This series aims to address the interconnected nature between climate and health with a focus on Pakistan. The three parts address the gender climate nexus as well as problems such as antibiotic resistance in paving the way for a sustainable healthcare system in Pakistan. Sustainable Development Goals 3 Good Health and Wellbeing can not be met without meeting Goal 13 to address Climate Action. Goal 5 Gender Equality can only be met when we meet Goal 3. For each goal to be met the others must equally be worked on. The first two articles address a gendered approach to climate change and health whereas the last two articles tackle broader themes of SDG 3 and 13.
- Hormones, Heatwaves and Healthcare
The links between climate change and its impact on health have been of great concern. However, this threat to global health disproportionately affects women, particularly in the global south such as Pakistan. Climate catastrophes from heat waves, floods and droughts have exacerbated existing gender inequalities affecting women’s health. The intersection of gender and climate change in Pakistan has been shown to have effects on hormones, menstrual hygiene and access to healthcare for women.
The frequency of heatwaves in Pakistan has become a growing concern, with regions in Punjab being declared inhabitable in such high temperatures affecting the standard of living in numerous ways, one area often ignored is the hormonal imbalances. Firstly, the disruption of hormonal production under high temperatures and stress has caused an increase in women suffering from Polycystic Ovary Syndrome in Pakistan. Secondly, the high temperatures alongside other climate catastrophes affect Pakistan’s crop yield. Having to rely on processed foods or crops grown with chemicals that lead to hormonal imbalance in women leads to long-term physical and psychological impacts. Women and girls are often the first to experience nutritional deficiencies when food is scarce, as cultural norms may prioritise feeding men and boys first.
Nutritional deficiencies lead to women suffering from iron deficiency PCOS and pregnancy complications.
Maternal mortality and pregnancy-related risks have become an additional concern due to climate change. Pakistan already ranks third in the world with the highest maternal and neonatal mortality rates. With elevated temperatures and heat exhaustion, there is an increase in the risk of preterm labour and complications during pregnancy, increasing the number of maternal and neonatal deaths even further. The lack of electricity supply in rural and suburban areas whereby those relying on public hospitals do not have the basic right to adequate health care in these dire conditions.
Climate change can lead to water scarcity, making it harder to access clean water. Women and girls, traditionally responsible for water collection, may have to travel longer distances, increasing their exposure to health risks and limiting their time for education and economic activities. Carrying heavy water containers over long distances can lead to physical strain and injuries. Additionally, accessing contaminated water sources can increase the risk of waterborne diseases.
Menstrual hygiene challenges during floods have come to light time and time again with floods in Pakistan. The lack of infrastructure and preparedness for such events despite being aware of this being an annual event and a lack of investment into flood prevention has led to challenges for women in maintaining menstrual hygiene. These effects are not short term but a lack of menstrual hygiene can lead to long-term effects or even an increased death toll for women. The lack of sanitation and privacy during these times also exposes women to an increased risk of infections stripping them of their basic rights to dignity. When our aid packages do not consider women to need sanitation products for menstrual hygiene or other such taboo subjects for our society, neglecting women’s basic needs and compromising on their right to dignity leads to irreversible damage and shows a flaw in disaster response plans.
Climate change-induced events can disrupt education, as schools may be damaged or repurposed as shelters. Girls are more likely to be pulled out of school to help with household chores or care for younger siblings during crises. This is due to the stigmatization of girls being educated in Pakistan alongside the deep-rooted gender roles instilled in girls at a very young age. Oftentimes it is not just gender norms but the lack of security for girls when schooling is disrupted and there is a need to travel long distances alone to be able to attain education. Parents are more hesitant to send girls to school disrupting education. This leads to a long-term educational impact whereby girls’ future opportunities are interrupted, perpetuating cycles of poverty and limiting their ability to adapt in the future. The longer-term effects also lead to economic disparities and leave women vulnerable in society.
