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Climate change and maternal health
ETHICS/EDUCATION
Climate change and maternal health
Recent research supports this view. Women and children were estimated to be 14 times more likely to die in natural disasters than men. In the 2004 Asian Tsunami more than 70% of deaths were among women, and in the Bangladesh cyclone disaster of 1991, 90% of victims were female. Although neither the tsunami nor the cyclone were proven to be climate-related, such disasters resemble climate change in some details and, as such, provide useful proxies for insight into how climate change affects different sections of the population in different ways. In the aftermath of disasters, maternal health is especially at risk. Damage caused to health facilities and infrastructure during floods, storms and fires poses an immediate threat to pregnant women, new mothers and their children. Road and transport problems, coupled with interrupted power supplies drastically hamper key medical care services and render access to sanitary medical equipment, neonatal services and emergency ward care difficult. The destruction of storage facilities may ruin medicines, blood supplies and samples and other healthcare items, such as vaccines and sterilization materials. Meanwhile the disruption of potable drinking water supplies, a common consequence of natural disasters and droughts, poses another threat to maternal health through the spread of water-borne diseases like cholera and diarrhoea, to which pregnant women may be particularly at risk. Furthermore, under extreme weather conditions, associated problems such as water-logging, and the proliferation of mosquitoes also increase a pregnant woman’s chances of infection from vector-borne diseases such as malaria. Even after the physical signs of disaster have faded, women are still exposed to the longer-term social ramifications of climate change. Women tend to endure much of the psychological burden of climate change, as they struggle to hold families together following deaths, during climate-related conflicts and violence, or when seeking refuge after population displacement e all of which are likely to increase in the coming years. Gender-based violence, sadly pervasive in most societies, often increases in the aftermath of disaster, and entrenched sexism results in uneven distribution of information and financial support in the wake of catastrophes. It is not only the events surrounding climate-change disasters that threaten maternal health. Smaller daily changes wrought by climate change can be equally damaging. Women’s traditional dependence on natural resources, involvement in agricultural work (an estimated 70% of agricultural workers are women) and food and water collection renders them particularly vulnerable to physical and psychological stress and poverty as a result of food and water shortages. Pregnant women are particularly at risk from bad quality water supplies and dehydration. Moreover, a woman’s traditional role as mother and primary carer often results in her sacrificing her own nutritional needs during food shortages in order to feed her children and husband. At the peak of the Maha Akal drought in Rajasthan, India, women were eating less than men in 82% of hamlets. Culturally-enforced gender inhibitions also impact on women’s survival chances; during the 2004 tsunami, one reason for the large number of deaths among women was the sense of shame that kept them from running to the shore when the waves ripped their clothing. In the Nagapattinam district in India, women’s inability to swim, a further consequence of cultural norms, proved fatal for many. Mortality rates among those who could swim were 60% lower.
Mala Rao Emmeline Buckley
In March 2009 delegates from nearly 80 countries met at the International Scientific Congress in Copenhagen to discuss climate change. Their conclusions were grim: they confirmed that worstcase scenario trajectories, as estimated by the Inter-Governmental Panel for Climate Change, are being realized and that, left unchecked, many of the trends may accelerate in the near future, leading to an increasing risk of abrupt or irreversible climatic shifts. Now, in 2011, the effects of climate change are already palpable. The developed world e Britain, France, Spain, and Italy e often seemingly impervious to such events, has seen lives lost during the unbearable summer of 2003, and due to dramatic flooding. More often, however e and as highlighted at Copenhagen in 2009 e it is the developing world that bears the brunt of climate disasters: India and Pakistan in 2010, and Sri Lanka and Brazil in January this year have all suffered from devastating climate disasters. Heat waves and droughts causing food shortages and illness are now common events. The Sunderbans in Bangladesh and India have already begun to disappear from rising sea-levels, while cases of dengue fever have increased by 50% in Indonesia in recent years due to rising temperatures and changing patterns of vector-borne disease, and the incidence of malaria in places such as India and parts of Africa are a major cause for concern. Against this background, we are hoping to achieve the eight Millennium Development Goals by 2015. These goals identify key targets in an attempt to ‘improve lives’: they address hunger and poverty, child mortality, infectious diseases, education, poor maternal health and gender inequality and empowerment. Environmental sustainability is also listed as a goal e separately. What has become clear over the past decade, however, is that the environmental considerations cannot realistically be detached from human and economic factors: ‘the MDGs themselves are undermined by the early impacts of climate change’. This is especially true for those MDGs relating to women’s health, well-being and empowerment. Both history and recent experience have shown that when conditions are harsh and resources scarce, the poor and groups marginalized by more than poverty e women, the young, the elderly, indigenous populations and other minorities e are most vulnerable.
