In November, the city of Lahore, Pakistan, was choked by smog. The city’s Air Quality Index (AQI) set a record, topping 1,300 on a scale where anything over 200 is considered “very unhealthy.” What has gone so wrong in recent years for Lahore’s AQI to reach nearly 7 times that benchmark?
Lahore’s AQI issues stem from increased vehicle and industrial emissions, stagnant weather that traps pollutants, and crop burning, along with toxic air drifting in from neighboring India. To dig deeper, my husband and I decided to visit Lahore ourselves. The day we arrived, the AQI was 204 – relatively low compared to the previous days. For much of mid-December, the AQI hovered around 300.
“This is nothing compared to last week,” remarked Haider Jawad Bukhari, a former resident of Lahore who recently returned to Pakistan to visit family from Romania. “I have been wearing a mask since I got here.”
What Causes Smog in Lahore?
Lahore’s smog is a toxic blend of fine particles like PM2.5 and PM10, harmful gases such as nitrogen oxides, sulfur dioxide, and carbon monoxide, along with black carbon, volatile organic compounds, and construction dust.
These pollutants come from vehicles, which have increased by 9 percent in the last five years, industrial emissions, coal-burning brick kilns, and open agricultural burning in Pakistan and across the border in India.
Winter weather exacerbates the problem, with PM2.5 levels in Lahore often four times higher in winter compared to summer. Cold air traps these pollutants near the ground, creating a dense haze. Usually this phenomenon peaks right around winter crop rotation times, when farmers light their fields on fire to clear the ground before sowing the winter crop.
The city’s lack of public transport further fuels vehicle emissions. As of 2021, Lahore had approximately 6.29 million registered vehicles, with motorcycles comprising about 4.8 million of this total. Waste burning and construction dust add to the pollution.
Lahore’s air quality is among the third worst globally, leading to severe health and environmental damage. Air pollution is estimated to cause over 1,250 deaths annually.
However, air pollution doesn’t affect everyone equally, and women are often at a higher risk of respiratory diseases due to both biological and societal factors. Biologically, women’s lungs are 10 to 12 percent smaller than men’s, and they tend to have faster breathing rates, which means they inhale more air – and pollutants – per minute.
Hormonal differences also make them more susceptible to conditions like asthma and chronic obstructive pulmonary disease. As per a clinical study by the American Thoracic Society asthma tends to be more common in boys than girls before age 15, but after that, it becomes more common in women until they reach the perimenopausal stage. Forty percent of women with asthma report worsening symptoms before their periods.
Women who cook indoors are at significant risk, as cooking with wood, coal, or other biomass fuels in urban homes can raise PM2.5 levels to about 1,800 micrograms per cubic meter according to a study on indoor air pollution in Pakistan. This problem affected around 4 percent of households that rely on these cooking mediums as per 2022 study by PJSR. With gas load-shedding becoming more significant nationally, this number could have possibly risen; rough indicators point to a rise in biomass, coal, or wood burning stove usage compared to 2022.
Impact of Smog on Women’s Fertility
Air pollution also affects women’s fertility. Breathing in nitrogen dioxide and ozone leads to lower chances of live births, while PM10 can increase the risk of miscarriage. Even smaller particles (PM2.5) can make it harder for women to conceive. Other pollutants like sulfur dioxide, carbon monoxide, and nitrogen dioxide may also raise the chances of miscarriage and stillbirth.
Recent research shows that high levels of air pollution, particularly exposure to PM2.5, can significantly impact fertility by reducing ovarian reserves and lowering pregnancy rates. Epidemiological research further supports these findings, with a study from the National Library of Medicine revealing that air pollutants lead to reproductive abnormalities, reducing fertility in vulnerable populations.
Talking about the impact of smog on women’s fertility in Pakistan, the principal of Ameer-ud Din Medical College, Lahore, Dr Al-Fareed Zafar said that smog “may increase the risk of preterm labor and other problems, such as low birth weight, underdeveloped lungs in the baby, and death of the baby during or shortly after birth.”
