Breathing Inequality: Air pollution’s disproportionate impact on women

Air pollution is an insidious global threat, yet its impact on women’s reproductive health in India remains significantly overlooked. Across both urban and rural landscapes, women are continuously exposed to an invisible but relentless threat to their health through the very air they breathe. While much of the conversation around pollution centers on lungs or heart disease, emerging global evidence shows that air pollution is deeply entangled with hormonal imbalances, ovarian dysfunction, miscarriages, and disorders like polycystic ovary syndrome (PCOS). Despite being one of the most adversely affected nations in terms of poor air quality, India largely ignores this link in research, policy, and public awareness.

Women in India are particularly vulnerable to this threat, not only due to their physiology but also because of their social roles and working conditions. Those from lower-income households continue to rely on unclean fuels like firewood and dung cakes for cooking, exposing them to high levels of indoor pollutants. Others, including migrant and informal workers, spend long hours outdoors in urban areas where fine particulate matter (PM2.5) concentrations regularly exceed international safety thresholds recommended by the World Health Organization (WHO).


The transition between indoor and outdoor environments does not offer protection, it only extends the duration and variety of exposures. This double burden places women at an elevated risk of long-term reproductive harm, a reality that is rarely acknowledged in mainstream discourse. Scientific studies from across the world have revealed how pollutants such as PM2.5, black carbon, benzene, and dioxins can interfere with the endocrine system, disrupt estrogen and progesterone levels, and cause oxidative stress and chronic inflammation. These disruptions contribute to hormonal disorders and reduce ovarian reserve, making conception difficult and increasing the risk of pregnancy complications. Among these, PCOS, a condition marked by irregular menstrual cycles, hormonal imbalance, and cysts in the ovaries, is now being increasingly studied for its link to air quality. Pollutants can trigger mechanisms that exacerbate or even initiate this disorder, yet India still lacks original epidemiological studies exploring this association within our own populations.
While global estimates suggest that PCOS affects anywhere between 4% and 21% of women, Indian studies indicate an even wider range, from 2% to as high as 35%, depending on region and diagnostic approach. A recent survey among college-going women in Delhi NCR found a prevalence of 17.4% in the 18–25 age group, double the pooled national average for that demographic. Despite Delhi’s notorious air quality and chronic exposure to PM2.5 levels often five to ten times above the WHO recommended limits, there is still no published research examining the direct link between this exposure and PCOS or other reproductive disorders. Most studies from India continue to focus on prevalence and sociocultural risk factors, while neglecting pollution as a possible driver for PCOS. This silence can be costly.
The WHO recommends that annual average PM2.5 exposure should not exceed 5 μg/m3, and daily levels should stay under 15 μg/m3. While according to recent Lancet Planetary Health study the entire population of India lived in areas where annual PM2.5 consistently exceeded the WHO guideline, and over 80% lived in areas above national guideline. Much of this pollution comes from incomplete combustion processes, industrial activities, outdated vehicles, biomass use, and open waste burning. For most of the year, residents breathe air that would be deemed hazardous in almost any other country. For women, this chronic exposure may be just as dangerous
as cigarette smoking, which is already linked to infertility, miscarriage, and reproductive organ damage. A study published in The Lancet Planetary Health also showed an association between maternal exposure to ambient particulate matter (PM₂.₅) and pregnancy loss (i.e., stillbirth and miscarriage) in South Asian countries.
More alarming is the growing body of international evidence showing black carbon particles lodged in placental tissue. These particles, often bound to co-pollutants such as polycyclic aromatic hydrocarbons (PAHs) and dioxins, can travel from the lungs into the bloodstream and reach the uterus, compromising fetal development. A study published in Nature Communications provided the first direct evidence that black carbon particles from air pollution can be detected on the fetal side of the human placenta, highlighting the impact of air pollutants on women and childbirth. Pollutants from vehicular emissions, waste burning, and industrial activity are also known to mimic estrogen, hijacking hormonal signaling and triggering a host of reproductive and developmental problems.
The main challenge, however, is that although a few health datasets are available, there is still a lack of well-established, consistently maintained, and nationally accessible electronic health records (EHRs) that researchers can utilize, particularly for studying pregnant women’s health in India. In contrast, India lacks a robust, integrated health data management system, underscoring the need for stronger government intervention.
Improved health data infrastructure is essential to support research on air pollution exposure and its health impacts, particularly to protect vulnerable populations from disproportionate exposure and associated health risks. This is a critical gap, especially in a country where both air pollution and women’s health inequalities are so widespread.
Protecting women’s reproductive health in India requires urgent attention to the growing evidence linking air pollution to hormonal and reproductive disorders. Policy responses must go beyond urban planning and vehicle emissions to include a gender-sensitive public health strategy.
This will improve the diagnosis rate of PCOS and other women’s reproductive health issues attributable to air pollution, thereby protecting women, especially during pregnancy. It will also aid informed decision-making to protect vulnerable women and guide actions related to air pollution. Reducing exposure to harmful particles is not only a climate and development imperative but also a national responsibility to safeguard women’s well-being and secure the health of future generations.
We cannot continue to ignore the silent damage caused by toxic air on women’s reproductive health.

Authored by: Manisha Mishra- Assistant Professor, School of Climate Change and Sustainability, Azim Premji University, Bengaluru, India, and Nidhi Shukla- Doctoral Research Scholar, Department of Population Health Sciences, Centre for Environmental Health and Sustainability, University of Leicester, UK.