Climate extremes are harming maternal and reproductive well-being.

Key messages

• The increasing risks of illness and harm for pregnant women, foetuses, and newborns, driven by climate change, are threatening a reversal in the progress made in recent decades in maternal and reproductive health. 
• Entrenched gender norms and low levels of income and education further amplify the impacts of climate change on maternal and reproductive health. Hence, interventions to minimise the negative impacts should be integrated with cross-cutting approaches to advance gender equity and justice.

Addressing the effects of climate change on maternal and reproductive health (MRH) is an important element of tackling the gendered impacts of climate change. Changing climate patterns have direct and indirect effects on pregnant women, with more severe impacts in climate-vulnerable regions where there is limited access to resources (Figure 4). Increased pregnancy loss, preterm birth, severe maternal ailments, and cognitive impacts on offspring are some of the risks, yet policy responses are insufficient. Only 27 out of 119 Nationally Determined Contributions (NDCs) make references to maternal and newborn health and sexual reproductive health. There are also gaps in higher education and training on climate change and health, with limited preparedness across healthcare services and social safety nets to address these challenges. While current research shows strong linkages between climate change and MRH, exact pathways are still not clear and research from the most vulnerable regions is under-represented. This makes it difficult to fully understand the magnitude of the impact. Without effectively addressing these gaps, we risk a reversal of the progress made in MRH in recent decades. Urgent calls are being made to increase awareness and catalyse action globally, including the recent “Protecting maternal, newborn and child health from the impacts of climate change” Call to Action by UN agencies ahead of COP28.

Recent studies highlight the growing concern about the effects of climate change on MRH, in particular in climate-vulnerable regions. For example, in India, a study of 800 pregnant working women found that nearly 50% reported exposure to occupational heat stress (working outside of the threshold for safe manual work). The same study found that miscarriage risk was double in pregnant women who were exposed to heat stress compared to those who were not, which has significant implications for tropical nations where millions of women risk exposure to occupational heat stress. In Southern California, researchers found significant associations between long-term heat exposure and increases in birth complications (for example stillbirth and preterm birth), with increased risk in women with lower educational level and less exposure to green spaces. Research across 33 countries in South and Central America, Asia and Africa estimated that flood events may be responsible for over 107,000 pregnancy losses each year in these regions, and reported elevated risk for women with lower income and education levels. 

Climate change can also indirectly impact MRH. Increased heat can reduce the availability of food and water, resulting in new mothers needing to travel further in heat, thus experiencing delayed recovery from birth. Food insecurity is linked with inadequate nutrition during pregnancy, lower birth weight and reduced breast milk production. Studies have also reported declines in breastfeeding frequency, reduced travel for medical care and lower use of mosquito nets in extreme heat, all of which have MRH implications. Research in three South Asian countries found that a 1°C increase in annual mean temperature was associated with a 4.5% increase in intimate partner violence. Climate-related displacement has been linked to inadequate healthcare support, lack of proper nutrition; inadequate rest, sanitation and social support networks; as well as an increased risk of sexual violence. While this chapter focuses on extreme heat and flooding, it is important to mention that other climate change driven impacts such as air pollution continue to be a major concern to MRH. 

Solutions addressing the effects of climate change on MRH cannot be separate from justice and gender-transformative rights-based approaches. Women of colour, and with low income and education levels, face greater impacts of climate change and have limited access to healthcare services, meaning they face disproportionate challenges to their MRH. Entrenched gender norms restrict pregnant women from changing harmful practices (e.g., collecting firewood and water) even in extreme heat. Increasing women’s rights to participate in decision-making processes will help the formation of policies, programmes and standards to protect MRH from the impacts of climate change.