Climate education as adaptation: A scoping review of programs advancing maternal and newborn health

Structured abstract

Background

Climate change is a growing threat to maternal and newborn health (MNH). Alongside urgent emissions reductions, effective efforts to address climate-driven health disparities – both in MNH and more broadly – will require a stronger collective understanding of climate impacts on health. This will necessitate further investment not only in climate and health research, but also in climate and health education and literacy. Critically, the extent to which climate education can or is being used to advance MNH remains unknown.

Methods

We conducted a scoping review of climate education programs specifically focused on MNH. We searched PubMed, Embase, and gray literature through May 2025 and consulted relevant experts. All programs were screened independently and in duplicate, with discrepancies resolved via discussion.

Findings

We screened 2,138 papers and programs, 45 of which underwent full text review. Seventeen programs were included in our sample. The majority were implemented in low and middle income countries (LMICs) (n = 9) and the United States (n = 6). Most aimed to improve healthcare provider and/or patient understanding of climate-specific risks to MNH. Nearly half were embedded into existing MNH care pathways. Four programs conducted formal evaluations, all of which reported positive outcomes; two programs that assessed health impacts found significant reductions in adverse climate-related health outcomes following MNH-specific climate education.

Conclusion

MNH-specific climate education may be an important element of effective climate adaptation, with the potential to enhance climate knowledge and perceived self-efficacy, and improve climate-mediated health outcomes in pregnancy and postpartum. Further research is needed to evaluate existing programs and guide the development of evidence-based policies and interventions.

1. Introduction

Climate change is a growing threat to maternal and newborn health (MNH). Climate-driven disasters can interfere with health systems and delivery, including the availability of and access to sexual and reproductive healthcare services [[1], [2], [3]]. Climate-related stressors, from extreme weather events to escalating heat, are associated with many adverse pregnancy, perinatal, and neonatal outcomes, including hypertensive disorders of pregnancy, gestational diabetes, pregnancy loss, stillbirth, preterm birth, and some congenital anomalies [[4], [5], [6]]. Because antenatal and early-life exposures influence developmental trajectories, climate impacts that occur during pregnancy and/or shortly after birth may continue to negatively impact health throughout the lifecourse [[7], [8], [9]].

Climate impacts exacerbate existing disparities in MNH and weigh most heavily on already vulnerable pregnant and postpartum women1 and babies. The association between tropical cyclone exposure and early preterm birth, for example, is stronger among pregnant women in “socially vulnerable countries” [10]. The association between high temperatures and some adverse pregnancy outcomes is stronger among women in lower socioeconomic groups; and in the United States, these associations are strongest among pregnant women of color [[11], [12], [13]]. In low- and middle-income countries (LMICs), pregnant women’s vulnerability to climate stressors may be heightened due to greater exposure to outdoor physical labor during the prenatal period or within a few weeks of delivery [14]. Globally, climate change is also worsening inequalities in maternal nutrition [15].

In combination with urgent global emissions reductions, effective efforts to address climate-driven health disparities – both in MNH and more broadly – will require improving collective understanding of climate impacts on health [16]. This will necessitate further investment not only in climate and health research, but also in climate and health education and literacy [17,18].

Climate education is widely recognized as a critical arm of climate adaptation [[18], [19], [20]], in part because education can help beneficiaries better understand how to protect themselves against the adverse effects of climate change [21]. Emerging evidence shows that climate education not only increases understanding of climate risks, but can also drive community engagement and meaningful behavioral responses [14,22,23]. Yet climate literacy rates remain low in many populations across the world, particularly in LMICs and among women [[24], [25], [26]], and little is known about climate knowledge among MNH stakeholders.

Recent research calls for initiatives that safeguard pregnant women and newborns from emerging climate threats, beginning with “enhanced education” and information sharing to raise awareness about the unique and increasing risks faced by these groups [8,27,28]. Critically, however, the extent to which climate education can or is being used to advance MNH remains unknown. In this scoping review and call to action, we examine climate education and information programs that explicitly target MNH.

