THE RESEARCH IS IN: Climate change impacts women’s sexual and reproductive health

© Fabeha Monir/Ipas

Research findings from Mozambique and Bangladesh

Climate change is now affecting every country on every continent, disrupting national economies and individual lives.

Women and girls disproportionately bear the brunt of climate-related events and environmental stress. Women comprise 20 million of the 26 million people estimated to have been displaced already by climate change. And they are more vulnerable to the impact of climate change because they lack power. Ultimately, climate crises deny women the ability to control their own fertility and hence their own lives.

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Between 2020-2021, Ipas conducted qualitative research in Zambezia, Mozambique and Khulna, Bangladesh. We wanted to understand how women’s experiences with climate change impact their sexual and reproductive health decisionmaking, behavior, and outcomes in cyclone-prone communities. Mozambique and Bangladesh are both highly vulnerable to cyclones and flooding, making them among the countries most severely impacted by climate change—which in turn exacerbates poverty and poor health outcomes for rural and coastal populations.

Our main finding: Women have solutions

That’s why we need women-led climate justice

Before Cyclone Idai hit the port city of Beira, Mozambique, Fátima João had a house to live in with her husband and four children. She had just bought the children notebooks, backpacks, and pencils for school. But the storm destroyed everything. Photo by Amilton Neves for Ipas

Women play a leading role in helping their families and communities survive extreme weather events and adapt to climate change, but opportunities for women’s participation in climate action decisionmaking bodies is insufficient—especially at the leadership level. Climate action that is not gender inclusive risks making existing problems even worse. We need to listen to women and girls.

Our study participants brainstormed ways to lessen the impact of climate change on women and girls, focusing in on these five recommendations:

1.

Increase women’s opportunities for paid work, so they don’t have to resort to jobs that risk their health and safety.

2.

Consider women’s needs when building spaces for shelter during and after climate disasters.

3.

Improve access to health care—particularly sexual and reproductive health care—that is resilient to climate disasters.

4.

Invest in women’s education and contraception to give them more power over their own lives and decisions.

5.

Involve people most affected by climate change—including women and youth—to develop climate resilience education that includes reproductive health.

"We can all sit together and discuss what is best to do. If everyone works together, then it will be possible to deal with the situation."

In-depth interview participant, age 19, Bangladesh

Overview of findings

  • Climate change disproportionately impacts women and girls by exacerbating existing gender inequalities, disrupting access to sexual and reproductive health care, and reducing their already limited economic opportunities.
  • Climate change directly and indirectly affects women’s contraceptive use, fertility intentions, pregnancy outcomes, vulnerability to sexual and gender-based violence (SGBV), economic roles, and sexual health.
  • The time immediately before, during, and after extreme weather events, such as cyclones, is when access to care for contraception, pregnancy and abortion is most compromised.
  • Pregnant women are particularly at risk due to climate change, facing increased risk of miscarriage, early labor, and pregnancy complications that could lead to illness, injury or death. Adolescent girls experience increased risk of SGBV, child marriage, early sexual debut and pregnancy.

Our method

Bangladesh: We conducted our study in Chalna Bazar, Bajuya, Lawdube, and Tildanga in Dacope upazila of Khulna division due to these communities’ experience with Cyclone Bulbul in November 2019.

Mozambique: We selected communities in Mocubela, Maganja da costa, and Derre districts due to their experience with Cyclone Idai in March 2019. For this study we collaborated with the Provincial Health Directorate and Provincial Health Services of Zambezia as well as the National Institute for the Management and Reduction of Risk of Disasters.

We interviewed 19 key informants with expertise in the sexual and reproductive health of their communities or in climate change resilience and adaptation. This included representatives from disaster risk management committees, community leaders, community health workers, local government representatives, community-based organizations and women’s groups.

We held 14 small community dialogue meetings with women ages 15-49. Participatory activities at these meetings included free listing and ranking, reproductive health lifelines adapted to include climatic events, and community action planning.

We also conducted in-depth interviews with 29 women about their personal experiences with climate change and its impact on their sexual and reproductive health and rights. Some women participated in both a community dialogue meeting and an in-depth interview.

Age: About half (48%) of participating women were 15-24 years old, while the other half were ages 25-49.

Marital status: In Bangladesh, all women were married, widowed, or separated, while in Mozambique, half of women were married and half unmarried.

Our findings in detail

1.

Climate change directly impacts sexual and reproductive health

2.

Climate change intensifies economic crisis and family instability

3.

Climate change makes women more vulnerable to sexual and gender-based violence

4.

Gender norms and inequality magnify the impact of climate change by denying women power to make critical decisions

5.

