|
Getting your Trinity Audio player ready...
|
At 8:30 a.m., Stella is usually already at the Kakamega Forest dispensary in Kakamega County, western Kenya, for her antenatal care (ANC) appointment. Seven months pregnant, she has learnt to organise her household around the rising heat, doing most of her chores when temperatures are lower.
The clinic is 2.5 kilometres away, a distance she walks. Arriving early allows her to complete her check-ups and begin the journey home before the sun becomes unbearable.
Her routine reflects a change that Doreen Atamba, a community health promoter who has supported expectant mothers for the past ten years, has observed among women attending the facility. Increasingly, expectant mothers arrive between 8 a.m. and 10 a.m., with fewer coming after 10 a.m. By late morning, attendance drops considerably.
Atamba says the heat is affecting not only when women seek antenatal care but also their comfort and well-being at home. Some expectant mothers complain that intense temperatures make everyday activities difficult and disrupt their sleep.
“Some of them tell me they are really struggling with the heat, even at night when they are trying to sleep,” she says.
To help them cope, Atamba encourages pregnant women to wear loose-fitting clothing, drink plenty of water, avoid unnecessary exposure to extreme heat, rest frequently and seek relief in cooler places, especially shaded areas.
These everyday adjustments are taking place amid rising temperatures and growing concern about the effects of climate change on maternal and newborn health.
Across Africa, experts in Kenya, South Africa, Senegal and Nigeria are increasingly concerned about how climate-related extremes are affecting pregnant women and newborns. Extreme heat can cause dehydration and physical strain, while drought, flooding, food insecurity and disrupted healthcare services can compound the risks. Experts say the consequences depend not only on the weather but also on women’s living and working conditions, access to water and nutrition, and the ability of health facilities to provide safe care.
Heat and pregnancy
Pregnancy places additional demands on the body. During extreme heat, dehydration and the effort required to regulate body temperature can put additional strain on the heart and circulatory system. Researchers are still investigating how this stress may affect the placenta and developing baby.
Ijeoma Solarin, a senior researcher at Wits Planetary Health Research, and Kimberly McAlpine, a medical student and PhD researcher at Wits University, point to growing evidence associating high temperatures with preterm birth, stillbirth, low birth weight and hypertensive disorders of pregnancy.
A 2025 study by Carrie Ngongo and colleagues, analysing 22.7 million births in the Democratic Republic of the Congo, found that each 1°C increase in temperature above 34°C was associated with an additional 2.3 stillbirths per 1,000 births and 27.3 maternal deaths per 100,000 live births.
A separate study at a Johannesburg hospital linked high temperatures early in pregnancy to approximately 1.8 times the risk of severe hypertensive disorders, including pre-eclampsia and eclampsia.
Research involving pregnant subsistence farmers in The Gambia has also documented signs of fetal distress during hot weather, including unusual changes in the baby’s heart rate and increased resistance to blood flow through the umbilical cord, which supplies oxygen and nutrients from the placenta.
The scale of concern extends beyond individual studies. A Wellcome-commissioned poll of 1,001 healthcare professionals in Australia, Brazil, India, the United Kingdom and Zimbabwe found that 98 per cent had cared for a pregnant woman whose health they believed had been adversely affected by extreme heat. Meanwhile, 99 per cent reported caring for a baby whose health they believed had been adversely affected by extreme heat.
These findings reflect healthcare professionals’ reported experiences and perceptions, rather than estimates of the proportion of pregnant women or babies experiencing medically confirmed heat-related harm. Nevertheless, they highlight concerns among health workers about the effects of extreme heat on mothers and babies.
As climate change drives more frequent and intense heat extremes, exposure to dangerous temperatures is becoming an increasing health risk. However, this risk is not experienced equally. Social and economic inequalities mean some women have fewer resources and less ability to protect themselves.
For Solarin and McAlpine, the risks cannot be separated from the conditions in which women live.
“Heat exposure is shaped as much by social conditions as by the weather,” they explain.
In informal settlements, corrugated-metal homes can trap heat indoors, while unreliable electricity makes fans difficult to use and water shortages limit opportunities to cool down and stay hydrated. Women who farm, trade outdoors, cook in hot environments or collect water may also have little control over how long they spend in the heat.
Poor sleeping conditions can compound the problem, leaving women exhausted and with little relief even at night.
“The evidence points to the same conclusion across settings that climate exposures amplify existing inequalities rather than creating new ones,” Solarin and McAlpine say.
When avoiding heat is not an option
Climate scientist Dr Jeanne Sambou says pregnancy places additional physiological demands on the body, while many women have limited control over their exposure to heat. A pregnant woman may still need to work outdoors, sell goods at a market, process fish, cook in a hot environment or travel considerable distances to obtain healthcare.