1.1. The need for climate education in the context of MNH

Though climate and health education is increasingly integrated into school curricula and medical training, information about climate literacy related to MNH is limited [[29], [30], [31]]. In particular, there exists a lack of information regarding healthcare provider knowledge about climate impacts on pregnancy, perinatal, and neonatal outcomes. There is also limited information about whether this knowledge, where it does exist, is effectively communicated to patients. A study of 255 maternity nurses in Egypt found that though the overall level of understanding of climate risks was considered “fair,” the mean score of their climate-related care practices was ranked "unsatisfactory" – demonstrating a gap between knowledge and practice [32].

Alhough research about climate literacy rates among pregnant and postpartum women is advancing, data in the area remains limited. Still, emerging findings suggest a need for increased climate knowledge among these populations. Though a small number of studies report “satisfactory” or “high” levels of climate change awareness among pregnant participants [33,34], others find that pregnant populations generally lack climate literacy, particularly about how climate change might impact pregnancy. A study in Egypt found that almost 79 % (n = 300) of pregnant participants “had poor knowledge regarding climate change and its effects on their pregnancy” [35]; a study in Turkey reported that all pregnant women in their sample (n = 12) had “incomplete and insufficient” knowledge about climate impacts on maternal health during pregnancy [36]; and a study in Burkina Faso concluded that postpartum women often lacked “awareness of heat impacts and risks to maternal health and child health” [37].

In some cases, poor climate knowledge led to behaviors that compounded climate-related health risks. In Burkina Faso, researchers noted that though it is important for birthing and breastfeeding women to be well hydrated, some participants mentioned not being able to hydrate properly because of the belief that pregnant and postpartum women should avoid cold water and drink warm water only, even in hot weather [37]. In Kenya, a similar study found that experiences and beliefs related to high temperature extremes were negatively impacting breastfeeding practices, and were associated with decreased rates of exclusive breastfeeding [38]. Evidence suggests that comprehensive health education improves compliance with breastfeeding guidelines and increases exclusive breastfeeding under various climatic conditions, underscoring the importance of incorporating climate into health education [39].

There exists almost no information about MNH-related climate literacy among other stakeholders, such as pregnant and postpartum women’s partners, communities, and providers. However, we consider that the above findings about the climate-related knowledge, practices, and beliefs of pregnant and postpartum women may be broader reflections of the knowledge, practices, and beliefs of their communities.

Inadequate access to climate-relevant health information may limit the ability of pregnant and postpartum people and other stakeholders to make informed decisions about their and other’s health, which may contribute to reduced autonomy and increased vulnerability. Integrating climate education into MNH may help to address this gap by providing individuals with the knowledge needed to make evidence-based choices and adopt protective behaviors [40].

2. Materials and methods

In April and May 2025, we conducted a scoping review of existing climate education initiatives targeted toward or focused specifically on MNH. We report our findings according to the PRISMA Extension for Scoping Reviews (Supplemental Figure I) [41].

We searched PubMed and Embase for papers that referenced climate education programs tailored specifically to MNH using the following search terms: “antenatal” or “breastfeed” or “doctor” or “doula” or “gynecologist” or “healthcare worker” or “health worker” or “maternal health” or “medical education” or “midwife” or “midwives” or “MNH” or “newborn health” or “nurse” or “OBGYN” or “obstetrician/gynecologist” or “obstetrician” or “physician” or “postnatal” or “pregnancy” or “pregnant” or “prenatal” and “climate and health literacy” or “climate education” or “climate knowledge” or “climate-health literacy” or “climate literacy” or “climate program” or “climate training” or “disaster education” or “disaster training” or “heat education” or “heat-health education”. No language restrictions were applied. We searched more broadly through the gray literature to capture programs not included in academic databases. We reviewed additional resources shared via the Climate x Sexual and Reproductive Health Research (SRHR) Hub, the SRHR and Climate Justice Coalition, Human Rights Watch, and the Global Heat Health Information Network’s websites [36,42,43]. We further included a small number of programs identified via expert knowledge and consultation; we included these to ensure more comprehensive coverage of the review topic. All sources are included in Table 2. Given the emergent nature of the field, we limited our search to include only studies or programs published or implemented within the last ten years.