Mala Rao MBBS MSc PhD FFPH Hon FFSRH is Professor of International Health, University of East London and Honorary Public Health Adviser, Administrative Staff College of India, Hyderabad, India. Conflicts of interest: none declared. Emmeline Buckley BA (Hons) MSc is an Independent Health Policy Researcher. Conflicts of interest: none declared.
OBSTETRICS, GYNAECOLOGY AND REPRODUCTIVE MEDICINE 21:12
356
Ó 2011 Elsevier Ltd. All rights reserved.
ETHICS/EDUCATION
FURTHER READING 1 United Nations Population Fund (UNFPA), State of world population 2009. Facing a changing world: women, population and climate. New York: UNFPA, (USA). Available from: http://www.unfpa.org/swp/ 2009/en/pdf/EN_SOWP09.pdf; 2009 (accessed 3 August 2011). 2 United Nations Population Fund (UNFPA)/Women’s Environment and Development Organisation (WEDO). Climate change connections: a resource kit on climate, population and gender. New York: UNFPA, WEDO (USA). Available from: http://www.unfpa.org/public/ publications/pid/4028; 2009 (accessed 10 April 2011). 3 Aguilar L. IUCN Fact sheet: climate change and disaster mitigation. Cited in: Araujo A, Quesada-Aguilar A, Aguilar L, Pearl R, IUCN Factsheet: Gender equality and adaptation, United Nations Economic Commission for Africa [Internet] (date unknown). Switzerland: IUCN. Available from: http://www.uneca.org/acpc/resources/Gender-and-climate-change/ IUCN_Factsheet_Adaptation.pdf; 2004 (accessed 4 August 2011). 4 Soroptimist International of the Americas. Reaching out to women when disaster strikes, White paper: disaster relief. Soroptimist International of the Americas, [Internet]. Available from: http://www. soroptimist.org/whitepapers/WhitePaperDocs/WPReachingWomen Disaster.pdf; 2006 (Updated May 2011; accessed 28 March 2011). 5 Ogbuagu SC. Rural dimensions of gender population concerns, in Food and Agriculture Organisation of the United Nations [internet]. Available from: http://www.fao.org/sd/wpdirect/WPan0014.htm; 1996 December (accessed 24 March 2011). 6 Briceno S. Written statement on environmental management and mitigation of natural disasters: a gender perspective, Proceedings of the Commission on the Status of Women forty-sixth session. New York: USA, 2002 March 4e15. 7 Oxfam. Rethinking disasters: why death and disaster is not nature’s fault but human failure. New Delhi: South Asia Regional Centre Oxfam International (India). Available from: http://www.oxfam.org.uk/ resources/policy/conflict_disasters/downloads/oxfam_india_ rethinking_disasters.pdf; 2008 (accessed 4 August 2011). 8 McMichael AJ, Friel S, Nyong A, Corvalan C. Global environmental change and health: impacts, inequalities and the health sector. BMJ 2008; 336: 191e4. 9 United Nations Educational, Scientific and Cultural Organisation (UNESCO). Case studies on climate change and world heritage. Paris: UNESCO World Heritage Centre (France). Available from: http:// unesdoc.unesco.org/images/0015/001506/150600e.pdf; 2007 (accessed 15 April 2011). 10 Griffiths G, Rao M, Adshead F, Thorpe A, eds. The health practitioner’s guide to climate change. London: Published by Earthscan, 2009.
