Women's Ideas about the Health Effects of Household Air Pollution, Developed through Focus Group Discussions and Artwork in Southern Nepal

Abstract

Household air pollution is a major cause of ill health, but few solutions have been effective to date. While many quantitative studies have been conducted, few have explored the lived experiences and perceptions of women who do the cooking, and as a result are those most exposed to household air pollution. In this study, we worked with groups of home cooks, and sought to use art as a means of engaging them in discussions of how household air pollution from cooking affects their lives. In the Terai district of southern Nepal, we held four focus groups that included 26 local women from urban and peri-urban areas, as well as six local artists. The women then met approximately weekly over four months, and produced images related to air pollution. Transcripts from the focus groups were reviewed independently by two authors, who initially categorised data deductively to pre-defined nodes, and subsequently inductively reviewed emergent themes. Women identified a number of health effects from air pollution. The main physical effects related to the eye and the respiratory system, and women and young children were seen as most vulnerable. The psychosocial effects of air pollution included reduced food intake by women and lethargy. Suggested solutions included modifications to the cooking process, changing the location of stoves, and increasing ventilation. The main barriers were financial. The lived experiences of women in southern Nepal around the problem of air pollution offers a more nuanced and context-specific understanding of the perceptions and challenges of addressing air pollution, which can be used to inform future interventions.

Keywords: Nepal; biomass; focus groups; household air pollution.

Figure 1

The effect of air pollution on the eyes and lungs. Translation: Top line = “smoke entering the chest. Bottom line = cause of smoke”. The picture shows some of the health effects of air pollution, including streaming of the eyes and damage to the lungs.

Figure 2

The perceived impact of air pollution on children and the need to keep them away from the cooking. Translation: Figure 2 = “Use of an umbrella-type exhaust above the cooking stove and keeping the child away”. This picture describes ways to reduce air pollution exposure. It shows an improved stove that has a chimney taking the smoke away and a child being kept in a different room.

Figure 3

The effects of air pollution on women and newborn children. Translation: Top heading = Problems due to smoke in the mother and infant. Left photo = “Smoke causing poor appetite, giddiness, cough, and vomiting. Baby in utero not increasing in size”. The picture describes some of the health consequences for a pregnant woman, and the adverse effect on the growth of her fetus. Right photo = “Low birthweight baby may be born and may die as well”. This picture shows the result of air pollution exposure to the pregnant woman. It can lead to death of the fetus or newborn, or impair growth, leading to low birthweight.

Figure 4

The health concerns in children. Translation: Figure 4 = “Baby’s weight increases and mother and baby may become healthy”. The picture shows a mother taking her child to be weighed by a health professional. It illustrates both her concern and also how weight can improve without exposure to air pollution.

Figure 5

Potential solutions to reduce the air pollution. Translation: “Umbrella stove (hood). Cook outside the home (room) used for sleeping”. These pictures show methods to reduce air pollution exposure. On the left is a chimney or hood to channel the smoke outside. The middle picture shows increased ventilation by opening windows and doors. The right picture shows cooking outside.