Climate change is shifting women’s fertility intentions

1. Climate change directly impacts sexual and reproductive health

Our interviews and meetings with women and girls clearly showed that the conditions caused by climate change directly impact sexual and reproductive health outcomes. Climate change limits and interrupts access to contraception—particularly during and right after extreme weather events like cyclones. During a weather event, women may forget to pack their birth control for evacuation because their primary focus is survival. For others, their medicines are destroyed by the storm or washed away in flooding. Women and girls told us it’s usually impossible to access health centers or pharmacies for weeks after cyclones due to the flooding and devastation to the built environment. In turn, women face unintended pregnancies and must make difficult decisions—or even worse, have little control to make their own decisions due to cultural norms that deny women power.

Illustration by Marcita

"The main concern is whether I will survive or die. I don't even remember to take the [birth control] pill then. Suppose I had intercourse with my husband last night. The next day the storm is coming. However, due to the storm, I did not take the pill. Then an accident can happen. This is how I might get pregnant.”

— In-depth interview participant, age 24, Bangladesh

“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.”

— In-depth interview participant, age 27, Mozambique

How climate change contributes to unintended pregnancy and the need for abortion

Increased risk of SGBV*

  • Risk of SGBV while collecting relief and at cyclone shelters
  • Economic crisis increases intimate partner violence

*Sexual and gender-based violence

Economic insecurity and crisis

  • Food insecurity
  • Need to engage in risky work
  • Fewer paid work opportunities
  • Destruction of property
  • Temporary or seasonal migration

Interrupted contraceptive use

  • Damage to health and transportation infrastructure
  • Forgetting to pack birth control
  • Being under-prepared for extreme weather events
  • Birth control destroyed by storms
  • Trapped in place for weeks due to flooding and destruction

Impact on children

  • Fear of losing children or being unable to protect them
  • Children’s education interrupted
  • Vulnerable to injury, drowning, starvation and malnutrition

Changing fertility intentions

  • Fear of being unable to protect, educate, and feed children
  • Desire for more children (usually sons) to protect against future economic insecurity
  • Desire to not have children or delay until feeling prepared

Impact on pregnant women

  • Fear of pregnancy during a future climate disaster
  • Increased miscarriage and premature labor
  • Unattended births in cyclone centers, boats, on the road and at home
  • Increased birth complications and maternal and newborn deaths

How women describe the impact of climate change on their reproductive health

Irregular and difficult menstrual cycles

  • Extreme period pain
  • Poor menstrual hygiene

Unintended pregnancy

  • Early and teen pregnancy
  • Forgotten, missed, and destroyed birth control pills

    Pregnancy complications

    • Miscarriage
    • Childbirth in cyclone centers and boats, on the roads and under trees
    • Unassisted labor and labor with an untrained assistant
    • Early labor and premature birth

      Need for abortion

      • Difficult to access health facility-based abortion care

      • Self-managed abortion using unsafe methods

      • Postabortion complications

      Infections, disease, and injury to reproductive organs

      • Urinary tract infections
      • Vaginal sores
      • Vaginal itching, irritation and discharge
      • Wounds in uterus
      • Tumors in uterus and uterine cancer (this may include cervical cancers based on descriptions provided)

      2. Climate change intensifies economic crisis and family instability

      In Mozambique, interview participants explained that women tend to be the ones primarily responsible for farming and food production. As a result, they are disproportionately impacted by devastation to the agricultural sector. The most fertile farmland also tends to be in the highest-risk areas for extreme weather, called “risk zones.” Resettlement neighborhoods set up by the government are in “safe zones” not ideal for farming, with few alternative economic opportunities nearby. Resettlement neighborhoods are primarily inhabited by women and children, while men commonly migrate to cities or neighboring countries in search of work.

      As a result, many women and their children in the communities we studied in Mozambique lead an unstable, semi-nomadic lifestyle, frequently migrating between their farmland and resettlement neighborhoods. Mothers either bring their children with them, which interrupts their education, or else leave them behind at the resettlement centers for extended periods of time. Some women have decided to remain permanently on their farms in risk zones to avoid constant migration.

      In Bangladesh, a central theme interview participants identified was that women lack opportunities for paid work outside of the home due to cultural norms around their role as caregivers and household workers. Climate-induced migration leaves many women to care for their families alone. Women who become heads of household in this way—in addition to unmarried, widowed, or divorced women—are particularly vulnerable to violence and poverty. They described resorting to jobs that put their reproductive health at risk—such as fishing waist-deep in polluted waters and transactional sex—to feed their children and save money for future disasters.

      "For the woman to have to move from the risk zone to the safe zone, even though the husband is absent, she has to call him quickly, she doesn't have that power to decide."

      — Key informant interviewee, Mozambique

      3. Climate change makes women more vulnerable to sexual and gender-based violence

      In both Mozambique and Bangladesh, we found that the climate crisis intensifies sexual and gender-based violence. Destruction to housing, food sources and jobs can force women and girls to shelter in unsafe locations, travel long and unsafe routes for food and water, and resort to work that puts them at higher risk for violence. Exploitation and transactional sex are a particular threat to young girls experiencing economic crisis.

