Climate Change and Reproductive Health: Adopting a Comprehensive Approach to Reduce the Impact

ABSTRACT

In the current century, climate change has been regarded as one of the most serious public health threats, which has drastic health, environmental, and social aftereffects. The purpose of the current article is to identify the direct and indirect impacts of climate change on reproductive health and to propose specific public health recommendations to reduce these identified impacts. Climate change has been linked with multiple reproductive concerns, such as pregnancy complications, sexually transmitted infections, and infertility, which can cumulatively pose to be a major concern. Climate change significantly contributes to the deterioration of the air quality, while exposure to fine particulate matter and heavy metals can result in infertility in both men and women by altering hormone levels, impairment of sperm, and the quality of eggs. There arises the need to adopt a proactive and interdisciplinary approach to minimize the impact of climate change on reproductive health. In conclusion, a wide range of direct and indirect consequences of climate change have been reported on reproductive health. This calls for the need to develop climate-adaptive healthcare systems and policies to reduce the existing risks, including promoting easy access to family planning.

INTRODUCTION

In the current century, climate change has been regarded as one of the most serious public health threats, which has drastic health, environmental, and social aftereffects.[1] Climate change affects human health in multiple ways by affecting different systems, and one of the least explored domains is its effect on reproductive health.[1,2] Climate change has been linked with multiple reproductive concerns, such as pregnancy complications, sexually transmitted infections, and infertility, which can cumulatively pose to be a major concern.[2] There arises the need to adopt a proactive and interdisciplinary approach to minimize the impact of climate change on reproductive health.[2] The purpose of the current article is to identify the direct and indirect impacts of climate change on reproductive health and to propose specific public health recommendations to reduce these identified impacts.

DIRECT IMPACT OF CLIMATE CHANGE ON REPRODUCTIVE HEALTH

Climate change influences reproductive health directly in multiple ways, beginning with prolonged exposure to high temperatures, which can cause dehydration and cardiovascular strain among pregnant women, and can also remarkably increase the risk of pregnancy-linked complications (viz. preterm birth, stillbirths, and low birth weight).[3] Further, these high temperatures and humidity levels give an ideal platform for bacterial and fungal infections, which not only augments the probability of maternal and neonatal infections but even the incidence of birth defects and miscarriages.[2,3] In addition, rising temperatures or extremes of weather events can limit access to clean water, which can interfere with the maintenance of reproductive hygiene among women, thereby augmenting the risk of infections among them.[3,4] As the reported climate changes can interfere with agricultural production, it can result in food shortages and poor nutrition of the pregnant women.[5] These poorly nourished antenatal women are more likely to experience anemia and newborns with low birth weight.[2,5] Further, the combination of food insecurity and extreme heat can contribute to the development of gestational hypertension and preeclampsia, which can subsequently lead to complications such as stroke, preterm births, and maternal mortality.[6]

Considering the fact that impending climate changes have contributed to the expansion of mosquitoes, there is a simultaneous rise in the incidence of Zika virus, malaria, and dengue infections during pregnancy, which can even lead to miscarriages, congenital anomalies, and neonatal mortality.[7] The available literature suggests that climate change can exacerbate environmental pollution, which augments exposure to endocrine-disrupting chemicals that interfere with hormonal function and result in menstrual irregularities, infertility, and different pregnancy-related complications.[8] Climate change significantly contributes to the deterioration of the air quality, while exposure to fine particulate matter and heavy metals can result in infertility in both men and women by altering hormone levels, impairment of sperm, and quality of eggs.[2,9] In addition, there is a simultaneous increase in the likelihood of miscarriage, premature rupture of membranes, and stillbirth due to oxidative stress, placental damage, and fetal distress.[9,10] Finally, natural disasters and environmental changes can play an important role in increasing psychological stress and anxiety among pregnant women, which can further lead to adverse pregnancy outcomes, postpartum depression, and impaired child development.[4,11]

