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As Israeli and US strikes on oil infrastructure blanketed Tehran in toxic smoke, IPPF is warning of serious, lasting risks to maternal and reproductive health - risks that are now spreading across the region.When oil infrastructure is bombed, fine particulates, soot, sulphur compounds and other toxic pollutants spread through the air, water and soil, creating serious health risks for entire communities. The World Health Organization has already warned that damage to petroleum facilities in Iran risks contaminating food, water and air supplies, with potentially severe consequences, particularly for vulnerable groups.Pregnant women and newborns are among those most at risk. There is no historical parallel for an attack on oil infrastructure of this magnitude in a city of over nine million people. However, a substantial body of research on air pollution and petroleum-related contamination points to the potential consequences for pregnant women.The environmental and public health threat extends well beyond Iran's borders. The head of the International Energy Agency warned this week that at least 40 energy assets across nine countries in the Middle East have sustained severe or critical damage since the outbreak of the war. Yet the reproductive health consequences remain entirely absent from public and political debate. Toxic smoke and the harms to pregnancy  According to the Conflict and Environment Observatory (CEOBS), oil fires of this kind generate particulate matter, carbon monoxide, sulphur dioxide, nitrogen oxides and volatile organic compounds. Doug Weir, Director of the CEOBS, warns that:"The intensive use of explosive weapons in a densely populated area like Tehran generates a diverse mixture of pollutants, including pulverised building materials, heavy metals, particulate matter and explosives residues. When you include pollution from oil facility fires it is clear that pregnant women are being exposed to a complex mixture of pollutants during a period where stress may also contribute to increased vulnerability to harm."  Four oil facilities in and around the city were struck, including the Tehran refinery, which has the capacity to process 225,000 barrels of oil per day. Tehran's geography makes this exposure particularly acute: the city sits in a semi-enclosed basin surrounded by the Alborz mountains, which trap pollutants within the city boundary rather than dispersing them. Reports have also described ‘black’ rain over Tehran, which can further contaminate water sources, soil and food supplies.These are the same substances that research consistently identifies as potentially harmful to a woman and her foetus during pregnancy. What we are yet to ascertain is the level and length of exposure women in Tehran will be subject to. What the evidence tells us: increased risk of preterm birth, low birth weight and miscarriageMaternal exposure to oil pollution is a significant public health concern, as exposure to air pollutants during critical stages of foetal development may lead to serious long-term adverse pregnancy outcomes¹. According to the Institute for Health Metrics and Evaluation, in its 2023 Global Burden of Disease study, 32% of preterm births in 2023 were attributed to exposure to PM air pollution². A systematic review published in JAMA Network Open reinforces this picture, analysing data from over 32 million births across over 50 studies. The study found that exposure to pollutants, particularly through fine particulate matter, was associated with an increased risk of preterm birth in 79% of studies and low birth weight in 86% of studies.³ A global meta-analysis published in PLOS Medicine, covering 204 countries and territories, found an 11% greater risk of low birth weight and a 12% greater risk of preterm birth for every 10 micrograms per cubic metre increase in exposure to fine particulate matter.⁴In addition to the risk associated with particulate matter, the fires generate neurotoxic compounds called polycyclic aromatic hydrocarbons (PAHs), formed during incomplete combustion. These compounds cross the placenta, resulting in reduced birthweight, smaller head circumference and longer-term cancer risk and cognitive deficits in offspring. Evidence comes from studies in New York⁵ ⁶, Krakow⁷, and the Gulf War oil fires ⁸ . According to Virginia Rauh, Professor of Population and Family Health at the Columbia University Mailman School of Public Health:“This multi-layered mixture of pollutants has an immediate adverse impact on fetal growth and longer-term consequences for newborn lungs and brain development, resulting in a devastating public health scenario for reproductive and child health.”Research specifically examining petroleum pollution, points to a wider pattern of reproductive harm. A 2025 systematic review and meta-analysis in BMC Pregnancy and Childbirth, found possible associations between maternal exposure to oil and gas processes and adverse outcomes including preterm birth and miscarriage.¹⁰ Whilst a prospective cohort study of 1,418 pregnant women in the Niger Delta, Nigeria, found that women in the most exposed communities faced significantly higher rates of premature rupture of membranes, postpartum haemorrhage and caesarean section compared to women in low-exposure areas.