91% deaths of preterm babies from air pollution in low- & middle income countries: UN report

High income countries make the greatest contribution to climate change but the people who have contributed least to the crisis are the most hit, with 91 per cent deaths of preterm babies related to air pollution occurring in low and middle income nations, says a report by UN agencies.

The recently released 'Born Too Soon: Decade of Action on Preterm Birth' report by WHO, UNICEF and Partnership for Maternal New Born and Child Health highlights myriad impacts of climate change—both direct and indirecton pregnancy resulting in stillbirths, preterm birth and small for gestational age. 

Climate change impacts pregnancy through heat exposure, storms, floods, drought, wildfires and air pollution besides in terms of food insecurity, water or food borne diseases, vector borne diseases, migration, conflict and health system resilience, according to experts.

The report suggested more investment is needed to specifically mitigate risks and to increase focus on women and babies in policies and programmes addressing the climate emergency.

Air pollution is estimated to contribute to six million preterm births each year. "As recent research from the IPCC and others have clearly pointed out, vulnerability to climate change is a multi-dimensional, dynamic phenomenon shaped by intersecting historical and contemporary political, economic and cultural processes of marginalisation. Societies with high levels of inequity are less resilient to climate change," said Dr Ana Bonell from the Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine (MRCG at LSHTM).

According to the report, climate change has a harmful impact during the perinatal period. It increases the risk of preterm birth by direct pathways, such as air pollution caused by burning fossil fuels which increases risk by 52 per cent in asthmatic mothers; extreme heat exposure which increases risk by 16 per cent and other extreme weather events, such as drought.

"Although the impacts of climate change are being felt in all areas of the world, the people most affected have contributed least to the crisis. For example, globally, 91 per cent of deaths of preterm babies related to air pollution occur in low and middle income countries, while high income countries make the greatest contribution to climate change," the report said.

Recent estimates suggest that household air pollution was an attributable factor for 15.6 per cent of all low-birth-weight babies and 35.7 per cent of all preterm births, notably in low-income countries, it pointed out.

A study on 92 pregnant women in Gambia led by Dr Bonell showed that every extra degree Celsius in extreme heat stress caused a 17 per cent increase in strain on the foetus, specifically by raising fetal heart rate and slowing blood flow through the umbilical cord.

Another study showed a macro-level association between climate change vulnerability and women and children's health (WCH) at the district level in India, as districts that had high levels of climate change vulnerability also performed poorly in WCH. 

"Climate change impacts pregnancy in women through both direct and indirect pathways. The common direct pathways include heat exposure, storms, floods, drought, wildfires and air pollution. Indirect pathways include food insecurity, water or food borne diseases, vector borne diseases, migration, conflict and health system resilience," said Dr Bonell.  Despite the growing body of evidence linking the effects of climate change with maternal and newborn health, its impact remains politically under-appreciated, the report highlighted.

Pregnancy and newborn health are often prioritised below other health concerns, and environmental impacts on maternal and newborn health have rarely drawn the attention or resources of policy-makers and implementers.  

Speaking at the IMNHC conference hosted by the Government of South Africa and AlignMNH in Cape Town recently, Dr Anshu Banerjee, Director, Department of Maternal, Newborn, Child and Adolescent Health and Ageing at the World Health Organisation (WHO) urged governments to begin a dialogue with representatives of women and community groups, health workers associations, and other stakeholders to identify and address their needs, drawing on a range of behavioural, health systems, policy, health and environmental solutions. 

Dr Banerjee underlined that the health sector needs to play a dual role by building intrinsic climate resilience by reducing greenhouse gas emissions and at the same time this transition should not come at the expense of the quality of care, and patients and health workers' own health and wellbeing.  Noting that women and vulnerable newborns are at risk from siloed approaches, the report said government and multi-partner efforts are needed to overcome the fragmentation between sectors.P