ABSTRACT
The review examines how climate change adversely affects maternal health and pregnancy outcomes in Africa, a region particularly vulnerable to climate-related disasters. It highlights the increased incidence of tropical and waterborne illnesses due to climate change, disproportionately impacting expectant mothers. The study thoroughly evaluates the effects of extreme weather events like heatwaves and floods on maternal health, both directly and indirectly. It underscores significant gaps in policy and research within African health sectors regarding these issues. Key findings reveal that maternal death rates remain alarmingly high, with risks like preterm birth, stillbirth, and maternal hypertension exacerbated by climate change. The review calls for urgent action, including enhanced research, increased funding for climate adaptation, and the integration of maternal health into broader climate resilience strategies. Additionally, it emphasizes the need for greater awareness and international collaboration to strengthen health systems in Africa, particularly addressing the vulnerabilities of pregnant women. This work aims to enhance understanding among policymakers and researchers about the critical health impacts of climate change on pregnant women in Africa.
HIGHLIGHTS
Climate change and health are intrinsically connected.
Extreme weather events like heat waves and air pollution threaten pregnancy.
The maternal mortality rate has increased in Africa as of 2020 due to climate change.
Most African countries do not include health in their NDCs.
There is a need for more research on climate change impacts on health in Africa.
INTRODUCTION
The World Health Organisation (WHO) defines maternal health as the state of well-being of women during their pregnancies, deliveries, and postpartum periods. Unfortunately, problems during these periods result in the deaths of nearly 536,000 women globally each year (Rylander et al. 2013). The effects of the anthropogenic climate change-driven rise in global temperatures on human health are profound. Unless greenhouse gas emissions are dramatically decreased, the average global temperature will rise by around 1.2 °C from pre-industrial levels. This trend is predicted to continue and might have catastrophic health consequences (Bonell et al. 2022).
The Maternal Death Surveillance and Reaction (MDSR) plan was introduced by the WHO in 2012 as a response to the persistent maternal health crisis, involving multiple African countries. However, implementing this strategy across different African countries faced many challenges. These included communication barriers at the district or community levels, insufficient attention to recommendations, politically sensitive issues, limited accountability, and organizational difficulties (Onambele et al. 2022).
Maternal mortality rates in Sub-Saharan Africa (SSA) are still startlingly high because of a lack of funding for excellent maternal healthcare as well as patient-related issues like the accessibility and cost of these services. One of the main causes of maternal death is haemorrhage, which is frequently associated with a lack of resources. These include unskilled birth attendants, subpar delivery facilities, and a shortage of vital obstetric supplies like blood for transfusions (Musarandega et al. 2021).
Furthermore, these challenges are made worse by climate change. For instance, exposure to heat can hurt the health of foetuses, infants, and pregnant women. Research indicates that a 1 °C increase in temperature in the week before delivery is associated with a 6% increased risk of stillbirth (UNFPA 2023). This suggests that high temperatures heighten the risk of pregnancy complications, including preterm delivery and stillbirth (Sbiroli et al. 2022). Climate change also places direct and indirect pressure on health systems, complicating their ability to respond to shocks and stresses, thereby threatening the availability, accessibility, quality, and financial sustainability of healthcare. To address these current and future challenges, it is crucial to adapt to the environment in which health services are delivered and utilized (USAID 2022).
Globally, women in low- and middle-income nations make up 70% of the 1.3 billion people who live in poverty. These women have distinct health issues that are made worse by climate change, especially during pregnancy when the health and nutrition of the mother have a significant impact on the development of the foetus (Desai & Zhang 2021). Because they are among the most vulnerable groups and are frequently marginalized in different nations, pregnant women, developing foetuses, and newborn babies are especially exposed to the negative effects of climate change (Rylander et al. 2013). Preterm birth, defined as delivery before the 37th week of pregnancy, accounts for over a million deaths annually. Preterm births are most prevalent among economically disadvantaged populations in the United States, Southern and Southeast Asia, and SSA, with an estimated global incidence of 15 million annually (Batiz et al. 2022).
Additionally, studies have indicated that the health of society's most vulnerable people, especially infants and young children, is being negatively impacted by rising temperatures and falling moisture levels. In SSA, a region already struggling with chronic food insecurity and poor health conditions, the added stress of rising temperatures and declining precipitation has a pronounced impact on child well-being (Davenport et al. 2017).
Climate change disproportionately affects women in economically disadvantaged communities, increasing their vulnerability to negative health outcomes. Pregnant women, in particular, face heightened risks due to specialized health needs and pregnancy-related morbidities. In low-resource areas, many women struggle to maintain a healthy diet during pregnancy, particularly during the hunger season. As food security continues to diminish as a result of climate change, the situation is expected to get worse (Bryson et al. 2021). According to the World Meteorological Organization (WMO), Africa is particularly vulnerable to the negative health impacts of climate change due to the continent's ‘elevated prevalence of climate-sensitive diseases and limited readiness and ability to adapt and respond at both institutional and community levels’ (UNFPA 2023).