To address the gap of gender inclusivity in disaster response frameworks for climate change the state needs to focus on the provision of menstrual hygiene products, and reproductive health services and strengthening healthcare systems with investing in resilient infrastructure. Equally, there is a need to invest in the effective training and recruitment of medical workers who go into the field during these times. Ensuring response teams are treated well is essential to ensuring the system does not crumble, simultaneously, there must be a focus on increasing the number of female workers in response teams to ensure the comfort level of women suffering under these circumstances needing emergent medical care. Public awareness should be focused on to ensure there is adequate knowledge on the matter which can contribute to more effective fundraising, projects and preparedness to respond to such matters.
The gender-climate nexus in Pakistan highlights the urgent need to integrate gender perspectives into climate change policies and disaster response strategies. Addressing the unique challenges faced by women during heatwaves, floods and other climate-related events is essential for building a more resilient and equitable society. By prioritizing women’s health and well-being, Pakistan can better cope with the impacts of climate change and ensure a sustainable future for all its citizens.
- Silent Crisis: Maternal Mortality Rates and Climate Change
In 2020, Pakistan ranked third in the top ten countries with the largest number of maternal deaths and stillbirths. Maternal health is a critical component of public health that is increasingly being threatened by the impacts of climate change. The intersection of maternal health and climate change presents urgency to be addressed by Pakistan.
In Pakistan, a country already grappling with various socio-economic challenges, the intersection of maternal health and climate change presents a complex and urgent issue. This article delves into the implications of rising temperatures and extreme weather conditions on maternal health in Pakistan.
Concerning trends emerge from the link between high ambient temperatures and adverse maternal health outcomes. Heat exposure has been shown to cause premature rupture of membranes and streptococcus infection. In 2024, Southern Punjab and Sindh saw temperatures reach up to 52 degrees Celsius making it inhabitable for many. The high temperatures coupled with a lack of electricity and infrastructure that is not heat friendly leaves women vulnerable to high heat exposure during their pregnancy leading to a premature rupture of membranes, placental abruptions, and antenatal hemorrhage.
Socio-cultural norms and economic realities compound the situation in Pakistan. Women in rural and low-income areas often bear the brunt of climate-related stresses due to their roles in household and agricultural tasks. Pregnant women are frequently involved in intense physical activities, such as carrying heavy loads of water, crop yielding etc. This physical strain in extreme heat has led to complications like abdominal pain, vaginal bleeding, and even miscarriages. Heavy domestic workload often exacerbates their conditions. With traditional gender roles so heavily engraved into society alongside an increasingly worsening economic condition women are unable to break away from domestic work alongside horticultural work. The lack of reduction in work during extreme heat highlights a problem in a lack of heat adaptation plans but also socio-cultural issues impacting pregnant women during climate catastrophes.
In 2023 UNICEF reported an increase in malnutrition in mothers by 25%. Studies show nearly 18% of all married women of reproductive age in Pakistan are nutrition deficient. Climate change further leads to dehydration and nutritional deficiencies in women posing a particular danger to pregnant women. Prolonged exposure to heat alongside struggling to find clean drinking water. The International Organisation for Migration found only 36% of Pakistan’s water supply safe for consumption. However, this is not solely applicable to dire heat conditions but access to clean drinking water has become a problem during the flooding in 2022 particularly in Sindh. Maternal health care took a toll during this. Nutritional health is another critical area affected by climate change. Poor maternal nutrition not only compromises the health of the mother but also affects the growth and development of the fetus. This issue is further compounded during the breastfeeding stage. The mother’s nutritional status directly impacts the quality of milk and consequently, the health of the newborn.
