The Inequitable Realities and the Opportunity at Hand

Sometimes in May 2023, I was invited to give the keynote address at the University of Michigan’s Global Health Summer Institute 2023 on the topic: Maternal and child health and climate change: The role of socially marginalized groups in disaster risk reduction. Maternal and newborn health is one of the closest topics to my heart given my almost 17 years of dedicated experience in Reproductive, Maternal, Newborn and Child Health (MNCH) , immersing myself in the diverse landscapes of Sub-Saharan Africa and various regions of Southeast Asia.

This keynote address was not just an opportunity to share knowledge and experiences to this eager audience, drawn from many parts of the world but gave me a chance to open up about a subject so close to my heart. . The focal point of my discussion revolved around the vital relationship between
maternal, newborn and child health, climate change, and the crucial involvement of socially marginalized groups in disaster risk reduction.

Fast forward to today when the world is gearing up towards the Africa Climate Summit and the 28th Conference of the Parties of the United Nations Framework Convention on Climate Change (CoP28), all taking place in the last quarter of 2023, I took a moment to reflect back on my Key Note speech and the realities and opportunities at hand for some of the most impacted groups, Women, girls, children, and other socially excluded groups.

Climate change is a grave and mounting threat to our collective well-being and a healthy planet. According to the Intergovernmental Panel on Climate Change (IPCC), the intergovernmental body of the United Nations responsible for advancing knowledge on human-induced climate change report,[1] human-induced climate change is causing dangerous and widespread disruption in nature and thus affecting the lives of billions of people around the world. The hardest hit of these populations are those that already live in existing vulnerabilities. Ironically, these populations are the least contributors to climate change. The report made over thirty (30) references to maternal health highlighting, with high confidence, how pregnant women and children are particularly impacted.

Climate Change

Climate Change and other unexpected shocks such as the COVID-19 pandemic, conflict, and the high cost of living  ( The four C’s) have brought in a new twist to MNCH. While conversations on the “4 c’s” have dominated global and country headlines and attention—women, young people, children, and newborns are increasingly being edged out of these discussions. 

Although climate change affects all sections of the population, countries most reliant on natural resources for their livelihoods are gravely impacted. Women from those countries commonly face multiple risks and bear greater burdens from the impacts of climate change, patriarchy and social norms, poverty, and deepening inequalities.

When I talk about low-income countries, I am referring to those that are especially vulnerable to climate change due to poverty, poor sanitation, malnutrition, illness, non-communicable diseases, inadequate housing, and non-resilient healthcare systems. Extreme weather affects food supplies through outcomes like droughts, flooding, displacement, etc. which impacts the many nutrients needed to support good health during pregnancy. While emerging evidence of the intersectionality between climate and health has created some discussion, we still see little action taken towards pregnant people.

As we speak, the climate crisis is worsening with unacceptably high levels of maternal newborn and child mortality and of course morbidity. The health of women, girls, and their children is further endangered by limiting access to MNCH services and healthcare

 Unfortunately, climate change-related impacts are driving inequities in health outcomes between and within countries. In my view, this is a big deal given that pregnancy increases vulnerability to climate change due to factors like extreme temperatures, air pollution, massive spread of vector-borne diseases, natural disasters, drought, food insecurity, poverty, displacement, extinction, severe storms, flooding, wildfires and so much more – especially for poor and marginalized communities. 

Let me break it further from my own lived experiences as a midwife, an implementer, and now an advocate, working in the most affected region – Sub-Saharan Africa. This is in addition to some pieces of research that have been done on this issue:

Pregnant women

The developing foetus, and newborns have specific biological vulnerabilities to the climate crisis with associated higher rates of miscarriage, preterm birth, and poorer neonatal outcomes and stillbirths.

-Climate change and especially the rising temperature also impacts the patterns of vector-borne diseases, such as malaria and dengue fever in the region. These diseases are more harmful to pregnant women and their unborn babies.

-Pregnant and lactating women face greater risks from food insecurity in combination with the nutritional needs associated with pregnancy and breastfeeding. This could lead to stunting for children and obstructed labor

-Women broadly are poorer than men and face higher risks and burdens from the climate crisis. Pregnant women, and far more so for those facing other forms of marginalization such as poverty, racism, lack of access /poor healthcare or other factors can have specific additional social disadvantages.

