Syed Saad Ahmed

How Can We Protect Mothers and Babies Against Climate Change

The world has made huge gains in maternal and child health in recent decades.¹ However, a significant adversary to this progress has emerged: climate change.² 

Many studies have linked heat stress during pregnancy with negative outcomes, such as low birth weight.³ For every 1°C rise in temperature, the odds of preterm birth and stillbirth rise by 5%. Heat waves increase the risk of preterm birth by 16%.

However, we do not have enough evidence regarding the pathways by which heat exposure results in these problems.⁴ We also do not know the safe limit of heat exposure for pregnant women.⁵ Moreover, there is a lack of studies from low- and middle-income countries,⁶ where the effects of climate change are often the most pronounced.⁷

To understand the impact of climate change on maternal and child health and explore safeguarding measures, I spoke with Dr Adelaide Lusambili, a lead investigator in the Climate, Heat and Maternal and Neonatal Health in Africa project.⁸

Dr Lusambili is an internationally recognized scientific researcher and educator with over 18 years of experience in the UK and several sub-Saharan African countries.  She is an Associate Professor at Africa International University in Nairobi, Kenya. Dr Lusambili has over 50 publications on a range of public health issues and has spoken at international forums, such as COP, Africa Health Agenda International Conference, and World Meteorological Organization.

Expert Insights from Dr Adelaide Lusambili

Research on climate change’s impact on maternal and child health

The issue has gained attention only recently and research on the topic is just beginning. Climate change impacts are broad, ranging from flooding to extreme temperatures. My research has focused on high ambient temperatures and how they are impacting maternal and child health.

While there is some research on the topic, we have limited funding for it. We need more evidence, especially epidemiological evidence, to inform policy and

Climate, Maternal and Neonatal Health in Africa (CHAMNHA) project

CHAMNHA was a consortium of different universities across the globe to understand the effects of heat stress on pregnant women and newborns. We also wanted to generate evidence to inform public health responses and support plans for adaptation in sub-Saharan Africa. We had different workstreams: a group of experts codified the impacts of heat stress in Kenya and Burkina Faso,⁹ there were qualitative studies, and there were interventions based on our findings.

Public health challenges in Kilifi County, Kenya, where Dr Lusambili conducted research

Kilifi is on the east coast of Kenya. The areas where we collected the data were very hot — in summer, temperatures can rise to 45°C (113F). The communities there have low literacy levels, high birth rates, and high maternal mortality rates. The infrastructure is poor in terms of transport and healthcare facilities.

Effect of extreme heat on mothers and newborns in the region

We found that extreme heat leads to extreme exhaustion during pregnancy — women cannot continue performing daily activities.¹⁰ It also compromises certain behaviors. For instance, when it’s hot, they don’t go to health facilities for ante-natal care to avoid walking in the heat. In the east coast of Kenya, malaria is rampant, but they are not able to use mosquito nets due to the heat. This increases the risk of malaria.

Extreme heat has also impacted water sources, so women need to travel longer distances to look for drinking water. There is a greater risk of violence as they have to go to unsafe places to look for water. It has affected food production as well, leading to a scarcity of food. All these factors amplify anxiety and other mental health issues.

Women who get dehydrated due to the heat often end up having a Cesarean section because they can’t push out their babies. Heat is also likely to lead to early labor. Healthcare workers may not be prepared to assist women during heat stress because they don’t have the right tools and that affects outcomes during deliveries.

Postpartum women talked about a lack of adequate food and water. They don’t eat enough, leading to low breast milk production. So, they cannot exclusively breastfeed their child for the first six months. Even maintaining personal hygiene and cleanliness at home becomes difficult. They don’t go to get post-natal care at health facilities due to the heat. They are worried about their babies, food, water, and hygiene, so they become more anxious and irritable.

Mothers also talked about having more underweight babies — they link this to poor nutrition. They mentioned the discomfort newborns go through and how the health of babies is compromised. They get blisters on their body and tongue, making it difficult to breastfeed them.

Key takeaways from a co-design workshop organized with various community members to discuss what interventions can help mothers and their newborns in periods of high temperature

We held the co-design workshop to bring together all the stakeholders in Kilifi and present findings from our research so that they could deliberate on possible interventions to support women against climate impacts. One of the key takeaways was that the water system needed to be upgraded because most women walked long distances in the heat to fetch water.

Another was behavior change interventions. Since heat has been normalized in these settings and they don’t see climate change as real, women continue to perform activities that could be harmful to them and their children. These behaviors include walking in the heat with their babies, not using mosquito nets, and covering their children in many layers of clothing due to traditional norms. Nature-based solutions such as planting trees and keeping the environment clean also came up during the workshop.

Why people don’t see heat as a problem or don’t believe that climate change is real

People didn’t see climate change as something real because in some parts of Africa and especially where we collected our data, the climate is tropical — temperatures have been high for decades. So when we talk about climate change, they say, “It’s always been hot, what’s the difference between now and before?”