Table 2.

Sample characteristics.

	Initiative	Organization(s)	Country	Phase	Description	Target Audience(s)	Source
1	Building Climate-Resilient Health Systems in Nepal [44]	Ipas	Nepal	Ongoing	Program that, among other efforts to build climate-resilient health systems, aims to increase community awareness about the relationship between sexual and reproductive health and rights (SRHR) and climate change through educational workshops. Workshops address how extreme weather events can increase workloads, disrupt access to critical SRHR services, and worsen the risk of gender-based violence and other factors that impact mental and reproductive health – and provide information on household interventions for climate resilience. Workshops are co-created in partnership with Indigenous women.	Women and girls, youth groups, government officials, other community stakeholders	SRHR and Climate Justice Coalition
2	Extreme Heat and Maternal and Child Health Climate Literacy Tool [45]	Mama-Pikin Foundation, Human Rights Watch	Sierra Leone	Ongoing	Visual and conversation-based climate literacy tool that aims to provide an accessible way for stakeholders to learn, understand, and discuss some of the available science on the effects of climate change on maternal, infant, and sexual and reproductive health. The tool prioritizes teaching actionable strategies and solutions created with and by women and other stakeholders who are most vulnerable.	Pregnant and postpartum women, healthcare providers, government officials, other community stakeholders	Human Rights Watch
3	Climate Change and the Health of Pregnant Women: Color Comic Book [53]	Intervention executed by researchers at the George Mason University; materials developed by the United States Environmental Protection Agency	United States	Completed	Narrative-based, full-color comic book intended to communicate the ways climate change – specifically extreme heat, air pollution, and flooding – can affect the health of pregnant women and infants. Factual content was based off of a United States Environmental Protection Agency (EPA) brochure The comic was shown to women in waiting rooms at obstetric practices and/or hospital clinics as part of a study that sought to showcase the efficacy of narrative information compared to didactic information in this context.	Pregnant women	Database search
4	Climate Change and Pregnancy Education Program for Anxiety and Awareness [46]	Intervention executed by researchers at the University of Health Sciences; materials developed by Health and Environment Alliance (HEAL), the FIGO, and the University of California, San Francisco (UCSF)	Turkey	Ongoing	Full-color brochure detailing the connections between climate change, preterm birth, and low birthweight – and how to advocate for policies that divest from fossil fuels, reduce air pollution and toxic exposure. The brochure was provided to pregnant women at a maternity hospital. Following the intervention, researchers found that participants' awareness, perception, knowledge, and policy expectations regarding climate change significantly increased, while pregnant women's anxiety regarding climate change significantly decreased.	Pregnant women, healthcare providers	Database search
5	Committee on Climate Change and Toxic Environmental Exposures (C2TE2) [54]	International Federation of Gynecology and Obstetrics (FIGO)	United States	Ongoing	Global organization of obstetrician gynecologists (OB/GYNs) that contributes to the incorporation of climate change and toxic environmental exposures into medical school and residency curricula – and provides continuing medical education activities for physicians highlighting the impacts of climate change on women and girls’ lives.	Pregnant women, healthcare providers	Expert consultation
6	Community codesign workshop on reducing impact of heat exposure on pregnant and postpartum women and newborns [47] Evaluation: Reducing Extreme Heat Impacts on Health in Pregnant Women and Infants: a community based intervention in Kilifi, Kenya	Climate Heat and Maternal and Neonatal Health in Africa (CHAMNHA) consortium	Kenya	Completed	Co-designed workshop and community-based behavior change intervention that uses tools such as digital storytelling and facilitated group discussions to increase education and awareness of strategies to reduce heat exposure among pregnant and postpartum women and infants.	Pregnant and postpartum women, spouses of pregnant and postpartum women, mothers-in-law, government officials, other community stakeholders	Database search
7	Doula C—Hot Program [55]	Florida Clinicians for Climate Action, Metro Mommy Agency	United States	Ongoing	Educational program that trains doulas to assess climate change-related risks, particularly heat, for pregnant and postpartum women in communities with high heat vulnerability. Doulas learn to use tools like the CDC’s CHILL’D Out Screening and Heat and Health Tracker, to create perinatal disaster action plans, and to connect clients with local resources. The program also equips doulas to educate community members about climate change impacts through monthly presentations at local health centers.	Healthcare providers – specifically doulas, who will then educate pregnant and postpartum people	Human Rights Watch
8	Educational Program on Climate Change and Heat Stress for Pregnant Women Working Outdoors [48]	Benha University	Egypt	Completed	Educational program designed as part of a study to evaluate knowledge and health-related behaviors toward climate change and heat stress among pregnant women working outdoors. The intervention was implemented via a series of three scheduled collaborative sessions, which took place at an outpatient obstetrics clinic at Benha University Hospital. The program had a positive effect on the improvement of pregnant women’s knowledge and health-related behaviors surrounding pregnancy, climate change, and heat stress.	Pregnant women – specifically those who work outdoors	Database search
