‘Was I right to bring a child into this world?’

The cityrsquos air quality index AQI has been hovering around 300 as per BMC for a while now and everyonersquos falling ill more often than not including children A few schools have shifted to online classes until the situation gets better As it gets harder and harder to breathe the familiar excuses are being offered mdash ldquoitrsquos the lack of wind during winter months itrsquos just a matter of a couple of monthsrdquoSet aside the question of why we should choke without complaining even for a few weeks mdash the bigger question is how do we know that the thick blanket of smog smothering our city wonrsquot have a more longlasting impact especially on our childrenrsquos growing bodies and brainsIn 2024 the State of Global Air report thatrsquos released annually by UNICEF in collaboration with USbased nonprofits Institute For Health Metrics and Evaluation and Health Effects Institute stated that as many as 2000 children under the age of five are estimated to die across the world every day from air pollutionrelated health impacts mdash this accounts for 15 per cent of all global child deaths The same report also stated that the impact extends to unborn children as well with air pollution linked to 34 per cent of preterm births globally in 2021 It added that among affected babies those who survive may face developmental delays disabilities and health consequences throughout their lifeA child comes to play at the Asha Bhosle musical garden at Bandra Reclamation only to be surrounded by smog Representational PicNimesh DaveItrsquos a worry that has plagued Pemiya Gandhi ever since she gave birth to her son Theo six months ago The toddler is relegated to the bedroom in his parentsrsquo south Delhi apartment to keep him safe amid Delhirsquos dismal air quality Gandhi already overwhelmed as a new mother checks the AQI every few hours For the past month the capitalrsquos AQI has mostly stayed upwards of 300 climbing as far as 727 on November 7ldquoWe escaped to Dehradhun during Diwali but as soon as we came back he fell sick He had a runny nose cold and cough Even now a month later his cough hasnrsquot gonerdquo she tells usThere are no medicines that can be given to a sixmonthold apart from saline drops and steam inhalation ldquoItrsquos heartbreaking to hold my baby down to put the saline drops in his nose He begins to wail Then I have to hold under a bedsheet with steam for some time just so he can take a breathrdquo she addsPemiya Gandhi plays with her sixmonthold Theo who has had a persistant cough since Diwali she says PicNishad AlamTheo has also just begun to crawl and explore ldquoHe loves greenery but I canrsquot even take him to parks Therersquos nothing I can dordquo she says as frustration takes overGandhi who is originally from Mumbai even discussed moving back here with her husband But seeing the AQI plummet to hazardous levels in Mumbai too the couple was disheartened ldquoMy husband and I thought maybe Mumbai is not as bad as Delhi now but in a few years it will get there too Then would we have to move againrdquoNow they are thinking of moving to tier2 or tier3 cities even if it means Gandhi takes a massive pay cut as a corporate communications employee ldquoAnd if I do take a pay cut I still need to move to a city that has good medical facilities for Theo So again less money and subpar medical facilities are added concernsrdquo she saysItrsquos a loselose equation Gandhi fears ldquoI have so much selfdoubt right now I keep thinking lsquoWas I right to have a baby in this environment in the first placersquordquoDr Manisha Mukhija and Dr Preeti MhatreThere is little research about the correlation between polluted air and its impact on a growing child The most exhaustive one we came across was a study done by American and Mexican researchers as far back as 2008 which continues to be cited often in subsequent studies The research Lilian CalderoacutenGarciduentildeas et al was conducted through a series of autopsies on road accident victims between the ages of two to 47 and residing in Mexico City which had seen fastpaced urbanisation with rampant construction and a citywide vehicle count that had reached 40 lakhMumbai has seen similar conditions with many asking for an immediate ban on construction work ongoing across the city The cityrsquos vehicle count is even higher with fourwheelers touching the 48lakh mark in MarchThe Mexico City study found that even clinically healthy cognitively and neurologically intact children teenagers and young adults who grow up breathing polluted air can not only show compromised immune systems but also early brain and nerve inflammation as well as bloodndashbrain barrier damage These are changes associated with increased risk for neurodevelopmental problems cognitive decline and neurodegenerative conditions like Alzheimerrsquos disease and dementia later in life The study also highlighted inhibitors that might affect memory attention decisionmaking academic performance and emotional regulation in children and teensNeha Gupta JainIn the same study during the autopsy of an 11yearold the researchers found the protein synuclein in the brain stem nuclei This finding is associated with neurodegenerative diseases like Parkinsonrsquos disease dementia as well as hampered breathing heart rate and movement coordinationThis is the same protein that was at the centre of a 2025 study by US researchers mdash titled Lewy