Despite these challenges, climate change adaptation and mitigation efforts in the health sector across most African countries remain underfunded. A recent United Nations Fund for Population Activities (UNFPA) report highlighted a significant policy gap in many African nations' Nationally Determined Contributions (NDCs) concerning sexual and reproductive health and rights issues. While some countries have included health-related issues in their NDCs, these discussions often lack the depth and comprehensiveness needed to address the problem fully.
This review aims to comprehensively assess how climate variability and change affect African maternal health and pregnancy outcomes. It also aims to assess the detrimental effects of extreme weather events like floods and excessive heat on maternal health throughout the continent. Given the substantial gaps in research and policy regarding health and climate change in Africa, this study is expected to be highly significant in directing policymakers and non-state actors. The study aims to strengthen the resilience and effectiveness of health systems in Africa by identifying inadequacies in relevant policy texts and the African NDCs.
REVIEW METHODOLOGY
Research question
This systematic review aims to answer the question: How does climate change impact affect maternal health and pregnancy outcomes in Africa? The review will focus on identifying the direct and indirect effects of climate change (such as extreme weather events, heat stress, and food insecurity) on maternal health and pregnancy outcomes, including preterm births, stillbirths, and maternal mortality.
Search strategy
A comprehensive and systematic search was conducted across multiple databases, including WHO, UNFPA, UNICEF, UNEP, and Google Scholar. The search includes studies published in English, with publication dates ranging from 2007 to 2024. The following keywords and Boolean operators were used in the search strategy: ‘Climate change’ AND ‘maternal health’ AND ‘Africa’ ‘pregnancy outcomes’ AND ‘climate change’ OR ‘extreme weather events’ AND ‘maternal mortality’ ‘food insecurity’ OR ‘heat stress’ AND ‘pregnancy complications’ AND ‘Africa’.
Inclusion and exclusion criteria
Inclusion criteria
(1) Study type: Reports, conference papers, peer-reviewed studies, systematic reviews, meta-analyses, observational studies, and case studies were included.
(2) Population: Studies involving pregnant women or maternal health outcomes in African regions affected by climate change.
(3) Interventions/Exposure: Studies that analysed the impact of climate factors such as heatwaves, floods, and food insecurity and other environmental factors such as air and water pollution on maternal health.
(4) Outcomes: Studies reporting maternal and neonatal outcomes such as preterm birth, stillbirth, maternal mortality, pregnancy complications, or adverse birth outcomes.
(5) Geographical focus: Only studies conducted in Africa or that specifically address African maternal health issues were the main focus of this paper.
(6) Type of data: Both quantitative and qualitative studies were considered for inclusion, studies with good empirical analysis were preferred.
Exclusion criteria
(1) Study type: Editorials, commentaries, and opinion pieces.
(2) Population: Studies focusing on non-pregnant women or non-maternal health outcomes and other unrelated studies were not considered.
(3) Outcomes: Studies that do not provide specific maternal or neonatal health outcomes related to climate change were excluded.
(4) Geographical focus: Studies focusing on regions outside Africa.
Data extraction
For each included study, the following data were extracted: Author(s), Publication year, Study design, Sample size, Study location (country or region within Africa), Type of climate exposure (e.g., heatwaves, droughts, food insecurity), Maternal or neonatal health outcome (e.g., preterm birth, maternal mortality, stillbirth), and Key findings (association between climate factors and health outcomes).
Research quality assessment and data extraction
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) flowchart for searching and extracting data. Source: Adapted from Moher et al. (2009).
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) flowchart for searching and extracting data. Source: Adapted from Moher et al. (2009).
RELATIONSHIP BETWEEN CLIMATE CHANGE AND HEALTH SECTOR
While climate change is not a direct cause of most human health issues, it significantly exacerbates them by altering weather patterns and climatic conditions, leaving communities vulnerable to new and intensified health threats. For example, climate change increases the frequency and intensity of extreme weather events (EWEs) such as hurricanes, heatwaves, floods, and droughts. These events can lead to malnutrition and alter the distribution of diseases, particularly vector-borne illnesses, by affecting the lifecycles and ranges of pathogens (ACPC 2011). The substantial adverse effects that climate change is having on human health highlight the urgent need for more understanding and the development of crucial skills in this field. The WHO states that environmental factors that are modifiable or controllable are responsible for 23% of global mortality and 26% of fatalities in children under five (Osama et al. 2018).
Schematic shows how climate change and maternal health are intrinsically related. Source: Authors computation from the literature.
Schematic shows how climate change and maternal health are intrinsically related. Source: Authors computation from the literature.