9	Environmental Justice Initiative [56]	National Association of Nurse Practitioners for Women’s Health	United States	Ongoing	United States-based professional association that provides continuing education programs and resources for nurse practitioners in women's health and other advanced practice registered nurses who provide healthcare for women to increase knowledge about the health risks associated with climate change and train providers to use adaptation and mitigation strategies to address these risks at individual, community, and population-based levels.	Pregnant women, healthcare providers – specifically nurse practitioners for women’s health	Expert consultation
10	Heat Adaptation for Pregnant Women and Infants (HAPI) Study [49]	WITS RHI, University of the Witwatersrand	South Africa, Zimbabwe	Ongoing	Project seeking to advance heat-adaptation policies and practices in low- and middle-income countries. Researchers are developing and testing a co-produced, multi-level, and multicomponent intervention to increase knowledge and awareness on strategies to reduce heat impacts on pregnant women and newborns in Southern Africa. The proposed intervention will encompass behavioral adaptation mechanisms, as well as built environment, nature-based, health services, and policy components.	Pregnant women, government officials, other community stakeholders	Global Heat Health Information Network
11	Optimal Pregnancy Environment Risk Assessment (OPERA) [50]	Worldwide interdisciplinary network, WHO, March of Dimes USA, University of Alberta in India	India	Planned	International program designed to generate awareness about the impacts of climate change on pregnancy and maternal health via health education in schools and educational webinars. Through collaboration with community stakeholders, the program will provide accessible information about the latest risk assessment and mitigation tools to diagnose women at risk of preterm birth, and will educate providers about pregnancy outcomes linked to environmental stressors, including pollution, heat, infection, trauma, and migration.	Healthcare providers	Database search
12	MotherHeat Alert [59]	HIGH Horizons	Africa, Europe	Planned	Heart-health mobile phone application designed to warn and inform pregnant and postpartum women and healthcare workers about extreme heat in their area. This output is part of a broader, international research project focused on extreme heat and maternal and newborn health. The project includes a range of additional communication activities to help disseminate findings through partners like the World Health Organization, UNICEF, and UNFPA.	Pregnant and postpartum women, spouses of pregnant and postpartum women, parents, healthcare providers	Global Heat Health Information Network
13	Mom and Baby Action Network’s Environmental Justice Working Group [60]	March of Dimes	Based in the United States; coalition members work globally	Ongoing	Alliance comprised of over 40 individual and organizational partners – including companies, health practitioners, government officials, and human rights organizations – that work to promote patient and healthcare provider education about environmental threats to maternal and newborn health (MNH), create toolkits to aid local and state emergency planning and ensure inclusion of pregnant people in their plans, and advance policy changes relevant to climate and MNH.	Local and state emergency planners, government officials, healthcare providers, other community stakeholders	Human Rights Watch
14	MomConnect [51]	Clinton Health Access Initiative, South African National Department of Health	South Africa	Planned	Mobile phone application developed by the South African National Department of Health to provide free maternal health messaging to close to five million people. The app is currently piloting an opt-in feature that includes messaging around weather warnings and climate disasters.	Pregnant and postpartum women	Citation search
15	Nurturely [57]	Nurturely	United States	Ongoing	Organization designed to promote equity in perinatal wellness and strengthen cultures of support for infants and caregivers through preventative knowledge-sharing, collaborative exploration, and proactive community engagement. The organization runs programs for caregivers, professionals, and the general public to help raise awareness about the impacts of climate change on perinatal health, among a range of other priority areas.	Pregnant and postpartum people, healthcare providers	Human Rights Watch
16	Pregnancy and Heat-Health Outdoor and Digital Campaign [58]	The Women’s Fund Miami-Dade	United States	Ongoing	Outdoor and digital campaign that shares heat-health graphics and messages on billboards, bus shelters, metro rail, and social media, specifically targeting pregnant people. The graphics include a weblink to additional pregnancy-specific heat-health resources.	Pregnant people, caregivers, other community stakeholders	Expert consultation
17	Western Uganda FBO Network (WUFBON) [52]	Panorama, 128 Collective	Uganda	Ongoing	Program designed to empower young people in western Uganda with knowledge about the links between climate change, poverty, and sexual and reproductive health. The program, which is based on the experience of the community members to whom they can relate, integrates climate change knowledge with a curriculum about sex and sexuality. The project also used community theater performances, radio shows, music and dances, and traditional poetry to entertain, inform, and educate community members on the complex issues of climate change and sexual and reproductive health. This combined education and entertainment approach was integrated into school forums to educate children on climate change across primary schools in the Kyenjojo district. In total, they have recorded a reach of 33,000 participants with knowledge of climate change and SRHR.	Rural women and girls, men, youth, religious leaders, teachers, government officials	Climate x SRHR Hub

