PMNCH Knowledge Summary #32 Protecting women’s and children’s health from a changing climate
Publisher: The Partnership for Maternal, Newborn and Child Health
Publication date: 2014
Language: English only
Climate change increases challenges to women’s and children’s health. There is more likelihood of women and children suffering and dying from problems such as diarrhoea, undernutrition, malaria, and from the harmful effects of extreme weather events, including floods or drought. While women and children in developing countries have made comparatively small contributions to historical carbon emissions, they bear the brunt of the health effects of climate change, both now and in the future. Efforts to prevent, mitigate and address the effects of climate change should include integrated action across sectors to address these health inequities now and for future generations.
The International Panel on Climate Change (IPCC) Fifth Assessment Report notes that up to 2050, the main impact of climate change on health will be an increase in illness and deaths related to the environment.1 This means people who are already vulnerable to diarrhoea, malaria and undernutrition will be at increased risk from the harmful effects of climate change on water, food and transmission of diseases by insects. There is also an increased risk of illness and death from many types of extreme weather events, emergencies and disasters. Those who are most at risk include marginalized populations due to geography, age, gender, ethnicity, displacement, disability and socioeconomic status.1, 2 Among these groups, pregnant and lactating women and children will be particularly vulnerable.3 For women whose livelihoods depend on the environment, including those in rural and tribal populations, climate change will intensify loss of land and unemployment. As many as three million neonatal deaths and stillbirths are attributable to poor maternal health, particularly from poor nutrition and infectious diseases.3 Globally, 99% of deaths related to climate change occur in low- and middle-income countries and of these deaths, 80% occur among children.4
What we know
Reduced access to a safe and secure water supply and sanitation
The United Nations Children’s Fund (UNICEF) estimates that over 1 800 children die everyday from illnesses linked to contaminated water, lack of sanitation, or inadequate hygiene.5 Similarly, maternal mortality is significantly higher with poor hygiene practices during and after birth.3 In low income countries throughout Africa, Asia and South America, over 50% of all urban residents already suffer from diseases associated with poor water quality and sanitation facilities.6 Climate change will increase morbidity and mortality related to poor water quality and access. More seasonable variability in rainfall and temperatures increases breeding opportunities for insects, bacteria and other germs. More frequent droughts lead to water shortages, particularly for human use, thereby reducing opportunity for appropriate hygiene practices. Where flooding has become more frequent, sanitation systems are often overwhelmed. This increases the chance of drinking contaminated water and incidence of water-related illnesses such as cholera, typhoid and diarrhoea.7
Increased food insecurity and undernutrition
Climate change impacts on the key determinants of maternal and child undernutrition, namely: household food access, maternal and child feeding practices, and access to health services.8 Reduced access to quality food and related undernutrition leads to micronutrient deficiencies. This is a significant problem for women during pregnancy and when breastfeeding due to increased nutritional needs. Twice as many women suffer from malnutrition as men, and girls are twice as likely to die from malnutrition as boys.9 The Food and Agriculture Organization of the United Nations (FAO) estimates that as many as three million children under five die every year from undernutrition.9 The International Food Policy Research Institute (IFPRI) projects that as a result of climate change, 25 million more children will be malnourished in 2050.10 Malnourishment has devastating impacts on cognitive development and learning opportunities. Every day, 66 million primary school children attend class hungry. This could get worse over the coming decades as food crops are expected to decline as a consequence of climate change.11
The rise in global temperatures, changes in rainfall patterns and increased frequency of extreme events can increase or decrease crop productivity. For populations already suffering from hunger and food insecurity, the projected decline in crop productivity can reduce essential food crops and lead to higher prices.12 This leads to greater food insecurity, undernutrition and ill health.1 Food safety may also decline due to an increase in existing infections, such as those transmitted by domestic animals, or the emergence of new ones.13
Increase of infectious diseases
Women and children are more vulnerable to disease if they are poor and have less access to health clinics and affordable health care. Malaria and dengue are among the infectious diseases of greatest concern for public health.14 Children, pregnant women and people living with HIV/AIDS are at considerably higher risk of contracting malaria and becoming severely ill.15 In 2012, there were an estimated 627 000 malaria deaths globally, of which 77% were children under the age of five.16 Malaria in pregnancy can lead to anaemia, spontaneous abortion, stillbirth, prematurity and low birth weight.16 Dengue, like malaria, is transmitted by mosquitos. It is the fastest growing of such infectious diseases, particularly in urban tropical areas. There has been a 30-fold increase in dengue over the last 50 years. This is due in part to higher temperatures, longer summers, and changing rain patterns.17 This allows mosquitos carrying and transmitting dengue to live longer and travel further, increasing the risk of infection. Dengue fever has become a leading cause of hospitalization and death among children in Latin America and Asia.18
Fluctuations in global temperatures and rainfall patterns reduce the transmission of some disease-causing organisms, and create new opportunities for others. Changes in rainfall can affect their transport and dispersal; fluctuations in temperatures affect their reproduction, growth and survival.