Potential climate change health risks during pregnancy
Maternal mortality remains a critical issue for women of childbearing age in Africa. While the global maternal mortality ratio (MMR) declined by 34.2% between 2000 and 2020, Africa continues to experience significantly high MMRs. The WHO and other stakeholders must make it a top priority to reduce the MMR to 70 deaths per 100,000 live births by 2030 to address this imbalance because 69% of all maternal fatalities occur in the African region (WHO Analytical Factsheet 2023a). Climate change exacerbates numerous factors that influence the health of expectant mothers and their babies. The physiological and anatomical changes during pregnancy, coupled with the newborn period, reduce the body's ability to regulate temperature effectively. Due to the expanding foetus, pregnant women have considerable increases in their body mass index (BMI) and internal heat generation, associated with a decrease in the body surface area to body mass ratio (Roos et al. 2021). Furthermore, the well-being of mothers and infants depends on social and environmental determinants of health like food security, good drinking water, and clean air. These factors can all be impacted by climate change.
Pregnancy creates a distinct immune state that affects the immune system at various phases and may cause unfavourable responses to infections and environmental chemicals. Women are particularly vulnerable to high heat waves and air pollution because of their weakened immune systems and decreased thermoregulation during pregnancy (Adebayo 2022). Extreme heat exposure during pregnancy raises the risk of water, food, and vector-borne infections, as well as mental, respiratory, and diarrhoeal illnesses. More importantly, exposure to high temperatures increases the risk of heat-related illnesses, both acute and chronic. Pregnant women and foetuses may be more severely affected by these temperatures than other groups (Cil & Cameron 2017).
The direct and indirect health repercussions of natural disasters induced by climate change – such as heat-related deaths and injuries – pose a significant threat to public health. These risks are particularly acute in developing nations and among vulnerable groups, including the elderly, those with chronic illnesses, women, and children (WHO 2008). Although approximately 200 studies worldwide have documented the adverse effects of high ambient temperatures on the health of pregnant women and infants, the threshold for dangerous temperature exposure varies depending on climate zone, maternal health, and individual risk profiles (Chersich & Phiri 2023).
Pregnancy-related female deaths in SSA from 2006 to 2021. Source: Modified after Okonji et al. (2023).
Pregnancy-related female deaths in SSA from 2006 to 2021. Source: Modified after Okonji et al. (2023).
POTENTIAL IMPACTS OF CLIMATE CHANGE ON MATERNAL HEALTH AND PREGNANCY OUTCOMES
The potential impacts of climate change on maternal health and pregnancy outcomes. It demonstrates how the risk of maternal and newborn death might rise as a result of both direct and indirect effects of climate change. Source: Authors computation from the literature.
The potential impacts of climate change on maternal health and pregnancy outcomes. It demonstrates how the risk of maternal and newborn death might rise as a result of both direct and indirect effects of climate change. Source: Authors computation from the literature.
Temperature
In 2023, the European Union recorded the warmest year since the Sangamonian Interglacial period, over 120,000 years ago, when the northern polar ice cap completely melted (Abnett & Dickie 2023). This alarming trend was also observed in global climate assessments of surface temperatures (NOAA 2023). In 2023, most countries in North and West Africa experienced extreme temperatures exceeding 40 °C, leading to significant health risks, water scarcity, threats to food security, and numerous record-breaking heatwaves (Probst 2023). A severe heatwave struck North Africa in April 2023, affecting Algeria, Morocco, and Tunisia. This event lasted 3 days and resulted in deadly heat strokes and wildfires (Crisis24 2023). Additionally, Southern African countries experienced a major heatwave during the winter months of 2023. Predictions indicate that global temperatures could rise by 2 °C by 2050 (Krishnamurthy 2023).
The increasing temperatures pose serious risks to pregnant women, who are already vulnerable due to the natural elevation of body temperature during pregnancy. Additional heat exposure can be catastrophic for both mother and foetus (National Partnership 2021). One of the most significant risks is the development of high blood pressure, which often manifests in the first trimester but can persist throughout pregnancy and, in extreme cases, continue beyond childbirth (Chen et al. 2023).
The pathophysiological routes from heat to premature birth are shown. It illustrates how heat can cause premature delivery. Source: Modified after Chersich et al. (2022).
The pathophysiological routes from heat to premature birth are shown. It illustrates how heat can cause premature delivery. Source: Modified after Chersich et al. (2022).
For the foetus, heat stress is particularly concerning in the third trimester when sensory responses to external factors like pressure, pain, and heat begin to develop (Morgan 2017). This can lead to low birth weight, premature birth, stillbirth due to temperature-induced cervical dilation, increased risk of childhood epilepsy, impaired brain function, and even death, as infants have limited capacity to regulate their body temperature (Sun et al. 2011). Between 2011 and 2020, at least 12,000 child deaths were associated with heat exposure in Africa (Stone & Nelson-Piercy 2012).