We include in this review only climate education programs that explicitly focus on MNH. We exclude informational materials without a specific programming component, as well as education interventions focused on child health, as the climate vulnerability of older children is shaped by a different set of pathways and requires different interventions and analyses [42]. A summary of inclusion and exclusion criteria can be found in Table 1.

Table 1.

.

Inclusion Criteria	Exclusion Criteria
-Climate education interventions or programs explicitly tailored to maternal and/or newborn health -Published and/or implemented between 2015 and 2025	-Climate education interventions or programs not specifically focused on maternal or newborn health, including initiatives focused exclusively on children’s education, as well as broader initiatives that may touch on MNH but do not prioritize it -Climate education materials without specific programming -Published and/or implemented prior to 2015 -Review articles

All results were imported into Covidence for screening. Following the removal of duplicates, titles and abstracts were screened independently by two reviewers, with conflicts resolved by a third reviewer. Full-text reviews were conducted in the same manner.

3. Results

Our search strategy yielded a total of 2,211 records. We removed 73 duplicates and screened the remaining 2,138 articles. We removed 2,093 items that did not meet inclusion criteria, leaving 45 papers for full text review, of which 17 are included in our final sample. A screening process diagram can be found in Fig. 1.

Fig. 1.

Identification, screening, and inclusion of research articles in this scoping review.

We identified a range of interventions aimed at educating a diverse array of stakeholders about climate impacts on MNH. Of the 17 interventions included in our sample, nine are implemented primarily in LMICs [[44], [45], [46], [47], [48], [49], [50], [51], [52]], six in the United States [[53], [54], [55], [56], [57], [58]], and two globally or in multiple regions [59,60] (see Table 2).

3.1. Target populations

Most programs (n = 13) focus on improving understanding of climate risks to pregnancy health among pregnant or postpartum women. These programs range from formal climate education programs for pregnant patients, such as that in Egypt, to social media and billboard education campaigns, as in the United States, to direct outreach programs, like MomConnect in South Africa, which provides free SMS messaging about maternal health and climate disasters [48,51,58].