The links between climate change and women’s health are clear. But why are women so vulnerable? As Kavita Ramdas, the president of the Global Fund for Women recently stated, it is ‘the gender inequalities that define women’s lives prior to a climate disaster’ that put them at increased risk from climate change. An estimated 70% of the world’s poor are women and in traditional societies they tend to be highly dependent on local natural resources and agriculture for their livelihood and face historical disadvantages that include limited access to decision-making and economic assets. These disadvantages do not only increase women’s vulnerability to climate change, they also undermine the other MDGs: poor reproductive health, illness and gender inequalities in education and economics all directly impact on child mortality, hunger and poverty and environmental sustainability. Conversely, where women are empowered and healthy they can better care for their children, their families and the wider environment, thus easing pressure on already scarce resources, reducing hunger and poverty levels. When empowered politically and economically, women are also able to use their skills as ‘innovators, organizers, leaders, educators and caregivers’ to combat and adapt to climate change. Women also often hold traditional knowledge and have access to social networks that help in disaster response and climate change planning. In the wake of a cyclone in Orissa in 1999, most of the relief efforts were targeted at or through women. Many NGOs distributed their relief packages to women. The recovery was successful and improved women’s status in the process. One study of deforestation found that ‘a high presence of women’s non-governmental organizations in low-income countries may help protect forests against destruction’. Societies that have empowered women in this way have demonstrated impressive results and should be emulated. In conclusion, the gender dimension of climate change must be recognized if progress is to be made towards environmental sustainability and the achievement of all the other MDGs. Healthcare practitioners worldwide are urged to equip themselves with a greater understanding of the health impacts of climate change and how they could support their communities, and women in particular, to address these impacts. As the UNFPA report on Women, Population and Climate states, women are both at the ‘front line’ of climate change and ‘hold the keys’ to climate’s future; their needs must not be overlooked. A
OBSTETRICS, GYNAECOLOGY AND REPRODUCTIVE MEDICINE 21:12
357
Ó 2011 Elsevier Ltd. All rights reserved.
Climate change and maternal health
Recent research supports this view. Women and children were estimated to be 14 times more likely to die in natural disasters than men. In the 2004 Asian Tsunami more than 70% of deaths were among women, and in the Bangladesh cyclone disaster of 1991, 90% of victims were female. Although neither the tsunami nor the cyclone were proven to be climate-related, such disasters resemble climate change in some details and, as such, provide useful proxies for insight into how climate change affects different sections of the population in different ways. In the aftermath of disasters, maternal health is especially at risk. Damage caused to health facilities and infrastructure during floods, storms and fires poses an immediate threat to pregnant women, new mothers and their children. Road and transport problems, coupled with interrupted power supplies drastically hamper key medical care services and render access to sanitary medical equipment, neonatal services and emergency ward care difficult. The destruction of storage facilities may ruin medicines, blood supplies and samples and other healthcare items, such as vaccines and sterilization materials. Meanwhile the disruption of potable drinking water supplies, a common consequence of natural disasters and droughts, poses another threat to maternal health through the spread of water-borne diseases like cholera and diarrhoea, to which pregnant women may be particularly at risk. Furthermore, under extreme weather conditions, associated problems such as water-logging, and the proliferation of mosquitoes also increase a pregnant woman’s chances of infection from vector-borne diseases such as malaria. Even after the physical signs of disaster have faded, women are still exposed to the longer-term social ramifications of climate change. Women tend to endure much of the psychological burden of climate change, as they struggle to hold families together following deaths, during climate-related conflicts and violence, or when seeking refuge after population displacement e all of which are likely to increase in the coming years. Gender-based violence, sadly pervasive in most societies, often increases in the aftermath of disaster, and entrenched sexism results in uneven distribution of information and financial support in the wake of catastrophes. It is not only the events surrounding climate-change disasters that threaten maternal health. Smaller daily changes wrought by climate change can be equally damaging. Women’s traditional dependence on natural resources, involvement in agricultural work (an estimated 70% of agricultural workers are women) and food and water collection renders them particularly vulnerable to physical and psychological stress and poverty as a result of food and water shortages. Pregnant women are particularly at risk from bad quality water supplies and dehydration. Moreover, a woman’s traditional role as mother and primary carer often results in her sacrificing her own nutritional needs during food shortages in order to feed her children and husband. At the peak of the Maha Akal drought in Rajasthan, India, women were eating less than men in 82% of hamlets. Culturally-enforced gender inhibitions also impact on women’s survival chances; during the 2004 tsunami, one reason for the large number of deaths among women was the sense of shame that kept them from running to the shore when the waves ripped their clothing. In the Nagapattinam district in India, women’s inability to swim, a further consequence of cultural norms, proved fatal for many. Mortality rates among those who could swim were 60% lower.
