The effects of climate change are already being experienced in some regions Picture: Stock image
The effects of climate change are already being experienced in some regions Picture: Stock image

Climate change, excessive heat and maternal and newborn health

By Time of article published Nov 11, 2021

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Dr Yogan Pillay and Dr Manala Makua

We are, regrettably, in the era of colliding or compounding global epidemics making the future uncertain for every generation that succeeds us. While this is a scary thought, it should also be an urgent call to action.

Between 31 October and 12 November, the United Kingdom is hosting the 26th United Nations Climate Change Conference of the Parties (COP 26). This event is arguably the last real chance that global and national leaders have to make decisions that will prevent ongoing large-scale damage to the planet and its people. As President Ramaphosa noted, there is great urgency to rapidly retard the rate of global warming and deal with the effects of climate change.

Climate change and excessive heat is likely to exacerbate the already high maternal and newborn mortality, especially in low and middle countries, and in Sub-Saharan Africa, in particular. According to the WHO, Sub-Saharan Africa accounts for roughly two-thirds or 196 000 maternal deaths, with South Asia accounting for nearly one-fifth or 58 000 annually. Put another way, the maternity mortality ratio in low-income countries is 462 per 100 000 live births while it is 11 per 100 00 in high-income countries.

Similarly, according to Unicef, neonatal mortality is 27 per 1000 live births in sub-Saharan Africa and 25 per 1000 in South Asia. Put another way, a child born in sub-Saharan Africa is 10 times more likely to die in the first month of life than a child born in a high-income country, while a child born in South Asia is nine times more likely to die.

In South Africa, according to the South African Medical Research Council, the maternal mortality ratio is estimated at 134 per 100 000 live births, with the neonatal mortality rate at 12 per 1000 live births. There is evidence that these rates increased as a result of the Covid-19 pandemic in the last year.

It is clear that pregnant women and newborns are already extremely vulnerable, which simply means that this situation is going to get worse due to pandemics and the impact of climate change. Unless we act now, the existing inequity in mortality between the global north and the global south and the rich and the poor will only get wider.

What we know is that the biology of pregnancy creates specific vulnerability to climate change. Pregnant women are more at risk for heat-related illnesses than their non-pregnant counterparts. In addition, moms exposed to extreme heat during pregnancy are at higher risk of stillbirths, pre-term births and delivering low birth weight infants.

Increased heat is already a reality for many – including people living in informal settlements, where the houses are often built of corrugated iron with little or no ventilation!

UN Habitat estimates that a staggering one billion people live in so-called ‘slums’. These people are highly vulnerable to climate change and poor health outcomes. Among this number are pregnant women who do a variety of outdoor work and the homeless who are continuously exposed to the elements.

Increasing temperature is also associated with increases in the rates of malaria, dengue and Zika, which are more harmful to pregnant women compared to non-pregnant women as well as their foetus. Additionally, droughts and floods decrease food security which impacts on maternal nutrition. Further, the odds of an under-five child suffering from a respiratory illness is up to five times higher when fossil fuel is used for indoor cooking in a home with poor ventilation.

What is the state of readiness of South Africa to deal with climate change, and what has been done in the past decade on climate change and health?

In 2011, the South African government published the National Climate Change Response White Paper, which has several goals and objectives, including a focus on heat stress, and called for heat-health action plans. Subsequently, in 2014, the Ministry of Health published its National Climate Change and Health Adaptation Plan for the period 2014 to 2019.

While the Department of Environmental Affairs has published two reports on climate change in 2015 and 2017, there is little evidence that much has changed. This clearly illustrates that policies and plans are necessary but clearly not sufficient! We need additional resources as well as activism to get plans implemented as there is little time to waste.

What’s to be done? Here are a few actions we can take now.

Develop government-wide policies that increase awareness of the impact of excessive heat on pregnant women and newborns as well as strategies to mitigate its impact & support civil society organisations to hold governments accountable for implementation

Consider the use of cash transfers for indigent pregnant women to enable them to protect themselves during their pregnancy and the post-partum period.

Monitor heat levels especially in poorly constructed and poorly ventilated homes.

Work with employers to protect pregnant women from working in environments with excessive heat and explore the option of flexible working hours.

Make health workers aware of the dangers of excessive heat and its impact on pregnant women and their newborns and share knowledge on how to mitigate the impact of heat (staying out of the sun, hydration, etc).

Collaborate with other government Departments to ensure the availability of free and clean drinking water in strategic places to improve hydration status, especially for pregnant women and children under five living in informal settlements and rural areas.

Promote the development of family, clinic and community gardens from which pregnant women can obtain fresh produce.

Improve access and quality of health and social welfare services for pregnant refugees and their newborns and for those that are homeless.

A quote from President Nelson Mandela can be used to summarise what we need to do: “It is in our hands to create a better world for all who live in it”. This quote speaks to both our responsibility as well as the importance of equity. Let us not leave pregnant women and newborns behind – especially the poor!

*Dr Pillay is an Affiliate: Centre for Global Health Innovation at the George Washington University and Dr Makua is the Chief Director for Women and Maternal Health at the, National Department of Health

** The views expressed here are not necessarily those of IOL and Independent Media.

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