Climate change takes toll on internally displaced women in Pakistan

“Women are not receiving the medical attention they require”

Originally published on Global Voices

In Pakistan, internally displaced women, who are already dealing with the loss of their homes and livelihoods, are facing unique pressures — particularly around women's health and maternity care.

Pakistan is among the countries most vulnerable to the effects of climate change. Rising temperatures, sporadic monsoons, and severe droughts have become the new normal, displacing millions of people, particularly in the north. According to the Internal Displacement Monitoring Centre (IDMC), over 3 million Pakistanis were internally displaced by natural disasters in 2023 alone.

Trials of pregnant women in camps

Shabana Bibi (name changed), a 28-year-old woman from a remote area in northern Pakistan, had no idea that climate change would force her to make tough decisions about her health and family. Shabana and hundreds of others have been living in a temporary settlement for almost a year after being displaced by disastrous floods in the Chitral region in July 2023.

“Everything was gone in an instant,” Shabana recalls. “Our home, our crops, our livestock. We had to leave with just the clothes on our backs.” Her family found refuge in a makeshift camp on higher ground, joining hundreds of other displaced families.

Her journey to the camp was horrific, but the everyday difficulty she endures reveals a far more serious issue: A lack of women's health resources and maternity care among women displaced as a result of climate change.

Similarly, when Geetha (name changed) felt the first tremors of labour, she realized she wasn't prepared. The 25-year-old was relocated from her house in Pakistan's drought-stricken Tharparkar region in Sindh province in southern Pakistan and was living in a makeshift tent with her two children. The continuous droughts led her and countless other families to seek refuge in other parts of the Sindh province. As she held her growing belly, the terror of what was to come overwhelmed her joy at bringing a new life into the world.

Shabana Bibi and Geetha's sufferings are an acute reflection of a looming crisis in Pakistan, where climate change-induced migration has a significant impact on women's health and mothers.

Women are particularly vulnerable

Women endure even more serious consequences as a result of displacement compared to men. Pregnant women who live in temporary shelters with limited access to healthcare, sanitation, and nutrition face increased risks. The stress of displacement, along with inadequate living conditions, often exacerbates pregnancy and delivery problems. Likewise, losing access to everyday contraceptives and women's health products can lead to unplanned pregnancy or other health issues.

Samina Hussain, an obstetrician working with a local NGO in Central Punjab, an area hardest hit by the floods, reveals that many displaced women neglect prenatal and postnatal consultations. “The situation for internally displaced people is grave. Women are not receiving the medical attention they require, and many are too afraid or too far away from healthcare facilities to seek assistance,” she says. Because there is limited access to adequate medical treatment, pregnancy issues are frequently left untreated. In these circumstances, infections, malnutrition, and high blood pressure, which can be treated promptly in proper medical facilities, become life-threatening. Dr. Hussain recalls an incident when a woman in a rural area was transported more than three hours to the nearest hospital, only to lose her baby due to the delays and lack of proper healthcare facilities.

Fatima reveals her fears about childbirth amid her displacement and migration. “I’ve seen women suffer here. The medical facilities are not equipped to handle emergencies. My neighbor lost her baby because there was no doctor available at the time. I don’t want to go through that,” she says, her voice trembling with emotion.

Handling the stress of the displacement

Climate-induced displacement disrupts healthcare services, which are made worse by other stresses too. The psychological and physical stress of displacement frequently causes difficulties during pregnancy and childbirth.

An expert from the Pakistan National Institutes of Health elaborated that stress hormones such as cortisol are influenced by both temperature and stress and can potentially have a deleterious impact on pregnancy outcomes. Elevated cortisol levels, which are frequent among displaced communities, correlate with premature deliveries and low birth weight.

Naila, a newly married woman preparing for his first delivery suffers from severe anxiety and depression, conditions that are exacerbated by the uncertainty of her situation. “I worry every day about the future of my children. I don’t know how I will provide for this new baby,” she confides.

“Climate change poses an existential threat to all of us, but pregnant women, babies, and children face some of the gravest consequences of all,” said Bruce Aylward, Assistant Director General for Universal Health Coverage, Life Course at the World Health Organization (WHO). “Children’s futures need to be consciously protected, which means taking climate action now for the sake of their health and survival while ensuring their unique needs are recognized in the climate response.”

Climate change's influence on menstruation and reproductive health, particularly among displaced women, exacerbates the pre-existing multifaceted issue. The relationship between changing environmental circumstances and reproductive health obstacles is becoming apparent. Rising temperatures and harsh weather events have been reported to impact menstruation cycles and general reproductive health, causing further hardship for women like Shabana. For example, extreme heatwaves in Pakistan have been associated with irregular menstrual periods. The National Institute of Health has discovered that stress hormones like cortisol might disrupt menstrual cycles. High cortisol levels under intense heat can cause illnesses such as dysmenorrhea, which is characterized by severe period cramps, as well as delaying or stopping menstruation entirely.

Food insecurity

Climate change's influence on agriculture also contributes to food insecurity, which is seen as one of the most pressing issues for pregnant and breastfeeding women. As unpredictable weather trends alter crop production, communities worry about providing sufficient food for themselves and their children. Amina, displaced from a drought-stricken village in Balochistan, shares her anxieties, “How can I bring a child into this world when I can barely feed myself?”

Shabana, while sharing the grim situation of other pregnant women, said; “We barely have enough food to feed ourselves,” she explains. “Most days, women survive on lentils and rice. There is no milk or fresh vegetables.” The limited diet not only affects their health but also their ability to produce sufficient breast milk for the newborn.

According to the WHO article “Protecting Maternal, newborn, and Child Health from the impacts of climate change,” the effects of climate events on the health of mothers and their babies have been overlooked, underreported, and underestimated. It highlights that very few countries’ climate change response plans mention maternal or child health, describing this as “a glaring omission and emblematic of the inadequate attention to the needs of women, newborns, and children in the climate change discourse”.

Despite these daunting hurdles, there are attempts to ameliorate the situation. Local NGOs and international organizations have stepped up an initiative to identify the critical need for maternal health services in IDP camps and areas with larger displaced populations. One significant project is that of the Turkish Cooperation and Coordination Agency, which has developed mobile clinics to provide prenatal and postnatal care to women in isolated locations. These mobile units, staffed by trained midwives and stocked with necessary medical supplies, travel to various camps to provide critical healthcare services. However, much more must be done. The extent of climate-induced displacement and the frequency of climate catastrophes are growing, and our resources are inadequate.

Written by Asfandiyar