-Pregnant women are additionally vulnerable to heat-related conditions, diseases and death. Newborns are especially heat-sensitive with high heat exposure during pregnancy being linked to increased rates of preterm births, low birth weight and stillbirths.

-Smoke and Smog exposure has been associated with preterm births and low birth weight. This has also been associated with hypertensive diseases of pregnancy such as pre-eclampsia and in extreme cases eclampsia

Drought in many parts of Africa has left many pregnant women, new mothers and newborns badly beaten

Many nutrient deficient diseases are prevalent such as anemia which leads to adverse pregnancy results

-Pre-existing health conditions, poor housing and working conditions for women and girls all deepen exposure, driving injustices and inequities in maternal health and child birth outcomes.

It is critical to point out that health adaptation planning and response to the climate crisis has been grossly inadequate, and lacking a gendered focus; but even within this context; maternal and newborn health has been especially marginalized. Most affected groups especially women from SSA and SEA are too often locked out of the decision-making tables and corridors of power where climate change policies are made and adaptation programs designed. If we zoom in the MNCH space, the IPCC report reiterates that addressing inequities in access to resources, assets, and services, and participation in decision-making and leadership, is essential to achieving gender equality and climate justice. It further reveals that intentional long-term policy and program measures and investments to support shifts in social rules, norms, and behaviors are essential to address structural inequalities and create an enabling environment for marginalized groups to effectively adapt to climate change. This will be of high importance as the world moves faster in addressing the urgent climate crisis.

It is important to take into consideration the knowledge and expertise of those living the contexts and the realities of where the climate adaptation policies will be applied if we are to solve the climate crisis and leave a lasting impact. It is important to note that despite facing multiple challenges and various forms of marginalization, women, girls, and indigenous people from the most affected regions of Africa and Asia are leading exceptional work in addressing the climate crisis. Locally led, gender transformative solutions can be traced across the African continent;

from green energy projects in rural Uganda for households and agricultural cooperatives, to empowering rural women through integrated, climate-resilient development in Ethiopia, to local women’s groups in Nigeria engaging with the Green Climate Fund (GCF) among others. These solutions and many others are a testimony to the invaluable leadership of these socially excluded groups in the fight against climate change. Investing in the leadership and solutions by these groups is not just the right thing to do but a mitigation strategy to the climate crisis in itself.

The WRA Kenya ASK-LISTEN- ACT approach proves that when women and girls are at the center of our solutions, listening to them, and acting with them, change is possible. As the Government of Kenya and the African Union prepare to co-host the Africa Climate Summit( 4th- 6th September 2023) ,and as CoP28 beckons in Dubai, UAE (30th November -12th December 2023), it is important that the following critical points are considered in the planning and shaping of the Summit conversations as all players find lasting solutions to the climate crisis:

• Acknowledging that gender equality is key to climate action, and that the voices of women, girls, other socially excluded groups are key to addressing climate change and shaping the climate response agenda
• Supporting solutions for and by women and girls and other socially excluded groups; acknowledging that they live the realities of climate change and have the solutions at hand
• Undertaking more evidence generation that centres listening to the lived experiences of all people most impacted especially those traditionally socially excluded groups and acting with them to address the gaps
• Inclusion of women and girls and other socially excluded groups in every level of decision-making processes by ensuring equal representation and meaningful engagement of women, girls, people with disabilities, indigenous groups, and youth in their diversity at all climate change conversations
• Meaningfully engaging and including these groups in the development of funding criteria and resource allocation for climate change initiatives, including adaptation, mitigation, technology transfer, and capacity strengthening at all levels with matching financing and capacity development on mitigation strategies for sustainability.
• An inclusive development of national and regional climate learning strategies that are transformative and recognize the importance of the leadership of these groups by prioritizing active citizens engagement, policy processes, and activism, and meaningfully engaging all players that are excluded:- girls and women in all their diversity in the development of these strategies.
• Allowing women and girls and other socially excluded groups to hold governments and other key actors in the climate change conversations to account for commitments made and resources spent