“The heat was just agonising. It led to a habit where I took very cold showers which goes against what medical people tell us,” said Barati.
Now holding a bouncing baby girl in her arms, she is grateful.
“Her toothless smile fills the air with happiness. “I reckon there is no better compensation for the weather pressures like this little princess.”
It has been nearly two decades since Rosita Mabuiango's birth in a tree above swirling waters in Mozambique, the worst floods to hit that country in recent memory. Who could ever forget what she and her mother went through on that fateful day?
Research has shown that weather disasters such as floods and windstorms limit pregnant women’s mobility and independence in these settings, leading to reduced access to routine and emergency services. The situation is compounded by destroyed infrastructure in many instances.
While the polar bear has become globally recognised as the face of climate change due to its dependence on sea ice, Santiago Alba-Corral says a pregnant woman could also perfectly be emblematic of the problem.
Based on Barati’s lived experience and those of scores of women around the world, Alba-Corral, who is the Director of Climate Resilient Food Systems with the International Development Research Centre stresses that pregnant women are the face of climate change.
Speaking at last month’s World Health Organisation (WHO) session on maternal health and climate, at the COP28, Alba- Corral said although data on maternal and infant mortality is available, the gap is around “more localised research that needs to be connecting elements.”
Botswana is currently experiencing an uptick in maternal deaths at a rate of 240 deaths per 100,000 live births. This comes after a steady decline was noted between 2016 and 2018, when the rate dropped from 156.6 deaths per 100,000 live births to 133.7. In 2019, the rate increased to 163.3 deaths per 100,000 live births and has since moved to 240 deaths.
The disturbing numbers were shared by Ministry of Health chief health officer, Thato Sengwaketse, at the WHO session.
“The dip in the graph concerns us deeply,” noted Sengwaketse. “This is particularly troubling because we not have a system in place to give out the causes of these deaths and this has to be remedied.
“The mortality is against the set targets and so if our Sustainable Development Goals target is at 85 per 100,000 live births and we are at 240, most definitely we should be concerned.
Haemorrhage, abortion, pregnancy-induced hypertension have all been mentioned as the leading causes of these increasing mortalities. Botswana has committed to the COP26 programme focused on creating climate resilient and low carbon sustainable health systems.
According to Sengwaketse, this approach is key to a “One Health Approach” that would ensure strengthened climate resilience through collaboration and cooperation with the health sector.
“The current system does not attribute maternal mortality to climate change effects,” she said. “For instance there are no linkages of hypertension during pregnancy to any of the climate change variables. “Such a system will be helpful in connecting the factors and devising interventions.”
Botswana has a solid base of maternal and child health care programming and the development of the National Adaptation Plan for climate change will critically factor in health, Sengwaketse said.
Dr Gloria Maimela, the director of Climate and Health at Wits Reproductive Health and HIV Institute (Wits RHI), believes that no climate change policy should be adopted without incorporating health. Wits RHI is a research institute focusing on HIV, sexual and reproductive health as well as vaccine-preventable diseases.
“Every climate related proposal should have a maternal health aspect to it,” she said. “Our health infrastructure needs to adapt and there must be cooling areas in facilities for vulnerable groups like women and children. “Hydration needs must be taken care through monitoring water intake, and availing water in facilities for the most at risk. “The health sector should also dispose of waste in an eco-friendly way.”
Professor Veronique Filippi, who has conducted interdisciplinary research in maternal health and epidemiology to help improve pregnant women's health in low and middle-income settings, said high temperatures pose increased risks of eclampsia which is problematic in the first trimester. Eclampsia is a rare but serious condition where high blood pressure results in seizures during pregnancy. Its symptoms include high blood pressure, headaches, blurry vision, and convulsions.
“High temperatures increase the risks of hypertension and eclampsia, gestational diabetes, mental health as well as access to care,” she told the WHO session. “Certain types of infectious diseases such as vector and the water-borne variety, have also been linked to miscarriages and neonatal mortality.”
The London School of Hygiene and Tropical Medicine scholar added that there is evidence that action is required to address the linkages between climate hazards and preterm births, stillbirths, congenital abnormalities, infections, mental health, and child mortality.
“How to act is complicated because there is low awareness while interventions specific to the needs of pregnant women and new-borns are unclear or untested. “Maternal and new-born health are not included in many climate adaptation plans or multi sectoral actions,” she said.
Climate change has also been strongly associated with compromised water quality. In an interview on the sidelines of the WHO session, Professor Michael Kremer of Chicago University said increased water temperatures cause excess algae growth as well as sediments which compromise the quality of drinking water.
According to studies, algal blooms or growth may form when nutrients, mainly nitrogen and phosphorus, build up in excess amounts in water. Water sedimentation, on the other hand, is a process where particles settle at the bottom of a water body.
“One in four child deaths could be avoided by treating drinking water,” Prof Kremer said. “Drinking water is a major leading cause of death in children, and the climate crisis is aggravating the situation as cyclones and floods for instance spread pathogens in drinking water, which in turn cause diseases like cholera and malaria.”
The Nobel Laureate added that droughts could also displace people to less safe water places. As such, Prof Kremer said there is strong evidence suggesting that access to improved water quality is critical to reducing communicable diseases and that young children stand to benefit the most from access to clean water. This has led to some interventions such as water treatment and dispensing programmes in places such as Zambia, Malawi and Kenya, amongst others.
“Water treatment programmes are very inexpensive and the focus of this intervention really is providing treated water which is integrated within the existing maternal and infant care. “These programmes target the most at risk, and 80 percent of them are given vouchers to access the dispensary,” he said.
Chlorine interventions are yet another approach suited for countries where water is delivered through pipes, and where it is stored in tanks.
“You add chlorine to the storage tanks which treats water automatically. “More than 100,000 lives are saved in India annually through this strategy, as areas that have embraced the intervention now have lower rates of cholera and safe water in the face of climate change,” Prof Kremer added.
*Not her real name *The article was produced with support from MESHA and IDRC Eastern and Southern Africa office. Kayawe is an MPhil Natural Resources Management and Participatory Development Communication candidate at the Okavango Research Institute
