For the inhabitants of Baba Island, which lies just off the coast of the Pakistan’s capital and megacity of Karachi, life is becoming tougher every year that passes. Some 25,000 people are packed into a single square kilometre of tightly-packed concrete, with little greenery, unreliable electricity, and few options for work beyond fishing. At sea, however, the catch is shrinking as overfishing, environmental degradation, and increasing sea temperatures transform the waters they depend on.
For women, the daily pressures are often even greater. Islanders regularly now experience heat of more than 45C during the summer months, but women often have less freedom to move, spending their days in cramped homes with little ventilation, without the option of jumping into the sea on the hottest days as men do.
When a woman becomes pregnant, the heat becomes even more perilous. “I would say that in the summer months, maybe 30 to 40 per cent of the population has some kind of adverse event, and most of those adverse events are related to heat in some way,” says Neha Mankani, a midwife and charity founder who works in the community, speaking to The Independent.
Those adverse events range from women arriving at the clinic extremely dehydrated after weeks stuck in homes without electricity. Hotter times of year also bring increased numbers of babies born prematurely and needing intensive care, while others are born with neurological or cardiac problems. Other newborns in the community – many of whom are “over-wrapped” thanks to cultural norms, says Neha – are returning to the clinic overheated and dehydrated.
The risks faced by women like those on Baba Island are forcing an urgent rethink of how pregnant women should be protected in a warming world, with one group, HERA, announcing the world’s first heat-pregnancy insurance programme. Experts warn, however, that not nearly enough is being done to meet the pace at which climate impacts are increasing.
Neha has experienced the level of extreme heat “increase significantly” in the six years since she converted a small shop in the community into a clinic, which has solar-powered fans (though no air conditioning), and is the only such facility for the women of Baba Island. “Oftentimes women will come and just sit in the clinic, or bring their newborns to the space, just to cool down,” she says.
Science is still catching up with what medical professionals are seeing on the ground as the world warms: "Not everything we witness in the clinic is reflected in the research yet," says Neha. Nonetheless, research papers have found that high heat exposure can increase the odds of premature birth by as much as 26 per cent, and that high temperatures increase the rate of stillbirths by roughly five per cent per 1°C rise in temperature. Other papers point to increased risks of cardiovascular complications for pregnant mothers, as well as decreased blood flow to the placenta which can exacerbate conditions like pre-eclampsia.
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All across the world, midwives like Neha are also raising the alarm that extreme heat is becoming an ever-growing threat to pregnant women. A 2024 survey of 77 midwives across 41 countries from the International Confederation of Midwives found that 75 per cent of them believed that climate change was harming the communities that they serve, with rising rates of preterm births, food insecurity, and restricted access to care during disasters like floods.
Despite mounting evidence that extreme heat is becoming a major maternal health threat, practical solutions remain scarce. Traditional public health systems are often overstretched, and wealthy governments have slashed foreign aid for developing countries. Money for adapting to the climate crisis is seen as particularly tight, while NGOs report how training on how heat and other climate change impacts affect pregnant women has dried up since the effective closure of the US Agency for International Development (USAID) by Donald Trump.
Heat insurance for pregnant women
Constrained budgets mean that innovative solutions to push every aid dollar further are becoming more important than ever. So it was that last week, women-led climate adaptation NGO HERA unveiled the world's first heat-pregnancy insurance programme at a sweltering London Climate Action Week, with the hope that it will ease the burden on pregnant women facing extreme heat.
“Women are already at the bottom of the ladder when it comes to extreme heat, working over hot stoves, caring for family members, sitting at hot market stands, or being forced to remain inside when the men can go outside,” Kathy Baughman McLeod, CEO of HERA tells The Independent. “If you bring pregnancy into the mix, women's vulnerability only increases.”
HERA has an existing insurance scheme that already protects more than 300,000 informal workers in India by paying out direct cash when temperatures exceed dangerous thresholds. The new scheme is an “add-on” that will enhance the heat-sensitivity of the scheme to provide additional protection for pregnant women. “”What this scheme is doing is saying: okay, when things get too hot, you can work less, and you can be protected,” says Kathy.
It is being backed by philanthropic funding, including from the L'Oréal Foundation, and is being first introduced in India next year, with plans to expand into Thailand and Sierra Leone.
“I can absolutely see how this scheme would benefit women here,” says Neha on Baba Island. “We don’t have a public health system that is accessible to everyone. Therefore in the summer months, things like water, electricity, or hospital visits are all added costs. A scheme that could protect from the hottest days while ensuring women still receive money could go a long way.”
The aim for the scheme is to transform thousands of lives - but according to Baughman McLeod, it should only be the beginning. As well as suffering during pregnancy, women suffer more domestic violence during hot weather, she says, and they face other health challenges including hormone fluctuations, and more challenging menstrual cycles.
"Heat is killing more people than any other climate hazard. It's a huge drain on productivity, and many parts of the world remain completely ill-adapted," she says. "As it stands, there remains a chasm between the reality of extreme heat and the policy conversations taking place."
This article was produced as part of The Independent’s Rethinking Global Aid project
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