The adverse effects of air pollution on newborns' health are well established, particularly in developed countries with relatively low ambient pollution levels. The purpose of this pilot study is to evaluate the potentially beneficial effects of avoidance behavior during pregnancy in an abnormally polluted urban area in the city of Bishkek, Kyrgyzstan.
Bishkek is a valley city with a population of 1m that suffers from very high levels of air pollution, particularly during winter when the pollution from coal-based centralized heating system enters the city. The public information on air pollution in Bishkek appears to be limited, as evidenced by the fact that daily measurements and air pollution forecasts, which are a norm in developed countries, are not being provided by public authorities but instead supplied by a private initiative. No public warning system responding to frequent extreme pollution levels, nor mitigation measures, are being utilized.
The exposure to pollution and health effects can be reduced by staying indoors during high pollution periods, avoiding exertion, limiting ventilation, or using air filters. However, little is known about the avoidance behavior and health benefits of avoidance strategies in general (Laumbach, Meng, and Kipen 2015). There are only a few studies on this topic (Graff Zivin and Neidell 2009; Moretti and Neidell 2010; Neidell 2004, 2009), all from developed countries. No research exists on avoidance behavior and its effects in developing or middle-income countries.
The efficacy of avoidance behavior in developed countries is a priori ambiguous. Arceo et al. (2016) hypothesize that avoidance behavior may be costlier and less effective in developing countries, due to worse access to health care and lower quality of housing stock, implying that a marginal decrease in air pollution might have a large overall health impact.
We hypothesize that some avoidance behavior (staying indoors, limiting ventilation, etc.) may be more effective in developing countries as the potential for exposure reduction is greater given the higher baseline pollution levels. This may specifically apply to countries with cold winters, as their housing stock is likely to have better insulation than in countries with a warm climate. At the same time, limited awareness about the pollution-related health risks and ways to minimize them, together with the lack of information about the actual pollution levels, may limit individuals’ ability to respond and lead to avoidance opportunities being left unexploited.
Thus apart from contributing to the general knowledge about avoidance behavior and its effects, this study may contribute to a better understanding of opportunities to limit exposure in highly polluted urban areas.