n the coastal neighbourhoods of Ibrahim Hyderi, Rehri Goth and Korangi in Karachi, a quiet but serious crisis is affecting mothers and their newborn babies.

These low-income fishing communities deal with heavy pollution from dirty water, bad air and industrial waste. Combined with poverty and limited access to healthcare, this makes pregnancy and childbirth much more dangerous. Expectant mothers and their babies face higher risks of serious problems like premature births, pneumonia and sepsis.

A distinct, overpowering stench fills the air. Untreated industrial effluents from leather dyeing plants, tanneries and other factories in nearby Landhi and Korangi flow into the sea through several drains and the Malir River, carrying toxic chemicals and heavy metals such as lead and chromium.

Waste from the nearby Cattle Colony - water mixed with buffalo dung - adds a massive organic load. Raw domestic sewage and piles of garbage, including plastic, are also dumped directly into the sea and are increasingly ‘suspected’ of percolating to the groundwater aquifer. The residents of these areas, especially children, experience skin diseases, gastric problems, diarrhea and other ailments.

The areas of Korangi, including Ali Akram Shah Goth, Juma Goth, Madina Colony and Charcoal Colony, are particularly vulnerable due to their proximity to Ibrahim Hyderi and Rehri Goth. Open burning of trash contributes more pollutants to the already poor-quality air.

The communities, comprising Sindhis, Bengalis and Urdu-speaking residents - mostly blue-collar workers - face dire sanitation and hygiene issues, leading to grave health risks. Most of them work in carpet weaving and hand-knitting units, fishing and packaging.

Poverty, malnutrition and early marriages result in high rates of adolescent pregnancy. Most of the first-time mothers are between 16 and 20 years old.

“These factors make pregnancy and childbirth more risky,” says AKU health counsellor, Gulnaz. “A significant number of pregnant women suffer from anaemia. The issue is now being addressed through the provision of free testing and treatment with IV iron, iron supplements and counselling.”

Deliveries at home are another complicating factor. Gulnaz says many young mothers turn up at the AKU-Vital Health Care health centres for antenatal care but not for delivery.

“In some cases, the husbands are away for weeks on fishing trips and there is no one to bring a pregnant woman to the health centre. Instead, they opt for midwives,” she said. The midwives offer their services at paltry Rs 3,000-4,000 per case. “Besides the poor hygienic and sanitary conditions of the area, the midwives are not adequately trained, making the prospect of a midwife-assisted birth frightening,” Gulnaz says.

Considering the financial conditions, the AKU and Vital Health Care “provide food rations for proper nutrition. They offer pregnancy and delivery care paid for in easy instalments. They also offer a pick-and-drop service to the clinics to ensure that deliveries takes place at the health centre,” the AKU counsellor says.

“10 years ago, more than 60 percent of the women would not choose delivery at the health centres. After years of door-to-door campaigning, there has been an improvement. However, pre-term births remain a serious issue,“ Gulnaz says.

“The residents of Karachi’s coastal settlements continue to bear the brunt of environmental neglect, economic marginalisation and climate shocks,” says Dr Fayezah Jehan, who has worked extensively in these neighbourhoods. She is a maternal child health researcher and a paediatrician working as the Ruby & Karim Bahadur Ali Jessani Endowed Chair at the Department of Paediatrics and Child Health, Aga Khan University.

“Alarmingly, the area has the world’s highest rates of premature births. About 25 percent of babies arrive early and are especially vulnerable to lung infections,” Dr Fayeza says.

Nabila Sarfraz recounts her harrowing experience of giving birth to a pre-term daughter who weighed just 1.9 kg at birth. “Initially, I didn’t even get to hold her in my arms,” she says.

Her blood pressure had shot up, forcing doctors to rush her into an emergency delivery. “It was a nightmare; I was so scared for her,” Nabila recalls.

Sabah Tufail, in her mid-20s had four elder children when she gave birth to a pre-term baby weighing just 1.2 kg. “My older kids are my blessings, but Masooma needs extra care,” she says. “I know breast milk is crucial. I’m reaching out to fellow mothers to help my little one grow strong.”

Pollution remains a relentless threat to the health of these communities. Each year, 5-10 percent of newborns develop pneumonia, requiring hospitalisation, says Dr Fayeza. “Weak immunity in both mothers and infants makes these infections spread more easily and linger longer.”

Cold winters worsen the problem as many households rely on wood as a fuel for cooking and heating, filling homes with thick smoke. “In many houses, cooking and living take place in the same space with poor ventilation,” says the AKU paediatrician. “This fuels a cycle of respiratory diseases, aggravated by poor nutrition,” she says.

Dr Fayezah Jehan says that ten years ago, 45 percent of the infants suffered from skin, eye mouth and umbilical cord infections, with 1 in 8 babies progressing to sepsis and more than 60 pc of births occurred at home. Over time the situation has changed reversed, with a significant drop in newborn infections.

Experts are of the view that most impacts on human health are indirect and long-term, occurring through pathways such as contaminated seafood consumption, occupational exposure among fishing communities, chronic exposure to poor ambient air quality and broader livelihood and nutritional effects.

Growing challenges of climate change and unequal access to healthcare in communities like Ibrahim Hyderi and Rehri Goth and adjoining parts of Korangi highlight the suffering caused by long-term neglect.

The writer is a senior The News staffer in Karachi.