I talked to multiple doctors. All of them repeated is that currently no studies or surveys have been conducted in Lahore to monitor the effects of air pollution on female fertility and infant mortality.
Infertility has become a global concern, affecting nearly one in six adults – or 17.5 percent of the world’s population – according to the World Health Organization. A study published in the Environment International to study the effects of airborne particulate matter on infertility revealed that women exposed to small particle pollution at levels 10 micrograms per cubic meter higher over the course of a year faced a 20 percent increased risk of infertility.
Given global trends, I fear that if Lahore continues to grapple with its worsening smog crisis, the city could face a significant rise in infertility rates. Unfortunately, Pakistan and its neighbor have all the right ingredients for a bleak future regarding female fertility.
As Dr. Manju Gupta, senior consultant obstetrician and gynecologist at Motherhood Hospital, India, aptly explained in a recent conversation with the Hindustan Times, “Air pollutants, including heavy metals and polycyclic aromatic hydrocarbons (PAHs), have been associated with hormone imbalances. These contaminants can disrupt the menstrual cycle and interfere with hormonal activity, posing risks to reproductive health.” Endocrine-disrupting chemicals, such as those found in industrial and vehicular pollution, can contribute to conditions like Polycystic Ovarian Syndrome, which significantly impacts female fertility by disrupting hormonal balance and ovulation.
Protective Measures by the Punjab Government to Mitigate Health Risks During Smog
In November, the Environmental Protection and Climate Change Department of the Punjab Government (EPD) introduced some protective measures to reduce the impact of smog in Lahore, along with Multan, Faisalabad, Gujranwala, and other districts of Punjab. In Lahore and Multan, from November 24 of last year, educational institutions, including universities, colleges, schools, and tuition centers, remained closed and shifted to online learning. Outdoor activities such as sports events, exhibitions, and festivals were banned, with exceptions made for religious congregations and unavoidable rites, including funerals.
Public entry into parks, zoos, playgrounds, historical places, monuments, museums, and recreational areas was completely banned. Construction activities, except for projects of national importance funded by the government, were prohibited. Restaurants ceased dine-in services after 4 p.m. and restricted takeaway to before 8 p.m. The operation of brick kilns and furnace-based industries was completely banned. Heavy transport vehicles were restricted from entering the districts, with exceptions for those carrying essential supplies, emergency vehicles, and certified passenger buses. Shops, markets, and shopping malls were required to close by 8 p.m., except for essential services like pharmacies, petrol pumps, and grocery stores.
It’s an open question how these policies impact the economy and how tangibly they contribute to better health. And one aspect is missing from these measures – none of them were designed with an eye to the gendered impact of climate change.
Hameed Akhtar, assistant director of the Punjab EPD, told me that the EPD has historically had a very low number of women in its workforce. However, he noted that for the first time in its history, female field officers have been placed as district officers, with several stations in different cities across Punjab now being headed by women. He also shared the Punjab government’s plans to raise awareness campaigns, involving gender-based policies.
“As part of the EPA [Environmental Protection Agency, the central government body] strengthening program, two new wings are being established: the Environmental Policy Wing and the Climate Change Wing. These will focus on environmental monitoring and aim to integrate gender-based policies in the future,” Akhtar said.
“Currently, [the Punjab] EPD operates only an Enforcement Wing, which limits policy formulation. However, a Climate Action Policy has already been developed for Punjab, paving the way for more inclusive environmental strategies, with a particular focus on initiatives for women.”
Efforts for Pollution Awareness and Advocacy for Change
In Pakistan, women and young activists are stepping up to tackle air pollution and raise awareness about its dangers. A great example of this is Pedal 2024, a cycling event organized by the Punjab EPD to promote eco-friendly transportation, cut down on carbon emissions, and help clear Lahore’s skies. Similarly, a cycle rally was held in January 2022 by the Walled City of Lahore Authority and Critical Mass Lahore. About 150 cyclists, including many women, rode from Lahore’s Gulberg area to the historic Shahi Qila. Most recently, we saw the collaboration between LUMS and the Lahore Biennale’s Climate Congress, fostering awareness about environmental challenges in Pakistan.