Maternal health and sustainability are interlinked and always have been. How we produce our food to how we treat our climate leaves a long-lasting impact on the health of women. From infertility to maternal mortality rates, there is a dire need to address these issues. Policymakers and public health officials must focus on a multifaceted approach to first, implement heat adaptation strategies. Developing and investing in heat-friendly infrastructure as well as looking into various mechanisms such as solar power to run electricity in hospitals should be a top priority. Secondly, improving access to healthcare, ensures that healthcare facilities are equipped to handle heat-related complications and there is adequate training as well as facilities provided for professionals to tackle such issues. A part of this should be an investment into training midwives handling home births and complications. Thirdly, the promotion of gender-sensitive awareness campaigns to educate both men and women on the effects of heavy workload during pregnancy, nutritional values etc. More importantly, there is a need to focus on investing in equipment for those women working in agriculture to lower their workloads. Lastly, enhancing water and nutrition security. Targeted food security programmes alongside investment into water well projects to ensure women do not have to carry heavy buckets or struggle to find access to clean drinking water can make a huge impact.
The intersection of maternal health and climate change in Pakistan underscores a critical public health care crisis. Targeted intervention can help alleviate the problem at hand. Pakistan can mitigate the adverse effects of climate change on maternal health and ensure a healthier future for mothers and their children.
- Climate Cures: SDG 3 and 13 Combatting Air, Water and Vector-Borne Diseases
While women are disproportionately affected by climate change and the health care crisis in Pakistan, lower-income households also bear the burden of the impact of Climate Change through extreme exposure to pollution and airborne diseases. The comprehensive blueprint for sustainability under the Sustainable Development Goals provides for the necessity to tackle sustainable solutions for a healthier earth and those that inhabit it. This article will explore the intersection of airborne diseases, pollution and health impacts in Pakistan under the Sustainable Development Goals framework.
Rising temperatures, flooding, lack of clean water, and pollution have all contributed towards an increase in health complications, particularly respiratory issues. Pakistan already deals with a high number of airborne diseases before the COVID-19 Pandemic. A big concern is the high number of individuals suffering from Tuberculosis (TB). Over the years studies have found TB rates to increase during high heat periods, April to June. The high rise in temperature during the entire year as a result of climate change may lead to changes in this trend, increasing the overall number of patients infected with diseases such as TB.
Smog and poor air quality have also led to cities like Lahore becoming highly infected with respiratory illnesses. Smog, particularly in the winter, has left Lahore ranking among one of the most polluted cities globally with toxins in the air reaching hazardous levels well above the recommended limit of the WHO for safe living.
Extreme weather conditions and events such as flooding can further increase the risk of infections. In 2022, Sindh reported a surge in cholera cases. Flooding alongside the heat and humidity facilitates the survival and transmission of pathogens. Children with weaker immune systems and those without access to clean water often become exposed to diseases quickly. With the population displacement that also arises from climate-induced migration, the spread of contagious diseases becomes widespread. Containing both airborne and waterborne diseases becomes problematic.
Climate change also exacerbates the spread of vector-borne diseases such as malaria and dengue. Warmer temperatures and increased rainfall create ideal breeding conditions for mosquitoes, the primary vectors of these diseases. Pakistan remains one of the few countries still grappling with Malaria and Dengue at such high scales. The monsoon season brings about a dire need to have prevention protocols in place to avoid the spread and fatality of these vector-borne diseases.
Strengthening the healthcare system to combat air, water and vector-borne diseases requires a holistic approach. SDG 3 and 13 go in line with SDG 7 to have clean energy. Policy solutions focusing on the promotion of clean renewable energy could lower the pollution rates mitigating climate impacts and health impacts. Public awareness of prevention and policy regulation is essential to implementing air quality standards and limiting vehicle and industry emissions. A sustainable future can only be possible when we begin to tackle these problems as being interlinked with one another.
- Antimicrobial and Antibiotic Resistance: A Sustainability Challenge
Antimicrobial resistance (AMR) represents a formidable challenge to global health, with significant implications for sustainable development. In Pakistan, AMR poses a particularly severe threat, undermining efforts to control disease spread and deliver effective healthcare. This article explores the impact of AMR on healthcare sustainability in Pakistan, drawing on the urgency of addressing this issue.