Food insecurity
Scholarly works have recognized the consequences of climate change as significant contributors to food insecurity, affecting the quality, availability, and accessibility of climate-dependant food crops such as agricultural produce (EPA 2010). Africa is particularly vulnerable to these impacts as most countries rely on rain-fed agriculture, with increased temperatures and altered precipitation patterns posing a substantial risk (UNEP 2017). This vulnerability is especially pronounced in SSA, where the most severe food crises are frequently reported (Rocca & Schultes 2020). Proper nutrition is important during pregnancy to ensure the health of both the mother and the foetus and to enhance pregnancy outcomes (OSHU 2022). The relationship between nutrition and maternal health is unidirectional – poor nutrition directly impacts maternal and fetal health, increasing the risk of malnutrition, which can compromise the health and survival of both mother and child.
Research has indicated the link between food insecurity and various pregnancy complications, including gestational diabetes, preterm birth, stillbirth, low birth weight, antenatal depression, anxiety, gestational diabetes, anaemia, and hypertension (Agho & van der Pligt 2023). These complications can lead to additional health risks, such as low blood sugar and severe respiratory issues in the newborn, as well as high blood pressure and the potential for recurring diabetes in the mother after delivery (Mayo Clinic 2023). Further research supports the association between nutritional deficiencies caused by food insecurity and adverse pregnancy and maternal health outcomes. These effects are also significant contributors to infant obesity and poor child development, which may persist into adulthood (Chmielewska 2021). Africa, though fully committed to achieving the UN SDGs by 2030, is still way far from meeting the food security and nutrition targets due to many factors such as climate change and outbreaks of pandemics such as COVID-19 which have disturbed normal production. In Africa, about 20% of people are undernourished, and over 30% of children are stunted as a result of malnutrition (OCHA 2023). A food security study conducted on over 3,000 pregnant women in the most populous African country (NIgeria) in 2021 indicated that food insecurity is highly prevalent among pregnant women in Nigeria, with nearly 75% of the participants reporting moderate to severe food insecurity in the duration of the study. The study acknowledged that food insecurity has negative consequences on child and maternal health, thus implementing interventions to address it during pregnancy is extremely critical if pregnancy outcomes are to be improved (Ujah et al. 2023).
Environmental pollution (air, water, and noise)
Pollution, in the forms of air, water, and noise, poses significant hazards to maternal health and pregnancy outcomes. Pregnancy is a crucial period of vulnerability to environmental pollutants such as heavy metals and pesticides, and exposure to high amounts can severely affect both mother and foetus (Rani & Dhok 2023). Africa experiences extreme pollution trends, especially air pollution, which is the second leading risk factor for death on the continent (Health Effects Institute 2022). Environmental contaminants provide significant dangers to the developing foetus, including smoke from tobacco cigarettes and gaseous substances from industrial activities (Rani & Dhok 2023). These pollutants can lead to adverse birth outcomes, including miscarriages, stillbirths, premature births, low birth weight, and impaired organ development (Mitku et al. 2023). Pregnancy-related exposure to air pollutants may also worsen lung function and raise the risk of respiratory conditions like asthma in both the mother and the unborn child. These conditions may eventually result in long-term respiratory problems, weakened immune systems, and an increased risk of death (Stone & Nelson-Piercy 2012). For a child's long-term health, exposure to air pollution from conception through the second year of life may be particularly critical (Harville et al. 2021). As of 2019, about 99% of the world's population was living under compromised WHO air quality levels due to the presence of fine particulate matter, leading to over four million premature deaths globally. Out of those premature deaths, about 89% were recorded in low- and middle-income countries (LMICs) (WHO 2022).
Polluted water during pregnancy is another significant risk, as it can harbour bacteria, pathogens, viruses, and heavy metals, all of which pose serious health threats. Heavy metals like mercury and lead, which can accumulate in fish, may cause long-term nervous system abnormalities in the infant, such as autism, cerebral palsy, mental retardation, short attention span, low intelligence, and an increased risk of behavioural problems in adulthood (EPA 2015). In some cases, impaired vision and hearing capacity in infants can also be traced back to heavy metal exposure during pregnancy. Additionally, waterborne diseases like diarrhoea, dysentery, and typhoid pose severe risks to pregnant women, potentially leading to pregnancy complications, poor outcomes, and even fatality before delivery (Bhaskar & Chaudhury 2017). SSA is predicted to become the new water pollution hotspot owing to escalating climate crises. According to the United Nations, over a hundred people die hourly in Africa due to the consumption of dirty water, some of which could be pregnant (Jones et al. 2023).
