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Published in final edited form as: Sci Total Environ. 2025 Jun 16;990:179887. doi: 10.1016/j.scitotenv.2025.179887

Children’s environmental and occupational exposures to pesticides in Low- and Middle-Income Countries rural areas - an elephant in the room

Rafael Buralli 1,*, Siti Nurshahida Nazli 2,3, Leonel Cordoba 4, Lesliam Quiros-Alcala 5, Carly Hyland 6, María Teresa Muñoz-Quezada 7, Paulina Farías 8, Alexis J Handal 9
PMCID: PMC12478522  NIHMSID: NIHMS2110300  PMID: 40527261

Abstract

In rural areas of Low- and Middle-Income Countries, children are regularly exposed to pesticides through various environmental, para-occupational, and occupational pathways, often connected to family-based agricultural activities. Work and living spaces are commonly intertwined, increasing the likelihood of unintentional pesticide exposure among children, including before birth. This commentary explores how such wide-spread exposures to these pervasive chemicals occur – even before birth, and affect critical aspects of child health and development through life. Using the history of Zeca, a child living in rural Brazil whose asthma worsens due to pesticide applications near his home, this discussion paper illustrates how this critical issue is deeply embedded in daily life in many agricultural communities. However, these risks are frequently overlooked in clinical assessments, health surveillance, and policy responses. We discuss how broader structural conditions contribute to children’s exposure to pesticides, including poverty, lack of healthcare access, weak surveillance or enforcement of occupational and environmental protections, and the chemical colonialism. These patterns reflect entrenched social and environmental injustices that disproportionately affect rural children. Thus, we call for a coordinated and systemic response involving stronger regulation, enhanced health surveillance and management, support for safer and more sustainable agricultural practices, and the inclusion of rural communities in decision-making processes. The protection of children from harmful pesticide exposure must be recognized as a public health priority and a matter of social and environmental justice.

Graphical Abstract

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INTRODUCTION

Rural children are among the first and most vulnerable victims of pesticides. This is the case of Zeca, a 12-year-old boy from a small rural town in Brazil, whose chronic asthma and anxiety are often exacerbated by pesticide applications on crops near his home. Despite his young age, Zeca is knowledgeable about agriculture. Raised on a small farm, he began accompanying his parents to the fields as a baby. From an early age, he and his siblings helped with farm work, but Zeca had to stop at 11 due to his worsening asthma. His family, with little education, lives in a humble home in a remote area with limited access to medical care. In this community, pesticide use is a routine agricultural practice, yet families receive no technical support to implement more sustainable farming methods. These chemicals are used near homes, water sources, and where animals live. ‘Depending on the wind, it can even drench the animals’, farmers say. Farming in the area relies heavily on water from nearby rivers, but farmers are increasingly concerned that ‘water is getting contaminated, and scarce’ (Buralli et al., 2021).

Like Zeca, millions of children in rural areas, especially in low- and middle-income countries (LMICs), are exposed daily to multiple pesticides through environmental and work-related pathways. Studies show that farmworker families experience higher pesticide exposures compared to non-farmworker households, with children being the most vulnerable to associated health risks (López-Gálvez et al., 2019; Fernández, 2020; Bliznashka et al., 2023; Conejo-Bolaños et al., 2024).

Children’s vulnerability to pesticide exposure begins in utero, as the developing fetus is more susceptible to chemicals due to rapid physiological changes and critical developmental windows. Once born, their bodies are less capable of metabolizing and eliminating toxins, leading to a proportionally higher internal dose than in adults. Children’s unique behaviors further increase exposure: children consume more food and water, and inhale more air per unit of body weight; spend more time playing outdoors; and engage in frequent hand-to-mouth activity. Their diets are often less varied but include food groups such as fruits, juices, and milk, which may carry higher pesticide residues (Hyland & Laribi, 2017; Scott & Pocock, 2021). Moreover, personal protective equipment (PPE), if available, are not designed for children, leaving them unprotected when participating in farm work.

