Talking heads

In the year 1991-92, 2,297 metric tonnes (mt) of pesticides in the rabi season and 903 mt in the kharif season are reported to have been used in Rajasthan, says Kabra. In 1998- 99, the total pesticide usage during the kharif season was 879 mt, whereas the estimated target was 850 mt, according to the plant protection officer at Krishi Bhawan in Jaipur. In the rabi season, the usage was 2,585.6 mt, 85.6 mt in excess. A report released by the Voluntary Health Association of India (VHAI) also documents the indiscriminate use and handling of highly neurotoxic pesticides in Rajasthan, besides the list of pesticides in use and their health effects (see table: Pest of a problem). But many experts believe that a more detailed study between pesticides and congenital defects is required to establish the link.

What medics say

Agreeing that the number of babies born with NTDs are on the rise, Jaipur-based paediatrician S K Gupta says this may due to improvements in health care facilities and, hence, better diagnosis. However, he calls for more research on the role of occupational and environmental exposures to determine the cause of these defects. Attention needs to be directed particularly to organic solvents, agricultural chemicals, including pesticides, water nitrates, heavy metals such as mercury, ionising radiation and water disinfection. Agrees A K Wangnoo, senior consultant (endocrinologist and diabetologist) at the Apollo Hospital, New Delhi: “The exact causes of these defects are still unknown. There are geographical and seasonal differences in the incidence and association with occupational exposures suggesting that environmental factors such as pesticides are a possible link.” He emphasises that research and field data do suggest that a wide range of pesticides interfere with the normal functioning of the body’s hormone system. “Hormones play a vital role in the proper development and healthy growth of the developing foetus. Hence, pre-natal diagnosis is very important and it is possible to screen mothers at great risk,” he adds. In the rabi season, when the market is flooded with vegetables, the chances of poisoning may be more because green vegetables contain more pesticide residues, says J P Singh of VHAI. “Pregnant women are prescribed more green vegetables. Thus, there might be a possible link between consumption of pesticide-laden vegetables and birth of children with severe neural defects,” he adds. “We do around 7,000 sonographies a year. Any congenital disorder can be detected from the 13th week onwards. I think the birth of NTD babies can be related more to environmental pollution as a whole,” says P Periwala, consultant radiologist at Jaipur’s SDM Hospital. Veena Kalra of the All India Institute of Medical Sciences (AIIMS) points out a loophole in Kabra’s study. “Kabra’s report stating that the months of March and November are more frequently associated with birth defects should be checked with data of other years, too. Certain tables in the study that correlate month of conception and congenital anomalies does not support the stated hypothesis — 9/430 in April, 11/468 in March, 11/722 in November and 7/683 in October,” she says. These are not significant differences to postulate March and November and significantly associated with birth defects, notes Kalra. K Satyanarayana, deputy director general, Indian Council of Medical Research (ICMR), New Delhi, stresses on the need for more studies, but he admits that in India there is a fund crunch and policy-makers are only keen on putting money on diseases which kill people. “Majority of the health sector budget goes for the eradication of malaria, filaria and infectious diseases like tuberculosis and AIDS simply because these kill more people. In other words, the number of deaths is proportional to the money that is put into the project,” he says. There is hardly any funding available to study occupational health diseases, like NTDs, he says. The bureaucrats, too, always react to deaths in numbers. If 100 people, for instance, die of some disease, there will be a furore. Immediately, the government orders a study to understand the cause. “But in case of babies with NTDs, there is no epidemic as such. There might actually be many babies dying due to this but the cases go unreported,” says Satyanarayana.