Noise pollution is another critical concern, as it can cause stress in pregnant women, which may be transferred to the baby, leading to irreversible hearing loss, low birth weight, preterm birth, fetal abnormalities, fetal stress, and increased blood pressure (NIOSH 2023). Long-term exposure to noise pollution can also result in chronic hypertension, diabetes, sleep disorders, mental instability, and gastrointestinal complications in both the mother and infant (Wang et al. 2022). Urbanization and industrialization are some major causes of climate change and subsequent noise pollution. A 25-year-duration study conducted in health centres in two African countries, Rwanda and South Africa, revealed that noise pollution affected the ideal care for newborns. It resulted in trauma risks and physiological instability in infants. Daily exposure resulted in hearing problems as recorded levels were higher than the 45 dB recommended by the American Association of Paediatrics (AAP). These noise levels further affect heart rate, respiratory rate, and blood pressure (Osei & Effah 2022).
Climate-induced disasters
Africa is the most disaster-vulnerable continent in terms of both the severity and frequency of events, with over 700,000 deaths recorded as of 2019 (IFC 2022). According to estimates, 50% of all maternal deaths occur in disaster settings, making pregnant women one of the most susceptible groups during disasters (Joseph & Curtis 2022). Natural disasters including heat waves, droughts, wildfires, and floods can have an immediate and long-term effect on a mother's health and the course of her pregnancy (Harville et al. 2021).
During these events, pregnant women are exposed to stress, trauma, physical pain, and environmental pollutants. These factors may be passed on to the developing foetus, perhaps resulting in unfavourable birth outcomes like low birth weight, miscarriage, and birth abnormalities. Disasters can have long-term effects that persist into adulthood, such as poor mental health and behavioural problems. Furthermore, during disasters, medical and healthcare facilities are frequently unavailable or insufficient, further jeopardizing the lives of both mother and child (Agrawal 2018).
Socioeconomic inequalities
It is a fundamental human right that all people, especially expectant mothers, should have access to essential services such as clean water, sanitary conditions, nutritious food, and appropriate medical treatment (UN 2020). Pregnant women, however, are especially susceptible to the effects of climate change, which frequently keeps them from exercising their fundamental rights (UNHCR 2022).
Women, many of whom are pregnant, are thought to make up 80% of those who have been relocated as a result of climate change (Halton 2018). Due to physical limitations associated with pregnancy, these women struggle to cope with escalating climate-induced events such as disasters and displacement, posing significant threats to their overall well-being and mental health. Research indicates that African countries are particularly at risk of exposing their women to socioeconomic inequalities, further exacerbating the vulnerabilities of pregnant women in these regions (CGIAR 2022).
Water quality and quantity impacts
Water quality refers to how suitable water is for human use based on specific biological, chemical, and physical characteristics. In contrast, water quantity pertains to the availability and accessibility of this water (Water Science School 2018). The United Nations supports this definition and emphasizes that human activities significantly impact water quality and quantity (UN 2015). Scholarly reviews suggest that human activities such as improper waste disposal, the use of non-organic fertilizers, industrialization, and poor sanitation practices like open defecation, have a complex and multifaceted impact on water quality. Directly, these activities introduce foreign materials into water sources, almost immediately compromising water quality. Even after treatment, contaminants from these practices may still leak into aging or poorly maintained distribution networks.
Another critical concern is the significant contribution of these human activities to the increase in greenhouse gases, which are major drivers of climate change. Climate change, in turn, affects water quality and quantity through extreme weather events like flooding and rising temperatures (UN 2015). Rising temperatures can dry up water sources, making water less accessible, and can also promote the growth and proliferation of harmful microorganisms in water, rendering it unsafe for consumption.
For pregnant women, the intake of poor quality water is particularly dangerous, as it poses significant risks to both the mother and the unborn child. Bacteria, parasites, and viruses present in contaminated water can lead to serious health complications, including preterm delivery, fetal infections, respiratory syndromes, and miscarriages, as these infections can be transmitted from mother to foetus. In extreme cases, such complications can result in mortality regarding water quantity, pregnant women require a greater intake of clean water to meet the needs of the foetus, such as amniotic fluid formation and nutrient circulation – about 2,700 mL/day, which is nearly 400 mL more than the average requirement. When water is inaccessible, pregnant women may not consume enough to adequately support themselves and their unborn child. This can lead to severe dehydration, which may result in adverse pregnancy outcomes such as low amniotic fluid levels, preterm delivery, birth defects, and even death (American Pregnancy Association 2024). Approximately 70% of the global population faces water insecurity today owing to climate change, and more than 90% of Africa's population is in this bracket thus making Africa the second-driest continent (Nkatha 2024).
Extreme flood impacts
Flowchart showing the main climate change factors, with the related impacts on maternal health and pregnancy outcomes. Source: Authors computation from the literature.
Flowchart showing the main climate change factors, with the related impacts on maternal health and pregnancy outcomes. Source: Authors computation from the literature.
