Anticipated Impacts of the Climate Crisis on Women’s Health: A Call to Action

There is now 95–100% confidence that human-related (anthropogenic) activities account for the rise in CO2, (as well as less prevalent GHGs) over the past several centuries, and thus for climate change (1,2). This level of certainty arises from a variety of independent data sources and lines of inquiry that are well reviewed in the United Nations Intergovernmental Panel on Climate Change (UN IPCC) Fifth Assessment Report and the United States Fourth National Climate Assessment. Alarmingly, there has been an acceleration in GHG emissions since the first IPCC report published in 1990, with more than half of all historical CO2 emissions having occurred in the past 30 years. Matching this trend, the warmest years on record have occurred since 1970, with ten having occurred since 1998, and the five warmest years being 2015, 2016, 2017, 2018, and 2019 (8–10). Were human activities to remain unabated, current projections by the IPCC portend CO2 concentrations reaching horrific levels of greater than 1000 ppm and an average surface temperature increase of more than 3–4°C by as early as 2100.

Impacts of the Climate Crisis

The ongoing as well as anticipated impacts of climate change include: sea level rise; ocean acidification; more intense droughts, flooding, and storms; more frequent hot and fewer cold extremes, resulting in increased frequency and intensity of heatwaves; and more wildfires as well as extreme weather events (1,2,11). The magnitude of these effects will ultimately depend on what steady-state level of GHGs are achieved, and thus, what average temperature eventually results. It is important to note this is a process that will take thousands of years to achieve equilibrium, and there will be no “new normal” with regards to climate within the lifetimes of any human beings who are currently alive, nor will there likely be for tens to hundreds of generations.

All of these altered environmental conditions pose significant threats to the habitability of the planet, and the survivability of life as we know it. Indeed, the negative impact on Earth’s flora and fauna from climate change is already underway. It is estimated that up to 1 million species of plant and animal species are now facing the risk of extinction this century, and the current rate of extinction is already tens to hundreds of times higher than that seen over the past 10 million years (12). Besides this mass extinction, there have been five other major mass extinctions in the history of life on Earth. Alarmingly, four of these five mass extinctions have now been linked to the emissions of greenhouse gases from geophysical processes (13,14). There is nothing in the record of life on Earth to reassure us that humanity has any protected or sacred place in the evolutionary tree; our species will be vulnerable to climate change just as countless millions of other species have been and will be in the future.

Adverse Effects to Human Health

Anticipated adverse impacts due to the climate crisis that are specific to human health include: increased exposures to extreme weather events, including droughts, flooding, and extremes of temperature; altered food-, water-, and vector-borne infectious disease; reduced food, water and air quality; decreased food security; and loss of access to healthcare resources due to political and economic instability, as well as due to mass migration (1,2,11,14–17). Some of the effects on morbidity and mortality include (15,16):

• direct effects, including death from heat, heat stress, and heat stroke
• direct injuries, loss of life, and depression and anxiety from extreme weather events
• poor air quality leading to respiratory complications (such as asthma, allergies) as well as cardiovascular disease
• poor water quality and lack of access to clean water leading to increased diarrheal diseases such as cholera
• food insecurity from rising levels of CO2 leading to decreased levels of protein, micronutrients, and B vitamins (and hence, nutritional quality) of rice, wheat, and other crops, as well as reduced yields of vegetables and legumes, in turn leading to undernutrition, stunted childhood growth, and vulnerability to non-communicable diseases
• geographic spread of mosquitoes and other vectors that can disseminate diseases such as malaria, dengue, yellow fever, Zika virus, etc.
• repercussions from climate-induced migration, including adverse mental health outcomes, lack of access to reliable healthcare, food and water and susceptibility to violence

Adverse Effects to Women

The populations who will feel the initial brunt of this climate crisis will be the most societally disadvantaged. These populations are invariably poor and are already living in environmentally marginal circumstances (18). Among such populations, women have been recognized as a vulnerable group, since in many parts of the world they lack adequate access to family planning services, educational resources, and sufficient income (19–21). Additionally, given the differing roles men and women play in most societies, as well as women’s unique reproductive burden, climate change impacts are expected to have a differential impact on men versus women (19–21). In many cases, adverse impacts are likely to be worse for women than men by widening health disparities that already exist in many parts of the world. Examples of adverse health effects to be felt disproportionately by women include (19–23):

• respiratory and cardiovascular disease from greater exposure to poor-quality air, especially due to particulate air pollution from both indoor sources (e.g., cooking and heating sources), as well as from outdoor environmental sources
• anemia and malnutrition from food insecurity and increased nutritional needs due to childbearing and menstruation
• physical and sexual violence, as well as anxiety, depression, and other mood disorders related to climate-induced migration and environmental disasters
• pregnancy-related complications (e.g., intrauterine growth restriction, preterm birth, congenital anomalies, stillbirth)
• lack of access to prenatal care, contraception, and family planning options

The Unique Role of Women

Women mediate the interplay between population growth and climate change through their reproductive behaviors. If contraception were more readily available in both developed and developing regions, CO2 emissions could be reduced by 30% by 2100 while simultaneously eliminating more than 100,000 maternal deaths per year, resulting in significant benefits not only for regions of the world with high fertility rates, but also with high levels of vulnerability to climate change such as Sub-Saharan Africa and South Asia (2,24–28). Meeting unmet contraceptive demand will result in a greater reduction in per capita emissions from developed nations than in developing nations. Reducing fertility rates in developing nations would prevent the birth of millions of people who would inevitably become victims of the worst ravages of climate change, but also significant contributors to future GHG emissions due to increasing adoption of high GHG-emitting consumption lifestyles akin to those seen in developed nations (2,18,24).