Mala Rao Emmeline Buckley
In March 2009 delegates from nearly 80 countries met at the International Scientific Congress in Copenhagen to discuss climate change. Their conclusions were grim: they confirmed that worstcase scenario trajectories, as estimated by the Inter-Governmental Panel for Climate Change, are being realized and that, left unchecked, many of the trends may accelerate in the near future, leading to an increasing risk of abrupt or irreversible climatic shifts. Now, in 2011, the effects of climate change are already palpable. The developed world e Britain, France, Spain, and Italy e often seemingly impervious to such events, has seen lives lost during the unbearable summer of 2003, and due to dramatic flooding. More often, however e and as highlighted at Copenhagen in 2009 e it is the developing world that bears the brunt of climate disasters: India and Pakistan in 2010, and Sri Lanka and Brazil in January this year have all suffered from devastating climate disasters. Heat waves and droughts causing food shortages and illness are now common events. The Sunderbans in Bangladesh and India have already begun to disappear from rising sea-levels, while cases of dengue fever have increased by 50% in Indonesia in recent years due to rising temperatures and changing patterns of vector-borne disease, and the incidence of malaria in places such as India and parts of Africa are a major cause for concern. Against this background, we are hoping to achieve the eight Millennium Development Goals by 2015. These goals identify key targets in an attempt to ‘improve lives’: they address hunger and poverty, child mortality, infectious diseases, education, poor maternal health and gender inequality and empowerment. Environmental sustainability is also listed as a goal e separately. What has become clear over the past decade, however, is that the environmental considerations cannot realistically be detached from human and economic factors: ‘the MDGs themselves are undermined by the early impacts of climate change’. This is especially true for those MDGs relating to women’s health, well-being and empowerment. Both history and recent experience have shown that when conditions are harsh and resources scarce, the poor and groups marginalized by more than poverty e women, the young, the elderly, indigenous populations and other minorities e are most vulnerable.
Mala Rao MBBS MSc PhD FFPH Hon FFSRH is Professor of International Health, University of East London and Honorary Public Health Adviser, Administrative Staff College of India, Hyderabad, India. Conflicts of interest: none declared. Emmeline Buckley BA (Hons) MSc is an Independent Health Policy Researcher. Conflicts of interest: none declared.
OBSTETRICS, GYNAECOLOGY AND REPRODUCTIVE MEDICINE 21:12
356
Ó 2011 Elsevier Ltd. All rights reserved.