Recurring cholera outbreaks are a significant concern, especially in southern African countries. Zambia, for example, reported the first case of cholera in Africa in October 2023 and is currently battling another outbreak just a month into 2024, with pregnant women being among the affected population. Cholera in pregnant women can cause severe complications, including maternal dehydration and diarrhoea, which threatens fetal survival. Research has indicated that women who become pregnant while suffering from cholera have a six-fold increased risk of miscarriage and a three-fold increased risk of stillbirth (Hayek et al. 2023).
Floods also create favourable conditions for breeding mosquitoes and ticks, which are vectors for diseases such as malaria, yellow fever, and dengue fever – diseases to which pregnant women are particularly vulnerable (WHO 2004). Each year, at least 25 million women become pregnant in Africa's malaria hotspots. Malaria during pregnancy is extremely dangerous and is responsible for approximately 10,000 maternal deaths annually in Africa. Additionally, studies indicate that malaria contributes to at least 75,000 cases of low birth weight, fetal growth challenges, and preterm deliveries (Rogerson et al. 2007).
Yellow fever is another serious threat to pregnant women. The disease can cause severe infections that are easily transmittable to the foetus, leading to adverse pregnancy outcomes (Public Health Agency of Canada 2023). Africa accounts for 90% of global yellow fever cases, with a minimum of 20% of these cases resulting in death. However, due to restrictions on yellow fever immunization for pregnant women – owing to potential effects on the foetus – and the lack of specific treatments, most pregnant women exposed to yellow fever face a high risk of mortality (Global Health 2018).
Extreme floods also disrupt daily life, often displacing pregnant women and, in some cases, leading to fatalities. In 2023, approximately 1.6 million people were displaced by climate-induced floods across the Horn of Africa, and given Africa's high pregnancy rate, it is likely that many expecting mothers were among those affected (Action Against Hunger 2024). Additionally, essential infrastructure, such as health facilities, is often destroyed during floods, leaving pregnant women without access to adequate healthcare. For instance, in 2023, more than 300 health centres were destroyed by Cyclone Freddy in Malawi, Madagascar, and Mozambique (Adepoju 2023).
PREGNANCY-RELATED CLIMATE CHANGE MITIGATION
Even though it is widely acknowledged that climate change is a worldwide emergency, less emphasis has recently been paid to how it specifically affects maternal health and pregnancy outcomes (Ha 2022). Due to this delayed awareness, communities – including expectant mothers – often do not have enough knowledge about the serious effects that climate change may have on maternal health (Adnan 2023). As a result, there is an urgent need for authorities to implement effective strategies to mitigate and prevent the worsening of this crisis.
The distribution of efforts to mitigate and adapt to climate change in Africa by different players, including governments, citizens, and commercial industries, is shown. The figure indicates that there is much more that African countries need to do to mitigate and adapt to climate change. The corporate sector comes next, and citizens come last. Source: Modified after https://www.afrobarometer.org.
The distribution of efforts to mitigate and adapt to climate change in Africa by different players, including governments, citizens, and commercial industries, is shown. The figure indicates that there is much more that African countries need to do to mitigate and adapt to climate change. The corporate sector comes next, and citizens come last. Source: Modified after https://www.afrobarometer.org.
Maternal health awareness and global action
Awareness, if effectively implemented, has the potential to enhance the current behaviours of people towards climate change and maternal health. Communities and pregnant women too need to be educated on the tragic impacts of climate change on maternal health, and how they can lead to fatalities or endure in an exposed infant's life even in adulthood. Research has proven that behavioural shifts can be expected after robust awareness and sensitization (Halady & Rao 2010). This awareness should be targeted at all stakeholders including schools and communities and should be incorporated into the routine antenatal meetings held for expecting mothers at health centres in Africa during the duration of the pregnancy. As pregnant women are made aware, communities around them also need to know so that everyone can come on board to ensure the safety of both expecting mothers and infants. Apart from discussions that only link issues like high blood pressure, stress, diabetes, infections, and unwanted pregnancy outcomes to other well-known contributors, their linkage to climate change should be emphasized. Knowledge of this has the potential to shift people's behaviours in the fight for a clean and green environment (Roos et al. 2021). In addition, authorities and stakeholders will deliberately and specifically manage environmental risks, promote sustainable practices, and work on ensuring adequate and accessible nutrition and prenatal care for expecting mothers.
Climate funding for maternal health research and implementation
As of 2022, Africa faced significant funding challenges in climate change mitigation and adaptation (Moghalu 2022). The continent requires an estimated $53 billion annually. Still, it has only secured $11 billion – less than a fifth of what is needed – allocated to sectors such as forestry, technology, transportation, energy, and agriculture (Iberdrola 2023). Without sufficient financial support, emerging issues like maternal health may not receive the necessary attention compared with more traditional concerns.
Cross-sectoral climate finance by sub-sector (2019/2020 average USD billion). Source: Meattle et al. (2022).
Cross-sectoral climate finance by sub-sector (2019/2020 average USD billion). Source: Meattle et al. (2022).
