Mitigating Climate Change Effects on Maternal and Prenatal Health in Nigeria

Abstract

Generally, women and children have been considered at-risk populations, especially pregnant women, and their unborn babies. In the past decade, there has been overwhelming evidence linking climate change—extreme heat and air pollution—to adverse pregnancy, reproductive, and overall maternal health outcomes across the globe. This formative report highlights the effects of climate change. Using autoethnography and an adapted Delphi method—the combination of the different expert opinions—this report makes contextualized recommendations for women to mitigate the effects of climate change on maternal health outcomes in Nigeria.

1. Introduction

The discourse surrounding climate change has continuously emphasized the adverse effects on developing nations, especially among vulnerable populations—women and children. Globally, 700 newborn and 830 women die daily, with 99% of these deaths occurring in developing nations [1]. These alarming statistics that define maternal and neonatal health problems in developing nations will grow as the effect of climate change increases. According to the Intergovernmental Panel on Climate Change (IPCC), the negative influences of climate change on maternal and neonatal health in developing nations pose worse consequences if left unimpeded [2, 3]. Developing nations are already dealing with many public health issues such as malaria, diarrheal diseases, diabetes, and tuberculosis [4, 5]. Hence, a high confidence vote has been placed on African nations as being one of the most vulnerable continents to climate change and climate variability, a situation aggravated by the interaction of ‘multiple stresses,’ occurring at various levels, and low adaptive capacity [6].

Nigeria is listed among the top 10 countries of the world in the climate change vulnerability index [2]. Due to Nigeria’s unique population, the consequences of climate change are likely to include increased water and food shortages, high exposure to heat stress, and dangerous levels of ultraviolet radiation. These climate change consequences have far more dire effects on at-risk populations—women and children. Also, extreme climate change influence on rainfall and temperature events can lead to increased incidence of diarrhea, cholera malnutrition, and even mortality in younger children.

Several reports have focused specifically on the direct and indirect negative effects of climate change on child and maternal health outcomes [7, 8, 9, 10, 11]. However, only a few studies have been conducted in Nigeria about climate-related health issues, especially related to climate change’s direct and indirect effects on maternal and prenatal health outcomes [12, 13, 14]. Although most of the effects of climate change on health are yet to be foregrounded in climate research in Nigeria, it does not change the population’s vulnerability and the current adverse health effects that are yet to be accounted for among at-risk populations.

2. Climate change framing in Nigeria

Nigeria is in West Africa—bordering Niger in the north, Cameroon in the west, Benin in the west, and Gulf of Guinea in the South. Nigeria is the most populous African country and seventh in the world with over 200 million people. She is often considered the giant of Africa because of her population and economy. Nigeria has the largest economy in Sub Saharan Africa and relies heavily on crude oil export. Aside from crude oil being the major source of Nigeria’s economy, agriculture plays a pivotal role in the population’s local economy and general sustainability. She has a diverse geography, ranging from arid to humid equatorial—equatorial in the south, tropical in the center, and arid in the north. Nigeria has a tropical climate with varying rainy and dry seasons, depending on location—more rainy days in the south, west, and east, and less precipitation in the north and northeast. With Nigeria having low precipitation in the north to high precipitation in the south, the climate change can lead to drought and desertification in the north, then flood and erosion in the south. Climate change would most likely impact sectors such as agriculture, fisheries, food security, water, forestry, health, economy, and energy.

Over the past couple of years, in the global context, there has been several media discourse and research around climate change impact on public health raised by the World Health Organization (WHO), United Nations (UN), Sustainable Development Goals (SDGs), and other governmental and private parastatal. The health concerns raised from the global discourse have led to the issuance of a global health concern [2, 15]. Other studies have been based on numerous studies of experts seeking to conceptualize climate change and reframe the perceived idea that climate change is a distant threat and highlight the anthropogenic nature [16, 17, 18, 19, 20].

Climate change is largely framed primarily as a public health issue within the global context, and the same is often projected to African nations [21, 22]. However, within the Nigerian context and Africa at large, there is a different discourse regarding climate change and its effects. For example, the media in Nigeria report climate change issues through the local and national lenses rather than the “expected” global context [23, 24, 25]. These media reports are centered on the negative effects of climate change on agricultural yields, economic strains, and infrastructural damage.

