The Challenges of Working in the Heat Whilst Pregnant: Insights From Gambian Women Farmers in the Face of Climate Change

Abstract

BackgroundThe expected increase in heat in The Gambia is one of the most significant health threats caused by climate change. However, little is known about the gendered dynamics of exposure and response to heat stress, including women's perceived health risks, their adaptation strategies to heat, and their perceptions of climate change. This research project aims to answer the question of whether and how pregnant farmers in The Gambia perceive and act upon occupational heat stress and its health impacts on both themselves and their unborn children, against the backdrop of current and expected climatic changes.MethodIn-depth semi-structured interviews were conducted with 12 women who practice subsistence farming and were either pregnant or had delivered within the past month in West Kiang, The Gambia. Participants were selected using purposive sampling. Translated interview transcripts were coded and qualitative thematic content analysis with an intersectional lens was used to arrive at the results.ResultsAll women who participated in the study experience significant heat stress while working outdoors during pregnancy, with symptoms often including headache, dizziness, nausea, and chills. The most common adaptive techniques included resting in the shade while working, completing their work in multiple shorter time increments, taking medicine to reduce symptoms like headache, using water to cool down, and reducing the amount of area they cultivate. Layered identities, experiences, and household power structures related to age, migration, marital situation, socioeconomic status, and supportive social relationships shaped the extent to which women were able to prevent and reduce the effects of heat exposure during their work whilst pregnant. Women who participated in this study demonstrated high awareness of climate change and offered important insights into potential values, priorities, and mechanisms to enable effective adaptation.ConclusionOur findings reveal many intersecting social and economic factors that shape the space within which women can make decisions and take adaptive action to reduce the impact of heat during their pregnancy. To improve the health of pregnant working women exposed to heat, these intersectionalities must be considered when supporting women to adapt their working practices and cope with heat stress.

Past and projected climate change impacts on heat-related child mortality in Africa

“…Adaptation options may be limited in this region due to limited economic capacity, specifically the affordability of space cooling. Emerging research in African settings has identified some low costs interventions, including cool roofs, and behaviour change interventions for reducing occupational heat risks (Spencer et al 2022). This study supports the need for increased prevention of heat-related risks in Africa, including the adoption of public health measures such as heat health action plans.…”

Physiological mechanisms of the impact of heat during pregnancy and the clinical implications: review of the evidence from an expert group meeting

“…Heat can be perceived as a barrier to engaging in outdoor activities (Caperchoine et al 2009 ) and may deter women from physical activity. Additionally, many women have to work in high temperatures until late in their pregnancy (Spencer et al 2022 ). However, there is a lack of evidence on the pathophysiological mechanisms and outcomes that are needed to inform clinical practice and public health strategies to manage heat risks and reduce impacts on mothers and babies.…”

Environmental heat stress on maternal physiology and fetal blood flow in pregnant subsistence farmers in The Gambia, west Africa: an observational cohort study

“… 38 For subsistence farmers, the pressures are often different, but the inability to avoid the heat is a shared problem, as detailed in our qualitative analysis of heat perception during pregnancy in this population. 39 …”