In this Q&A, climate researcher Apolinar Contreras discusses how climate change is affecting women’s reproductive health, livelihoods, and resilience in Bolivian Indigenous communities—and what must change to better support them.
In rural Indigenous communities across Bolivia, women are already adapting to a changing climate. They are having fewer children, finding new ways to earn money as farming grows unreliable, and keeping households running when men leave to find work. What they’re missing isn’t determination. It’s support that meets them where they are.
Ipas Bolivia studied eight Indigenous communities across four of the country’s ecological regions, from the high-altitude Altiplano to the Amazon lowlands. The research documented how climate impacts like drought and flooding are affecting women’s reproductive health, their family lives, and the balance of power at home.
Apolinar Contreras helped design and oversee that research as the coordinator of research, monitoring and evaluation at Ipas Bolivia. We asked him what the study found, and what women in these communities need most.
One thread ran through every region we studied: When climate change creates scarcity, women absorb the cost first.
Across the four ecological regions included in the study, what pattern did researchers see again and again?
The study shows that, despite the ecological diversity of the Altiplano, the Valleys, the Chaco and the Amazon, there is a cross-cutting pattern: Climate-related changes to water availability (rainfall, droughts, polluted rivers or rivers with lower flow) are undermining livelihoods, food security and community health. Reduced access to water (for consumption, hygiene and agricultural production) triggers agricultural and livestock losses, new or worsening pest problems, a decrease in the availability of food and an increase in diseases associated with lack of hygiene.
This deterioration disproportionately affects women, who face a greater workload and a direct impact on their sexual and reproductive health, hence deepening gender inequality.
When men migrate and do not return, what changes first for women who are left behind?
The first change for women is an immediate shift in their roles and responsibilities. They take on agricultural work, household care, childrearing, community responsibilities and decision-making for their family’s survival, often all at once. The overload of responsibilities for women can lead to them leaving their children in the care of other adults and consequently increase vulnerability to sexual abuse within families, particularly for children.
The women in this study are already making difficult decisions about their families and futures. What support do they need the most?
Women’s resilience is expressed in how they adapt to changing conditions, but it depends on three important factors. The first is the lack of water: Without sufficient access, it becomes impossible to maintain production, personal hygiene, maternal care and menstrual health. The second is unreliable health services, especially when facilities lack staff, medicines, or care that responds to women’s specific needs. The third is the weakening of community networks due to migration, which leaves women alone when they must make critical decisions about health, family and survival.
If you could point to one example of women-led adaptation that works and can be supported and scaled, what would it be?
A significant example of adaptation led by women is finding new ways to earn income using local knowledge and skills, such as textile, artisanal or food processing enterprises. These initiatives make it possible to generate income when farming alone is no longer reliable, strengthen economic and reproductive autonomy, and rebuild support networks among women.
For example, this is the case of women in the Amazon who started ventures with local fabrics to sell them in nearby markets, generating income that helps sustain their families. In general, women demonstrate strong organizational capacity, creating initiatives around schools and promoting women’s organizations.
The study concluded that climate and health policies operate in isolated silos. What does that failure look like on the ground, and what does integration look like in practice?
The disconnect between climate change and health policies shows up on the ground as a lack of coordinated responses to climate impacts. Policies exist on paper, but they do not translate into concrete actions that respond to water loss, food insecurity, or effects on sexual and reproductive health.
In the municipality of El Puente, for example, the drought of the Momené River affects fishing and access to water and hygiene, but there is no effective coordination between the health, environment and economic development sectors. Tsimané women (an Indigenous people of the Bolivian Amazon) face discrimination in health services, and there are no programs that integrate climate adaptation with reproductive care, even though the two are closely linked. This distance between policy and reality generates gaps that communities must face alone.
If you had additional resources to act on these findings, what would you do first?
With additional resources, the priority action would be to guarantee sustainable access to water, since this element connects agricultural production, health and daily life. This would include community-based water harvesting and storage systems, efficient irrigation technologies, and local climate-monitoring mechanisms.
At the same time, it would be essential to strengthen health services with a gender and generational approach, ensuring care responds to women’s needs across life stages, maintaining a continuous supply of essential medicines and supplies, and promoting programs of female economic autonomy. These combined interventions would reduce vulnerabilities and improve communities’ ability to adapt.
What would success look like? What would be different in these communities two or three years from now with sustained support for this work?
Success would be reflected in communities with more reliable availability of water for consumption and agricultural production, a significant reduction in diseases associated with lack of hygiene and an improvement in sexual and reproductive health. Health services would be more responsive, with consistent staffing and respectful treatment, and women would have more support to make decisions about their health, families and futures with less pressure and fewer barriers.
Although it is an incredibly comprehensive study, what would you suggest needs further investigation so that this evidence has a greater impact?
The causal links between climate events and sexual and reproductive health, including the effects of prolonged droughts on pregnancy, childbirth, and menstrual health, would benefit from further exploration. It is also important to study the intergenerational impact, especially how girls and adolescents reshape their plans for the future in the face of the climate crisis. Finally, it is necessary to systematically evaluate adaptation strategies led by women, identifying what works, why it works and how it can be adapted to different ecological and cultural contexts.
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Policies exist on paper, but they do not translate into concrete actions that respond to water loss, food insecurity, or effects on sexual and reproductive health.
The study points to a clear priority: policies that treat climate adaptation and reproductive health as the connected challenges they are. For the women in these eight communities, that integration is not abstract—it is an essential component of the solutions they need.