OP-ED | Silent threat: How air pollution may shape SA children’s faces

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In South Africa, pregnant women living in areas with high levels of air pollution face an increased risk of giving birth to a child with a congenial anomaly, particularly craniofacial cleft lip and palate (CLP.)

CLP is one of the five most common congenital birth disorders in South Africa.

It happens in the early weeks of pregnancy when the bone and tissue of the baby’s upper jaw, nose and mouth fuse to form the roof of the mouth and the upper lip. When this tissue does not join completely, a gap – called a cleft – remains.

The development of the face and skull is highly intricate. Experts believe that clefts arise from a combination of genetic and environmental factors.

In South Africa, the prevalence of CLP is estimated at 0.3 per 1,000 live births, though rates vary widely—from 0.1 per 1,000 in the Eastern and Northern Cape to 1.2 per 1,000 in the Free State.

Globally, a child is born with a cleft lip or palate every three minutes.

While cleft conditions can be hereditary, other contributing factors include certain medications during pregnancy, poor prenatal nutrition, and more recently, environmental factors—particularly air pollution.

Dr Caradee Wright, Chief Specialist Scientist at the SAMRC’s Environment and Health Research Unit, says, “Air pollution levels are known to be high in South Africa. Domestic fuel burning, coal-fired power stations, traffic, mining and industry all contribute to the problem. We wanted to explore whether a mother’s exposure to air pollution affected her baby’s risk of cleft lip and palate.”

Dr. Wright studied 2 515 cases of children born with cleft conditions across the country and found that many of the mothers had lived in areas with high levels of air pollution—also known as “hotspots”- with elevated levels of smoke and dust in the air.

In contrast, areas with cleaner air showed fewer cleft cases.

She also highlights that that specific air pollutants – such as particulate matter (PM₂.₅), nitrogen dioxide (NO₂), sulphur dioxide (SO₂), and polycyclic aromatic hydrocarbons (PAHs) – can interfere with fetal development, particularly during the early stages of pregnancy when facial structures are forming.

CLP “hotspot” clusters were identified in Gauteng, Limpopo, the North West, Mpumalanga, and the Free State, often overlapping with lower-income communities, rural and informal settlements.

Geographic exposure plays a significant role in pollution-related health outcomes.

In South Africa, stark disparities exist between high- and low-income provinces and municipality districts.

Low-income communities face multiple challenges like greater exposure to pollutants from burning tyres, charcoal, wood and sometimes dung for cooking and heating. There is also limited access to primary and prenatal healthcare for the duration of the pregnancy. Delayed or insufficient public health facilities hamstrung to intervene, while weak policy implementation on air quality regulations are prevalent.

These conditions increase the risk of low birth weight, stillbirth, preterm birth and birth defects such as craniofacial anomalies.

In contrast, high-income countries, in European cities for instance, tend to benefit from stricter air quality regulations, access to clean energy for ordinary citizens and stronger healthcare infrastructure.

However, they are by no means immune to air pollution. Traffic emissions, industry, and wildfires still contribute to maternal health risks—even if at lower pollution levels, chronic exposure remains harmful.

Many high-income countries have successfully reduced air pollution-related pregnancy complications through policy reform, emissions control, public advocacy and awareness.  

For instance, some European cities have introduced low-emission zones, while the US has implemented Clean Air Act policies, reducing adverse birth outcomes.

In South Africa, there is hope.

Greenpeace Africa proposes several practical and impactful actions, including:

• A shift to clean and renewable energy production – this includes replacing coal plants with solar and wind power, improve fuel efficiency, and promote the use of electric vehicles.
• Stronger Government Policies – this will help mobilise investment in clean technology, enhance public transport and legislate against coal dependency.
• Enhance air quality monitoring and regulation – real-time air monitoring that can help hold governments accountable and empower citizens to demand change.

Despite the growing evidence, many pregnant women remain unaware of the risks of air pollution to fetal development.

Public health campaigns by various government departments to pregnant women typically focus on smoking, nutrition, and general prenatal care, while neglecting environmental hazards.

In rural and low-income areas such as townships, reliable health information is scarce whist misinformation is rife. Households often lack the means to switch to cleaner energy sources—leaving them particularly vulnerable to indoor air pollution.

Organizations like Operation Smile and researchers like Dr Wright advocate for the need to better understand the critical window of exposure during pregnancy and how different pollutants affect early stages of fetal development. This research could inform better clinical guidelines, public health strategies, and policy development to reduce preventable birth defects.

While more research is needed, the evidence already shows a compelling link between environmental health and fetal development.

Tackling air pollution is not just about saving the planet—it’s also about protecting mothers and giving every child a healthy start in life.

Kholofelo Mphahlele is a paralegal at SECTION27.