Enhancing Usage of Clean Fuels among Pregnant Women in India

Abstract

Background. Recent Indian policies have vastly expanded access to clean fuels. Access does not necessarily lead to displacement of traditional stoves and fuels, however. We evaluated methods to encourage usage of LPG, including provision of subsidized and free fuel. We also explored recruiting women at marriage to cover the vulnerable time prior to typical detection of pregnancy.Methods. 150 pregnant women and 50 newly married couples were recruited through local accredited social healthcare activists (ASHAs). Participants were provided an LPG stove, related accessories, and two full LPG cylinders. Stove use monitors were installed on the primary traditional and stove and on both LPG burners. Households were asked to destroy or remove their traditional stoves upon receipt of the intervention package. Pregnancy arms included free fuel (n=50), fuel subsidized on usage (a conditional cash transfer or CCT, n=50), and a control arm (n=50). Newly married couples (n=50) were provided a stove and related accessories. PM exposures and kitchen concentrations were measured.Results. Over two-thirds of households either destroyed or removed their traditional stoves. The number of refills was much higher in the free fuel arm than in either the conditional cash transfer or control arms. Recruiting at marriage proved successful, with approximately 1/3 of households pregnant within 4 months of recruitment. Approximately 66% of households have purchased or will purchase their second LPG cylinder rather than return it to the study.Conclusions. Provision of free fuel during pregnancy fits well within Indian paradigms of providing services to poor households. Assuming detection in the third month of pregnancy, such a program would cost approximately 70 dollars per household for fuel. Expanding to newly married couples could cover vulnerable periods of pregnancy prior to typical detection. Providing a second cylinder appears valuable to households to smooth out supply issues.