Air pollution hits women informal workers hard and different

“Aankh mein mirchi jaisa lagta hai (It feels like chillies in our eyes),” says Sarita Devi, 38, about the smog-filled winter in New Delhi. India’s capital has been consistently ranked among the world’s most polluted cities and was the most polluted capital last year.^[1] Sarita Devi, a professional cook, has nursed a cold, sore throat, and difficulty in breathing since Delhi’s Air Quality Index (AQI) levels started climbing to dangerously high levels around Diwali this year.

Meera Devi, an Anganwadi worker and street vendor, became so ill that she skipped work for ten days. A 29-year-old woman gig worker felt like she would be choked to death. Sarita Devi’s friend went to work with a nebulisation machine to avoid loss of pay. Like these women, hundreds of thousands of women working as delivery partners, waste pickers, street vendors and domestic help have been struggling through the winter months as the smog leaves them gasping for breath. In 2017-18, 23.6 percent of Delhi’s women workers were employed in the informal sector.^[2]

For most of November, the ‘very poor’ AQI across Delhi-NCR breached the 1000 mark on November 17-18. This prompted the government to resort to Stage IV of the Graded Response Action Plan on November 18, or emergency anti-pollution measures, and the issue reached the Supreme Court of India. The emergency restrictions were in force for 18 days.^[3] With six days of “severe” and 22 days of “very poor” quality air, it was the worst November in seven years.^[4]

This is a repeating pattern. A study published in Lancet Planetary Health stated that Delhi experienced the highest percentage of daily and yearly deaths attributable to PM2.5 air pollution; every year, the city records around 12,000 deaths connected to air pollution, adding up to a staggering 11.5 percent of its overall deaths.^[5] From 2017 to 2023, as many as 26 of the world’s 30 cities with the worst air quality, especially PM2.5, were in India.^[6] Women form approximately half the population in nearly every urban centre. 

Air pollution, initially seen as an environmental issue, has lately been acknowledged as a public health emergency but its impacts on women’s health and lives is different from men’s — besides respiratory illnesses in both genders which are now tracked, women’s reproductive and mental health are affected too. Although bad quality air undermines everyone’s health, differences along the lines of gender, class and caste have to be recognised and addressed. These need greater awareness, deeper research, and a sustained focus of governments especially when the affected women are from  marginalised groups.

Women carry a double load of pollution. Besides the polluted air, women are impacted by indoor air quality too which tends to be hazardous from burning firewood or coal as cooking fuels; women spend longer hours in congested homes without proper ventilation in informal settlements. Indoor air pollution disproportionately affects women.^[7] Moreover, women’s nutrition levels are poorer than men’s^[8] and they lack timely or adequate healthcare, they also walk to work or for domestic chores and childcare such as dropping children to school more than men do,^[9] and tend to be more exposed to hazardous air.  

Evidence piling up
India-specific studies on the impact of air pollution on women vis-à-vis men are few and far between. However, the available international research is unequivocal about the differing and graver impacts. This study^[10] in 2022 found that the impact of breathing diesel exhaust fumes was more severe for women than men. In it, researchers at the University of Manitoba, Canada, found that levels of 90 proteins were distinctly different between women and men volunteers; some of these proteins affect inflammation, damage repair, blood clotting, cardiovascular disease and the immune system.^[11] “This is important as respiratory diseases such as asthma are known to affect females and males differently with females more likely to suffer severe asthma that does not respond to treatments,” remarked Professor Neeloffer Mookherjee who led a group in the study.  

A study published in The Lancet^[12] in 2021 explored the impact of pollution on pregnancy in South Asian countries; 77 percent of the nearly 34,100 women were from India. “Our findings add to epidemiological evidence of the association between pregnancy loss and PM2.5. Suboptimal air quality contributes to a considerable fraction of total pregnancy loss in south Asia,” noted the researchers. A review of 43 studies on pregnancy and pollution^[13] showed the adverse effects of pollutants on pregnancy loss, including spontaneous abortion, miscarriage, and stillbirth.

Beyond reproductive health, air pollution affects women’s anaemia across age groups. Researchers found that “long-term exposure to ambient fine Particulate Matter (PM2.5), a type of air pollution, may increase the prevalence of anaemia through systemic inflammation”.^[14] 

Nature of work, double pollution load
Air pollution is not the great equaliser it is presumed to be. Class and caste vulnerabilities, which determine the kind of work women do and homes they live in, exacerbate the hazards. Even in the pollution-pregnancy matrix, as this study^[15] showed, short-term and long-term exposures to air pollutants meant that “vulnerable sub-populations…pregnant parents from more disadvantaged populations may be more impacted even at the same exposure level”. 

Across India’s cities, marginalised class and caste women are usually found working in low-income work besides care-giving. Meera Devi, 53, an Anganwadi worker and street vendor, experienced severe pains in her limbs past few weeks in addition to the usual cough, cold, and general body pain; her fever did not subside for nearly a month and she lost weight. She had to miss work for ten days in November which meant lower earnings. “We struggle financially if we take days off,” she says. She was forced to see a private doctor after the government clinics did not give her relief. Street sweepers are another group of women affected. The risk of chronic respiratory morbidity among street sweepers was at least 4.24 times higher than that in the comparison group, found this study^[16]. 