In many LMICs, factors like poverty, inadequate housing, lack of healthcare, and poor access to water and sanitation services amplify these vulnerabilities in rural areas. Pesticide exposure does not occur in isolation — it compounds existing social and environmental inequalities and threatens children’s health, development, and long-term wellbeing. Therefore, pesticide exposures pose both short- and long-term health risks that can be severe for children in LMICs. Evidence indicates that pesticide exposures are linked to acute neurological symptoms, diminished neurobehavioral test performance, and reduced pulmonary function, among other outcomes (Zúñiga-Venegas et al., 2022). Children and adolescents involved in pesticide applications are at particularly high risk (Scott & Pocock, 2021). Studies conducted in the Latin America and Caribbean region have identified associations between children’s environmental and occupational exposure to pesticides and a broad range of adverse outcomes, including preterm birth, reduced birth weight and head circumference, genotoxic and cytogenetic damage, neurodevelopmental and cognitive effects (e.g., autism, learning delays, emotional and attention difficulties), respiratory problems, allergies, leukemia, and disruptions in thyroid and sexual hormone regulation (Zúñiga-Venegas et al., 2022). Additional studies have corroborated these findings internationally, linking pesticide exposure in children to asthma, allergies, neurodevelopmental issues and renal disorders (Ramezanifar et al., 2024; Ding et al., 2024). An endemic chronic kidney disease of unknown cause affects young farmers and rural residents — mainly males — who are exposed to heat, pesticides, and metals, leading to early-life kidney injury in several LMICs (Polo et al., 2020).

Despite this consistent scientific evidence, children’s pesticide exposure in LMIC rural areas remains largely neglected in occupational health and maternal-child health agendas. It continues to be underrecognized, understudied, and underfunded — both in research and clinical practice. This invisibility delays essential policy responses, and undermines risk assessments, effective interventions, healthcare and surveillance. In short, it remains the “elephant in the room” — a global public health crisis we are collectively ignoring.

An alarming practice exacerbating this crisis is “chemical colonialism” – the continued export of pesticides banned in high-income countries to LMICs, where regulation, surveillance, and enforcement are often absent or insufficient (Scorza et al., 2023). Paradoxically, many of these poorer countries subsidize their own contamination. In 2017 alone, Brazil provided nearly 10 billion reais (approximately USD 3 billion dollars) in tax incentives for pesticide industries, based on the premise that pesticides are vital for national development and agricultural modernization (Cunha & Soares, 2020). Thus, the profits of wealthier nations are built on the toxic burden placed upon the children of poorer countries.

This commentary is a call to action. It seeks to draw attention to the serious risks posed by environmental, para-occupational, and occupational exposure to pesticides in rural settings for children in LMICs. It also aims to prompt urgent dialogue and concrete measures that prioritize the health of those most vulnerable. Above all, it calls for coordinated and systemic change to protect children from preventable, pervasive, and harmful pesticide exposures that pose significant health risks to current and future generations. In the subsequent sections, we examine common pathways of pesticide exposure for children in LMICs and highlight the urgent need for multi-level systemic change, resilient health systems, and active stakeholder engagement.

Environmental pathways of pesticide exposure for rural children

Just like our boy Zeca, children living in rural areas in most LMICs are frequently exposed to pesticides through multiple environmental pathways, even when their families are not directly involved in agricultural work. Pesticide drift from nearby agricultural fields significantly increases exposure among rural populations (Madrigal et al., 2024) from diverse routes, including contaminated water from wells and rivers, soil, air, household dust, and food — particularly fresh fruits and vegetables (Hyland & Laribi, 2017; Teysseire et al., 2020). In addition, the widespread availability of pesticides often leads to intensive use in household settings and home gardens, further increasing children’s risk of exposure.

In many LMICs, exposure begins as early as the prenatal stage. Pregnant women in rural areas may have contact with pesticides through diffuse ambient contamination or while directly working in agriculture or handling these chemicals (Rohweder et al., 2024). However, women’s exposure to pesticides is not a health crisis exclusive to LMICs. Studies in high-income countries have also documented prenatal and early-life exposure to pesticides that have been linked with adverse health outcomes in the United States (Gunier et al., 2017; von Ehrenstein et al., 2019), the Netherlands (Brouwer et al., 2018), and Denmark (Patel et al., 2020). However, risks tend to be more severe in LMICs due to weaker surveillance, regulation and enforcement, the continued use of highly hazardous pesticides banned in many high-income countries (Buralli et al., 2021; Atinkut Asmare et al., 2022), and the high proportion of women of reproductive age working as farmers in LMICs (FAO, 2023). This was the case for Zeca’s mother, who worked as a farmer throughout all her pregnancies, including those that ended in stillbirth and miscarriage. Her labor was essential to the family’s small farm, so she also worked while breastfeeding.

Postnatal exposure can also occur through various sources, including breast milk. In several Latin American regions with intensive pesticide use, chemical residues have been detected in breast milk (Figueiredo et al., 2024). Due to its high lipid content, body fat and breast milk can accumulate organochlorine pesticides, which are lipophilic compounds. Despite the potential for low-level pesticide exposure, breastfeeding remains the safest and most beneficial feeding option for newborns and infants, particularly in LMICs where alternatives are often limited and expensive. Breastfeeding provides essential nutrition, immunological protection, and neurodevelopmental benefits. Thus, public health efforts must prioritize reducing maternal and environmental exposure to chemicals, while reinforcing breastfeeding as the optimal practice for infant feeding.

