intervention to mitigate the problem apart from the yearly policy interventions such as school closures, advisories for wearing masks or suggestions for young children and elderly to stay home during winter early mornings or late evenings. Some of the mitigation measures such as shutting down construction activities have in fact proved to be a double blow for the already struggling poor migrant communities of Delhi as it has also impacted their income and ability to access basic requirements such as food and medicine.
The study’s findings show the way forward: that while it is important to build scientific evidence on the close connection between air pollution and human health, it is equally imperative to assess the impact from the social and economic lens and focus on those living rough in the city’s poor localities.
Also, policy makers working on mitigation strategies need to ensure that the scope of solutions is not restricted only to the winter months. For starters, building better health facilities, investment in public infrastructure such as public parks, waste disposal systems and sanitation facilities to support the poor in their approach to tackle the impact of poor air and building education campaigns so that parents are better informed to protect their children, should be focused upon. Also necessary action needs to be taken regarding management of landfills, to check both groundwater and air pollution. Investment in age-appropriate quality childcare centres (creches) for children would also help in building child’s immunity and resilience to prolonged infections and diseases.
Lastly, more research and evidence need to be generated to ensure that the challenges related to air pollution get the adequate policy attention it requires.
To access the full study report Air pollution and the child of the poor.pdf
The author is Head, Monitoring Evaluation Accountability and Learning (MEAL) at non-profit Mobile Creches
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