Young change-makers like Hania Imran, who has been called the “Greta Thunberg of Pakistan,” are also raising awareness about climate issues through social media outreach and activism. She and another climate activist, Rida Rashid Bhatti, recently filed a petition at the Islamabad High Court to enforce the implementation of laws like the Environmental Protection Act (1997), the Climate Change Act (2017), and the National Clean Air Policy (2023).
“I believe youth activism plays a significant role in challenging the status quo, introducing fresh perspectives, and equipping young people to speak up and take action,” said Imran. “For example, we recently filed a petition in the Islamabad High Court about the national clean air policy. Some people even started a campaign, ‘Saans Lene Do’ [Let me breathe]. A lot of people reached out to share their support, saying they didn’t realize such initiatives were possible for young people.”
The Way Forward
The government needs to enforce stricter rules on industries and vehicles to tackle smog and air pollution. This means requiring heavily polluting brick kilns to update their design for better environmental compliance, moving toward designs that are less polluting, while requiring factories to install cyclone separators, bag filters, and wet scrubbers or electrostatic precipitators. Cities should also focus on creating micro scrubbing forests (small densely planted urban forests) and improving public transport to cut down on car traffic and emissions. All this should be done while creating a greener energy footprint.
According to Sana Rasool, a carbon market specialist at the Pakistan Ministry of Climate Change, the EPA and provincial bodies are working actively to monitor air quality, penalize violators, and enforce rules, with Punjab even launching a dedicated environmental force.
“The Green Tech Hub, established at the Ministry of Climate Change, is actively collaborating with the private sector and academia to develop indigenous technologies for smog mitigation. Technologies like carbon mitigation towers and carbon dioxide scrubbers are being developed to absorb air pollutants,” Rasool told The Diplomat.
“Nonetheless, challenges persist, such as scalability due to a nascent private sector in climate and environmental technologies. There is a lack of readily available investors and manufacturers to scale these projects, requiring us to seek international investors. Despite these challenges, the Ministry is pushing these efforts with great rigor.”
On a public service level, hospitals should have special units to help those affected by air pollution, offering free check-ups for pregnant women and others at risk. Communities can make a big difference too. Local efforts like planting trees, reducing waste burning, and encouraging carpooling or cycling can help. People need to know how serious air pollution is. Public health campaigns must teach families simple and correct ways to protect themselves.
“There’s a lot of misinformation about solutions. Recently, a government official recommended using surgical masks to address air pollution, but experts have confirmed that these masks are ineffective. N95 or N99 masks are the correct choice, but such essential information is not being communicated properly by the authorities,” said Imran.
Small changes at home can help too, like switching from smoky cooking fuels to cleaner options. Community leaders and NGOs like the Pakistan Environment Trust and Sustainable Development Policy Institute can step in to make these solutions affordable for low-income families.
The National Clean Air Policy (2023) must be fully implemented. Farmers need alternatives to burning crop waste, such as cheaper machinery for eco-friendly disposal and simple composting practices to remediate burning. Composting can not only reduce burning emissions but also improve soil fertility for successive planting cycles.
Since air pollution doesn’t stop at borders, working with India on cross-border pollution is also imperative. But unfortunately, the two neighboring countries, collectively home to a fifth of the world’s population, often engage in blame games, accusing each other of contributing to the smog that engulfs their territories.
Talking about specific policy changes and enforcement measures to mitigate air pollution in Pakistan, Imran explained:
Two areas need urgent focus. First, the quality of fuel in Pakistan must improve. The fuel currently in use is Euro-2 standard, while we need to move to Euro-5 or Euro-6 standards to reduce pollution and improve air quality. Second, public transport needs to be accessible, effective, and equitable. It should reach every corner of cities and prioritize marginalized communities, including women, young people, and disabled individuals.
Smog is not just limited to Punjab. In November and December, Karachi’s AQI also surpassed the 200 mark, falling into the “very unhealthy” category Pakistan’s government and civil society must collectively and urgently work toward solutions to prevent the entire country from facing an alarming smog crisis in the future – with all the negative impacts that will have on health, especially for women.