Para-occupational exposures among rural children

Although frequently overlooked in clinical assessments, the occupational activities of parents, particularly in agriculture, play a crucial role in children’s health. This is especially relevant in family farming and home-based crop activities, where the boundaries between work and domestic life are blurred. Para-occupational exposure to pesticides represents an important threat to children’s health, especially in LMICs. As a consequence, children of farmworkers are consistently found to have higher pesticide exposures than those whose parents are not engaged in agricultural labor, even when living in the same rural areas (Hyland & Laribi, 2017).

Despite its severity, para-occupational exposure is often neglected in health protocols and policy frameworks. It commonly occurs when pesticide residues are transported into the home by workers, typically through contaminated clothing, footwear, or agricultural equipment, commonly referred to as “take-home” exposures (Hyland & Laribi, 2017). Children come into contact with these residues directly by hugging their parents, playing on contaminated surfaces, or assisting with household chores, such as washing work clothes. Additional risks arise when pesticides or equipment are stored in or near homes (Hyland & Laribi, 2017; Teysseire et al., 2020; Ramezanifar et al., 2024).

The degree of para-occupational exposure varies depending on several factors: the child’s age, frequency of interaction with farmworkers, number of agricultural workers in the household, type and scale of farming, residential proximity to pesticide-treated fields, crop cycles, and the use (or lack) of occupational safety and health (OSH) measures. Preventive practices, such as changing clothes before entering the home, storing chemicals outside living spaces, and adopting personal hygiene routines, including washing hands and showering before playing with kids or interacting with relatives after fieldwork can significantly reduce exposure risks for both workers and their families (Hyland & Laribi, 2017).

Occupational exposures among children

In many regions worldwide — particularly in LMICs — children are also exposed to pesticides through direct occupational activities, most commonly when assisting their families in subsistence or small-to-medium-scale farming (Buralli et al., 2021; ILO, 2024a). The International Labor Organization (ILO) defines child labor as work that deprives their childhood, potential, and dignity, and is harmful to their physical or mental development. Hazardous child labor includes tasks that endanger children’s health, safety, or morals (ILO, 2024a).

In agriculture, child labor is pervasive, often normalized, and involves diverse tasks from planting seeds, weeding, and harvesting to applying fertilizers and pesticides, handling heavy loads, and using dangerous tools and machinery (ILO, 2024b). In rural LMICs, child participation is frequently seen as a cultural norm and economic need, particularly within family farms. Globally, millions of children — some as young as 5y — are engaged in unsafe labor. About 160 million children aged 5–17y were engaged in child labor in 2020, with nearly half working under hazardous conditions, mainly in agriculture. Among the youngest group (ages 5–11), approximately 75% work in agricultural settings, where pesticide exposure is a routine risk (ILO & UNICEF, 2021). This is the harsh reality faced by Zeca in his childhood.

In many LMICs, pesticide spraying is typically carried out by men, while women and children perform re-entry tasks such as weeding, harvesting or watering, often on the same day or shortly after spraying (Buralli et al., 2021; Quisumbing & Doss, 2021). Although less involved in direct spraying, children may still be exposed through contact with contaminated surfaces or drift during re-entry tasks. This indirect exposure is often underestimated, leading to limited use of PPE – which are not designed for children — thereby increasing the risk of unprotected, high-level exposure (Buralli et al., 2021). Zeca was considered one of those brave boys who worked hard and even helped his father apply pesticides by holding the spraying hose. His fragile health may not be accidental.

Environmental injustices of pesticide exposure in LMICs

Children’s exposure to pesticides in rural areas of LMICs is not only a public health crisis; it is also a deeply rooted environmental injustice. Pesticide risks are intertwined with poverty and lack of education and health resources. Rural communities often bear the burden of pesticide contamination without adequate protection, representation, or access to information or recourse. In most LMICs, lack of preventive regulation and community participation mechanisms exacerbate these harms, undermining children’s right to live in a healthy environment. Moreover, institutional responses often downplay the pesticide risks, reinforcing structural conditions that perpetuate environmental injustices.

