safe inside the warm womb of the mother, a child kicks and turns. This is the third time that Sarah Connell is pregnant, but she has never reached her second trimester of pregnancy. She aborted twice earlier. This time she has moved houses, cleaned up her home, and taken every precaution to ensure that this baby survives. So far all is well. The seed to the problem began when Sarah was a not quite in her teens, but had reached puberty when she was all of nine years old. Like every girl in the scenic town of Lake Charles, Lousiana, also known as the capital of the vinyl industry of usa. "All the girls are reaching puberty early in this generation," assured the local gynaecologist. Sarah remembers this vividly. She knows that her failure to conceive is because of the contamination of her womb. She is not alone -- at least not the only one from Lake Charles. Or from any industrial town elsewhere in the world, including India.
When Shubha Kulkarni, a nine-year-old schoolchild from Mumbai, reached home, she complained of severe uneasiness. Then she started coughing, often bending with pain, her eyes watering. Her mother thought she had caught an allergy, given the city's high air pollution levels. Suddenly, Shubha spluttered, her face contorted and almost choked, her lungs gasping for air. This was Shubha's first asthma attack. She's had several since then.
More children are suffering from asthma, cancer and learning disorders than ever before. Global figures suggest that since 1990, childhood cancer rates have risen by 12 per cent, asthma in children by 17 per cent and systemic disorders by 16 per cent. But these are just conservative estimates. Developing countries like India do not have authoritative registries, and guesstimates do the rounds. "There are few epidemiological studies conducted in India," says India's leading paediatrician H N Billimoria. Worse, even physicians are inept in diagnosing diseases. A critical review published in the Journal of the American Medical Association shows that doctors in India 'under-diagnose' asthma by 15 per cent.
Some indicators do throw light on this alarming increase. Some may argue though that this could be due to increased awareness. Still sample this. Children's hospitals in India increased from 22 in 1990 to 148 in 2001, according to the Directorate General of Health Services. Contribution of asthma drugs for children increased from seven per cent in 1987 to 18 per cent in 1999, says the All India Pharmaceutical Manufacturers Association. Childhood cancer cases grew from 4,124 in 1988 to 6,187 in 1996, says the recently-published Cancer Registry of India. "These figures in many ways reflect the poor environment we live in," says Anupam Sachdev, paediatric oncologist at the Sir Ganga Ram Hospital, New Delhi.
Environmental changes affect children the most
It is frightening. Children and adults today carry an estimated 300 or more chemical residues that were not present in their grandparent's body. The fact that a compound bio-accumulates tells us that the body cannot metabolise and eliminate every compound. The human body simply doesn't possess enzymes or other chemical mechanisms to counter the assault of novel compounds whose molecular structures are different from natural compounds. These chemicals accumulate in the body with time and are passed on to the next generation through the placenta and breast milk, often in high concentrations.
From conception to adolescence, rapid growth can be easily disrupted due to exposures to toxins. Cell growth is particularly rapid in the embryo, providing more opportunity for chemicals to cause mutations and congenital anomalies. During this period, structures are developed and vital connections are established. The foetus and infant have different vulnerabilities to damage. Children's metabolic pathways, especially in the first months after birth, are immature. And their ability to detoxify and excrete chemicals is much lower than adults.
That's why any change in the environment will affect them the most. Children drink more water, eat more food and breathe more air than adults in relation to their body weight. For example, the air intake of a resting infant is twice that of an adult. An infant (six months old) drinks 8-12 times more water per kilogramme of body weight than an average adult. Children between the age of 1-5 eat three to four times more food per unit body weight than the average adult. Absorption rates are also higher: infants absorb as much as 50 per cent of the lead and other heavy metal contaminants present in food while adults have an uptake of only 10 per cent.