Only recently, after signing the Sustainable Development Goals (SDGs) and Millennium Development Goals (MDGs) in 2015, Nigeria began to report climate change effects on health. However, even with the SDGs and MDGs accentuation of climate change threats on health, the coverage and reports of climate change effects on health are still lagging. The media coverages are often centered around irregular rainfall, flood, drought, vulnerable farming populations, and desertification related to agricultural productivity—food quality and supply—and economic effects. Hence, it is through the lenses of agricultural sustainability and economic growth that climate change is mostly viewed.

3. Brief overview of climate change and health in Nigeria

Although Nigeria’s coverage of climate change has been focused on agricultural and economic impact, there are growing reports and studies in the areas of health. Climate change studies in Nigeria have shown that increasing temperatures, heat stress, water quality, and air pollution can significantly have adverse direct and indirect effects on health outcomes [15, 26, 27, 28].

3.1 Direct effects of climate change on health outcome

Direct health impacts stem from extreme events such as heatwaves, floods, droughts, windstorms, and wildfires. Currently, there are numerous news reports of excruciating heat waves across the country. In the last 5 years, the whole country has been experiencing intense heat waves [29]. For example, in the first 4 months of 2019, the Nigerian Meteorology Agency (NiMet) reported an increase in the mercury of up to 5° higher than average—around 35°C—in the humid commercial capital [30]. Also, there were recorded incidences of deaths from heatwave in the northern part of Nigeria [30, 31].

It is pertinent to note that high temperatures can trigger tropical diseases, such as heat cramps, heat strokes, cerebrospinal meningitis [32], and malaria. Increasing temperatures and drought can also reduce freshwater quantity, increase heat stress, compromise hygiene, and raise the risk of water-borne diseases such as typhoid fever, cholera, dysentery, diarrhea, and even polio. Air pollution from climate change can increase the incidences of respiratory and cardiovascular diseases.

3.2 Indirect effects of climate change on health outcome

Indirect climate change effects can arise from malnutrition due to food shortages from floods and droughts. Rising temperatures, rising sea levels, floods, and rainfall patterns can affect freshwater supply, predisposing people to infections and water-borne illnesses. Increased rainfall intensity, flooding, stagnated water, and polluted groundwater will increase diseases like hepatitis and malaria commonly experienced in Southern Nigeria [32, 33, 34]. Heavy rainfall events can also lead to contaminated drinking water from sewage, industrial and chemical waste, leading to the outbreak of infections.

In coastal eco-zones, windstorms, and extreme rainfall, rising sea levels, and floods can cause injuries, drowning, death, severe physical and mental trauma, particularly for citizens who live along major river deltas, on islands, and in low-lying coastal areas [35, 36]. For example, in parts of Southern Nigeria, flooding from sea level rise has contaminated freshwater aquifers, rivers, and stock-watering points. This has increased salinity in these bodies of water and polluted them with sediment and sewage [37].

4. Maternal and prenatal health in Nigeria

Globally, 2.4 million children died in the first month of life in 2019 alone—approximately 7000 neonatal deaths every single day, most of which occurred in the first week of birth—about 1 million dying on the first day and close to 1 million dying within the next 6 days [38]. Most of these neonatal deaths happen in developing countries such as; India, Pakistan, Nigeria, China, Bangladesh, the Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan, and the United Republic of Tanzania [38, 39]. In Nigeria, the number of neonates that still die of preventable/treatable causes and diseases as of 2020 is as high as 38 per 1000 live births [40, 41].

Similarly, according to the World Health Organization (WHO), approximately 830 women die from pregnancy and child-related causes every day, and 99% of all maternal deaths occur in developing nations [42]. It is pertinent to note that nearly 20% of all global maternal deaths happen in Nigeria [43]. Compared to other developed countries, a Nigerian woman has a 1 in 22-lifetime risk of dying during pregnancy, childbirth, or postpartum/post-abortion. In contrast, in the most developed countries, the lifetime risk is 1 in 4900 [43].

With these alarming statistics and the prevalent climate change health effect on maternal and neonatal health outcomes, the mortality numbers might not decrease at the desired pace suggested in the Millennium Development Goal 5 (MDG) and Sustainable Development Goal 3 (SDG) nationally and globally, respectively.