A significant portion of the identified programming (n = 11) seeks to improve healthcare providers’ understanding of climate-specific risks to pregnancy health. This approach appears to mimic the broader landscape of both climate and health education programs, where many initiatives target healthcare providers and/or trainees [61]. Examples of these types of programs include the National Association of Nurse Practitioners for Women’s Health’s Environmental Justice Initiative, which provides continuing education training for nurses [56]; the International Federation of Gynecology and Obstetrics’ Committee on Climate Change and Toxic Environmental Exposures, which incorporates climate education into existing medical school curricula for obstetrician/gynecologists (OB/GYNs) in training [54]; and the Doula C-Hot Program in the United States, which trains doulas to assess climate-related risks for pregnant and postpartum women in heat-vulnerable communities [55].

Seven initiatives seek to provide information to broader audiences via community education and outreach, including programming that targets spouses or mothers in law of pregnant women, as in the community codesign workshop in Kenya [47]; parents and guardians, as in the HIGH Horizons’ MotherHeat Alert project in Europe and across Africa [59]; and youth, in addition to community religious leaders, as in WUFBON in Uganda [52].

Others (n = 6) include education programming designed for government officials and/or policy makers, as with the Heat Adaptation for Pregnant Women and Infants (HAPI) study ongoing in South Africa and Zimbabwe, which will include policy components in addition to education – and the Mom and Baby Action Network’s Environmental Justice Working Group, which includes education programming and toolkits to aid local and state emergency planning and ensure inclusion of pregnant people in their plans, and advance policy changes relevant to climate and MNH [49,60].

3.2. Program design and execution

Most programs (n = 12) included direct outreach to pregnant women, through text or app-based messaging (MomConnect and MotherHeat Alert) [51,59]; community-based workshops (Nurturley and researchers in Kenya) [47,57]; or care-site interventions (Mama-Pikin Foundation and Human Rights Watch), and in educational programming (researchers at George Mason University) [45,53].

Seven programs (n = 7) either integrate climate education into existing MNH care pathways or intend for this to be an outcome of their intervention. At least half (n = 10) consulted with and/or included pregnant women in the development of the intervention. In Sierra Leone, the Mama-Pikin Foundation and Human Rights Watch integrated feedback from focus groups with pregnant and lactating mothers into their education tool [45]; and in Kenya, researchers with the Climate Heat and Maternal and Neonatal Health in Africa (CHAMNHA) group co-designed their intervention with the community [47].

3.3. Evaluation of programs

Only four of the initiatives included a formal program evaluation to assess impact and/or effectiveness, though at least three additional initiatives stated their intent to conduct such an analysis moving forward [45,49,59]. All four programs that conducted an evaluation reported positive associations with outcomes measured, including knowledge and understanding of heat-related risks to MNH [[46], [47], [48],53]. Two of the four reported findings on risk perception, both of which found that climate-related risk perception increased following the education interventions [46,53]. Three of the four reported findings related to behaviors, all of which found that climate-protective behaviors increased following educational programming [47,48,53]. Only one study evaluated outcomes related to community education and found that pregnant people reported an increase in mothers-in-law and spouses assisting with household chores and disseminating heat-health messaging to families [47].

Two evaluated interventions detailed findings on specific health outcomes. One evaluated anxiety outcomes, reporting a statistically significant decrease in anxiety among pregnant women following MNH-tailored climate education [46]. One study evaluated the association between a tailored educational program and birth outcomes, and found a statistically significant reduction in adverse outcomes among pregnant women who received the intervention [48].

4. Discussion

In this review, we draw attention to the limited number of climate education programs focused specifically on promoting MNH and highlight the need for formal evaluation of existing initiatives. Our findings suggest that MNH-specific climate education, especially coupled with existing MNH care, is an intervention with the potential to enhance climate knowledge and perceived self-efficacy, and improve climate-mediated health outcomes in the pregnancy and postpartum periods [46,48,53,62].

Broadly disseminating accurate and actionable information about the effects of climate change on health, including MNH, will require multi-stakeholder collaboration at the global, national, and local levels. The responsibility to develop, support, and implement these programs lies with international institutions and governments, educational institutions, health professional associations, and MNH caregivers and healthcare providers alike. Together these stakeholders need to prepare healthcare workers – including physicians, nurses, doulas, midwives, traditional birth attendants, community health workers (CHWs), and pharmacists and/or drug sellers – to communicate effectively with patients about their health, including climate-specific risks and how to minimize them [28,63,64].