For working women in rural areas, injustices can pile up. Agrifood systems employ almost 40% of working women globally, with much higher proportions in some LMICs. However, women’s work in agriculture tends to be marginalized, and conducted in more precarious and risky conditions than men’s work (e.g., more irregular, informal, part-time, unpaid, and labor intensive). Discriminatory social norms reinforce women to have less access to essential assets and resources, including to land, inputs, credit, technical support, and technology (FAO, 2023). Just like Zeca’s mother, millions of workers of reproductive age or who are pregnant are employed in family farms or export-driven agricultural industry with intensive pesticide use globally, exposing themselves and their developing fetuses to harmful chemicals, as has been observed in flower farming in Ecuador (Handal et al., 2007).

Studies have consistently demonstrated these threats in LMICs around the world. Research in Latin America has shown high pesticide levels, often exceeding reference values, among rural school children near agricultural areas in Chile (Muñoz-Quezada and Lucero, 2019); agribusiness-driven water appropriation and pesticide use compromising land rights and health of traditional communities in Brazil (Egger et al., 2021); and frequent exposure at homes and schools near soybean fields after aerial spraying in Argentina (Lapegna and Kunin, 2022). Children in South Africa are exposed to multiple pesticides — sometimes at even higher levels than their guardians (Fuhrimann et al., 2022).

In Sub-Saharan Africa, privatized seeds by multinational corporations threaten indigenous agricultural systems and compromise food security (Leonard, 2022). Market liberalization, perceived need for pesticides and lack of regulations, enforcement, and technical support are putting farmers at increased risks and delaying social mobilization around pesticides in Uganda (Isgren & Andersson, 2020). In Sri Lanka, after the government banned highly hazardous pesticides to prevent suicide, media coverage increasingly highlighted farmer and industry concerns, fueling opposition and shaping public support, with very little reference to peoples’ voices (Schölin et al., 2024). Every day, millions of babies in LMICs, like Zeca, are being taken to agricultural areas with pesticide use daily because their smallholder farmer parents do not have childcare.

Another major issue impacting children’s health in LMICs is the historical intensive use of highly hazardous and legacy pesticides in agriculture and public health campaigns for mosquito control (e.g., malaria and dengue). Some of these chemicals, such as organochlorines compounds (e.g., DDT, DDE and their metabolites) continue to pose risks to children’s health decades after being banned due to their persistence, accumulation, and long biological half-lives (Verner et al., 2018). Critically, some LMICs still use these chemicals, further increasing risks and deepening environmental injustice (Fuhrimann et al., 2022).

These injustices are not incidental; they reflect systemic patterns tied to extractive agricultural models, inequitable and exploitative global production systems, land concentration, and historically unequal state responses. They are evidence of our bioethical failure, and part of a broader global pattern in which the most affected populations in LMICs — children, women, Indigenous people, and smallholder farmers — are those with the least institutional protection or voice. Recognizing pesticide exposure as an environmental justice issue demands that we shift our focus from individual-level interventions to structural reforms. It also requires acknowledging the political economy of pesticide governance and incorporating community voices into environmental decision-making. A justice-based approach must prioritize health surveillance and prevention, ensure corporate and state accountability, and guarantee that rural children and their communities are not sacrificed for the sake of chemical-based agricultural models.

Call for action - urgent steps for change

To reduce pesticide exposure among rural children, especially in LMICs and low-resource settings, coordinated, multisectoral actions and policies are needed at local, national, and global levels.

Systemic Change and Multi-Level, Cross-Sectoral Policies

Protecting children from pesticide exposure requires stronger regulatory frameworks, effective enforcement, and enhanced health promotion and surveillance. Integrated health and labor protection policies and strategies, as well as health surveillance and enforcement of OSH regulations for workers, especially pregnant workers are crucial. All children have the right to grow up in safe environments — free from pesticide exposure through contaminated air, water, soil, or breastmilk. Governments and companies must lead by clearly labelling pesticides with risks for children and pregnant women, promoting sustainable agriculture, reducing pesticide dependency, and supporting agroecological alternatives (EEA, 2023). LMICs must stop using highly hazardous pesticides banned in high-income countries, and stop financing.

Moreover, publicly accessible, disaggregated, and geo-referenced data on pesticide use are necessary for risk assessment and public health research, particularly in LMICs where such information is often scarce. Fiscal instruments, such as pesticide taxation, need to finance health surveillance, prevention, and sustainable farming initiatives (Cunha & Soares, 2020). Research funding should prioritize participatory, context-sensitive studies, especially on overlapping risks like child labor and other environmental exposures (Scott & Pocock, 2021).

