A recent report by UN agencies reveals that although high-income countries contribute the most to climate change, the ones bearing the brunt of its impacts are those who have contributed the least. The report, titled ’Born Too Soon: Decade of Action on Preterm Birth’, released by World Health Organization (WHO), UNICEF, and Partnership for Maternal Newborn and Child Health (PMNCH), highlights the diverse effects of climate change on pregnancy, leading to stillbirths, preterm births, and small gestational age. It reveals the alarming statistic that 91% of deaths related to air pollution among preterm babies occur in low and middle-income countries, despite high-income countries making the greatest contribution to climate change.

Air pollution is estimated to contribute to six million preterm births each year. Dr Ana Bonell from the Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine (MRCG at LSHTM) pointed out that the IPCC's 'Impacts, Adaptation and Vulnerability' report has recently noted that “Vulnerability to climate change is a multi-dimensional, dynamic phenomenon shaped by intersecting historical and contemporary political, economic and cultural processes of marginalisation. Societies with high levels of inequity are less resilient to climate change.â€_x009d_

Climate change and related natural disasters are displacing millions of people and the health impacts are wide-ranging and under-appreciated. Air pollutants, such as methane and black carbon, contribute to both climate change and ill health. According to the report, it is estimated that, in 2019, air pollution contributed to 6 million preterm births and almost 3 million low-birth-weight babies. A 2020 global report estimated that air pollution accounts for 20% of newborn deaths worldwide, mostly as a result of preterm birth and low birth weight. Extreme heat, which is increasingly frequent and widespread, is also increasingly being associated with adverse birth outcomes, including preterm birth and stillbirth.

The report underscores that climate change has a detrimental impact during the perinatal period, increasing the risk of preterm birth through direct pathways such as air pollution from fossil fuel combustion (which raises the risk by 52% in asthmatic mothers) and extreme heat exposure (which raises the risk by 16%).  Household air pollution has been identified as a significant factor in 15.6% of all low-birth-weight babies and 35.7% of all preterm births, particularly in low-income countries. 

“The report underlines why we must increase investment and accountability for preterm birth – the world’s largest cause of death of children under the age of five. Progress is flatlining for maternal and newborn health, as well as the prevention of stillbirths, and is now pushed back further through the devastating combination of COVID-19, climate change, expanding conflicts and rising living costs," said Helga Fogstad,  Executive Director, PMNCH

A study conducted  in India highlighted the association between climate change vulnerability and women and children's health at the district level, revealing that districts with high vulnerability to climate change also performed poorly in terms of women and children's health indicators.  Despite the growing evidence linking climate change to maternal and newborn health, the report emphasises that its impact remains under-appreciated from a political standpoint.