body dementia promotion by air pollutants and published in the Science journal The scientists combined data from over 56 million US patients with laboratory and animal studies revealing a molecular connection between air pollution and dementia development The study stated that exposure to pollutants particularly PM 25 triggers the formation of toxic protein clumps in the brain and increases the risk of lewy body dementia by up to 17 per centDevelopmental paediatricians say there is enough empirical data and undeniable lived experience to draw a direct relation between high AQI and its impact on childrenrsquos cognitive abilitiesArun Jain right with his son Aashman JainDr Preeti Mhatre a developmental paediatrician cites WHOrsquos global air quality guidelines published in 2021 as well as her own experience as a professional in the field for over 15 years and says ldquoAir pollution is often seen as a problem for the lungs but research now shows it can also interfere with how a childrsquos brain develops starting as early as pregnancy Scientific studies consistently show that children exposed to high levels of air pollution are more likely to have slower learning reduced attention span weaker memory and lower developmental or IQ scores Several studies have also reported a higher risk of neurodevelopmental conditions such as ADHD and autism The changes in each child may appear subtle but with millions of children exposed daily the impact on society is enormousrdquo she saysMhatre then adds ldquoWe now have enough evidence mdash from both global and Indian research mdash demonstrating this link Recent Indian studies are reporting findings identical to international data showing the same adverse effects on cognition attention and behaviour in children exposed to toxic air WHO has repeatedly raised concerns about air pollution being one of the biggest threats to childrenrsquos health and development Children are more vulnerable than adults because they breathe faster spend more time outdoors and their natural protective systems including the bloodbrain barrier are still developing Clean air is therefore not just a respiratory need but a developmental necessityrdquo she addsDr Mhatre also points out to us that many of the children in her care are coming in more often with health issues as AQI has reached hazardous levels in the city in the past few years ldquoChildren are coming back sooner with the same sicknesses that we treat them for in a shorter span of time Which indicates that there is a loss of natural immunity among children they are hardly in recovery mode and are back at the hospital for the same issuerdquo she saysDelhi residents put up with a thick haze during their morning walk and errands on Thursday PicGetty ImagesldquoAt this point the science is clear It is high time that Indian policy makers treat clean air as a core requirement for child development Reducing exposure mdash at home school and communitylevel mdash is one of the strongest investments we can make in safeguarding our childrenrsquos learning behaviour and longterm potentialrdquo she addsIn a glaring example of how the authorities do not follow a peoplefirst policy when it comes to developmentversushealth debate even when the National Capital Region NCRwas experiencing AQI upwards of 700 the Union governmentrsquos Commission for Air Quality Management did not impose their most stringent restrictions stage IV under its Graded Response Action Plan GRAP Even the stage III curbs that had been imposed were revoked on November 27 after the air quality improved slightly These measures included a ban on nonessential construction and demolition work as well as stone crushing and mining activitiesNeha Gupta Jain who lives in the Haus Khaz enclave in South Delhi is mother to a twoyearold and nineyearold and has been struggling with the decision to send her youngest to playschool ldquoMy child has grown up with nebulisers something I never experienced as a child The fact that they have revoked the strictest curbs under GRAP is just making me so angry What are they thinkingrdquo she asksJain is also very clear that this is not an indictment of any one government rather a series of bad decisions over two decades ldquoItrsquos a failure on part of the policy makers involved in the decisionmaking process who have not turned up for us and our childrenrdquo adds the entrepreneurWe see the same negligence in Mumbai when it comes to keeping people first in policies as well as failure to enforce existing regulations to minimise particulate matter dispersionOn Thursday BMC gave 53 construction sites a work stop notice in a bid to regulate the increasing AQIThe need of the hour is still more focused studies linking cognitive dysfunction to air pollution as that is more likely to push the authorities into action But Dr Manisha Mukhija developmental and behavioural paediatrician feels that while even the medical fraternity might demand more data to conclusively prove the connection studies have long since established the impact that secondhand smoking can have on a pregnant woman or a child aged 05ldquoThere is a genetic component to children who have Neurodevelopmental conditions and there are epigenetic or environmental factors that act on the genes These factors are yet to be completely identifiedrdquo she says ldquoThis includes social environments for example a child who is not exposed to friends to outdoors to language will have delays and