Nurses, midwives, doulas, and/or CHWs have a unique opportunity to facilitate effective climate adaptation because they provide many pregnant people with some or all of their pregnancy care and related education [40]. The maternity care guidance of these groups is generally well received by pregnant people and their families [65], positioning them to educate patients about emerging risks. MNH workers should therefore be prepared, and supported, to provide basic guidance on climate harms and teach evidence-based mitigation methods [66]. This can be achieved by incorporating climate content into professional healthcare worker training and curricula [56], and by providing opportunities for MNH providers to participate in climate-specific continuing education programs [54,67].

Healthcare provider education will be especially critical, in large part because existing MNH programs already offer the necessary infrastructure through which to disseminate climate information to patients, as these pathways are designed to integrate and communicate the latest health information [56,65,68]. More broadly, MNH services already include principles of preparedness and complication readiness, which may be easily adapted to encompass climate, disaster preparedness, and related interventions [69]. In some contexts, this is already being done. Group antenatal care programs that facilitate health knowledge and relationship-building, for example, have been successful in reducing some pregnancy complications, including by mediating some disaster-related pregnancy risks [70].

These programs should help patients understand how their health and the health of their fetus or newborn may be negatively impacted by climate change, and should offer anticipatory guidance about actions to adapt and lessen effects [71]. Maternal health visits should also integrate environmental assessments to identify location-specific risks or vulnerabilities [56,72].

Importantly, improving patient-provider understanding of climate-related pregnancy and newborn health risks, though necessary, will be insufficient to protect and promote MNH. Ensuring climate and MNH education reaches a broad audience – including family members, business owners, community leaders, emergency management workers, and the general public – can address sociocultural and other barriers to adaptation [68,73], and help distribute the burden of care. Specifically, governments and educational institutions should prioritize integrating climate and health education into school curricula at all levels [20]; policymakers should prioritize providing information to business owners and operators so they are informed of the specific needs of pregnant people as they relate to climate and their duties as employers; and governments should ensure local leaders and emergency response workers are well informed. In particular, communities may benefit from adapting existing methods for integrating climate change into education projects, such as the Seven Points for Climate and Health Literacy Model or the Community Resilience Education Theory of Change, to address the impacts of climate change on MNH outcomes [64,74]. These efforts should be accompanied by complementary activities to promote access to education and comprehensive family planning services [75].

Climate and health education should provide individuals and their communities with accessible and understandable information about climate and environmental threats and how these threats might impact human health, including MNH; how to access real-time information on climate and environmental threats; how to assess individual-level risks; and how to protect themselves from, and mitigate exposure to, climate and environmental hazards and disasters [20]. Providing individuals with a basic understanding of climate justice will also be a key part of comprehensive health education [76]. Climate information provided via these programs should include achievable, audience-appropriate, and evidence-based recommendations for location-specific risks – and should incorporate local resources, advice, and strategies to help build resilience [40,77,78].

Because the evidence base needed to support targeted adaptation interventions for MNH is limited [69,79], climate education should include general prevention methods and information about how to identify relevant signs and symptoms, including for preterm labor and hypertensive disorders of pregnancy – like abdominal pain or contractions, vaginal bleeding, vision changes, and/or decreased fetal movement – particularly in late pregnancy [40]. Where available, data-backed recommendations for pregnant people, specific to different climate events, should also be shared.

The way in which climate and health information is communicated will be key to the efficacy of interventions. For educational materials, evidence suggests a patient preference for printed brochures compared to digital formats, as well as for receiving information in an engaging, narrative format with visual components [53,80]. Climate-health education strategies should continue after childbirth, particularly those related to breastfeeding practices, as this approach has been shown to improve outcomes [81].

Ultimately, effective implementation of these programs and interventions will require that governments take measurable steps to include MNH in their climate adaptation planning, including through financial resourcing [75,82]. Improving MNH service provision through monetary investment in infrastructure and system strengthening is an essential first step in mitigating the impact of future climate disasters, particularly in LMICs [75]. Critically, high-income countries need to provide financial support to assist with the implementation of these efforts in developing countries, as agreed to under Article 9 of the Paris Agreement [19].