5. Climate change and maternal/prenatal health outcomes

The alarming statistics that define maternal and neonatal health problems in Nigeria will most likely continue to grow as the effect of climate change increases. There is evidence that extreme temperatures and air pollution lead to adverse birth outcomes, including gestational age, birth weight, stillbirth, and neonatal stress from unusually hot temperature exposures [9, 44, 45, 46].

5.1 Increasing temperatures

According to Intergovernmental Panel on Climate Change (IPCC), the increasing global temperature and its detrimental influences on neonatal and maternal health have led them to strong concerns about the negative effects of climate change on the growth and development of babies both before (pre-natal) and after (post-natal) birth. However, climate change-related health issues will adversely affect developing nations—like Nigeria—already dealing with many public health issues such as malaria, diarrheal diseases, diabetes, and tuberculosis [4, 5].

Molina and Saldarriaga [47] have identified five pathways through which climate change temperature can affect the growth and development of a healthy fetus which includes exposure to extreme temperatures, maternal infection by a temperature-sensitive disease (e.g., respiratory infections) or by a biological vector-borne disease, maternal mental illnesses, and food insecurity brought about by less predictable growing conditions.

Temperature rises will extend the habitats of vectors diseases such as malaria that significantly harm children’s health. Pregnant women are vulnerable to extreme temperatures and are especially susceptible to dehydration, which releases labor-inducing hormones [48]. Newborns are especially sensitive to ambient temperature extremes because their capacity for regulating body temperature is limited.

Extreme heat waves related to climate change may result in adverse pregnancy outcomes including but not limited to preterm births, still births, miscarriages, low birth weight, neonatal deaths, preeclampsia and eclampsia.

A study carried out to determine whether there is a seasonal variation in preeclamptic presentation undergoing cesarean delivery in a tropical rainforest belt in Nigeria showed seasonal variation in the cesarean delivery required for preeclampsia/eclampsia [12]. In an older retrospective report of eclampsia’s meteorological relations in Lagos—the busiest city in Nigeria—the study showed that the incidence of this condition varies significantly with weather changes [14].

Droughts and flooding, where sanitary infrastructure is inadequate, will result in increased frequency of epidemics and enteric diseases, with maternal and neonatal health being the most vulnerable in developing nations [49, 50]. Furthermore, drought and flood reduce pregnant women’s access to safe food and water, resulting in adverse psychological stress and disrupted health care, and increasing their vulnerability to dehydration (leading to pre-term labor), infectious agents and increased risk of exposure to environmental toxins.

5.2 Air pollution

During pregnancy, women have a unique immunological condition that causes modulation of the immune system at different stages of the pregnancy, which can lead to adverse reactions to environmental toxins and [51]. Also, pregnant women’s ability to thermoregulate is compromised, making them particularly susceptible to heatwaves and air pollutants [52, 53].

Studies have shown links between prenatal exposure to environmental chemicals and adverse health outcomes that that cuts across life include impacts on fertility and pregnancy, neurodevelopment, and cancer. Warmer/higher temperatures can allow certain chemicals to break down into toxic elements, vaporize and easily enter the air we breathe, leading to adverse effects on fertility and pregnancy outcomes [11, 54, 55]. Climate change affects how chemicals deposited into the environment by factories, car emissions, and congestion in urban areas interacting with the air we breathe. Therefore, prenatal and early childhood exposure to air pollution, especially PM2.5, contributes to respiratory illness such as asthma, pneumonia and chronic obstructive pulmonary disease [56].

Because of the dangers these environmental exposures will have on maternal health outcomes, both the American College of Obstetricians and Gynecologists (ACOG) and the International Federation of Gynecology and Obstetrics (FIGO) have alerted the members of the reproductive and maternal health community about the far-reaching effects of climate change on maternal and neonatal health outcomes [57, 58].

As stated above, both increasing temperatures and air pollution are important factors impacting pregnancy and birth outcomes. Women who are exposed to hot temperatures/extreme heat, heat stress, or air pollution are more likely to have negative birth outcomes such as, but not limited to, miscarriages and stillbirth, preterm and low birth weight, and other preventable pregnancy and birth complications such as preeclampsia.

6. Autoethnography and Delphi technique

The recommendations discussed below are contextualized and targeted towards Nigerian women to help them actively engage in behaviors to mitigate the effects of climate change on maternal health outcomes. The recommendation from this formative report builds upon two key approaches: autoethnography and an adaptation of the Delphi technique.