difficulties in language later on in life Now how does a polluted environment contribute to this We still donrsquot have enough data to say that it is directly related But we know that smoking around a pregnant mother affects the newborn in terms of growth and their development Can we extrapolate this to general environmental pollutants We also know that in cities we are exposed to endocrine disrupting chemicals in the air water and food These can disrupt the way our hormones are released in the body and can cause a whole host of health issuesrdquo she addsBack in Mumbai Arun Jain has been trying to inculcate clean habits in his 15yearold for a while but has refrained from scaring the teenager over the AQI ldquoI have try to lead by example he starts his day with soaked dry fruits and a glass of turmeric and ginger milkrdquo says Jain ldquoHomemade amla concoction and salads are a part of their daily lunch routine and we prefer sprouts fresh fruits and healthy home made Indian breakfast and meals While juices and shakes are always freshly prepared the packaged foods and drinks are extremely rarerdquo he addsGrowing up in the rsquo80s and rsquo90s in Kota Jain says there was no awareness about AQI at the time and he and his friends were accustomed to dusty roads and smoke from factories He hopes all this talk of AQI doesnrsquot stop children from going outdoors altogether ldquoI am a strong advocate of being health centric while being watchful of our ever changing surroundings I firmly believe that children should play outside as much as possible Wait for the air to improve but make sure they step out play and interact It not only strengthens their immunity but also helps them develop essential social skillsrdquo he saysPiciStock53no of construction sites in Mumbai that have received work stop notice from the BMC to control reduce the rising AQI2000no of children under 5 estimated to die every day from air pollutionrelated health impactsmdashaccounting for 15 per cent of all global child deaths3437of preterm births globally in 2021 were linked to air pollutionSource UNICEFrsquos State of Global Air report 20241737Rise in risk of developing Lewy body dementia on chronic exposure to PM25Source Johns Hopkins research study 2025Young life snuffed outNineyearold Ella AdooKissiDebrah suffered from severe asthma from a young age and was hospitalised 27 times in the three years before her death following an asthma attack in 2013 Ella lived on Londonrsquos South Circular Road known for high air pollution levelsLegal case A landmark inquest in 2020 ruled that air pollution was a ldquomaterial contributionrdquo to her death Her family later settled a legal case against the government which expressed sincere condolences for her loss Ellarsquos lawyers proved that she was exposed to illegal levels of nitrogen dioxideAdvocacy Ellarsquos mother Rosamund AdooKissiDebrah runs the Ella Roberta Foundation and continues her campaign for legally binding air quality targets to be lowered to meet World Health Organisation WHO guidelinesImmunityboosting foodsPiciStockJuicePomegranate cranberry blueberry and grape juices Citrus juices like oranges which are rich in vitamin C Beet juice for nitrates tomato juice for lycopene andgreen juices made from ingredients like spinach kale or cucumberPiciStockOther sources Nuts and seeds almonds walnuts flaxseeds Legumes and lentils Dark chocolatePiciStockHabits Exercising indoors Indoor swimminglsquoDocs said calm down every kid in Delhi is on nebuliserrsquoAnuja BaliAnuja Bali is a wellknown advocate for clean air for children ldquoIn 2008 when in Gurgaon my eight month son experienced breathing issues That changed our lives and we got into figuring out learning safeguarding and overprotecting mode But I remember that doctors had normalised it one told me lsquoCalm down every kid in Delhi is on a nebuliserrsquo I was stunned at the apathy After no improvement in his health we moved to Chennai in 2010 where within a few months he was better and did not have any breathing problems even in Alaska and the coldest winters in the USA she says After returning back to India in 2019 Bali became a core team member of Warrior Moms and started talking about air pollution and its long term health implications ldquoWe came back to India six years ago and now live in Pune As soon as we returned so did my sonrsquos breathing issuesrdquo she addsPiciStockWhen the summer vacations begin and he no longer has to commute in the smokeheavy traffic of Pune city the teenagerrsquos health markedly improves But then school reopens and his health comes crashing down with a vengeance ldquoHe has had to miss the first month of school every year because of the wheezing He keeps asking me why we came back from the US I didnrsquot want to stay in a foreign land away from home But now I find myself thinking mdash will I have to move again How many times will I move And how many other parents can move Why is basic need such as clean air such a rare commodityrdquoThe special needs educator feels there are direct links between neurodivergence and air pollution ldquoPeople are scared to come out and talk abt the link between neurodivergence and cognitive issues especially when at risk children unborn babies are exposed to polluted air There is even a Harvard study about it As a special educator I feel that despite a rise in such cases in India there is an acute absence of studies being done in Indiardquo she says