Amid the devastating heat waves that swept Pakistan in 2022, pregnant women walked miles each day to fetch household water – sometimes in 118-degree weather — or stood in the blazing heat to pump enough for their families’ increased needs. They went without sleep on unbearable nights, and without food when crops dried up. Knowing that the situation would most likely get worse as climate change increased, their mental health suffered.
Rafia Rauf, a maternal health leader, heard these and many other stories as part of a qualitative study conducted by the White Ribbon Alliance in Pakistan. The goal was to better understand, on an individual level, how climate change affected women’s pregnancies and birth outcomes. “My pregnancy was the worst experience of my life” due to the heat, one woman told her.
Growing evidence shows clearly that climate change is materially, measurably harmful to pregnant women and babies. Whether it’s a climate-related disaster like a hurricane or flood, or a harmful shift in local environmental conditions, climate change is a destructive force: It increases the risk of intimate partner violence, leads to reproductive complications and even pregnancy loss, and can kill infants exposed to contaminated water.
Midwives have essential roles to play in protecting women and babies — while helping to ensure a more sustainable future. On May 6, during an International Confederation of Midwives webinar, experts discussed the ways in which midwives are “the workforce we need for a warming world.”
World Health Organization Director-General, Tedros Adhanom Ghebreyesus, described midwives in pre-recorded remarks as “first responders” whose work could save 4.3 million lives each year.
During disasters, midwives are often the first responders on the ground. Paulina Ospina, associate director of maternal and child health at Direct Relief, described the way midwives swung into action in August of 2023, when destructive wildfires broke out in Hawai’i. The very first request for medical supplies Direct Relief received was from a local midwifery group, Healthy Mothers, Healthy Babies Coalition of Hawai’i, who were moving from Oahu to Maui to care for people displaced or affected by the blazes. And by the time Direct Relief staff were on the ground, the group was already working with the local health department.
“Midwives…are already embedded in the community. They’re representative of the community,” Ospina said. Where health services are frequently disrupted during a disaster, she added, midwives are frequently motivated to continue caring for mothers and babies.
Even as disasters continue to worsen, midwifery offers a sustainable model of care — and a focus on climate adaptation that’s sensitive to cultural and environmental needs.
“Most often, pregnancy and birth do not require grand interventions or technologies,” said Jahan Zuberi, a midwife coordinator at Pakistan’s Indus Health Network. Midwives, who rely on skill, experience, and local and cultural knowledge, “respect the climate that is available to them.”
Moreover, Zuberi explained, excessive outside intervention can separate communities from trust in their own traditional practices and resources. “As we continue to bring midwifery back to the community, we’re going to be promoting practices that are inherently sustainable,” such as the use of effective local herbs, she said.
Maeve O’Connell, a professor of midwifery at the Fatima College of Health Sciences in the United Arab Emirates, offered an important example: breastfeeding. Infant formula is so intensive to produce, she said, that meeting World Health Organization breastfeeding goals would do more to protect the climate than replacing natural gas with renewable gas. “We actually have done the calculations,” she said, referencing a study she conducted with colleagues on this subject.
Moreover, she said, it’s often unsafe to dilute with water – as some formulas require – after a natural disaster, because water can be contaminated by the event.
O’Connell emphasizes that mothers are not to blame for the prevalence of formula feeding. Policy is. Predatory advertising abounds, and the support that many women need to allow them to breastfeed successfully often isn’t available. “It needs to be a collective advocacy,” she said. Midwives can “advocate for policies and practices that support breastfeeding as a sustainable choice for families and the environment.”
That means, in part, giving midwives more room to practice the full scope of their profession. Many midwives, for example, work in labor and delivery wards but aren’t given the opportunity to follow up with families postpartum.
In the wake of a disaster, midwives can ensure that resources are used effectively and meet community and cultural needs. For Zuberi, Pakistan’s 2022 floods are an illuminating example. “There were donations that never got used because that was not the community’s practices,” she said. The menstrual pads were wasted, and menstruating women and girls went without needed resources.
In general, O’Connell said, midwives are uniquely qualified to “harness the evidence” that connects climate change to sexual and reproductive health. The issue is making sure that their voices, and the voices of the people they serve, are heard.
Rauf put it straightforwardly: “Let women be the guide.”
