Baba Island, Pakistan: On a densely populated island off the coast of Pakistan’s megacity Karachi, a group of pregnant women brave the sweltering heat to wait for the only midwife to arrive from the mainland.
Neha Mankani travels weekly by boat ambulance to Bhabha Island, an old fishing village with about 6,500 people crammed into an area of 0.15 square kilometers (0.06 miles), making it one of the most densely populated islands in the world.
Climate change is causing the surrounding seas to expand and rising temperatures to scorch the land, leaving pregnant women stranded and at the mercy of the elements until Mankani’s ambulance began operating last year.
At the entrance to the island’s clinic, Zainab Bibi, 26, is waiting. She is pregnant again after suffering a miscarriage in the middle of her pregnancy last summer.
“It was a very hot day and I was feeling very sick,” she recalled. After hours of her husband negotiating with the shipowner, he finally agreed to take them on a boat to the mainland, but it was too late.
“By the time I delivered the baby at the hospital, he had already passed away,” she said.
Pakistan is one of the countries most vulnerable to extreme weather caused by climate change, and heat waves are becoming hotter, lasting longer and occurring more frequently.
In May and June, consecutive heat waves saw temperatures exceed 52 degrees Celsius (126 degrees Fahrenheit) for several days in a row.
“Climate change does not affect everyone equally,” Mankani, 38, told AFP during the 20-minute boat trip.
“Pregnant women, newborns and postpartum women are definitely more affected,” she said.
“During the summer months, we see a real increase in low birth weight babies, premature births and miscarriages.”
A paper published in the British Journal of Obstetrics and Gynecology last year by experts found that women are at increased risk of stillbirth if they are exposed to temperatures above 90 per cent of the normal range for their location.
“Before, there was a lack of evidence and a lot of it was anecdotal,” Mancani said, “but the effects of climate change have been visible for some time.”
According to the United Nations, 154 women die for every 100,000 live births in Pakistan, and this high maternal mortality rate is shaped by socio-economic status, barriers to accessing healthcare and limited decision-making power, especially for young women.
Mankani began her 16-year career as a midwife in a Karachi hospital, working in high-risk wards and often treating women from the five islands scattered off the coast.
She founded the Mama Baby Foundation in 2015 and set up the islands’ first clinic for pregnant women and new mothers. “People welcomed us from their homes,” she said.
This was followed last year by a free 24/7 boat ambulance equipped with essential equipment to navigate rough seas in an area increasingly prone to flooding.
After suffering a stillbirth and a miscarriage in seven months, 26-year-old Sabira Rashid gave birth to a baby girl, named Esha, two months ago and blames her painful loss on not getting to hospital in time.
“At the dock, we are made to wait as they only want to pick up two or three people. In case of any emergency, we are asked to wait until there are more passengers,” she said.
Girls on the impoverished islands are often married off as early as 16, and marriage is seen as a source of security for women in an area where polluted waters have decimated fishing industries.
“Most of these girls do not know how to take care of themselves and have severe infections due to constant exposure to dirty water,” said Shahida Sumar, an assistant at the clinic, wiping sweat from her face.
The 45-year-old said basic advice is offered to young mothers during heatwaves, such as wrapping newborns in a clean, dry towel, washing breasts before feeding and staying well hydrated.
But with no running water and little electricity, preventing heatstroke is a challenge for all islanders.
Women are particularly at risk, often cooking over open fires in small rooms without fans or proper ventilation.
Aisha Mansour, 30, has four children and lives on the outskirts of Baba, where she has access to electricity for just four to five hours a day.
The path to her house is covered with discarded plastic bags and disappears underwater at high tide.
“Only those who have solar power systems can cope with the heat. We don’t have that luxury,” she said, waving away a fly that had landed on the baby.
Mariam Abu-Bakr, 18, who grew up on the island and works as an assistant at the clinic, hopes to become the island’s first full-time midwife.
“I wondered why there was no facility for us women here, no clinic that could cater to our specific needs,” she said.
“When Neha opened the clinic, I saw a way I could help women in my community.”