A study,^[17] by Chintan, an environmental research and action group, examined the impact of air pollution on safai karamcharis, security guards and waste pickers; it found that women participants in each group had lower lung function than the men in that group and women sweepers showed more lung deterioration than security guards and waste pickers. This, it attributed to “the women are more exposed to indoor air pollution during cooking using wood or coal”. Women waste pickers who also used biomass and wood as cooking fuel, were almost four times more likely to have respiratory illnesses.

Women in the gig economy – delivery partners – too carry a double pollution load. A 29-year-old Zomato delivery partner, requesting anonymity, narrated how difficult it was to ride a two-wheeler through the day-long smog and climb flights of stairs to deliver food parcels. “Aisa lagta hai main marr jaungi (I feel like I will die),” she told Question of Cities. Other women spoke of Delhi’s polluted air having “a foul smell and a dark colour” in a recent study by Martha Farrell Foundation,^[18] which found that pollution led to, among other health problems, eye infections and headaches too.

“In general, women’s needs for health care or access to services are always deprioritised. When families are on a limited budget, everybody else takes precedence over women’s needs. So, structurally also, in this patriarchal system, women and their needs are often considered the last. And that makes them more vulnerable, least cared about,” says Shweta Narayan, Campaign Lead, Global Climate and Health Alliance.

Public issue, private burdens
The pollution-related ailments mean increased medical expenses for women. Delhi’s Mohalla Clinics have been a saviour for many, especially if they are the only earning members of their families. The gig worker went to the nearest one when her cough and chest infection persisted because she had to account for medical care for an aging mother and a sister suffering from tuberculosis. “But it takes a long time at Mohalla Clinics,” she groans. Although Zomato covers some expenses incurred at private clinics, she cannot afford to first shell out the money.

Mohalla Clinics, however, are not the panacea for women like Raj Kumari, 55, a street vendor who sells snacks at National Zoological Park. For days, Kumari nursed chest pain, scratchy throat, tingling eyes, and skin allergies. Timely assistance by ASHA workers helped her when could not be on the streets. Kumari, the lone breadwinner of her six-member family living in two rooms near ITO, also raises two grandchildren after her daughter died.  

It’s not just physical health; women experience mental health setbacks too though they are less recognised. Feelings of sadness, cognitive difficulties, and a reduced ability to cope with life challenges are some of the mental health outcomes of air pollution exposure, say reports submitted by the Delhi government to the National Green Tribunal in April 2024.^[19]

Meera Devi, exhausted, says, “I feel stressed, I just want to sit at home and rest but my eyes tingle, my throat hurts and at night, I struggle to breathe after sitting at the shop all day.” She witnessed a 25-year-old man become severely ill and die “because of the bad air” and it affected her for days. The gig worker says “little things” make her angry and she does not “feel like talking to people”.

This study^[20] found that people living in Delhi’s areas with hazardous AQI levels had higher levels of depression and anxiety, and lower levels of well-being. However, none of the women we spoke to even thought of taking a day off due to their mental health setbacks; it would be an unnecessary loss of earnings.

A less-known impact of air pollution is the heat inside the jhuggis that women live in. “It is very difficult to move, let alone sit and stand with ease. Women feel suffocated because of this,” says domestic help Roshni Tigga, 34. Women domestic workers experience better air at their employers’ homes fitted with air purifiers and exhaust fans. However, they have to return to their hot hovels. The few who have exhaust fans, like Raj Kumari, find them inadequate to expel the heat from her two-room dwelling. A study found that “the summer of 2024 has witnessed widespread ground-level ozone exceedance making the air of Delhi-NCR even more toxic.”^[21] 

 Ways forward
The future lies, as Raj Kumari says, in going back to nature. When she’s near or in the greens of the zoo, she feels much better. “They should plant more trees as they are making more roads and buildings by chopping trees,” she says, unaware that her individual experience has been borne out in studies that recommend going green to curb air pollution. 

Masks are a temporary respite for women who work outdoors but they also mean an additional expense, especially if more than two-three people in the household have to use them. The women we spoke to complained that no one listens to them. “Hum log ka kaun dekhta hai (Who pays attention to us?),” asks Sarita Devi.  Pregnant women from under-privileged classes are the worst hit.

There is a need for a gender-sensitive approach in addressing the harm from air pollution, says Narayan. “In terms of providing care and protection, one cannot have a one size fits all or a singular approach and expect that everybody will be covered…Women will need additional care, protection and consideration while designing air pollution policies or health policies,” she opines.

Research by Janpahal, an advocacy group, covering 32 cities across India, found that more than 85 percent of respondents reported working for more than eight hours. Highlighting the dual burden of invisible unpaid labour by women workers, Nitesh Kumar Das, program manager, says, “The unpaid care work sustains families and communities. The struggles of these women are aggravated by poor AQI.” Adds Dharmendra Kumar, director, Janpahal, “The work of women workers is considered transient but the damage to their health because of poorAQI is permanent.” They urge immediate policy interventions to address this. 

Jashvitha Dhagey is a multimedia journalist and researcher. A recipient of the Laadli Media Award consecutively in 2023 and 2024, she observes and chronicles the multiple interactions between people, between people and power, and society and media. She developed a deep interest in the way cities function, watching Mumbai at work. She holds a post-graduate diploma in Social Communications Media from Sophia Polytechnic.

Cover photo: Deepali Tonk