Crisis Deliveries

During the floods in Pakistan in 2022, nearly 33 million people were affected, including 6.1 million pregnant women. Disasters raise risks of miscarriage, pre-term birth, low birth weight and other complications, as emergency responses often overlook reproductive health in favour of injuries and disease outbreaks.

The Islamabad-based Population Council Pakistan (PCP), an international research organisation, carried out an intervention, engaging community midwives (CMWs) in emergency response efforts. Iram Kamran, director programmes at PCP, who led this operation, recalls, “We knew their own homes were damaged, as were their birthing centres and the equipment they used. Even the supplies had been washed away.”

In some of the worst-hit districts of Sindh and Balochistan, PCP provided refresher training and equipped 106 CMWs with essential supplies, including medicines and contraceptives, delivery kits and basic equipment. Within six weeks, they were ready to resume safe deliveries in makeshift birthing centres.

Iram says that, within two months, 55 midwives had assisted 479 births, provided family planning to 792 couples, and delivered antenatal and postnatal care to 664 and 368 women, respectively.

A key lesson was clear: as Pakistan sits on the frontlines of the climate crisis, preparedness must strengthen across all sectors, including reproductive health. “Disaster plans need regular, practical training for community-based health workers, so they can function effectively in extreme conditions,” says Iram.

Too Hot to Deliver

Dr Fatima Jehangir has seen a rise in gestational diabetes, hypertension, as well as depression and anxiety among pregnant women. She and her colleagues run a primary care clinic in Gulshan-i-Sikandarabad, an informal settlement in Karachi.

She is unsure what is driving the rise but says there could be multiple predictors of such conditions, “including health illiteracy, unhealthy diet, a sedentary lifestyle.”

But hot summer months are when she sees a spike in these complications. “It may be linked to poor living conditions — cramped, poorly ventilated homes, long power outages and limited mobility,” she says. “Many women, especially in Pashtun households, are rarely allowed to step outside and, when they do, they must wrap themselves in yards of synthetic, non-breathable abayas that trap heat.”

Among new-borns, especially during the summer, she has seen a rise in heat rashes. “It’s distressing, particularly in neonates,” she says. While maternal and neonatal mortality has declined, Dr Jehangir notes that morbidity is rising, affecting the quality of life.

Karachi-based Dr Jai Das of the Institute for Global Health and Development at the Aga Khan University, who has been studying the effects of extreme heat on pregnant women since 2024, says global evidence links heat to maternal and neonatal complications, including pre-eclampsia, eclampsia, gestational diabetes, low birth weight, prematurity, stillbirths and congenital defects.

Measuring the heat’s impact is complex, as it is shaped by the local context and economic realities. “Tolerance varies across regions and populations,” says Dr Das, adding that AKU’s new research will be examining both prolonged and short-term heat exposure and its impact on the body.

Still, this needs some out-of-the-box thinking. “It is no rocket science to plan schedules to reduce the impact of heat, since it is a climate reality now,” he says, which includes simple, practical measures to reduce heat risks: adjust work hours, follow a work-rest cycle, stay hydrated and avoid peak heat. While pregnant women are especially vulnerable, he advises reducing exposure where possible, or at least maximising rest and hydration.

Drawing on both urban and rural observations, Das says pregnant women in Karachi’s informal settlements are as vulnerable as rural women in the fields, as women in these peri-urban settings are trapped in small unventilated houses with electricity shutdowns for long hours. Seen through the lens of class, culture and poverty, he believes that care for women in both peri-urban and rural settings must be prioritised.

But this climate burden does not stop at patients — it also extends to those caring for them. Like pregnant women, midwives working in extreme heat are under intense strain — even as they make life-and-death decisions.

“They need to stay alert, keep their judgement sharp,” says Neha Mankani, a midwife with 16 years’ experience. Yet, while expected to remain calm, empathetic and composed, they are rarely given the support they need. “Has anyone considered whether their uniform fabric is breathable, or if their restroom has a fan, or if they have access to cold drinking water?” she asks.

Published in Dawn, EOS, May 3rd, 2026