A perfect storm: Climate disasters are magnifying the U.S.’s maternal health crisis

During every humanitarian disaster — whether it’s a war, a pandemic, or an extreme weather event — pregnant mothers and their babies are hit particularly hard. More frequent and more intense climate disasters, shown by the recently released report by the United Nations Intergovernmental Panel on Climate Change to be the result of decades of inaction on climate change, make conditions particularly dire for pregnant mothers and their babies around the globe. These risks are increasingly apparent in the U.S., particularly for mothers of color.

While climate change has long been recognized as a racial justice issue, the impact of climate disasters on birth equity has received less attention. On average, Black, American Indian, and Alaska Native mothers in the U.S. are two to three times more likely to die from pregnancy-related causes than white mothers. This disparity is compounded by segregation. In segregated cities like New York, for instance, Black mothers are eight to 12 times more likely to die than white mothers from complications related to pregnancy and birth.

It’s no coincidence that places most vulnerable to disaster are disproportionately populated by people of color. In cities across the U.S., neighborhoods populated mainly by Black people were historically denied services and investment as part of policies known as redlining, and a long history of racist public policies and ongoing colonialism contributed to the underinvestment in American Indian and Alaska Native communities and tribal lands.

In urban areas, Black neighborhoods are most likely to experience the worst impacts of flooding. Native Americans are six times more likely than other groups to live in wildfire-prone areas. Homes in neighborhoods of color are also less likely to be well ventilated or heated, and these neighborhoods are less likely to have ready access to emergency services and health care.

When disaster strikes, Black and Hispanic households recover more slowly. The inequitable disaster response in parts of New Orleans hardest hit by Hurricane Katrina led Kanye West to infamously declare that “President Bush doesn’t care about Black people.” Horror stories and unforgettable images abounded during and after Katrina: Mothers had to swim for help while in labor, since hospital systems were overwhelmed.

Multiple studies suggest a specific link between disasters and complications during pregnancy. Emergency visits for pregnancy complications increased nearly 17% following Hurricane Sandy, with the highest increases among uninsured people and people of color. These findings mirror the national pattern of disparities in maternal and infant health. In other words, uninsured people and people of color, who are already at a higher risk of maternal stress and depression due to lower access to prenatal care and support, are those most affected by storms like Sandy and Katrina.

Tropical storms aren’t the only disasters that pose climate-related threats. Particulate matter in wildfire smoke is associated with pregnancy complications such as preterm birth and low birth weight. Experiencing a wildfire has also been shown to be associated with PTSD-like symptoms in pregnant and postpartum people. This fine particulate matter also appears to increase the risk of getting Covid-19 and dying from it. For birthing people and infants already facing progressively worsening air quality, the health effects of fine particulate matter in wildfire smoke compound this threat.

The urgency of this issue stems from the fact that disasters spawned by climate change are getting worse. California is now experiencing its second-largest fire, coming on the heels of the state’s most severe wildfire season in modern history. On the other side of the country, meteorologists expect dramatic hurricane activity this season, following a season with the most named storms on record.

In the face of these threats, U.S. policymakers need to take urgent action to address the climate change and maternal health crises — and the racial inequities that run through them — in tandem.

First, as extreme weather events become increasingly frequent and severe, it is essential for local, state, and federal policy leaders to include birthing people in disaster-preparedness and response efforts and climate resilience plans. The federal government has historically paid scant attention to the needs of birthing people during disasters, and there is currently no formal guidance from the Federal Emergency Management Agency on meeting their needs — even though there is specific guidance on the needs of pets. The words “pregnancy” and “pregnant” are absent from many emergency preparedness plans and guidance in jurisdictions across the country.

Second, the Biden administration’s climate plans for the U.S. should adopt a reproductive justice lens and acknowledge the distinct vulnerabilities experienced by birthing people of color. While we applaud the administration’s environmental justice approach that centers racial equity in addressing climate change, the recent executive order on Tackling the Climate Crisis at Home and Abroad fails to address the distinct impacts of climate change on pregnant people, particularly those of color.

Third, Congress must pass legislation that mitigates the effects of climate change on mothers and babies and addresses racial disparities in maternal health, especially those experienced by Black, American Indian, and Alaska Native mothers whose health has historically suffered most from racist policies. The introduction of the Protecting Moms and Babies Against Climate Change Act is an important step in addressing the climate risks that birthing people and infants face. This act, introduced by Sen. Edward J. Markey (D-Mass.) as part of the Black Maternal Health Momnibus Act led by Sen. Cory Booker (D-N.J.) and Reps. Lauren Underwood (D-Ill.) and Alma Adams (D-N.C.), seeks to support maternal health in the face of the climate crisis by investing in key organizations and federal programs and identifying climate-risk zones for pregnant people, among other initiatives. Identifying hot spot zones can help direct federal investment for health care and support the most at-risk pregnant people. Passing this piece of legislation, as well as the entire Momnibus act, could help ease the maternal mortality crisis and address the serious impacts of climate change on mothers and babies of color.

With the threat of climate change and the pregnancy-related mortality rate increasing in the U.S., there is no time to lose.

Emily Mediate works for a national nonprofit organization that focuses on preventing and responding to flooding. Neel Shah is the chief medical officer of Maven Clinic, an OB-GYN at Beth Israel Deaconess Medical Center, and an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School.