“Women aren’t getting the medical care they need.”
Flood-affected women return to their makeshift shelter after receiving hygiene kits and other essentials. Image by United Nations Civil Protection and Humanitarian Aid via Flickr. 2022. CC BY 2.0.
In Pakistan, internally displaced women who have already lost their homes and livelihoods face unique pressures, particularly regarding women’s health and maternity care.
Pakistan is one of the countries most vulnerable to the effects of climate change. Rising temperatures, sporadic monsoons and severe droughts are the new normal, forcing millions of people to flee, especially in the north. According to the Internal Displacement Monitoring Centre (IDMC), more than three million Pakistanis will be internally displaced by natural disasters in 2023 alone.
Pregnant women on trial in camps
Shabana Bibi (not her real name), a 28-year-old woman living in a remote area of northern Pakistan, never expected climate change to force her to make tough decisions about her health and her family. Shabana and hundreds of others have been living in makeshift settlements for almost a year now after being displaced by devastating floods in Chitral province in July 2023.
“In an instant, everything was gone,” Shabana recalled. “Our home, our crops, our livestock. We had to flee with just the clothes on our backs.” Her family fled to a makeshift camp on higher ground, joining hundreds of other displaced families.
While the journey to the camp was terrifying, the hardships she endures every day highlight a much deeper problem: a lack of female health resources and obstetric care among women displaced as a result of climate change.
Similarly, when Geeta (not her real name) felt the first shudders of labour pain, she realised she was unprepared. The 25-year-old had been living in a makeshift tent with her two children after relocating from her home in the drought-hit Tharparkar district of Sindh province in southern Pakistan. The continued drought had forced Geeta and countless other families to seek refuge in other parts of Sindh. As she held her growing belly, the fear of what was to come overwhelmed the joy of bringing a new life into the world.
Shabana Bibi and Gita’s plight is a poignant reflection of a pressing crisis in Pakistan, where climate-driven migration is having a devastating impact on women’s health and motherhood.
Women are particularly vulnerable
As a result of displacement, women are affected even more severely than men. Pregnant women living in temporary settlements with limited access to health care, sanitation and nutrition face greater risks. The stress of displacement, combined with inadequate living conditions, often exacerbates pregnancy and birth problems. Similarly, lack of access to routine contraception and feminine health products can lead to unplanned pregnancies and other health problems.
Samina Hussain, an obstetrician working with local NGOs in central Punjab province, which was hit hardest by the floods, reveals that many displaced women neglect their antenatal and postnatal check-ups. “The situation for internally displaced people is dire. Women do not have access to the medical care they need, and many are afraid or too far from health facilities to seek help,” she says. With limited access to proper medical care, pregnancy problems often go untreated. In such situations, infections, malnutrition and high blood pressure, which can be quickly treated at a proper health facility, become life-threatening. Dr Hussain recalls an incident where a woman living in a rural area lost her baby after being transported more than three hours to the nearest hospital, only to lose it due to delays and lack of proper health facilities.
Fatima confides her fears about giving birth amid displacement and relocation: “I have seen women suffering here. Health facilities are not equipped to handle emergencies. My neighbour lost her baby because there was no doctor at the time. I don’t want that to happen to me,” she says, her voice breaking with emotion.
Dealing with the stress of relocation
Climate displacement disrupts health services and is exacerbated by other stresses. The mental and physical stresses of displacement often lead to difficulties during pregnancy and childbirth.
Experts from Pakistan’s National Institute of Health elaborated that stress hormones such as cortisol are affected by both temperature and stress, which can have a negative impact on pregnancy outcomes. Elevated cortisol levels, which are frequently found in displaced communities, are correlated with premature births and low birth weight.
Naila, a newly married woman who is expecting her first child, is suffering from severe anxiety and depression, which is exacerbated by the uncertainty of the situation. “I worry every day about my children’s future. I don’t know how I will support this newborn baby,” she confides.
“Climate change is an existential threat to all of us, but pregnant women, infants and children face the most severe impacts,” said Bruce Aylward, Deputy Executive Director for Universal Health Coverage and Life Course at the World Health Organization (WHO). “Children’s futures need to be protected intentionally – this means taking climate action now for their health and survival, while ensuring that the climate response recognizes the specific needs of children.”
The impact of climate change on menstrual and reproductive health, especially on displaced women, is exacerbating existing multifaceted problems. The relationship between changing environmental conditions and impaired reproductive health is becoming clear. Rising temperatures and severe weather events have been reported to affect menstrual cycles and overall reproductive health, creating additional hardship for women like Shabana. For example, extreme heat waves in Pakistan have been linked to irregular menstrual periods. The National Institutes of Health has found that stress hormones such as cortisol can disrupt the menstrual cycle. Increased cortisol levels during extreme heat can lead to illnesses such as dysmenorrhea, characterized by severe period pain, or delayed or complete cessation of menstruation.
Food insecurity
The impact of climate change on agriculture is also leading to food insecurity, seen as one of the most pressing issues for pregnant and breastfeeding women. As unpredictable weather trends alter crop yields, communities worry about whether they will be able to provide enough food for themselves and their children. “How can I bring a child into the world when I can’t even feed myself?” worries Amina, who fled her drought-hit village in Balochistan.
“We barely have enough food to feed ourselves,” Shabana explains as she shares the dire plight of other pregnant women. “Most days, the women survive on lentils and rice. There is no milk or fresh vegetables.” The restricted diet is affecting not only their health, but also their ability to produce enough breast milk for their newborns.
According to the WHO article “Protecting maternal and child health from the impacts of climate change”, the impacts of climatic phenomena on maternal and infant health are overlooked, underreported and underestimated. The article highlights that few climate change response plans mention maternal and child health, describing this as “a glaring omission and emblematic of the insufficient attention to the needs of women, newborns and children in the climate change debate”.
Despite these daunting obstacles, attempts are being made to improve the situation. Local NGOs and international organizations are stepping up efforts to identify urgent needs for maternal and child health services in IDP camps and areas with high levels of displacement. One key project, by the Turkish Cooperation and Coordination Agency, is developing mobile clinics to provide pre- and post-natal care to women living in isolated locations. Staffed by trained midwives and loaded with essential medical supplies, these mobile units will travel to different camps to provide vital health services. But there is still much to be done. The extent of climate displacement and the frequency of climate disasters are increasing, and our resources are inadequate.