Environmental justice requires inclusive governance. Rural communities, especially represented by women, youth, and workers organizations — must have a voice in decisions about land use and pesticide policies. Expanding access to environmental information, legal resources, community monitoring and participatory mechanisms are critical for accountability. These efforts should also include reparative actions for populations already affected. Equitable responses must combine redistribution with recognition and meaningful participation (Martínez-Alier et al., 2016).

Transforming agricultural systems and protecting children from pesticide exposure cannot rely solely on affected countries. International actors — including exporters, corporations, and global donors — must share responsibility for addressing exposure disparities in low- and middle-income countries (LMICs). This includes banning the export of pesticides that are prohibited in their own countries, supporting binding international regulatory frameworks, and financing transitions toward sustainable agricultural models through technology transfer and technical cooperation. Fiscal and trade structures that favor pesticide use, such as tax exemptions, must be reassessed. Global responses should follow the principle of common but differentiated responsibilities, recognizing historical imbalances in capacity, accountability, and exposure to harm. These inequities reflect structural environmental injustice, driven by commercial interests that shift toxic burdens onto vulnerable populations.

Health systems and professionals: surveillance and care

Health systems must be equipped to respond to the extensive burden of pesticide exposure on children’s health. This includes improving curriculum and providing continuous training for healthcare workers to recognize and manage pesticide-related conditions in children. Surveillance and reporting systems should be reinforced to capture pesticide exposure and health outcomes; and multidisciplinary local teams can improve case investigation and support tailored interventions. Health professionals, especially in primary care, surveillance, maternal and child health, and occupational and environmental health play a critical role in detecting and preventing pesticide exposure in children. At the same time, educating children and their families on pesticide risks and protective behaviors empowers them to play an active role in reducing harmful exposures.

Companies, organizations, cooperatives, workers, and unions

Efforts to prevent pesticide exposure should be conducted by several stakeholders, including companies, cooperatives, workers, and unions. National pesticide regulation and stringent enforcement are key. Agricultural employers must ensure safe working conditions, provide training and personal protective equipment, and promote good practices to avoid children’s environmental, para-occupational, and occupational exposures. Given the large proportion of informal and small-scale farming in LMICs, governments need to offer technical assistance to producers and encourage organic and agroecological practices to ensure both environmental justice and food security. Further, countries engaged in large-scale agriculture that employs great proportions of women workers of reproductive age and pregnant workers must recognize this vulnerable workforce and provide safeguards for these workers and families.

Cooperatives and unions serve as a key platform for worker mobilization, outreach, and advocacy, and must work with government and academia to support farmer training and exposure prevention strategies. Providing farmers with training, resources, and infrastructure is essential to ensure responsible pesticide use and farming. Additionally, preventing “take-home” exposures and other para-occupational exposures to pesticides is essential for protecting families and children (Ramezanifar et al., 2024). This includes measures such as avoiding the reuse of empty containers, residential pesticide storage and use, and keeping shoes and work clothes outside residences.

Conclusions

It is urgent to promote global, regional, and local policies and strategies to protect children from pesticide exposures, such as stricter regulations; enforcement and health surveillance; banning the most hazardous chemicals; promoting sustainable agriculture, decent work, and safer practices; and strengthening collaboration across different actors and sectors, including governments, academia, workers, unions, stakeholders, and NGOs. The omission of public health authorities and practitioners to foster health promotion, surveillance, and assistance on children’s exposure to pesticides helps to perpetuate structural socio-environmental injustices.

As discussed, these exposures are not isolated events, but part of broader patterns of environmental injustice disproportionately affecting children in rural areas of LMICs. Addressing them requires more than technical solutions - it calls for political will, community engagement, and a human rights-based approach. Protecting children from pesticide exposure globally, especially in LMICs, is essential to promote equity and social justice, safeguard children’s health and rights, and ensure they are given the opportunity to thrive, live healthy lives and contribute fully to society.

Addressing pesticide exposure in LMICs requires stronger international accountability. Global actors, including exporting countries, multinational corporations, and international agencies, must acknowledge their role in perpetuating these risks and support LMICs through stronger regulation, sustained funding, and technical cooperation. Without confronting these global asymmetries, meaningful and lasting change will remain out of reach for the most affected communities.

Meanwhile, in Brazil, Zeca still suffers from health issues that keep him from playing at school like other children. But his story need not be repeated. We can prevent millions of rural children in LMICs from following the same path.

Acknowledgments:

This commentary was developed as part of the International Society for Children’s Health and the Environment (ISCHE) Research to Action R2A Fellowship Program. We thankful the University of Southern California support through the U.S. National Institutes of Health (grant #P2CES033433) to the ISCHE R2A Fellowship Program.

Footnotes

The authors declare no conflicts of interest.

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