It is therefore crucial to increase climate funding, particularly for the health sector, to replace outdated and insufficient approaches to climate action with innovative strategies that can effectively address emerging concerns, such as maternal health. Additionally, this funding should support robust research on protecting expectant mothers from the adverse impacts of climate change. Currently, the limited information available on this subject makes raising awareness even more challenging. Research would provide strong evidence for this linkage, thereby facilitating more effective awareness campaigns.
The meeting of Parties (COP), the largest international climate gathering for heads of state organized by the UN, highlights the urgent need to raise climate funds for Africa and is one strategy to accelerate climate action (MSCI 2023). As of 2022, COP27 faced pressure from private stakeholders to focus more specifically on pregnant women and their infants in the context of climate action (CHAI 2022). In November 2023, ahead of COP28, the United Nations highlighted the importance of prioritizing pregnant women and children in the climate crisis and proposed their inclusion on the agenda for COP28 (UN 2023). This suggests that the message is gaining traction, and we can hope that maternal health will be recognized as a critical and independent issue, receiving specific adaptive and mitigative strategies and innovations on par with other traditional issues.
International collaboration
In addition to existing global climate initiatives for African countries, there is a pressing need for individual nations to collaborate with other countries or institutions making significant progress in climate action. While some collaborations have been established, such efforts remain limited. For instance, Germany's International Climate Initiative (IKI) has recognized collaborative projects in Zambia and Namibia that support the achievement of NDCs (Common Wealth 2023). These collaborations are instrumental in customizing educational materials for students and enhancing capacity building for a sustainable transition.
Other countries demonstrating commendable progress in climate change include Somalia, where the government has partnered with leading universities for research; Kenya, which is working towards increasing forest cover; and Uganda, which has launched a tool to monitor, report, and verify climate action in real-time across all sectors (UNDP 2023). Although there have been efforts to mitigate and adapt to climate change, there are surprisingly few initiatives that are specifically focused on maternal health, despite the terrible figures for maternal and infant mortality in Africa that demand stabilization through a multisectoral approach (WHO 2023a,b,c). Accelerating climate action through international collaborations is essential and should be prioritized.
CLIMATE CHANGE POLICY GAPS ON MATERNAL HEALTH IN AFRICA
Although several governments have committed to adapting to climate change, most remain ill-equipped to address its adverse impacts on public health. Many West African nations have developed action plans focused on expanding public health initiatives, enhancing collaborations, advocating for research, integrating environmental and health monitoring, developing skills and knowledge, raising awareness, mobilizing communities, and implementing environmentally focused public health management strategies (Doumbia et al. 2014). Over 50% of developing countries in the NDC Partnership – an international alliance that provides technical support to help nations fulfil their climate commitments – have requested assistance in strengthening their health systems' resilience to climate change's effects (Tye & Waslander 2021).
However, many developing nations have made little progress in creating strategies, guidelines, or targeted initiatives to tackle this complex issue. Challenges include translating climate change-related technical jargon into actionable health policies, as well as a lack of funding and data to support the health risks associated with climate change (Tye & Waslander 2021). The Economic Commission for Africa (ECA) highlighted in a 2021 press release in Lusaka, Zambia, that low awareness of climate change issues across all sectors of society makes it difficult to develop and implement supportive policies (ECA 2012).
Furthermore, there is no comprehensive database of African-specific climate change policies. Although the London School of Economics and Political Science, in partnership with the Grantham Research Institute on Climate Change and the Environment, has developed a platform to make environmental laws, decrees, and policies more accessible, the database for African countries is incomplete, outdated, and disconnected from the actual policy texts. Direct searches for policy documents on national ministry websites have been equally challenging. Of the 48 ministry websites investigated, only 34 were operational, with the remaining 14 either malfunctioning or constantly under development. Even among the operational websites, few offered access to the policy texts (Sorgho et al. 2020).
Key research gaps in climate change on maternal health
Policy recommendations addressing the critical research domains required to tackle and mitigate the effects of climate change are conspicuously lacking. Furthermore, there has not been much progress in creating interdisciplinary research teams to address the intricate webs of disease pathogens, ecosystems, and climate connections. Creating and assessing models require access to high-quality, trustworthy climate and health datasets, and developing conceptual frameworks is necessary for model advancement, but finding such information has proven to be difficult (Githeko et al. 2014).
The study by Amis et al. (2014) on climate change adaptation in the Southern African health sector only evaluated a limited number of significant infectious diseases in terms of their impact on disease burden. Some forecasts about the impact of climate change on disease burden in the region may be unreliable because the models used were not developed or tested within the region (Amis et al. 2014). Our knowledge of the connections between climate change and its impacts on health is still insufficient. For example, improving our methods for predicting health impacts could enhance the accuracy of forecasts related to crucial health factors, such as crop yields and pest populations (including weeds, insects, and plant diseases). This could be achieved by refining models that simulate the processes leading to these impacts (ACPC 2011).