Women’s traditional role as family caregivers in many parts of the world places them in unique decision-making roles that can adversely impact climate repeatedly throughout the day, including in the use of appliances (e.g., for lighting, cooking, heating or cooling, heating water, laundry, etc., including time and frequency of use), purchases of household goods, establishment of family dietary habits and patterns (e.g., frequency and amount of consumption of meat, dairy, and vegetables), and the education and shaping of their children’s energy consumption habits (20). The modern food production industry has significantly contributed to environmental degradation, climate change, and health crises due to insufficient food consumption in over 800 million people worldwide while also resulting in an epidemic of obesity, cancer, diabetes, cardiovascular disease, and other ailments (30). Aligning the food industry and people’s food-eating habits to plant-dominant diets promotes health, sustainability, and climate change mitigation.

The Role of Women’s Healthcare Providers

Consideration of the interconnections between climate, population groups, and health is not in our usual mindset as healthcare providers, as we have historically focused on cultivating one-on-one relationships with our patients. However, as climate change threatens to undo all of our diligently-acquired gains in reducing women’s morbidity and mortality related to pregnancy, infectious diseases, and chronic medical illnesses, ignoring it is no longer an option.

Core principles of provider engagement must include political advocacy, provision of contraception and family planning methods, and nutrition and lifestyle counseling. Providers must advocate for political and social environments where women are free to limit the number of children they have, to pursue higher education and employment equally compensated to men, to participate in political leadership, and are free of societal and economic constraints so as to enable them to make healthy nutritional and lifestyle choices for themselves and their families. Providers, medical societies, and scientific institutions must resist corrosive political interests that seek to undermine scientific discovery and education, as well as politicians who sabotage the sacrosanct relationship between provider and patient.

As women’s healthcare providers we stand at a unique vantage point that overlooks the intersection of our patients’ health with environmental science, energy use, agriculture, land use, and public policy. Amazingly, advocating for interventions we have always emphasized as healthcare providers — women’s empowerment over their own reproductive health and education, better diets and lifestyles to reduce risk for chronic medical illnesses (e.g., cardiovascular disease, diabetes, and cancer), and reducing pregnancy-related complications to mother and fetus — brilliantly dovetails with the fight against climate change while also reinforcing the fight for reproductive justice and general human well-being. Thus far we have failed to have a macroscopic vision of this reality, as well as of the power we and our patients collectively possess to influence the narrative — but it does not need to remain this way. By educating women about the impact of their daily decisions, advocating for equal pay and career opportunities and thereby providing the means for self-reliance and resiliency, empowering them with contraception, and elevating their leadership roles within families and communities, women can become powerful agents in the mitigation of, and adaptation to, climate change (19–21,29).

Our Time Is Limited

We will have to limit temperature increase to 1.5°C by 2100 to avoid the worst outcomes. We can only emit 340 gigatons (Gt) of CO2 before we exceed our 1.5°C budget, which amounts to only 8–10 years of current emissions (31, 32). Currently global civilization is on a “business-as-usual” pathway, and we may have already crossed critical climate tipping points; it may be too late to prevent portions of the Earth from becoming uninhabitable by 2100. Amazingly, simply meeting the unmet demand for contraception, providing universal access to 12 years of education for all girls and women, and modifying our diets, have been estimated to collectively reduce global CO2 emissions by 180 Gt by 2050 (33) — enough reductions to “flatten the curve” of global warming and to buy us invaluable time to devise more definitive technological solutions. These interventions are well within the purview of women’s healthcare providers.

The adverse health outcomes previously listed are not fixed in stone — they represent an initial phase of adversity to the human species, but this adversity will quickly become an existential threat as temperatures rise and tipping points are reached. In the past few years it has become apparent that rising heat will lead to increased rates of fetal congenital anomalies such as heart defects (34), and fetuses exposed in utero to natural disasters such as Hurricane Sandy and Hurricane Katrina have altered neurodevelopmental outcomes and higher central adiposity, let alone their mothers having higher rates of anxiety, depression, and PTSD (35–37). It is clear that the climate crisis is already leading to a continuum of adverse health effects that will ripple across future generations of humanity with unpredictable effects (38). If we know all this already, what then will happen to human health as GHG and particulate emissions continue, warming continues, oceans rise, storms intensify, food and water become scarce, and people migrate leading to unprecedented economic and political calamities? Greta Thunberg famously stated that “our house is on fire.” From a physician’s point of view, it is more akin to the Earth having a fever.And what happens to a human body with a 1°C rise? And what happens if our temperature keeps going up? Our civilization, our agriculture, our species never evolved under the climactic conditions we will face in the coming century and beyond. It is far past time to ask if this uncontrolled experiment is one we truly want to conduct. Is there not enough “interim-analysis” data to abort this experiment now? And for the critics who still willfully choose to disbelieve it is imperative to emphasize that the solutions proposed will actually lead to a better world than before. Fighting climate change is not, and does not have to be, a zero-sum game.

Ultimately, climate change-mediated effects may pose far greater dangers to the well-being of all humans than any traditional ailments, COVID-19 not withstanding. Exactly what we do as a species, how we do it, and how quickly we do it will be the key determinants of humanity’s survival in the face of what has become no less than an existential crisis. As the former UN Secretary-General, Mr. Ban Ki-moon, stated in his opening address to the UN Climate Summit in 2014, “Climate change is the defining issue of our age. Our response will define our future. To ride this storm we need all hands on deck.” Millions of daily interactions between women and their care providers results in a potent force that can be conscripted into a global fight against the climate crisis. Healthcare providers not only have an ethical duty to act, but will ultimately have no choice but to be a part of the solution. It’s time to embrace this fight.

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