Safeguarding maternal health against extreme heat in India: a policy analysis of state‐level heat action plans
Author(s)
Cipriano Flores, Gabriela De Jesus
Surendran, Surya
Kumar, Karthika
Nambiar, Devaki
Hirst, Jane E
Type
Journal Article
Abstract
Objective
This study identifies and characterizes policy measures across Indian states to protect pregnant and lactating women from extreme heat exposure through a thematic analysis of state-level heat and climate adaptation plans.
Methods
Using content analysis, we systematically reviewed publicly available Heat Action Plans (HAPs) (N = 19) and, when unavailable, the State Action Plan on Climate Change (N = 16) from all Indian states and union territories. Strategies referencing pregnant and lactating women, either directly or indirectly (i.e., as part of a group identified as vulnerable), were extracted, categorized and coded.
Results
Twelve of 35 state plans (33%) contained no recommendations for pregnant or lactating women. The remaining 23 plans listed 214 strategies, comprising 102 unique strategies (no repetitions). However, only 40 directly addressed this group. Karnataka (16), Telangana (11), and Delhi (10) had the highest number of unique strategies. Strategies were categorized using the four-category climate adaptation framework of Chersich et al. and fell into behavior change actions (n = 100), structural/policy, and climate-financing support measures (n = 51), health system interventions (n = 38), and built environment/cooling solutions (n = 25).
Conclusion
Strategies specifically addressing pregnant and lactating women during extreme heat remain limited across Indian states, with most focusing on behavioral interventions rather than structural solutions. Critical gaps exist in 12 states with no targeted measures. Very few strategies focus on pregnant and lactating women in the HAPs. Strengthening evidence-based, targeted adaptation policies and implementing comprehensive structural interventions are critical to protecting them from the increasing heat exposure risks.
This study identifies and characterizes policy measures across Indian states to protect pregnant and lactating women from extreme heat exposure through a thematic analysis of state-level heat and climate adaptation plans.
Methods
Using content analysis, we systematically reviewed publicly available Heat Action Plans (HAPs) (N = 19) and, when unavailable, the State Action Plan on Climate Change (N = 16) from all Indian states and union territories. Strategies referencing pregnant and lactating women, either directly or indirectly (i.e., as part of a group identified as vulnerable), were extracted, categorized and coded.
Results
Twelve of 35 state plans (33%) contained no recommendations for pregnant or lactating women. The remaining 23 plans listed 214 strategies, comprising 102 unique strategies (no repetitions). However, only 40 directly addressed this group. Karnataka (16), Telangana (11), and Delhi (10) had the highest number of unique strategies. Strategies were categorized using the four-category climate adaptation framework of Chersich et al. and fell into behavior change actions (n = 100), structural/policy, and climate-financing support measures (n = 51), health system interventions (n = 38), and built environment/cooling solutions (n = 25).
Conclusion
Strategies specifically addressing pregnant and lactating women during extreme heat remain limited across Indian states, with most focusing on behavioral interventions rather than structural solutions. Critical gaps exist in 12 states with no targeted measures. Very few strategies focus on pregnant and lactating women in the HAPs. Strengthening evidence-based, targeted adaptation policies and implementing comprehensive structural interventions are critical to protecting them from the increasing heat exposure risks.
Date Issued
2026-06-01
Date Acceptance
2025-11-29
Citation
International Journal of Gynecology and Obstetrics, 2026, 173 (3), pp.1443-1453
ISSN
0020-7292
Publisher
Wiley
Start Page
1443
End Page
1453
Journal / Book Title
International Journal of Gynecology and Obstetrics
Volume
173
Issue
3
Copyright Statement
© 2025 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
10.1002/ijgo.70747
Publication Status
Published
Article Number
ijgo.70747
Date Publish Online
2025-12-17