When we talk about the effects they’re experiencing, they say, “Now, we’re seeing more maternal deaths and more women don’t attend ante-natal check-ups.” They begin to see how things are changing, so we ask them, “Don’t you think that’s climate change? The heat is increasing.”

Given the lack of knowledge about the impact of heat, the co-design workshop sought to raise awareness among the community so that they can come up with locally supported interventions to protect against it.

Ethical dilemmas of conducting research in high ambient temperatures

I have conducted research on various topics, but this experience was different because we collected data during high temperatures.¹² This had deleterious impacts on both the researchers and participants. I wrote this paper so that ethics committees or teams putting protocols are aware of these challenges. In extreme heat, it’s unlikely that participants will sit through an interview for an hour — they have babies, they have to walk long distances, and their homes are heated. So, there should be a shift in how ethics committees approve research. They have to carefully examine the context where research is being conducted and ensure that it is in the best interest of everyone so that no one group suffers.

What Dr Lusambili would change about how we currently approach climate change and maternal and child health

That’s a difficult one! I want everything to change.

But what would make a big difference is ensuring that communities are informed about the impacts of climate change on mothers and babies and are given the tools to support them.

A key point that came up during the co-design workshop was the need for a social and behavior change campaign. Because of the communities’ social and cultural norms, women are expected to continue working when they are pregnant and even immediately after childbirth. These norms are harmful to mothers and babies and need to change.

There is a need for spouses, mothers-in-law, and other relatives to support mothers and babies with daily activities and in attending ante-natal care and post-natal care at health facilities. Societal support can help enable simple behavioral changes such as drinking more water, boiling water before drinking, using bed nets, and avoiding walking in the heat with babies.

Disclaimer

Some photos are courtesy of Annie Spratt, Unsplash.

Citations

1. Lassi ZS, Kumar R, Bhutta ZA. Community-Based Care to Improve Maternal, Newborn, and Child Health. In: Black RE, Laxminarayan R, Temmerman M, et al., editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Apr 5. Chapter 14. doi: 10.1596/978-1-4648-0348-2_ch14
2. Chersich MF, Scorgie F, Filippi V, Luchters S. Increasing global temperatures threaten gains in maternal and newborn health in Africa: A review of impacts and an adaptation framework. International Journal of Gynaecology and Obstetrics. 2022;160(2):421-429. doi:10.1002/ijgo.14381
3. Chersich MF, Pham MD, Areal A, et al. Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and stillbirths: systematic review and meta-analysis. BMJ. 2020;371:m3811. Published 2020 Nov 4. doi:10.1136/bmj.m3811
4. Samuels L, Nakstad B, Roos N, et al. Physiological mechanisms of the impact of heat during pregnancy and the clinical implications: review of the evidence from an expert group meeting. Int J Biometeorol. 2022;66(8):1505-1513. doi:10.1007/s00484-022-02301-6
5. Wadman M. Expecting Extremes. Science. Published September 28,2023. Accessed June 1, 2023. https://www.science.org/content/article/how-much-heat-dangerous-during-pregnancy.
6. Protecting Maternal, Newborn and Child Health From the Impacts of Climate Change: A Call for Action. WHO, UNICEF, UNFPA. Published 2023. Accessed June 1, 2024. https://www.unfpa.org/sites/default/files/resource-pdf/HRP%20CLIMATE%20CHANGE%20IMPACT_WEB_V18_SPREADS_final.pdf
7. Naser K, Haq Z, Naughton BD. The Impact of Climate Change on Health Services in Low- and Middle-Income Countries: A Systematised Review and Thematic Analysis. Int J Environ Res Public Health. 2024;21(4):434. Published 2024 Apr 3. doi:10.3390/ijerph21040434
8. CHAMNHA. LSHTM. Accessed June 19, 2024. https://www.lshtm.ac.uk/research/centres-projects-groups/chamnha.
9. Lusambili AM, Kadio K, Chersich MC, et al. The CHAMNHA project: defining heat impacts on maternal and neonatal health and testing adaptive interventions in Burkina Faso and Kenya. Environmental Health Perspectives Supplements. 2021;2021(1). doi:10.1289/isee.2021.o-sy-049
10. Scorgie F, Lusambili A, Luchters S, et al. “Mothers get really exhausted!” The lived experience of pregnancy in extreme heat: Qualitative findings from Kilifi, Kenya. Social Science & Medicine. 2023;335:116223. doi:10.1016/j.socscimed.2023.116223
11. Lusambili A, Khaemba P, Agoi F, et al. Process and outputs from a community codesign workshop on reducing impact of heat exposure on pregnant and postpartum women and newborns in Kilifi, Kenya. Front Public Health. 2023;11:1146048. Published 2023 Aug 31. doi:10.3389/fpubh.2023.1146048
12. Lusambili A, Chabeda S, Khaemba P. In our own eyes: ethical dilemmas and insights encountered by researchers conducting qualitative research in high ambient temperatures in Kilifi, Kenya. International Health. Published online December 26, 2023. doi:10.1093/inthealth/ihad115

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