Recent research shows that the link between a degraded environment and children's health is unmistakable. "Even in the rich countries of Europe, the major environmental impact on people are borne by children. Policies as well as impacts are deeply unjust and hurt the poor communities more than the rich," says the World Health Organisation's (who) latest publication Children's health and environment: a review of evidence. In industrialised countries, many children die due to birth defects that cannot be explained. In usa, about 6,500 children die due to birth defects, which is the leading cause of infant morbidity. While only about 20 per cent of birth defects are due to known factors, the causes for the remaining 80 per cent remain elusive. And evidence against environmental factors is mounting.
Consider just three studies, which conclusively prove the link between environmental contamination and their impact on children. A review of global studies published in the Journal of Epidemiology and Community Health in 2001 showed that exposure to polychlorinated biphenyls (pcbs) caused childhood neurological disorders to the foetus, which can lead to birth defects, spontaneous abortions, mental retardations and reduce fertility. pcb are commonly used as industrial reagents in electrical equipments like transformers and in household cleaning solutions and sprays. Another study published in The Lancet in November 1999 showed that pregnant women and the foetuscan be affected indirectly by pesticides -- people can bring pesticides used in farms and gardens and expose them. The study showed that children between 0-9 years, whose parents had occupational exposure to pesticides, developed acute lymphoblastic anaemia (all) during early childhood.
In India, studies linking a changing environment to children's diseases are few. H Parmesh of the Lakeside Medical Centre, Bangalore, recently conducted a study using 20-year data for asthma in 20,000 cases in children under 18 years. He found that Bangalore, a city with comparatively cleaner air, showed a high rise of asthma prevalence -- from nine per cent in 1979 to 29 per cent in 1999. He attributes the rise in asthma due increasing urbanisation, industrialisation and more importantly vehicle exhaust.
A study by S G Kabra, a physician at the Indian Institute of Health Management Research in Jaipur, found that pesticide residues in food are responsible for deformed babies. An estimated 8,000 babies are born with neural defects each year in Rajasthan (see: Down To Earth, Vol 9, No 3; June 30).
A recent study by K Senthil Kumar of University of Yokohama, Japan, shows that dioxin levels in tissues of Indians is as high as heavily industrialised countries like Japan, while other developing and some industrialised countries have lower levels of dioxin. Dioxin are produced by incineration of plastics and vinyl. Children are particularly susceptible to dioxin exposure. It causes structural birth defects, premature births, mental retardations, and systemic cancers. It is also considered one of the most potent carcinogens.
What's eating our children?
The threats just don't end with pesticides and dioxins. Large amounts of toxic chemicals used in industrial processes are incorporated into products. For example, over half of the top 20 chemicals in use (over 120 million tonnes), and half of those incorporated into products in India, are known or suspected carcinogens. An additional 80 million tonnes of restricted pesticide products are legally released each year in India. Mercury and other heavy metal contamination of our waterways is growing.
These toxic chemicals diffuse across the globe -- to even environments that were considered pristine. Inuit mothers in the Arctic, far from sources of industrial pollution, have some of the highest levels of pcbs in their breast milk as a result of a diet rich in marine mammal fat. With "safe" levels for hazardous and toxic chemicals being revised more frequently than before, it appears that there is no safe limit to many chemicals. In combination, their safe limits decrease manifold.
Over and above, the Indian child suffers from a double burden -- dirty water is still the biggest killer in the country. All this exacerbated by the lack of nutrition. Incidences of traditional diseases like diarrhoea and malaria are also increasing. "Over half of the children under age of five years in India are moderately or severely malnourished, 30 per cent newborn children are significantly underweight," says the National Human Development Report 2001 of the Planning Commission.
The burden of disease on children is increasing. The constant onslaught of both traditional diseases and modern diseases (pesticides and fertilisers in dusts, air, water and food, plastic wastes, agricultural or industrial effluents) make children vulnerable to a range of infections. Lifestyle-related diseases such as diabetes and obesity are also on the rise, as urban children are getting addicted to "junk" food with little or no nutritive value and lead an increasingly sedentary life. The web of death and diseases does not seem to end.