Authors: Thoai D. Ngo, Neha Mankani, Nicole Haberland, Martha Schaaf, Aleya Khalifa, Allan A. Maleche, Eszter Kismődi, Sai Jyothirmai Racherla, Sapna Desai
In every region of the world, the climate crisis is already accelerating a sexual and reproductive health crisis.
Flooding, extreme heat, environmental degradation and extractive industries are not just reshaping ecosystems, they are reshaping bodies, pregnancies and futures. As women and girls, especially those who are already marginalized, face disproportionate risks to their sexual and reproductive health and rights (SRHR), national and global institutions remain inadequate to respond or completely abdicate their duty-bearing obligations.
At 70th Commission on the Status of Women (CSW70), one message was clear: promoting gender equality is no longer just about recognizing rights – it is about whether systems are fair and accountable.
We fail at both.
Reproductive health is already at risk from climate change
Consider extreme heat. Between May 2024 and May 2025, four billion people experienced at least 30 days of extreme heat linked to climate change. That exposure to extreme temperatures doesn’t just increase the risk of heat stroke and cardiovascular events – it can increase the risk series of pregnancy complications. Among factory workers in South India, occupational heat exposure can double the risk of miscarriage.
Or take fossil fuels, a primary driver of both climate change and environmental degradation, the latter leading to degradation of our air, water and soil quality. Not only does it Air pollution leads to asthma, lung cancer and other respiratory-related outcomesbut air pollution disrupts the development of the fetus and leads to adverse birth outcomes. Actually, Proximity to fossil fuel infrastructure has been linked to adverse reproductive, maternal and birth outcomes.
Ripple effects also flow from heavy rainfall and flooding – not only destroying property, crops and infrastructure, but disrupting access to contraception, safe abortion and maternal care. Economic shocks caused by climate events increase rates child marriage and transactional sex. Evidence increasingly shows that violence against women escalates in vulnerable settings.
These are not isolated effects. They are part of a pattern: climate change is eroding the conditions needed for safe, autonomous sexual and reproductive life, while at the same time triggering physiological responses that manifest in increased morbidity and mortality.
And yet climate policy and health systems continue to operate in silos, and the moral backbone and political will to address these complex crises is disappearing faster than the glaciers are melting.
The system is not built to deliver justice
Global health and development systems remain fragmented across climate, health, gender and economic sectors. Interventions are often designed in silos, with limited involvement of affected communities. Meanwhile, the economic priorities of high-income countries too often take precedence, while climate, health and gender commitments are underfunded.
Climate adaptation remains chronically underfunded, even as historic polluters avoid obligations recently upheld by the International Court of Justice. SRHR remains largely absent from Nationally Determined Contributions (NDC) and national climate adaptation plans.
Health systems are not equipped to withstand environmental shocks. Climate risks are disrupting SRHR services and supply chains, while women and girls are too often excluded from decisions that shape their future. In brief, Climate injustice impedes reproductive justicereinforcing the damage from generation to generation.
In mining areas, these failures are particularly pronounced. Mining and the petrochemical industry degrade land and water, disrupt livelihoods, sicken those living nearby and strain fragile health systems. At the same time, the influx of workers and growing informal economies lead to an increase in gender-based violence, commercial sex and the demand for sexual health services. In the US, “man camps” (labor housing) often come with a heavy security presence, interacting with local populations in intimidating or suggestive ways.
However, the communities that bear these costs have little influence over the policies or investments that govern these industries.
Justice requires more than recognizing harm — it requires shifting power and providing tangible solutions.
From rights to accountability
As witnessed at CSW70, the concept of human rights is increasingly under attack by authoritarian actors. The promise of human rights lies in accountability – what matters is whether the systems work.
This means:
- Breaking down silos between climate and health systems
- Mainstreaming gender and SRHR in climate finance and adaptation frameworks
- Holding governments and corporations accountable for damage to the environment and health
- Ensuring meaningful community participation in decisions that shape local environments and health systems
It also means rethinking how we produce evidence. Communities should be partners—not subjects—in research. Research needs to move from top-down assumptions to bottom-up, locally driven evidence systems that are scientifically rigorous, context-specific, and capable of revealing hidden disparities. Participatory approaches such as community mapping, photovoice and digital storytelling reveal not only risks but also the adaptive strategies already in place, while making scientific evidence more accessible to those who need to act. These insights are essential for designing effective and just interventions and policies, and for bringing people’s experience to the fore in advocacy and legal efforts to hold states, companies and corporations accountable.
Invest in what already works
In many climate-affected areas, resilient solutions already exist—often driven by the communities themselves.
Midwives are frontline climate adaptors, sustaining care in flood-prone and resource-constrained environments where formal health systems falter. Globally, 75% of midwives report that climate change is already leading to an increase in preterm births and food insecurity. In the coastal communities of Pakistan, the Mama Baby Fund has turned this evidence into action through a 24/7 boat ambulance, ensuring that rising tides do not interrupt access to life-saving care. These providers are more than service providers – they are anchors of trust and survival.
Investing in what works also means protecting those who hold the systems accountable.
In areas shaped by extractive industries, environmental damage is not temporary shocks— are cumulative and genealogical. Land degradation, water pollution and economic displacement have been reshaping communities for decades, with profound consequences for women’s health and livelihoods. Yet those most affected are often excluded from decision-makingwith commitment procedures, if they occur at all; often symbolic, serving corporate risk management goals and procedural control frameworks, rather than community empowerment. At the same time, the factors that cause these injuries remain largely unaccounted for.
Accountability must extend beyond states to companies, investors and international financial institutions whose decisions shape environmental harm and health.
Community organizations and human rights defenders are vital in exposing corruption, documenting harms and pushing for safeguards that protect the environment and reproductive health. They help ensure that policies reflect realities on the ground.
As civic space shrinks, supporting these actors requires legal protection, sustained funding, and formal recognition of their role in advancing justice.
The Path Forward
The convergence of climate change and reproductive injustice is no longer a future risk – it is a present reality. Responding to this requires more than technical solutions. It requires accountable and inclusive systems based on the lived experiences of those most affected, supported by stronger local data, community-generated evidence and digital tools that can track harm, guide responses and strengthen accountability. It also calls for gender-responsive climate policies, including countries’ NDCs and adaptation plans.
Above all, we need to move beyond fragmented responses to comprehensive justice-driven action and center women and girls not as beneficiaries of policy, but as leaders shaping the solutions that affect their lives.
Authors: All authors provided comments and approved this submission.
Thoai D. Ngo is chair and professor of the Heilbrunn Department of Population and Family Health at Columbia University’s Mailman School of Public Health.
Neha Mankani, is a midwife and humanitarian engagement and climate advisor for the International Confederation of Midwives (ICM)
Nicole Haberland is Associate Professor of Professional Practice in the Heilbrunn Department of Population and Family Health at the Columbia Mailman School of Public Health
Martha Schaaf is director of the Climate, Economic and Social Justice and Corporate Accountability Program at Amnesty International
Aleya Khalifa is a researcher at the Heilbrunn Department of Population and Family Health, Columbia Mailman School of Public Health
Allan A. Maleche is the Executive Director of the Kenya HIV and AIDS Legal & Ethical Network (KELIN)
Eszter Kismődi is CEO, Sexual and Reproductive Health Issues
Sai Jyothirmai Racherla is Deputy Executive Director of ARROW (Asia-Pacific Resource and Research Center for Women)
Sapna Desai is Editor-in-Chief, Sexual and Reproductive Health Issues and Assistant Professor in the Heilbrunn Division of Population and Family Health, Columbia University Mailman School of Public Health
