Climate change has made pregnancy and childbearing more treacherous in regions of the world most vulnerable to extreme heat. In Mumbai, searing heat in the summer of 2022, topping 38 degrees Celsius (104 F) during the day, made 23-year-old Madhuri Bolake lose so much sleep she actually thought about getting an abortion.
“Even after turning on the ceiling fan at the maximum speed, I found it difficult to fall asleep,” she recalled. “Often, I woke up in the middle of the night.” (Like others interviewed for this story, she spoke in the regional Marathi language.)
Eventually, she called Bharti Kamble, a community health care worker in Bolakewadi, her native village of 701 people roughly 500 kilometers away from Mumbai. Kamble advised returning to the village, which is typically cooler and less humid than Mumbai. During the third week of February, Bolake returned to the village seeking respite, but the heat wave followed her.
In the next two weeks, Bolakewadi was scorching hot and Bolake’s hemoglobin — the protein in her blood that carries oxygen — plummeted to just 6 grams per deciliter, far below the normal 12-16 for women of childbearing age. Low hemoglobin during pregnancy can harm the pregnant person’s health, and it increases the risk of premature delivery or low birth weight.
As Bolake continued to lose sleep in the heat, she got intense headaches and had trouble digesting food. After multiple visits to the doctor, sleep deprivation — a risk factor for low hemoglobin — was confirmed as the culprit.
“As night temperatures warm, it takes people a longer period of time to fall asleep and to get into the restorative sleep state,” said Kelton Minor, a postdoctoral research scientist at Columbia University’s Data Science Institute, who was not involved in treating Bolake.
Minor is the lead author of a 2022 study in the journal One Earth that found that people living in the warmest climate regions, such as Colombia, Saudi Arabia, and India, lost over twice the sleep per degree of global warming compared to those in colder climates. Other studies have also found that sleep deprivation during pregnancy can increase the risk of preterm births and other problems such as preeclampsia, low birth weight, Caesarean birth, and gestational diabetes. In a study published in the International Journal of Gynecology and Obstetrics, researchers found that inadequate sleep at 36 gestational weeks led to a significant risk of postpartum depression.
As the climate continues to warm, millions could be affected. India alone has more than 378 million women of childbearing age. And heat isn’t the only form of extreme weather growing worse as climate change intensifies: Flooding is also worsening in many places, complicating labor and delivery for those who give birth during a disaster.
Read: Extreme heat makes pregnancy more dangerous
The One Earth study found that “people started to actually wake up earlier during hot days, which indicates that heat not only delays when people get their sleep but also shortens the entire sleep period,” Minor said. “This increases the chance that people experience a short night of sleep — a risk factor for adverse mental and cardiovascular health outcomes.”
Minor’s paper analyzed over 7 million sleep records from more than 47,000 individuals from 68 countries globally. The researchers looked at whether people compensated for lost sleep over the course of a week during hot weather but found instead that people slept less than normal for the seven-day period.
And they found that getting used to hot weather didn’t help: “When we additionally looked at whether people would adapt across the summer months, we were surprised that people lost slightly more sleep at the end of summer even though the heat was more familiar cognitively,” Minor explained.
A pregnant woman needs seven to nine hours of sleep daily, according to the National Sleep Foundation, a U.S. nonprofit. Yet during the hot weather of 2022, Bolake typically clocked less than six hours.
Labor pains came after only seven months, and a doctor at a private hospital warned he could either save Bolake or the child. Kamble, the community health care worker, took her to a public hospital instead, where doctors were able to save both mother and baby.
“The surgery was extremely complicated since it was a preterm delivery. Somehow, she survived and was hospitalized for 15 days there,” Kamble said.
“One of the predominant reasons she faced so many problems was because she didn’t get enough rest and sleep during pregnancy,” says Kamble, who says she has handled over 60 childbirths since 2009 but has never seen such a complicated case. “From here, it will only get more complicated because of the rising heat.”
Bolake’s baby was also underweight and could not immediately receive vaccines against tuberculosis, polio, and hepatitis B, making the newborn vulnerable to those diseases. Within the next 15 months, the child recovered.
Delivery during a flood
Pregnant women can also lose a lot of sleep due to another scourge of climate change: extreme flooding. Two days before her child’s birth in August 2019, 26-year-old Vrushali Kamble from Maharashtra’s Ganeshwadi village was warned of a coming flood.
“Immediately, I moved to the government school that was converted into a makeshift evacuation center,” she said. Within a few hours, her house drowned in floodwater that took away all her belongings and didn’t recede for another 15 days.
“I couldn’t sleep at all during those two days,” she recalled. There were not enough evacuation centers, so at least 30 people were crammed into a 10-by-10-foot school room with crumbling plaster and cracked walls.
When she started experiencing labor pain one morning, community health care worker Chhaya Kamble, no relation to Bharti Kamble, immediately arranged an ambulance. “We crossed the state border and took her to the neighboring state, Karnataka, as all the hospitals here remained inaccessible because of the flood,” Chhaya Kamble said.
It took an hour for them to reach Karnataka’s Kagawad village, where Vrushali gave birth to a girl named Veera. The baby was born underweight and later died of a liver disease unrelated to the stress her mother experienced during pregnancy.
Creative solutions needed
Chhaya Kamble said that in the past four years, almost every pregnant woman in her village has faced the problem of sleep deprivation. “This is because of the fear of floods, rapid changes in the local climatic pattern to which they can’t adapt, and rising night temperatures,” she said.
What worries her most is how people have normalized this acute distress. “If a pregnant woman doesn’t get enough sleep, most of her family members say it is normal.” Now, the first question she asks all pregnant women is if they are getting enough sleep. At least this creates awareness of the problem even if it does not solve it.
Her experience helping Bolake has made Bharti Kamble extra cautious. She has created a WhatsApp group of pregnant women in her village, where she posts about the risk of rising temperatures. She also travels door to door to make every woman and family in her village aware of the dangers of rising temperatures. Both she and Chhaya Kamble begin their days now by monitoring the temperature and checking forecasts.
Fans, cooling showers, and wet rags can be used to cool pregnant women to help them sleep, as well as removing extra bedding, said Nick Obradovich, chief scientist for Environmental Mental Health at the Laureate Institute for Brain Research in Oklahoma and one of the authors of the paper published in One Earth. These strategies are vital in India, where just 13% of households have access to air conditioners, even less in rural areas.
“Ultimately, policymakers should strive to provide resources to cooling centers for vulnerable individuals, especially the elderly, and to enable the use of air conditioning where possible, with a preference for lower carbon forms of energy to power it,” he said.
Minor, his co-author, suggested changing roofing materials could help cool buildings. “Researchers and engineers have shown that installing cool reflective roofing can help reduce the temperature not just on the roof but also inside the rooms below.”
As the temperature has started rising again in several parts of India, Bolake will again return to her village to protect herself from the heat in Mumbai.
“Since childhood, summers have always been a vacation, but now even stepping out in summer has become dangerous. I never knew that rising temperature would completely change my life,” Bolake said. She fears losing more sleep this year.
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