Sambou also emphasises the importance of humidity. When temperatures and humidity are both high, the body has greater difficulty cooling itself through sweating.
Climate Central’s 2026 analysis found that the global average number of days with dangerous humid heat more than doubled, from 10 days a year in the 1970s to 23 days between 2016 and 2025. The analysis identified human-induced climate change as the main driver of this increase.
The Climate Shift Index interactive tool offers a way to explore this influence locally. In Kakamega, western Kenya, the tool showed that climate change made a forecast daily maximum wet-bulb temperature of 19.3°C on 28 October at least 60 times more likely.
Wet-bulb temperature combines heat and humidity to indicate how effectively the body can cool itself. The reading was below Climate Central’s 25°C threshold for dangerous humid heat, but illustrates why assessing heat risks requires looking beyond air temperature alone.
Two women exposed to the same outdoor temperature may face different levels of risk depending on their work, housing, health status and access to cooling and healthcare. Advising women simply to avoid the heat may accomplish little if their livelihoods and household responsibilities leave them with few alternatives.
In Kenya, Chris Abuor, executive director of Kuza Trust, a policy and narrative change organisation working on community-led public health and climate resilience, describes extreme heat as an overlooked threat in rural communities and informal settlements.
“Extreme heat is a silent crisis that I think, as civil society and communities, we have not really wrapped our heads around,” he says.
Abuor points to pregnant women working on farms and those living in poorly ventilated iron-sheet structures in informal settlements. In communities experiencing water shortages, women may also have to walk long distances to collect water, increasing their exposure to heat and physical exertion.
Thandi, who lives in Alexandra, Johannesburg, illustrates the difficulty of following heat-health advice when resources are limited. During her first pregnancy, she did not realise that her exhaustion, difficulty sleeping and discomfort in the heat were worth raising with a healthcare professional.
“Because it was my first pregnancy, I thought feeling exhausted, struggling to sleep and finding the heat difficult to cope with were normal parts of pregnancy. During a clinic visit, I mentioned these difficulties to the clinician and was advised to use a portable fan. However, with the cost of electricity and frequent power cuts, I could not always rely on one,” she says.
Her experience highlights the need for heat-health advice to take account of the practical constraints women face in accessing reliable and affordable cooling.
Drawing on his experience in Kitere Village in Rongo Sub-County, Abuor describes a stream that dried up following a prolonged drought. Women who traditionally bear responsibility for fetching household water must then travel farther to obtain it.
Such experiences reflect a wider challenge across the Horn of Africa, where a study found that human-induced climate change intensified the 2020–2023 drought by increasing temperatures and worsening the effects of low rainfall.
The problem extends to health facilities. Where maternity services lack a constant water supply because of drought, maintaining hygiene during delivery becomes more difficult, potentially increasing the risk of infection after childbirth.
In Nigeria, Dr H.M., a paediatrician and public-health specialist, says heat stress is among a wider range of climate-related risks that can affect maternal and newborn health. She says newborns deserve particular attention because their ability to regulate body temperature is still developing.
“One area receiving too little attention is the effect of climate change on newborns and the very early stages of life,” she says.
What researchers still need to understand
Despite growing international evidence linking extreme heat with adverse pregnancy outcomes, important gaps remain in understanding how these relationships vary across African settings.
Dr Sambou points to a Senegalese study covering more than two million births between 2018 and 2022, which found no statistically significant association between average monthly temperatures and stillbirth or maternal mortality.
She cautions against interpreting this as evidence that heat poses no risk. Monthly averages can conceal short periods of intense heat, while limitations in health and exposure data make it difficult to establish the full relationship.
Temperature recorded at a weather station may not reflect the conditions a woman experiences inside her home, at work or while travelling to a clinic. The intensity, duration and timing of heat exposure may also influence the risks.
Solarin and McAlpine identify another important gap: understanding the biological pathways through which heat affects pregnancy and determining which interventions can prevent harm.
At Wits Planetary Health Research, the Bio-HEAT study is investigating the biological pathways linking heat exposure to preterm birth and other adverse maternal and child health outcomes in South Africa.
In Senegal, SPRINT-Sen examines extreme heat alongside breastfeeding and maternal mental health in northern Senegal.
Both initiatives address questions that extend beyond whether a risk exists to how it develops and what can be done to reduce it.
“We already know enough about heat risk in pregnancy to act now,” Solarin and McAlpine say, while arguing that further African research is needed to identify effective interventions and inform investment.
Policies exist, but implementation remains a challenge
South Africa has a National Climate Change Adaptation Strategy, National Heat Health Action Guidelines and an impact-based warning system operated by the South African Weather Service. Pregnant women are also identified as a vulnerable population in national heat-health guidance.
Yet Solarin and McAlpine describe the gap between policy recognition and practical implementation as substantial.