INDIRECT IMPACT OF CLIMATE CHANGE ON REPRODUCTIVE HEALTH

Beyond its direct consequences, climate change also impacts reproductive health in multiple ways.[12,13,14,15] The extremes of weather events (like floods or wildfires) can damage healthcare infrastructure, making it difficult for pregnant women to timely access essential antenatal, childbirth, and postnatal care-related services.[12] In such humanitarian emergencies, there is an interruption in the supply chain management, which interferes with the constant availability of contraceptives, and this brings about an increase in the incidence of unintended pregnancies, unsafe abortions, and maternal mortality.[13] These climate-related disasters often force people to migrate and live in temporary shelters, which have limited access to reproductive healthcare services, and this again contributes to a broad spectrum of reproductive health issues.[14] In continuation, a significant rise in the incidence of gender-based violence, including sexual exploitation (leading to unplanned pregnancies, sexually transmitted infections, psychological trauma, etc.) and child marriage, has also been reported.[15]

IMPACT OF CLIMATE CHANGE ON CHANGES IN MIDLIFE AND POSTMENOPAUSE

Rising temperatures can contribute to the intensification of hot flashes and night sweats, which are quite common during menopause, while exposure to air pollution might worsen respiratory symptoms or cardiovascular strain among midlife women.[16] In addition, midlife women who must discharge multiple roles might become anxious, stressed, and emotionally unstable, especially when exposed to extreme weather events.[17] Reduced access to clean water can interfere with the maintenance of personal hygiene (more vulnerable to urogenital infections), while heatwaves and poor air quality reduce outdoor activity, negatively influencing fitness.[18,19] This reduced mobility and Vitamin D deficiency (due to staying indoors in hot regions) can contribute to loss of bone density.[19] Postmenopausal women, especially those with comorbidities, are more vulnerable to heat stress and dehydration. Moreover, as climate change influences food supply, it can affect calcium, protein, and micronutrient intake which is crucial among postmenopausal women.[20]

PUBLIC HEALTH INTERVENTIONS

Acknowledging the widespread impact of climate change on reproductive health, a multisectoral approach is the need of the hour.[12,13,14,15,21,22,23,24,25,26] The primary approach is to incorporate reproductive health services as an integral part of the national disaster preparedness plan, and this also includes training healthcare professionals to deliver emergency obstetric and neonatal care amid climate-related humanitarian emergencies.[1,14] There is an indispensable need to strengthen maternal and reproductive health services by ensuring that healthcare establishments are climate resilient and equipped to handle pregnancy complications.[14,21] This strengthening should also target improving the availability of skilled birth attendants and the provision of emergency obstetric care in climate-affected regions.[12] This must be followed by creating awareness about climate-associated reproductive health risks and preventive measures with the help of community-based education programs.[22] These awareness activities must aim to empower women and communities about climate-related policies that prioritize reproductive health.[12,14,22]

Pregnant women can be educated about measures to reduce heat stress in domiciliary settings, while specific policies can be implemented to reduce heat exposure for women in workplace settings.[23] To avoid the occurrence of complications related to air pollution, there is a need to strengthen monitoring of air quality, strictly implement emission regulations, and promote the use of masks/indoor air filtration in urban areas with high pollution levels.[8] There is a simultaneous need to ensure the supply of adequate amounts of safe drinking water and to improve sanitation facilities, especially in disaster-affected displaced communities, to reduce waterborne diseases affecting reproductive health.[24] Further, pregnant women should be counseled about nutrition education and food security program (viz., climate-adaptive agriculture and food fortification) to prevent malnutrition.[15] In addition, integrated vector control measures along with the promotion of easy access to vaccines and treatment for vector-borne diseases must be advocated to prevent diseases such as malaria and Zika virus diseases.[7]

There is a definite need to educate communities about endocrine-disrupting chemicals present in plastics and pesticides and to strengthen policies to limit exposure to these harmful chemicals in air and water.[8] Moreover, efforts must be taken to ensure continuous availability and access to contraceptive methods to avoid any unwanted pregnancies, especially in climate disaster-prone areas.[13] At this juncture, there is a definite need to implement strict provisions to reduce gender-based violence in climate-affected communities, including providing supportive services and reproductive healthcare to the survivors.[15] Further, mental health services must be integrated into maternal healthcare programs to address psychological problems, especially in pregnant women in climate-affected communities.[4,11] Finally, there is a scope to conduct research work to monitor fertility trends, pregnancy outcomes, and disease prevalence in climate-affected populations, and develop a comprehensive surveillance mechanism to track the presence of different reproductive health risks.[13,25,26]

CONCLUSION

A wide range of direct and indirect consequences of climate change have been reported on reproductive health. This calls for the need to develop climate-adaptive healthcare systems and policies to reduce the existing risks, including promoting easy access to family planning.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.