The autoethnography conducted explored the major sociocultural perspectives of women in Nigeria and the researcher’s perspective about climate change and health [59]. Through the ethnography, (a) there was an examination of the women’s ways of speaking and relating about the changes in their immediate environment; (b) there was a core evaluation of the investigative use of space and place as it relates to climate events; (c) the researcher being part of the culture and possessing the same cultural identity was able to use personal experience as data to describe, analyze, and understand the women’s sociocultural nuanced experiences [59].

Building on the existing autoethnography, this report employed the Delphi technique—a group facilitating technique that seeks to obtain consensus on the opinions of experts or individuals knowledgeable on the subject through a series of interviews [60]. The Delphi technique is a multistage process designed to combine [61] the different expert opinions into a consensus to best understand a problem, seek solutions, educate, and make informed recommendations to improve health outcomes. When there is limited or conflicting evidence, it is often used to develop evidence-based design recommendations and considerations for healthcare-built environments [62]. It has also been extensively used to generate many indicators relevant to health behaviors in communicating public health issues [63].

For this formative report, experts were purposefully selected—convenience sampling—to apply their knowledge to the existing research discourse on climate change and its effects on maternal/prenatal health outcomes (topical interview). These experts included obstetrician-gynecologists in Nigeria.

Experts were interviewed to explore their various opinions. They were asked three core questions; (a) what do you think women, especially pregnant women, need to know about the changing climate? (b) how do you think women protect themselves and their developing babies from the effects of climate change—rising temperatures; (c) how do you think women protect themselves and their developing babies from the effects of climate change—air pollution.

The experts provided nuanced contextual information related to the sociocultural and economic effects and how it is intertwined with climate effects on health outcomes. These experts’ communication adequately informed the recommendations in this report.

7. Recommendations to mitigate climate change effects on maternal and prenatal health outcomes in Nigeria

The recommendations below are contextualized and targeted towards Nigeria women with active consideration for the sociocultural and socioeconomic factors that typify an average Nigerian woman. However, it is crucial to note that communicating the negative effects of climate change might be challenging. For example, it is easier to describe the need for nutrition than the consequences of being exposed to extreme temperatures, especially to women who are busy co-bread winners of their families and go about their daily hustle to make ends meet for their families. The extreme temperature is least considered when these women have hungry mouths to feed. However, numerous sociocultural and socioeconomic factors vary across ethnic groups with implications for engaging in some of these protective recommendations. The recommendation from this formative review builds upon three key factors: existing literature, autoethnography [59], and findings from the adaption of the Delphi technique conducted.

7.1 Extreme heat (hotter days)

Limit the amount of time you spend outdoors:

1. Stay indoors or in the shade—out of the Sun—especially during mid-day.

2. Stay hydrated: Drink a lot of water.

3. Wear light clothing to avoid excessive sweat.

When outdoors:

1. Use headcovers or umbrellas as shade. Wearing headgears is almost typical for women in northern Nigeria. Hence, wearing headgears can also serve as protection from the Sun.

7.2 Air pollution

Spend as little time as possible in places:

1. Where outdoor air pollution is worst, such as busy roadways and industrial plants.

2. Where indoor air pollution is worst because of generator fumes or poorly vented indoor gas/biofuel cooking.

3. During pregnancy, most women become very sensitive to unpleasant smells—this attribute can also be used to navigate spaces with certain forms of air pollutants in and around your homes and workspaces.

4. Download an air quality app on your smartphone so that you will know when outdoor air pollution is dangerous.

7.3 Information seeking

Ask your doctor about other protective measures for your baby’s health from the risks associated with climate change.

8. Conclusion

Irrespective of the recommendations made, it is important to highlight that these protective actions would differ from one region of the country to another because of the climate variations. Also, self-efficacy is not just in the individual; it is also in the social and physical environmental barriers preventing the individual from engaging in certain behaviors or making health decisions. Climate change remains a monster staring Nigerian women’s reproductive health in the face through the adverse effects of extreme temperatures and air pollution.

Acknowledgments

Dr. Bruce Bekkar, Dr. Edward Maibach, Dr. Gary Kreps, Dr. Oluseyi Asaolu and Dr. Oluwaseun Fadare.

Conflict of interest

The authors declare no conflict of interest.