Increased vulnerability from warmer and more extreme weather
Extreme weather events such as floods, landslides, hurricanes and heat waves result in emergency and disaster situations, which increase stress on health and the health sector. They also increase the likelihood children will die from drowning, exposure to disease and trauma, become separated from their families and interrupt their education.19, 20 Extreme weather events can also discourage new mothers from breastfeeding their babies and lead to poor maternal and infant nutrition.3 In low income countries, more women die in extreme weather events than men: 90% of those killed in the 1991 cyclone in Bangladesh and 80% in the 2004 Indian Ocean tsunami were women and girls.21 Women who are socially and economically marginalized are less likely to know how to swim, or have access to warning systems and rescue mechanisms.21 For survivors, indirect health effects include vulnerability to sexual violence, exploitation and disruptions in health services. This increases the likelihood of dropping out of school, entering into early and forced marriage and unintended pregnancy, as well as increased exposure to civil conflict,22 and reduced mental health.23 Women and children will bear the burden of increased violence, whether civil or interpersonal, thus increasing their likelihood of mental illness.
Engaging with the health sector to strengthen services and reduce emissions
Better and sustained funding of women’s and children’s health is essential to protecting them from the negative effects of climate change. This includes building health systems that are capable of dealing with gradual and sudden changes and maintaining quality of care during disaster and emergency conditions.3 The health sector can also play a key role in reducing emissions. Improving access to reproductive health services and technologies will help to reduce population pressures. Improving environmental conditions and responding to health challenges related to climate change will not be possible in a context of continuing rapid population growth.24
Addressing nutrition and food security across the RMNCH continuum of care
The integration of reproductive, maternal, newborn and child health (RMNCH) and nutrition services are essential to promoting health and reducing hunger and undernutrition among women and children. Across the continuum of care for women’s and children’s health, direct nutrition interventions are needed that ensure food security, provide nutritional education, and promote good nutrition and feeding practices. Investment in drought and water resistant crops and water-conserving systems can increase the availability and diversity of food. Subsistence agricultural production for households, agriculture extension, and microfinance targeted at women producers can enhance both production and nutrition. In rain-fed agricultural areas, teaching women water harvesting and purification techniques can also help reduce risks. Agricultural systems that rely on locally supplied and produced energy also improve nutrition and economic security.
Gender mainstreaming in climate change policy and implementation
Gender needs and perspectives should be taken into account when developing climate change policies. Following natural disasters, women are key to protecting, managing and recovering household resources, and can be powerful contributors to development and change. Women must be able to participate in climate change mitigation and adaptation strategies at the national and local level.
Environmental policies that produce co-benefits for health
Climate change threatens environmental stability and predictability. A more sustainable use of resources both protects the environment and improves health. There are a number of ways this can be achieved. Improved management of water resources and safe disposal of waste can be done through more sustainable use of water resources, such as rainwater harvesting and investing in better sanitation and recycling facilities. Nutrition can be improved through the adoption of better agricultural practices that reduce the impact on soil and deforestation, and improve irrigation methods to protect water resources. The production of wild and cultivated foods also improves nutrition and biodiversity. Planting trees can improve degraded lands and help to reduce land-slides and soil degradation. This can increase land productivity, food production and in turn, food security.14
Climate change will have a substantial impact on the health and survival of future generations.3 Efforts to reduce emissions and adapt to the impacts of climate change must ensure action is taken across the health, transport, energy and agriculture sectors to improve health. Such coordinated action has the potential for many co-benefits, which would have major health benefits for women and children, as well as for the environment. Likewise, policies that address broader health protection, including agriculture and water supply, can work both to prevent mortality from climate change as well as reduce the significant economic losses from damages to health.25 The upcoming UN Climate Change Summit and on- going Post-2015 development discussions provide a unique opportunity to prioritize policies in response to climate change that protect vulnerable populations, particularly women and children, both now and in the future.