What government officials say

Government officials are not ready to buy Kabra’s argument. The reason: “private studies are not enough.” “Yes, I have seen some reports indicating the relation between pesticides and birth of NTD babies, but there have been no government reports indicating such a disorder. Private studies are not enough to take action,” says the person responsible for the health of millions living in Rajasthan, D S Gehlot, director of medical health services, Rajasthan. Ram Lubhaya, the state health secretary, is of the same view. “We have not got any reports that point to birth of NTD babies due to overuse of pesticides. Unless a government agency files a report like this, we will not take any action,” he says, adding, “Some doctors make off-the-cuff remarks and we are not obliged to take action.” Krishna Bhatnagar, agriculture secretary, also condemns the findings. “I have not heard of pesticides leading to birth defects. In any case the baby does not eat food directly.” Obviously, Bhatnagar doesn’t understand the umbilical cord link between the foetus and the mother, and how the foetus develops in the nine months in the womb. As far as folic acid is concerned, the government has a supplementation programme, says Lubhaya. This is where Kabra wishes to differ. He says folic acid supplementation is given after pregnancy is detected whereas it should be given within the first 24 days. “Studies have shown that supplementing the diet with folic acid can decrease the rate of NTDs by 72 per cent. The difficulty in this approach is that it requires the woman to start taking supplementation before she even knows that she is pregnant. If she waits until her pregnancy is confirmed, it will be too late as NTD would have already occurred,” says Babineau. In fact, Kabra had approached the Rajasthan government in 1997-98 for universal supplementation of folic acid but the plan fell through. “I said folic acid can be added to milk and this might be a costeffective solution. I went to the dairy board and met the chief. However, another official said that under law this would amount to adulteration and unless the law is modified, it cannot be done,” he says. The politicians have also shirked the responsibility, Kabra alleges. From 1992-96, at VHAI’s insistence, 27 questions related to pesticide use were raised in the Lok Sabha. But there have been no constructive actions. Meanwhile, researchers at the Texas A&M University, New Mexico, USA, have already embarked upon a project to study the possible link between pesticides and NTDs, says Saumitra Bharadwaj, a New Delhi-based physician (see box: Probing the link). Already many studies conducted in industralised countries suggest the link.

Spray and forget

A clear, comprehensive policy on pesticide
use and awareness about its harmful effects
can help in solving the problems

Pesticides have dominated the Green Revolution in India, so much that pesticides have become synonymous with plant protection. Only a few realise the problems associated with their use. Mira Shiva, head (policy), VHAI, sums them up:  There is no particular policy for pesticides and the government wishes to continue its use. It would like to encourage integrated pest management (IPM) programme, but there are no resources.  The farmers have been fed with the idea that without pesticides the harvest will not be good. Now the government has to point out the adverse effects and suggest alternatives.  Physicians in health centres across the country are not aware of pesticide-related health hazards. There is no facility to check pesticide residues in blood or food crops.  There is a lack of awareness about the chemical content in pesticides. Only the generic names of pesticides which are banned is known. Not their brand names. In some cases, the antidotes or remedies are not clearly mentioned.  There is lack of consumer awareness about pesticide-laced food crops. Singh of VHAI sees a reason for the government not drafting a comprehensive pesticide policy. “One has to agree that the pesticide lobby is very strong and obviously they will see to it that nothing harms their interests,” he says. In fact, newspapers that reach the grassroots level are awash with advertisements urging farmers to increase use of pesticides, he says. Another concern voiced by M C Diwakar, joint director (plant pathology), directorate of plant protection, quarantine and storage, ministry of agriculture, is related to pesticide review. “After a thorough analysis and debate on the subject, the existing Insecticides Act, 1968, and the Insecticides Rules, 1971, framed thereunder have to be suitably amended to keep a check on the unrestricted use of pesticides,” he says. Only safe and eco-friendly molecules should be registered and highly-toxic pesticides should be phased out and banned as soon as possible, he adds.

Lobbying for more

Discounting the charge that a very powerful pesticide lobby is working against ban, one of the high-ranking officials of the Faridabad Central Insecticide Board (CIB), on conditions of anonymity, explains the “strict” procedure that prevails before any pesticide company is given a licence. Certain tests are carried out on lab animals — first mice and at a later stage dogs — before any pesticide can be exported or imported. It is checked whether the pesticide can have immediate effect in, for instance, 30 months or any long-term effect. The experiments are carried out to check, among other things, neurotoxicity, metabolism and mutagenicity Epidemiological studies are also carried out to identify and assess risks and chalk out a risk management approach. “Only then is the licence given,” he says. “I do not agree that pesticide residue can cause neurological problems. About folic acid I have no information,” he adds. “To say that pesticides are behind all neural disorders is incorrect. I feel pesticides are needed for our food security. Either we die due to lack of food or 50 years hence we die of cancer. Personally, I think the latter is acceptable,” says the official. Singh refuses to buy the argument that pesticide use is important to meet the country’s food demand. “Pesticide use has gone up by more than 27 times, while food crop production has only grown 3.3 times in four decades, the base year being 1960-61,” he says. Regarding pesticide registration, the CIB official says, “New applications are few, mostly for herbicide. The number of applications for insecticides have also reduced. It is because IPM is getting popular.” Lest we forget, the official contends that pesticides also earn the country foreign exchange from exports to Germany, China and other countries. As far as review of pesticides and their effect is concerned, there are no laws that might make such activity mandatory, says the official. Only once in 8-10 years, after media reports appear, are review committees formed to study the effects.

