People seeking neonatal intensive care services for their newborns at the Thapathali-based Paropakar Maternity and Women’s Hospital have had to pay an exorbitant price at private centres as the hospital's beds remain occupied most of the time.

Due to a rise in the number of premature births (births before 36 weeks) and cases of low birth weight (less than 2.5 kg), the hospital’s neonatal intensive care beds remain always packed, doctors at the hospital said.

“We increased the neonatal intensive care unit beds to 20 from 10,” said Dr Shree Prasad Adhikari, director at the hospital. “Even if we doubled the bed numbers again, it would not be sufficient.”

Though the exact number of premature births and low birth weights in the country is not known, the hospital said that around 2,500 premature births and an equal number of neonates having low birth weight are born in the institution in a year.

The cause of both conditions—premature births and low birth weight—could be numerous including the growing air pollution, according to experts.

“The causes of premature births and low birth weight are numerous and growing air pollution level is one of them,” Adhikari said. “Even if a scientific study on the impact of air pollution on premature births and low birth weight has not yet been done in our country, multiple such studies carried out abroad indicate that air pollution is among the chief culprits for foetuses’ death and ill health.”

Each year, over 24,000 women from across the country give birth to their babies at the hospital. Of them, around 10 percent are premature births and the same percentage have low birth weight. Doctors say that both premature births and babies having low birth weight need neonatal intensive care for a long time, which is the reason for the high occupancy in neonatal intensive care unit beds.

A recent report has linked exposure to pollutants particularly PM 2.5, PM 10 and NOx to spontaneous abortion or miscarriage. The study published by Spinger’s Air Quality Atmosphere and Health Journal titled ‘Exploring the association between air pollution and spontaneous abortion through systematic review and bibliometric analysis’ consolidated 45 global studies and derived the conclusion.

Of late, Nepal has been witnessing deterioration in air quality, especially in winter, which often reaches ‘very unhealthy’ and ‘hazardous’ levels.

Air quality in the Kathmandu valley deteriorated on Wednesday last week reaching a hazardous level, crossing the 300 mark, and raised concern about respiratory conditions, especially among children and elderly people.

According to IQAIR, a Swiss group that collects real-time air-quality data from around the globe, particulate matter pollution PM2.5 levels of Sallaghari Bhaktapur reached 305 micrograms per cubic metre by 10:45 am.

PM2.5 refers to particulate matter or solid and liquid droplets in the air that are less than 2.5 micrometres, or 400th of a millimetre, in diameter.

“Air pollution can negatively affect maternal health and pregnancy outcomes of women leading to pregnancy loss, preterm birth, a low birth weight, stillbirth, intrauterine growth restriction and congenital abnormalities. Pregnancy loss is the most severe adverse pregnancy outcome,” reads the report.

Several other reports have also linked pregnancy loss, premature birth and low birth weight to air pollution.

Doctors in Nepal said that even if they have read that air pollution has a direct link to pregnancy outcomes, they cannot say for sure as such a study has not been carried out in the country and they do not have data to support the claim.

“Pollution affects the health of pregnant women and the foetus inside her,” said Dr Sudha Sharma, former secretary of health, who is also a consultant gynaecologist. “It could affect the blood, lungs, brain, kidneys, heart and also in growth, but I am not sure if it also contributes to miscarriage.”

Doctors at Paropakar Maternity and Women’s Hospital said that it will be difficult to save early premature births (28 weeks to 32 weeks). The survival rate of late premature births (32 to 36 weeks babies) is positive, according to doctors.

Neonatal deaths have not declined in the last five years, according to the Nepal Demographic and Health Survey-2022 carried out by the Ministry of Health and Population.

The nationwide study in 2022 with technical as well as financial support from the United States Agency for International Development shows that an average of 21 children in every 1,000 live births die within a month. The figure was the same in 2016.

Officials at the Ministry of Health and Population said that the government has not yet carried out a study on the impacts of air pollution in pregnancy and newborn babies. “We have not carried out such a study but air pollution could have caused negative impacts on maternal and child health,” said Nisha Joshi, a public health officer at the Family Welfare Division under the Department of Health Services.

Public health experts say that authorities concerned should carry out such a study, which will also support policy-making.

“Studies of air pollution’s effects on premature birth, low birth weight and miscarriage should be carried out in our country,” said Dr Bishnu Chaulagain, a maternal and child health expert. “The report will not only help in making policy decisions but also to prevent the preventable deaths.”