¹¹ A health crisis that could last generationsThe research points to a warning that IPPF's Global Humanitarian Director, Valerie Dourdin, says we cannot afford to ignore.“What may be framed politically as a short-term war will not produce only short-term consequences. The effects of destroying oil infrastructure do not end when the fires are extinguished. Contamination lingers in the air, in the water, in soil, and in people’s bodies. The full scale of what is unfolding over Tehran cannot yet be measured. The respiratory hazard is severe, but the evidence gives us real cause to believe this could also become a reproductive health emergency, with devastating consequences for the Iranian people, particularly women and families.”These health risks do not exist in isolation. They are compounded by the conditions of conflict itself. Women and girls in Iran already faced significant barriers to reproductive healthcare, and emergencies deepen those barriers further. In emergencies, sexual and reproductive health is routinely deprioritised. Antenatal and postnatal care is often disrupted or made unavailable. Contraception becomes harder to access, increasing unintended pregnancy and associated risks during pregnancy. Referral pathways for obstetric emergencies break down. Health workers are displaced or unable to reach those who need them, and clear public health guidance on exposure risks may be absent or inaccessible. IPPF calls on all parties, humanitarian actors and public health authorities to act with urgency. Sexual and reproductive health must be recognised as essential from the very outset of any emergency response. This means: Ensuring continuity of maternal and newborn care, including antenatal and postnatal care and emergency obstetric services.Continued and sustained active monitoring of air, water and soil contamination in Tehran must be treated as integral to protecting women's health.Increased public health measures such as awareness and clear guidance to reduce exposure risks to toxic fumes, polluted water bodies and contaminated food for pregnant people and newborns.Continuation of referral pathways and care for survivors of sexual violence and intimate partner violence.Ensuring STI and HIV screening, diagnosis and treatment services are available.Ensuring that women and girls affected by crises can access accurate SRH information, and the resources needed to manage menstruation safely and with dignity.Women's health, dignity and rights must not become collateral damage in the attacks on Iran. The evidence is worrying. Air pollution and petroleum-related contamination can harm pregnancy outcomes and threaten longer-term reproductive health. The political framing of this conflict as short-term does not change what the science tells us about the physical and psychological consequences that may follow. References¹ The associations between air pollution and adverse pregnancy outcomes in China. Tan Y, Yang R, Zhao J, Cao Z, Chen Y, Zhang B. Adv Exp Med Biol. 2017;1017:181–214. doi: 10.1007/978-981-10-5657-4_8.|² https://www.healthdata.org/research-analysis/health-topics/air-pollution³ Bekkar B et al (2020) Association of air pollution and heat exposure with preterm birth, low birth weight, and stillbirth in the US: a systematic review: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767260⁴ Ghosh R et al. (2021) Ambient and household PM2.5 pollution and adverse perinatal outcomes: A meta-analysis and estimates of population attributable fractions globally, regionally and nationally. https://pmc.ncbi.nlm.nih.gov/articles/PMC8478226/⁵ Prenatal exposure to air pollution during the early and middle stages of pregnancy is associated with adverse neurodevelopmental outcomes at ages 1 to 3 years.  Perera F, Miao Y, Ross Z, Rauh V, Margolis A, Hoepner L, Riley KW, Herbstman J, Wang S. Environ Health. 2024 Oct 30;23(1):95. doi: 10.1186/s12940-024-01132-9.PMID: 39478594 .⁶ Prenatal exposure to air pollution is associated with altered brain structure, function, and metabolism in childhood. Peterson BS, Bansal R, Sawardekar S, Nati C, Elgabalawy ER, Hoepner LA, Garcia W, Hao X, Margolis A, Perera F, Rauh V.J Child Psychol Psychiatry. 2022 Nov;63(11):1316-1331. doi: 10.1111/jcpp.13578. Epub 2022 Feb 14.PMID: 3516589⁷ Prenatal ambient air exposure to polycyclic aromatic hydrocarbons and the occurrence of respiratory symptoms over the first year of life. Jedrychowski W, Galas A, Pac A, Flak E, Camman D, Rauh V, Perera F.Eur J Epidemiol. 2005;20(9):775-82. doi: 10.1007/s10654-005-1048-1.PMID: 16170661⁸ 1991 Gulf War exposures and adverse birth outcomes. Arnetz B, Drutchas A, Sokol R, Kruger M, Jamil H.US Army Med Dep J. 2013 Apr-Jun:58-65.PMID: 23584910 ⁹Latifi Z et al. (2025) Association between maternal exposure to oil and gas extraction process with adverse birth outcomes: a systematic review and meta-analysis. BMC Pregnancy and Childbirth. https://link.springer.com/article/10.1186/s12884-025-08022-z¹⁰Oghenetega OB et al. (2022) Exposure to oil pollution and maternal outcomes: The Niger Delta prospective cohort study. _https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0263495