IPM: a solution?

During the Green Revolution, we gave pesticides as an input along with seed and credit facilities. It should have been used as the last resort in case there were problems. Nature itself has provided us with ways to solve such problems,” says Diwakar. Now there are alternatives like IPM which are being promulgated but the deep-rooted myth and attitude of many agricultural scientists and field workers that pesticides are indispensable is hampering its spread, he says. “Although there are no magic remedies to counter the problems in spreading IPM at a faster pace, the mission has to be made stronger by roping in committed people. The Indian Council of Agricultural Research should have a pro-IPM thrust in their syllabus. A better coordination system also has to be developed between researchers and field officers.” As IPM is a knowledge-based approach, it requires proper blending of traditional wisdom and modern scientific knowledge, he says. Singh calls for “de-education of the ill-educated” and “reeducation about harmful effects of pesticides” through publicity programmes.

Evidence cited by S K Kabra from his field studies allegedly indicates a strong circumstancial correlation between peak usage of chemical pesticides and appearance of NTDs suffers from the following shortcomings.  Statistically speaking, the incidence is not higher in the months as alleged by him.  No specific toxic agent(s) have been identified as the cause(s) of the alleged increase in incidence of NTDs.  No experimental research supporting the alleged teratogenic effects of any of the pesticides is incorporated.  Pesticides as the sole, or major cause, of folic acid deficiency has not been established. Even the presence of folic acid deficiency has not been documented.  As the author himself says, village folk rarely use the vegetables grown using high pesticides whereas the converse is truer for city folks. From the data presented it is not clear if ntds occurred more frequently in village or in the city people. A lot of village people do go to cities for delivery purposes as facilities at village level are often very deficient.  There is no evidence to suggest that vegetables grown during the period of high intensive use of pesticides have a higher percentage of the pesticides and, if so, in what form. A certain degree of change does occur during plant metabolism.  The contention of some of the quoted health administrators, that is the director and secretary of health services of Rajasthan, that as the report is from a private source and not a governmental source and, therefore, less reliable, is to say the least, untenable. Scientific reports are either accurate or inaccurate and not governmental or private. They have to be judged with strict scientific mind and not on the basis of organisations.  Lastly, Kabra shares the concern with many people that increasing use of pesticides is linked to various diseases, which manifest themselves at the time of birth or later. However, for

Other voices

A shadow of doubt has been raised on the
possible link between pesticide pollution and
babies with birth defects. But a detailed analysis
is yet to come by. As part of the article,
“Umbilical Discord”, DOWN TO EARTH wrote to a
few experts seeking their opinions on the subject.
Here, we present a reaction by three experts

a proper scientific understanding of the link, more rigorous methods will have to be used than this one employed by Kabra. ANIL K SINGH professor of neurosurgery, G B Pant Hospital, Delhi University

The most striking fact in the article is the argument in favour of pesticide residues being the culprit. I would be more cautious because the case is not sufficiently close to be convincing — though you may be absolutely right, of course. The problem is rather serious and it would be unfortunate if the government, or health authorities thought they were addressing it satisfactorily by showing — assuming they could — that pesticides were NOT the cause. This is most certainly an environment-related disaster, whether to do with pesticide use or fertilisers or something completely different (arsenic in the groundwater?) and, therefore, needs urgent attention.

VIDYANAND NANJUNDIAH
professor, Indian Institute of Science, Bangalore

The role of occupational and environmental exposure in the etiology of congenital birth defects, including NTDs, still remains speculative. The possible link of environmental factors such as use of pesticides with seasonal differences in the incidence of occupational class with congenital birth defects warrants further scientific studies to prove these facts. The study by S G Kabra is an eye opener to all of us wherein he has tried to link the increased incidence of NTDs during particular periods of the year with the use of pesticides. We need to undertake more studies and enough data is needed from different parts of the country spread over many years to hypothesise the possible link of pesticides with NTDs. Animal studies will help in documenting the direct effect of pesticides and other chemicals in causing these developmental defects. Authentic published data from all over the country will help us in taking remedial steps to prevent the possible effects of pesticides in causing these defects. Nonetheless, we should learn a lesson from the observations made by Kabra and undertake further scientific studies to prove the possible link of environmental factors with congenital birth defects.