Development is not just about economic growth. We must focus on facilitating opportunities for people to achieve fulfilling lives. Strengthening human capabilities is essential to improve the livelihoods of the 402 million people living in multidimensional poverty in South Asia. Maternal health underlies human capabilities, as good health fortifies individuals’ abilities to be and do what they desire.
Maternal health is at the core of South Asia’s efforts on SDG 3 (good health and well-being) as maternal health critically contributes to targets around maternal, infant, and child mortality; reproductive health; and diseases. Further, maternal health leads to lifetime health outcomes for mothers and children that enable achievements under SDG target 4.1 on effective learning outcomes, SDG target 5.5 on women’s participation in public life, SDG target 8.5 on full employment, and SDG target 10.2 on social, economic, and political inclusion.
However, South Asian women in rural communities face an impossible trade-off between maternal health and economic participation because agriculture forms a majority of workforce opportunities, and farm work carries inherent risks to pregnant women and their unborn children. In 2022, agriculture comprised 75% of women’s employment in Nepal, 66% in Pakistan, and 59% in India. As such, agricultural work drives income generation that South Asian women often cannot forgo during pregnancy. Yet, the region accounts for 24% of global maternal deaths and contributes 40% of the world’s annual low birth weight burden. A change in farming approaches could help improve these outcomes.
Exposure to pesticides increases the risk of miscarriage, preterm birth, and adverse health outcomes in newborns, including low birth weight, congenital disabilities, and neurodevelopmental disorders that affect livelihoods. Pesticides may pass into breast milk, so risks continue into early motherhood. Pesticide-related risks are a key concern for farmworkers in India, the ninth-largest country for pesticide use.
Additionally, heat exposure and strenuous manual labor can result in miscarriage, low birth weight, and the child’s impaired cognitive and health development. These challenges add to the existing occupational hazards for farmers, including unsanitary conditions, animal-acquired infections, physical injuries, and equipment-related accidents.
However, social norms in South Asia may lead women to face these risks disproportionately. In Nepal, for example, women – including pregnant women – often perform the bulk of labor-intensive agricultural work while men seek work abroad.
With high maternal health risks for pregnant farmworkers in South Asia, targeted interventions and policies are crucial. Integrated pest management (IPM) can be a healthy and environmentally beneficial alternative to chemical pesticides. For example, IPM can reduce chemical pesticides by 50-100% in rice production. IPM consists of five components: biological control of natural predators, parasites, and pathogens; cultural practices, such as crop rotation and intercropping; mechanical and physical control, including traps; chemical control (as a last resort); and monitoring and identification.
USAID’s Feed the Future Bangladesh has enhanced women’s agricultural capabilities and knowledge using IPM methods. IPM leads to lower maternal health risks, whereas conventional pesticide users are at a greater risk of miscarriage. However, despite being a well-established solution, inadequate training and technical support for farmers, lack of policies and collective action, and low literacy among farmers are the main barriers to widespread IPM adoption.
Community-driven initiatives like Nepal’s Health Mothers’ Groups and farming programs help ease the physical burden on pregnant women by redistributing workloads. Mobile clinics offering health screenings reduce risks for women in agriculture. Non-governmental organizations (NGOs) like BRAC in Bangladesh have succeeded with mobile clinics, offering scalable models to address healthcare gaps, advancing SDG target 3.8 on universal health coverage (UHC). Workplace accommodations, including personal protective equipment (PPE) and monitoring pesticide exposure, are essential for safeguarding maternal health and well-being. These efforts advance SDG targets 3.1 on maternal mortality and 3.4 on fetal health.
Stakeholders must collaborate to create safer agricultural environments for pregnant farmworkers. Governments in South Asia, including India’s National Health Mission, have introduced maternal health initiatives, but targeted programs for women farmworkers remain limited and require prioritization. Agricultural corporations can drive sustainability by adopting biopesticides, IPM, and capacity-building programs on safe pesticide use, heat stress, and ergonomic practices.
To maximize freedom of opportunity, stakeholders must recognize that protecting the health of pregnant farmworkers enables thriving communities. Adopting sustainable agricultural practices in South Asia is essential to supporting the health and well-being of not just mothers but entire communities.
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This article was authored by Jaya Parashar, Rubayet Khundoker, and Kanika Sahai. Parashar is a Master of Public Administration candidate, Khundoker is a Master of International Development candidate, and Sahai is a Master of International Economic Policy candidate at George Washington University.