With damaged facilities, dwindling supplies, overwhelmed providers and sometimes even floods and fires literally blocking access to services, health systems impacted by climate change are unable to meet the sexual and reproductive health needs of their communities.
Our research shows that climate disasters wreak havoc on health-care infrastructure. When coupled with crises like armed conflict or a disease epidemic, the strain intensifies. In climate change-vulnerable regions, repeated disasters deplete health system resources, with new climate events hitting before recovery from previous ones.
“We require a mini pharmacy and a mini laboratory that only serves one-stop center clients, but we lack those services. Even those who overcome all obstacles and make it to our centers usually leave after their first visit because they don’t have a place to stay and receive the services they require. As a facility, we don’t have the capacity or space to let them stay longer than 72 hours. For these reasons, we lost most survivors before they received the basic services.”
2 ways climate change damages health systems’ ability to provide abortion care
1. Care becomes unreachable
Climate change effects like increased flooding and fires can damage health facilities and block roads, making it impossible to access needed sexual and reproductive health care. This is even worse for Indigenous communities, who are more likely to reside in remote locations farther from resources and public facilities.
From our research: Nepal
In our interviews and focus group discussions with people in climate-impacted areas of Nepal, women reported that floods and landslides during the rainy season create dangerous obstacles to care. Roads become blocked, making it impossible for vehicles to cross. In surveys, 83% of women reported that despite the nearest female community health volunteer’s home being less than half an hour away, heavy flooding prevents these volunteers from reaching patients. These volunteers are often the first point of contact for people in need of care like abortion and contraception.
“During the rainy season, as the condition of roads was poor, one woman had to walk to the health center during her labor time. She could not reach the hospital on time, and unfortunately, the outcome was stillbirth.”
Women’s caretaking roles of children and elderly family members also greatly limit their mobility and ability to reach health services or even immediate safety during a crisis. As one focus group participant explained, “When the disasters occur due to climate change, the pregnant women, post-partum women and children cannot move to safe places by themselves.”
Many of those interviewed voiced concern about increased sexually transmitted infections and unintended pregnancies post-disaster, and the lack of contraception and treatment at a time when it is needed most.
“During the time of natural disaster, people didn’t have access to health services, [so] they didn’t have contraceptives to use, which resulted in unintended pregnancy.”
“Couples don’t want to have children during the time of calamities, but the risk of unwanted pregnancy is increased as both men and women stay at home.”
Risky roads and dangerous floodwaters
“In the time of disaster, pregnant women often go through miscarriage because they’re injured while traveling on the road. They don’t get the maternity health service properly. There is no other arrangement in the cyclone center for them.”
“My sister that got pregnant during this time of floods… she got pregnant when she was 13 years old. She was… still a child, not grown enough to get married. So she started looking for ways to abort. Everything that she could find she drank, every pill. She became very sick, and we had no way to move because there was too much water… She suffered, but she got better.”
2. Medical resources and providers are drained
Climate disasters compound existing crises where resources are already diverted away from reproductive health services, draining providers and medical supplies at a devastating rate. With drought, flood and extreme heat escalating rates of disease and injury, the demand for health services increases and leaves health centers with reduced capacity for sexual and reproductive health care.
From our research: Ethiopia
Climate change is making drought worse in Ethiopia and damaging a health system already struggling due to armed conflict. Worsening drought brings more disease and injury, adding to the strain and leaving people without vital sexual and reproductive health care, including abortion.
When women and girls are displaced from their homes and must move to crowded shelters, they face harmful living conditions, increased risk of sexual violence and a lack of specialized medical care.
“After 5 days, I went to Dillo Health Center, where they tested my blood and found that I was HIV/AIDS negative, but they said nothing about the pregnancy. So I was pregnant and gave birth to that child.”
“I recently received training about gender-based violence and its management . . . one other professional has received such training as well. However, there is no separately prepared room and necessary materials to set up the clinic and a lack of necessary drugs to deliver the service.”
Shortages of medications, equipment and trained staff cripple central health facilities, while travel barriers impede referrals to community-based “one-stop centers,” which the government has established to serve survivors of gender-based violence during the armed conflict in the northern part of the country. Even when a person can reach a one-stop center, the hours of operation are limited.
“Concerning sexual and reproductive health services included in one-stop services, such services are not available at the kebele [community] level; they are only available in administrative cities with hospitals.”
Armed conflict in the North and life-threatening diseases like malaria divert resources from drought-affected regions, worsening sexual and reproductive challenges.
“Our primary goal and commitment is to prevent a malaria epidemic. Because the death rate caused by such an epidemic is incomparable to the harms caused by sexual and gender-based violence, we are more concerned and committed to preventing malaria cases than providing [sexual and reproductive health services].”