4.1. Limitations

This review has several limitations. Our findings are not comprehensive. We include only published programs with publicly available web descriptions. We did not evaluate programs or interventions for quality due to limited information available online. We focused exclusively on climate-specific programs addressing direct climate impacts and did not include search terms related to indirect effects of climate change, such as air pollution. We included in our review only climate education initiatives that specifically emphasize comprehensive MNH. We are aware that broader initiatives that provide access to information and education on climate, though not necessarily focused on pregnancy health, may engage with and address the health of these populations. This review also fails to account for more routine, as opposed to programmatic, patient-to-provider communications about climate risks to pregnancy health, as these data are not often recorded in specific programs or policies.

4.2. Opportunities for future research

Despite the above limitations, our review highlights important knowledge gaps. We call attention to the lack of MNH-related climate education programming for pregnant and postpartum people, their healthcare providers, and other stakeholders, and the lack of existing program evaluations. More data are needed to better understand if and how healthcare providers, pregnant people, and their support systems are receiving information about the impacts of climate change on pregnancy health. More robust assessments of existing programs are needed to determine whether the information provided is reaching patients, influencing behaviors, and improving health outcomes.

Effective efforts to address these gaps and improve awareness and understanding at the intersection of climate change and MNH requires continued research efforts. Though research is increasing, there continue to be major gaps in our understanding of these issues, in part due to lack of standardization and attribution in reporting climate-related illnesses and deaths; ethical challenges in human subjects research; measurement inconsistencies and exposure misclassifications; and regional disparities in research attention and resources [[83], [84], [85], [86], [87]]. Future research should investigate a broader array of climate-related disasters, hazards, and relevant factors, as well as a wider range of health outcomes [79], and should increase focus on LMICs and other at-risk groups where individuals are most vulnerable to climate change.

Still, the most glaring gap in our understanding of these issues to date is the broader lack of data-backed interventions and adaptation guidance targeted specifically toward pregnant people. More research is urgently needed to clarify key windows of sensitivity and opportunity; develop and assess the effectiveness of potential MNH interventions [69,79]; and “articulate the relationship between climate change, social determinants of health and their corresponding risks to MNH” [8]. Understanding these connections will help support the implementation of sustainable and scalable solutions – including targeted climate education programming [8].

5. Call to action

Climate education is one element of an effective approach to climate adaptation. Embedding climate change education into existing MNH care may equip pregnant people with critical information to support evidence-informed decisions about their own health and that of their developing fetus. As temperatures rise, these efforts must be implemented alongside ambitious, multi-sectoral initiatives that develop and expand access to evidence-based interventions that aim to address health disparities, shape climate-responsive policies, and reduce emissions. With over 200 million pregnancies worldwide each year, adaptation interventions must integrate the needs of pregnant and postpartum people, and their newborns, to ensure equitable, appropriate, and comprehensive climate solutions.

Funding

Yasmine Baker received internal funding from her home institution, UC Berkeley, through the Social Sciences Research Pathways Fellowship to support her involvement in this project. Simone Gramling received internal funding from her home institution, UC Berkeley, via the Undergraduate Research Assistance Program to support her involvement in this project.

CRediT authorship contribution statement

Cara Schulte: Writing – review & editing, Writing – original draft, Project administration, Methodology, Investigation, Formal analysis, Conceptualization. Blake Erhardt-Ohren: Writing – review & editing, Methodology, Investigation, Formal analysis, Conceptualization. Yasmine Baker: Writing – review & editing, Validation. Simone Gramling: Writing – review & editing, Validation. Ndola Prata: Writing – review & editing, Supervision, Methodology, Conceptualization.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Throughout the duration of the project, the primary author of this manuscript was working as a consultant for Human Rights Watch and was involved in the project referenced in the cited publication on climate education for pregnant women in Sierra Leone. This publication was written in her capacity as a doctoral candidate at the University of California, Berkeley.