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The deteriorating quality of air we breathe is a well-known health hazard. Polluted air, indoors or outdoors, harms our health in various ways. In India, nearly 17.8% of total deaths are attributable to it. It also poses a major risk to child health, accounting for 8.8% of deaths in children under five. Tiny air pollutants, when inhaled, can enter the bloodstream, cross the placental barrier, and impair fetal growth. The harmful effects on children may begin at birth, leading to conditions like low birth weight, preterm births, or stillbirths.
Indoor air pollution in Indian homes primarily stems from the use of solid biomass fuels like wood and crop residue for cooking, heating water, and space heating. Women, particularly during pregnancy, are especially vulnerable to this pollution due to the extended time they spend indoors. Transitioning to cleaner fuels, such as liquefied petroleum gas (LPG), piped natural gas (PNG), electricity, or biogas, can significantly lower the risk of adverse health outcomes. To encourage this shift, the Prime Minister Ujjwala Yojana (PMUY) was introduced to promote the use of LPG. However, its impact on health outcomes remains to be thoroughly evaluated. While many health effects are chronic and difficult to quantify, the impact on child health, which can manifest after short-term exposure, is easier to measure and monitor.
Clean Cooking Fuel Reduces Low Birth Weight Risk, But High Ambient Air Pollution Negates Benefits
We analysed data from the National Family Health Survey (NFHS, 2019-21) to assess whether the use of clean cooking fuel reduces the risk of low birth weight. Our analysis focused on a sample of 56,000 full-term, singleton live births from rural households, all born after 2017. We compared the risk of low birth weight among users of clean cooking fuel and those using solid biomass fuels, accounting for varying levels of ambient air pollution. Our findings revealed that women who primarily used clean cooking fuel had a 17% lower likelihood of having a low birth weight baby, but only when ambient air pollution levels were at their lowest. As ambient air pollution increased, the benefit of using clean cooking fuel gradually diminished.
Our study also revealed that women in the Indo-Gangetic plains face the highest dual burden of household air pollution and ambient air pollution (Fig. 1).
These northern and eastern states have only recently experienced large-scale LPG penetration, with more than half of Prime Minister Ujjwala Yojana (PMUY) connections distributed in these areas. However, the refill rate among PMUY users was significantly lower (under four cylinders in 2021) compared to LPG-exclusive users (average 7-8 cylinders). This suggests high levels of fuel stacking, where both clean and unclean fuels are used simultaneously. As a result, household air pollution contributes substantially, accounting up to 30%, to ambient air pollution in these regions.
In India, LPG is the most widely used clean cooking fuel, while the traditional chulha, which burns solid biomass on an open fire, remains the predominant unclean option. Despite LPG availability, chulhas are still used daily for specific tasks like making roti and heating water for bathing. The frequency and duration of chulha use depend on factors such as household size, specific needs, and access to free biomass. Due to fuel stacking, even households that primarily use LPG are exposed to pollutants in quantities that can still cause adverse health effects.
Tangible Public Health Benefits Require Large-Scale Complete Shift to Clean Cooking Fuels
Affordability, access, awareness, and user needs are crucial factors in achieving desired health outcomes. Experts propose several mechanisms to subsidize clean cooking fuels (CCF) and enhance their accessibility, advocating for diverse options tailored to specific contexts. The publicly accessible, reliable data is still lacking; for instance, surveys like the National Family Health Survey do not capture information on fuel stacking. Incorporating sensitive indicators into these surveys could greatly improve our understanding of clean fuel usage and its impacts.
Using clean fuels for cooking is a critical health behavior, akin to drinking safe water, using sanitation facilities, and consuming nutritious food. The health sector has extensive experience in promoting such behaviors through awareness initiatives and community engagement platforms. Despite its significance as a social determinant of health, household air pollution has not received adequate attention within these initiatives.
To move forward, engaging local communities to drive behavior change through the formal health system is essential. We must prioritize integrating clean cooking fuels into health promotion efforts, ensuring that household air pollution becomes a focal point in public health initiatives. Together, we can improve health outcomes and enhance the quality of life for all.