“The gap is between naming these risks in planning strategies and guidelines, and actually operationalising that recognition and seeing action on the ground,” they explain.
They identify five priority areas: public awareness, clinical protocols, health-facility preparedness, healthcare-worker training and better data.
When a heat warning is issued, clinics need clear guidance on what to do differently, which women may require closer follow-up and what advice healthcare workers should provide. Health workers also need training to recognise heat as a potential risk during pregnancy.
Facilities require adequate ventilation, shaded waiting areas, reliable drinking water and contingency plans for power outages and water shortages.
Temperature-sensitive medicines present another concern. Solarin and McAlpine highlight the need to protect the storage conditions of oxytocin, which is used to prevent and treat postpartum haemorrhage. Prolonged exposure to inappropriate temperatures can compromise medicine quality.
Better data is also essential. Without routinely recording heat exposure alongside maternal health information, it is difficult to monitor impacts or evaluate whether interventions are effective.
At the launch of a new global framework in October this year, the World Health Organization (WHO), alongside the World Meteorological Organization (WMO), UNICEF and the United Nations Population Fund (UNFPA), highlighted the need to improve monitoring of heat exposure and its effects on pregnant women, newborns and children. The framework proposes priority indicators to help countries track health risks, strengthen preparedness and guide targeted interventions.
In Kenya, Abuor argues that the principal challenge is not a lack of policy recognition but a failure to turn commitments into action.
He says climate-resilient infrastructure and resources must reach primary-care dispensaries and rural maternity facilities, rather than being concentrated at major county referral hospitals.
Abuor also advocates stronger supply-chain monitoring to ensure essential medical supplies and emergency obstetric kits are available at frontline facilities, including during floods that disrupt transport routes.
Through Kuza Trust and the Resilience Action Network Africa civil society working group, he says they are working to strengthen community capacity, improve public health surveillance and enhance counties’ ability to respond to climate-related health risks, including extreme heat.
Abuor says the work also draws on broader public-health preparedness approaches, including the 7-1-7 framework for improving the detection and response to infectious disease outbreaks.
In Nigeria, Dr H.M. emphasises the need for climate-resilient facilities and continuity plans for antenatal, delivery and postnatal services. She recommends strengthening community health workers, mobile outreach services, referral systems and emergency transportation so that care can continue when women cannot reach health facilities.
“Implementation should move beyond having a policy document to actually changing how health services prepare for climate risks,” she says.
Turning warnings into protection
Across the four countries, experts point to practical measures that could help protect pregnant women and newborns from extreme heat and other climate-related risks.
Solarin and McAlpine recommend affordable interventions such as reflective roofs, window shading, improved cross-ventilation and shaded waiting areas. Health facilities also need reliable drinking water and contingency plans to maintain essential services during power outages and water shortages.
Heat warnings should prompt specific action, not simply alert the public to rising temperatures. Antenatal clinics could use existing communication channels to share practical advice, while healthcare workers identify women who may need additional support.
Community engagement is equally important. The experts point to work in Kilifi County, Kenya, involving spouses, mothers-in-law and community leaders in discussions about sharing domestic responsibilities and shifting strenuous activities to cooler hours. The approach recognises that women may have limited control over their workloads and need support from their households and communities.
Dr Sambou advocates integrating heat-related advice into routine antenatal care, including guidance on hydration, reducing heat exposure where possible, recognising warning signs and knowing when to seek medical attention. She also stresses the need to prepare for drought and flooding, which can undermine nutrition, livelihoods and access to healthcare.
For Abuor, stronger links between meteorological services, health information systems and frontline health workers are essential to ensure that climate warnings lead to timely responses. Dr H.M. similarly calls for climate adaptation to be integrated into existing maternal, newborn and child health programmes, supported by resilient facilities and plans to maintain care during disruptions.
But adaptation, while essential, cannot eliminate the growing risks if global temperatures continue to rise. The underlying cause is greenhouse gas emissions, particularly from burning fossil fuels such as coal, oil and gas, as well as activities including deforestation and industrial agriculture.
Without decisive action to reduce these emissions, extreme heat will continue to intensify, placing additional pressure on pregnant women, newborns and already overstretched health services.
With COP31 approaching, protecting maternal and newborn health must be part of the wider climate response. This requires both adaptation measures, such as climate-resilient health facilities, and decisive action to reduce greenhouse gas emissions. Accelerating the transition to renewable energy and ensuring that lower-income countries have the resources to protect their populations will be essential.
Ultimately, protecting mothers and babies will require more than advice on coping with hot weather. It will depend on whether health services, communities and policymakers can turn growing evidence of climate-related risks into practical support for women throughout pregnancy and childbirth, while also tackling the emissions that are making extreme heat more dangerous.
As Dr Sambou puts it, “The question is no longer only whether pregnant women are vulnerable. It is what we do differently because they are.”