Studies on health and climate change are primarily conducted in high-income countries (HICs), with little research conducted in LMICs. Our comprehension of the hazards linked to climate change is consequently restricted. The 2020 Lancet Countdown on Climate Change and Health states that between 2007 and 2019, original research and evidence evaluations on the relationship between health and climate change increased eight-fold, primarily due to the efforts of academics from HICs. For example, the majority of research on heat waves and the effects of high temperatures on human life and health come from HICs, under-representing LMICs in this corpus of work (Nilsson et al. 2021).
The global perspective – covering issues such as sea level rise, temperature increases, negotiations, regulations, global adaptation costs, and large-scale models – has dominated discussions about climate change. However, the effects of climate change and variability will be felt locally, impacting individuals, families, towns, and neighbourhoods, even if these impacts are widespread and severe. Extensive study is required to fill the large information gaps on health issues associated with climate variability and change. The region cannot effectively address and adapt to the myriad effects of climate variability and change without a deeper understanding of the relationships between climate and health (Nhemachena & Chakwizira 2010).
DISCUSSION
The well-being of people is seriously threatened by anthropogenic climate change in the twenty-first century, especially in Africa where there is a greater risk of heatwaves, droughts, floods, and wildfires. Given that climate change increases the strain on public health services, it is imperative to comprehend the relationship between climate change and human health. While contaminated water sources from heavy rains and floods are projected to aggravate waterborne infections, rising temperatures are predicted to accelerate the spread of severe tropical diseases. As per the WHO, environmental variables that are preventable or controllable are responsible for 23% of global deaths and 26% of child mortality. Furthermore, due to climate-related calamities, pregnant women are more likely to experience stillbirths along with premature deliveries.
Research indicates that most African nations struggle to effectively adapt to and mitigate the adverse impacts of climate change due to limited resources, particularly for women. A recent United Nations Population Fund (UNFPA) study found that a one-degree increase in temperature in the week before delivery increases the risk of stillbirth by 6%. Multiple studies suggest that climate change can directly and indirectly impact maternal health. Direct effects include heatwaves, floods, and wildfires, while indirect effects encompass pollution, malnutrition, food insecurity, and socioeconomic disparities.
Maternal death is still a major problem in Africa, according to a March 2023 report by the WHO's African Region and the Integrated African Health Observatory (IAHO). The WHO and other stakeholders have set a target to lower the MMR to 70 deaths per 100,000 live births by 2030, as the continent is responsible for more than two-thirds (69%) of all maternal fatalities worldwide. Africa accounted for 69% of all maternal fatalities globally in 2020, with an MMR of 531 deaths per 100,000 live births.
Severe bleeding, infections, pregnant hypertension (pre-eclampsia and eclampsia), delivery difficulties, and botched abortions account for about 75% of these deaths. The countries with the highest rates of pregnancy-related mortality are Chad, Niger, Nigeria, Mauritania, Senegal, Liberia, Benin, and Guinea, according to the report. Additionally, the study discovered that 14% of people in SSA had gestational diabetes mellitus (GDM) in 2019. Prevalence varied from 8.4 to 24% in the Middle East and North Africa and from 6 to 14% in East and West Africa.
Efforts to mitigate and adapt to climate change in Africa vary among different stakeholders. The study identified that climate change adaptation and mitigation efforts in the health sector are still underfunded in most African nations. There is a notable policy gap in the NDCs of various African countries regarding sexual and reproductive health and human rights issues. The research suggests that African governments, businesses, and citizens must take more substantial actions to mitigate and adapt to climate change. Additionally, increased climate funding is needed in the health sector, on par with the agriculture and energy sectors. Strengthening research, policy formulation, and education on the link between climate change and health in Africa is also crucial. These efforts would enhance public knowledge, reduce vulnerability to climate change's impact on the health sector, and bolster the resilience of health systems in Africa, particularly in maternal health.
CONCLUSION
Given that the continent already has disproportionately high rates of maternal mortality, which are made worse by climate-related disasters, climate change poses a danger to maternal health in Africa. With a focus on boosting funding for climate change research, filling policy gaps, and improving research, the report underscores the urgent need for comprehensive solutions to reduce the impact of climate change on maternal and infant health. The results highlight how urgently the health sector requires focused measures, especially when it comes to meeting the unique requirements of expectant mothers and newborns. The welfare of women and children will be protected as long as African countries continue to be safe from the negative consequences of climate change. This can be achieved by bolstering health systems and incorporating climate resilience into maternal health policy. It is also advised to take a multisectoral strategy and increase international cooperation to successfully address the threats that climate change poses to maternal health in Africa.
DATA AVAILABILITY STATEMENT
All relevant data are included in the paper or its Supplementary Information.
CONFLICT OF INTEREST
The authors declare there is no conflict.