AMR occurs when bacteria, viruses, fungi, and parasites evolve and become resistant to antimicrobial drugs, making infections harder to treat. The World Health Organization (WHO) has identified AMR as one of the top ten global public health threats facing humanity. In 2019, 4.95 million people worldwide died from drug-resistant infections. Alarmingly, 1 in 5 of these deaths occurred among children under 5 years old. With Pakistan ranking 176th in age-standardized mortality rate per 100,000 population associated with AMR out of 204 countries we need to address AMR in regards to sustainability to ensure the healthcare system does not crumble.
Currently, Pakistan ranks amongst the highest globally in mortality rate from drug-resistant infections. This highlights the urgent need for effective strategies to combat AMR and ensure sustainable healthcare. Without this Pakistan will continue to suffer from high levels of mortality rates from preventable diseases.
The Sustainable Development Goals (SDGs), adopted by all United Nations Member States in 2015, aim to address global challenges, including those related to health and well-being. While there is no direct mention of AMR, there is an essential need for there to be. The spread of AMR jeopardizes the achievement of several SDGs. SDG 3 Good health and wellbeing, AMR threatens to reverse progress made in combating infectious diseases, increasing the burden on healthcare systems.SDG 6: Clean Water and Sanitation as inadequate sanitation and clean water access can facilitate the spread of resistant pathogens.
SDG 12: Responsible Consumption and Production as sustainable practices in antibiotic use are critical to slowing down the spread of resistance.
Several factors contribute to the exacerbation of AMR in Pakistan. Firstly, overuse and misuse of antibiotics. There are currently no robust strategies to minimize the risk of unnecessary usage of antibiotics which leads to increased resistance. With the spread of self-medication, over-the-counter antibiotics being sold and the use of contacts or bribery to get medication over the counter, antibiotics have become too widely available. The consumption of antibiotics to treat small infections due to self-medication is a growing problem and will make it difficult for Pakistan to counter new diseases or preventable diseases in the future due to AMR.
Secondly, lack of adequate healthcare infrastructure. The healthcare system in Pakistan struggles with inadequate resources, insufficient infection control measures and little access to quality care if you are unable to afford private healthcare. The risk of spread of infections is high, particularly alongside climate disasters such as flooding which leads to makeshift shelters and camps where infections may spread more easily. Lack of ventilation in infrastructure often has similar results. High population density and inadequate sanitation further complicate the situation with the rapid spread of infectious diseases and AMR.
To tackle AMR in ensuring healthcare sustainability in Pakistan, we must first strengthen regulatory frameworks whereby the sale of antibiotics is put under control. This includes requiring prescriptions to purchase antibiotics, monitoring their use and ensuring a check-in-balance in pharmacies selling the antibiotics to limit the unnecessary sale of antibiotics. There must equally be an investment in research to understand resistance patterns and develop treatments as the next steps. For this, SDG 17 is crucial; the need for international collaboration to share resources and knowledge is vital for a response to AMR. With a country like Pakistan already struggling with its economy and infrastructure SDG 17 becomes pivotal to combating AMR.
Pakistan must also focus on improving infection control to reduce the spread of disease. There is a need to train healthcare workers and implement prevention and control measures in hospitals, clinics, at home etc. A large chunk of this comes with public awareness and education on the prevention of diseases and providing sanitation resources to prevent rapid infections. Spreading awareness on vaccinations and nutrition is also needed. The spread of knowledge on the dangers of antibiotic misuse is of utmost importance to combat the problem at hand. Lastly, there is a need to push for more female healthcare workers to reduce the number of women and children self-medicating due to cultural stigmas.
Antimicrobial and antibiotic resistance poses a significant threat to healthcare sustainability in Pakistan. The high mortality rates associated with drug-resistant infections highlight the urgent need to combat AMR. If Pakistan fails to act now, it will struggle to maintain its already crumbling healthcare system from diseases we are not equipped to fight.