      In Bangladesh, cyclone centers built to provide refuge during extreme weather events unintentionally put women and girls at risk for sexual harassment and rape due to crowded conditions, poor security, electricity outages, and lack of separate spaces and toilets for men and women. Women in both countries reported experiencing sexual harassment and abuse while collecting disaster relief after cyclones. And interview participants directly linked economic instability and stress in the aftermath of extreme weather events to increases in intimate partner violence, dowry and in-law abuse, transactional sex, sexual harassment, and early or child marriage.

      Illustration by Marcita

      "A lot of work has been done, but, unfortunately, we still register many cases of premature marriages, where the parents are the main promoters. They use their children as a strategy to alleviate poverty.”

      — Key informant interviewee, Mozambique

      “At some point, the community leader may know how to take advantage of the vulnerability of a woman and her family and be able to sexually harass. If you have 5 children, you will receive 1 bag, but if you go with me, in addition to 1, you may receive 2, and the woman is needy... So, she ends up accepting, and she suffers sexual harassment there.”

      — Key informant interviewee, Mozambique

      "In the shelter, if there was a separate arrangement for men and women then there would be less sexual harassment. Women face harassment while going to the washroom. Men touch their bodies.... There should be a separate room for pregnant women, and they should be taken care of."

      — Community dialogue meeting with girls ages 15-19, Bangladesh

      "To minimize the losses that happened from the disaster, men pressured women to bring dowry from their father's house."

      — Community dialogue meeting with women ages 18-19, Bangladesh

      4. Gender norms and inequality magnify the impact of climate change by denying women power to make critical decisions

      Women’s traditional role as caregivers means they play a lead role in preparing their families for evacuation before a storm and the many decisions that go into that preparation. Yet, at the same time, they often lack the power to decide if and when to evacuate.

      In Mozambique, one woman explained that she could not seek emergency health care during a cyclone because her husband was not around to grant her permission. In Bangladesh, the practice of purdah—which includes full-body clothing coverage to avoid being seen by men—means that some women are not allowed to go to cyclone centers, where men and women mix in crowded conditions. Traditional clothing also restricts their movement, hindering their ability to swim and run and increasing the risk of drowning and injury during a storm.

      “Women cannot go to the cyclone center first. If she has an old father-in-law and mother-in-law, then she has to shift them to cyclone centers first. If she has children, then she has to shift them first. To perform these duties, it has been observed that a woman cannot reach the cyclone center but she drowned or floated away [en route].”

      — Community dialogue meeting with women ages 35-44, Bangladesh

      "Because of dress women face many challenges... Village women wear sarees more, which are more risky for swimming underwater because it drapes the person. They say that they have to remove their sarees to save their lives."

      — Community dialogue meeting with women ages 35-44, Bangladesh

      Decisions in the context of climate change

      5. Climate change is shifting women’s fertility intentions

      Study participants in both Mozambique and Bangladesh had differing opinions about the impact of climate change on their fertility intentions. Due to the increased vulnerability of pregnant women and children to climate change, women fear being pregnant and losing children during climate disasters. Many participants described not wanting to have more children in the wake of disasters, as they find it difficult to protect, feed and care for the children they already have.

      Others felt the opposite, intentionally bearing more children to protect against becoming childless during a climate disaster. A key informant in Bangladesh explained that having at least one son is important for ensuring parents’ future financial security. In both countries, some participants also reported no impact on their reproductive decisionmaking. Regardless of their opinion on the role of climate change, most women described the need to prepare for children with similar factors—such as having an education, a home and enough money—which can be directly impacted by climate change.

      "When any disaster comes, people do not want to have a child at that time. They usually say that 'if we have a child now, how could we manage it. How could I manage myself in that situation?'"

      — In-depth interview participant, age 38, Bangladesh

      “Women wonder how they could face these events if they had many children. But others believe that if they had many children they would not suffer after an extreme event because the children would help them.”

      — Key informant interviewee, Mozambique

      “I told my husband I am not having a child now, first let’s build our own house... We can’t have a child because we are already suffering a lot."

      — In-depth interview participant, age 34, Mozambique

      What Ipas is doing

      Ipas is working to advance women-led climate justice as a technical leader, skilled convener, local partner, and advocate specialized in the intersection of climate change and sexual and reproductive health and rights. We use a comprehensive approach that works across communities, sectors and institutions to build sustainable abortion ecosystems.

      Our goal is to integrate abortion access and sexual and reproductive health and rights into climate justice efforts at the local, regional and global levels. Through our intersectional partnerships, solutions-oriented research, and locally rooted programs, we’re working for a world in which women and girls have bodily autonomy, are resilient in the face of climate change, and have the power to determine their own futures.

      Ipas gratefully acknowledges Canada’s Department of Foreign Affairs, Trade and Development for funding this research.

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