Climate Change, Extreme Heat, and Maternal Health: An Interlinked Crisis
Priya, seven months pregnant, lives in a village in Bihar. Along with her family members, she also works as a daily-wage farm worker. Their house is made of tin, asbestos, and thatch. During the extreme summer months of May–July, it offers little protection from the heat. She spends long hours outdoors, returns exhausted, struggles to sleep at night and sometimes feels dizzy from the heat. Staying indoors during a heatwave is simply not an option.
When Priya visits the local health centre, she receives the antenatal care the system is designed to provide. Her blood pressure, height, weight, and haemoglobin is checked. But an important part of her risk remains invisible. Nobody asks how many hours she spends working in the heat, whether she has access to enough water, or whether she can rest during the hottest part of the day. Probably, the health centre itself is not designed to be heat-resilient.
For women like Priya, extreme heat exposure does not sit outside maternal health. It interacts with work, housing, nutrition, water access, and the ability to reach care. Pregnancy itself increases vulnerability to heat because of physiological changes in cardiovascular function, metabolism, and thermoregulation. But vulnerability is not determined by biology alone. It is also shaped by the ecosystem around it, like in Priya’s case, it is not so conducive.
Heat exposure is associated with poor pregnancy outcomes
A 2026 study across all 38 districts of Bihar found that exposure to temperatures around 35°C was associated with a 7% higher risk of stillbirth. A study covering more than 36,000 pregnancies across Bihar, Uttar Pradesh, and West Bengal found that temperature extremes were associated with increased risk of preterm birth. Globally, a 2024 Nature Medicine systematic review covering 198 studies from 66 countries found that heat exposure was associated with higher risks of preterm birth, stillbirth, gestational diabetes, and hypertensive disorders.
Heat can also affect whether women reach the health system at all. An analysis of more than 10,000 pregnant women in India found that greater exposure to extreme heat was associated with lower healthcare utilisation.
Taken together, these findings point to two interconnected risks. Heat can affect pregnancy outcomes directly, while also making it harder for women to access the care intended to protect them. However, much of the advice given during heatwaves places the responsibility on women: drink more water, avoid the afternoon sun, rest and stay cool. Such advice has limited value for those who cannot afford to stop working or who live in a house that remains dangerously hot 24x7. The ecosystem must adapt too.
Extreme heat is not just another hot summer
If extreme heat is becoming a measurable risk during pregnancy, it needs to become visible within maternal health services. Heat exposure should be considered alongside risks such as anaemia, hypertension, and poor nutrition. Just umbrella guidelines for frontline workers to take care of pregnant women won’t work. Frontline workers need protection too. Health facilities also need basic measures to function during extreme heat, including safe drinking water, ventilation, shaded waiting areas, and preparedness for heat-related emergencies.
However, this is not the responsibility of the health system alone. Heat exposure is closely linked to water availability, agricultural work, labour, housing, transport, welfare, and disaster management. Local and national efforts therefore need to work across these systems to identify vulnerable communities and cater to context-specific needs.
In the face of climate crisis, the task in front of us is to strengthen our system, making health services climate-resilient and gender-responsive.