ETHICS/EDUCATION
FURTHER READING 1 United Nations Population Fund (UNFPA), State of world population 2009. Facing a changing world: women, population and climate. New York: UNFPA, (USA). Available from: http://www.unfpa.org/swp/ 2009/en/pdf/EN_SOWP09.pdf; 2009 (accessed 3 August 2011). 2 United Nations Population Fund (UNFPA)/Women’s Environment and Development Organisation (WEDO). Climate change connections: a resource kit on climate, population and gender. New York: UNFPA, WEDO (USA). Available from: http://www.unfpa.org/public/ publications/pid/4028; 2009 (accessed 10 April 2011). 3 Aguilar L. IUCN Fact sheet: climate change and disaster mitigation. Cited in: Araujo A, Quesada-Aguilar A, Aguilar L, Pearl R, IUCN Factsheet: Gender equality and adaptation, United Nations Economic Commission for Africa [Internet] (date unknown). Switzerland: IUCN. Available from: http://www.uneca.org/acpc/resources/Gender-and-climate-change/ IUCN_Factsheet_Adaptation.pdf; 2004 (accessed 4 August 2011). 4 Soroptimist International of the Americas. Reaching out to women when disaster strikes, White paper: disaster relief. Soroptimist International of the Americas, [Internet]. Available from: http://www. soroptimist.org/whitepapers/WhitePaperDocs/WPReachingWomen Disaster.pdf; 2006 (Updated May 2011; accessed 28 March 2011). 5 Ogbuagu SC. Rural dimensions of gender population concerns, in Food and Agriculture Organisation of the United Nations [internet]. Available from: http://www.fao.org/sd/wpdirect/WPan0014.htm; 1996 December (accessed 24 March 2011). 6 Briceno S. Written statement on environmental management and mitigation of natural disasters: a gender perspective, Proceedings of the Commission on the Status of Women forty-sixth session. New York: USA, 2002 March 4e15. 7 Oxfam. Rethinking disasters: why death and disaster is not nature’s fault but human failure. New Delhi: South Asia Regional Centre Oxfam International (India). Available from: http://www.oxfam.org.uk/ resources/policy/conflict_disasters/downloads/oxfam_india_ rethinking_disasters.pdf; 2008 (accessed 4 August 2011). 8 McMichael AJ, Friel S, Nyong A, Corvalan C. Global environmental change and health: impacts, inequalities and the health sector. BMJ 2008; 336: 191e4. 9 United Nations Educational, Scientific and Cultural Organisation (UNESCO). Case studies on climate change and world heritage. Paris: UNESCO World Heritage Centre (France). Available from: http:// unesdoc.unesco.org/images/0015/001506/150600e.pdf; 2007 (accessed 15 April 2011). 10 Griffiths G, Rao M, Adshead F, Thorpe A, eds. The health practitioner’s guide to climate change. London: Published by Earthscan, 2009.
The links between climate change and women’s health are clear. But why are women so vulnerable? As Kavita Ramdas, the president of the Global Fund for Women recently stated, it is ‘the gender inequalities that define women’s lives prior to a climate disaster’ that put them at increased risk from climate change. An estimated 70% of the world’s poor are women and in traditional societies they tend to be highly dependent on local natural resources and agriculture for their livelihood and face historical disadvantages that include limited access to decision-making and economic assets. These disadvantages do not only increase women’s vulnerability to climate change, they also undermine the other MDGs: poor reproductive health, illness and gender inequalities in education and economics all directly impact on child mortality, hunger and poverty and environmental sustainability. Conversely, where women are empowered and healthy they can better care for their children, their families and the wider environment, thus easing pressure on already scarce resources, reducing hunger and poverty levels. When empowered politically and economically, women are also able to use their skills as ‘innovators, organizers, leaders, educators and caregivers’ to combat and adapt to climate change. Women also often hold traditional knowledge and have access to social networks that help in disaster response and climate change planning. In the wake of a cyclone in Orissa in 1999, most of the relief efforts were targeted at or through women. Many NGOs distributed their relief packages to women. The recovery was successful and improved women’s status in the process. One study of deforestation found that ‘a high presence of women’s non-governmental organizations in low-income countries may help protect forests against destruction’. Societies that have empowered women in this way have demonstrated impressive results and should be emulated. In conclusion, the gender dimension of climate change must be recognized if progress is to be made towards environmental sustainability and the achievement of all the other MDGs. Healthcare practitioners worldwide are urged to equip themselves with a greater understanding of the health impacts of climate change and how they could support their communities, and women in particular, to address these impacts. As the UNFPA report on Women, Population and Climate states, women are both at the ‘front line’ of climate change and ‘hold the keys’ to climate’s future; their needs must not be overlooked. A
OBSTETRICS, GYNAECOLOGY AND REPRODUCTIVE MEDICINE 21:12
357
Ó 2011 Elsevier Ltd. All rights reserved.