1. International Panel on Climate Change. Climate Change 2014: Impacts, Adaptation, and Vulnerability. Chapter 11: Human Health: Impacts, Adaptation, and Co-Benefits; 2014. http://www.ipcc.ch/report/ar5/wg2/ 2. Gender, Climate Change and Health. Geneva: World Health Organization; 2011. http://www.who.int/globalchange/publications/reports/gender_climate_ change/en/ (accessed 27 July 2014) 3. Rylander C, Odland JO, Sandanger TM. Climate change and the potential effects on maternal and pregnancy outcomes: an assessment of the most vulnerable--the mother, fetus, and newborn child. Global health action. 2013;6:19538. doi:10.3402/gha.v6i0.19538. 4. The Challenges of Climate Change: Children on the front line. Florence: United Nations Children’s Fund. Office of Research; 2014. http://www.unicef-irc.org/publications/716 (accessed 10 July 2014) 5. Children dying daily because of unsafe water supplies and poor sanitation and hygiene. New York: United Nations Children’s Fund; 2013. http://www.unicef.org/media/media_68359.html (accessed 5 August 2014) 6. Meeting the MDG drinking water and sanitation target: The urban and rural challenge of the decade. Geneva: World Health Organization, United Nations Children Fund; 2006. http://www.who.int/water_sanitation_health/monitoring/ jmp2006/en/ (accessed 10 July 2014) 7. Diseases related to water and sanitation. London: Water Aid. www.wateraid. org/~/media/Publications/water-related-diseases.pdf (accessed 10 July 2014) 8. Tirado MC, Crayah P, Mahy L, Zanev C, Neira M, Msangi S. et al. Climate change and nutrition: creating a climate for nutrition security. Food Nutr Bull. 2013;34:533-547. 9. Women play a decisive role in household food security, dietary diversity and children’s health. Rome: Food and Agriculture Organization of the United Nations; 2008. http://www.fao.org/gender/gender-home/gender-programme/gender-food/en/ (accessed 10 July 2014) 10. Nelson GC, Rosegrant MW, Koo J, Robertson R, Sulser T, Zhu T, et al. Impact on Agriculture and Costs of Adaptation. International Food Policy Research Institute (IFPRI), Washington DC, 2009. http://www.ifpri.org/sites/default/files/publications/pr21.pdf 11. Two minutes to learn about: School Meals. Rome: World Food Programme; 2012. http://documents.wfp.org/stellent/groups/public/documents/communications/ wfp220221.pdf (accessed 10 July 2014) 12. Wheeler T. and von Braun J. Climate change impacts on global food security. Science. 2013;341: 508-513. doi:10.1126/science.1239402. 13. Tirado MC, Clarke R, Jaykus LA, McQuatters-Gollop A, Frank JM. Climate change and food safety: a review. Food Res Int. 2010;43:1745-1765. 14. Healthy Environments for Healthy Children. Geneva: World Health Organization and United Nations Environment Programme; 2010. http://www.who.int/ceh/publications/hehc_booklet/en/ (accessed 10 July 2014) 15. Hales S, Edwards SJ, Kovats RS, editors. Impacts on health of climate extremes: in Climate Change and Human Health. Geneva: World Health Organization; 2002. http://cdrwww.who.int/globalchange/publications/climatechangechap5.pdf 16. World Malaria Report. Geneva: World Health Organization; 2013. http://www.who.int/malaria/publications/world_malaria_report_2013/en/ (accessed 10 July 2014) 17. Better environmental management for control of dengue. Geneva: World Health Organization; 2014. http://www.who.int/heli/risks/vectors/denguecontrol/en/ (accessed 10 July 2014) 18. Benitez MA. Climate change could affect mosquito-borne diseases in Asia. Lancet. 2009; 373:1070. 19. Children’s health and the environment: A global perspective. Geneva: World Health Organization; 2005. http://www.who.int/ceh/publications/handbook/en/ (accessed 5 July 2010) 20. Climate change: children’s challenge. London: United Nations Children’s Fund UK; 2013. http://www.unicef.org.uk/Latest/Publications/climate-change-reportjon- snow-2013/ (accessed 5 July 2014) 21. Protecting Women and Girls from the Impacts of Disasters. New York: Women’s Refugee Commission; 2011. http://www.womensrefugeecommission.org/ blog/1223-protecting-women-and-girls-from-the-impacts-of-disasters (accessed 10 July 2014) 22. Hsiang SM, Burke M, Miguel E. Quantifying the influence of climate on human conflict. Science. 2013; 341: 1235367. doi:10.1126/science.1235367. 23. Frumkin H, Hess J, Luber G, Malilay J, McGeehin M. Climate change: the public health response. Am J Public Health. 2008;98: 435-45. doi:10.2105/ AJPH.2007.119362. 24. A Commission on climate change. Lancet. 2009;373:1659. doi:10.1016/S0140- 6736(09)60922-3.24. 25. Hutton G. The economics of health and climate change: key evidence for decision making. Globalization and Health. 2011; 7:1-7.
Scientific writer: Jennifer Franz-Vasdeki. Contributors and reviewers: Holly Atkinson, John Balbus, Protik Basu, Cara Beasley, Diarmid Campbell-Lendrum, Bernadette Daelmans, Kate Eardley, Lucia Fernandez, Andres de Francisco, Sepi Golzari, Toby Kasper, Fran McConville, Melinda Kimble, Philip J. Landrigan, Kelly Lou, Irma R. Makalinao, Paul Mitchell, Carole Presern, Elena Rahona, Alastair Robb, Jan-Willem Scheijgrond, A. Tianna Scozzaro, Marta Seoane-Aguilo, Katherine Shea, Perry Sheffield, Kimberly Thigpen-Tart, M. Cristina Tirado-von der Pahlen, Elena Villalobos, Joanna Vogel, Nick Watts. Coordinating team: Kadi Toure, Shyama Kuruvilla, Rachael Hinton, Vaibhav Gupta, Marie-Noel Bruné, Marina Maiero. Design by Roberta Annovi.