Summary
A BMJ opinion article argues that reproductive, maternal and community health services should be funded as essential climate adaptation infrastructure. It highlights how climate shocks can disrupt care and deepen risks for women and marginalised communities.
A BMJ opinion article argues that reproductive, maternal, newborn and child health services should be treated as essential climate adaptation infrastructure rather than as secondary social spending.
The article, published on 21 September 2026, describes how climate shocks can disrupt the systems that allow women and girls to access contraception, pregnancy care and protection from violence. Its authors—Carina Hirsch, Nabeeha Kazi Hutchins and Susannah H Mayhew—call for climate finance to support community health networks alongside physical infrastructure such as seawalls, power grids and climate-resilient agriculture.
The piece is an opinion article. It was not commissioned and was not externally peer reviewed, so its main contribution is a policy argument built around examples and estimates presented by the authors.
Why health systems are part of climate resilience
The authors point to a project in Rukiga District in southwest Uganda as an example of community-led climate resilience. Frontline healthcare workers there are trained to provide usual maternal care as well as information on reducing the effects of climate change on food and livelihoods. Working with residents, they identify groups most exposed to climate risks, connect prolonged drought with malnutrition, and examine links between environmental degradation and domestic violence.
The programme also brings climate-smart agriculture, family planning and maternal care into the same local response. During emergencies, the article describes the potential value of mobilising boats, supplies and health workers when roads flood or electricity fails, allowing displaced people to reach contraception and pregnant women to find a safe place to give birth.
The authors cite estimates that climate-related displacement over the next decade could leave 14 million women without access to contraception, contributing to an estimated 17 million unintended pregnancies and 20,000 additional maternal deaths. They also cite research associating a 1°C temperature increase during the week before delivery with a 6% higher risk of stillbirth. Another estimate in the article suggests that, with up to a 2°C temperature increase, an additional 40 million women and girls could experience intimate partner violence each year by 2090.
These figures describe the overlapping health and social effects that can follow climate shocks: interrupted clinical care, displacement, food insecurity, violence and reduced household ability to recover. The article also cites an estimate that each dollar invested in expanding family planning and maternal health could produce $8.40 in economic benefits by 2050.
The funding changes the authors propose
The authors identify two barriers. Climate finance often prioritises physical infrastructure and environmental or energy projects, while health funding is organised separately around medicines and healthcare delivery. Community-run health networks therefore struggle to qualify as climate adaptation, even when they help people withstand climate-related disruption.
The article says that less than 1% of international climate adaptation finance currently targets gender-responsive health projects. It calls for three changes:
- Governments should include family planning and reproductive, maternal, newborn and child health services in national adaptation plans, primary healthcare systems and community health networks.
- Climate funds, including the Green Climate Fund and bilateral adaptation budgets, should create explicit funding lines for gender-responsive, community-owned health initiatives.
- Funders should give more decision-making power and resources to local women and grassroots health workers, who understand the risks facing their communities.
The proposal is not to replace investment in flood protection, electricity, agriculture or technology. Instead, the authors argue that those measures work better when clinics remain open, health workers can continue providing care, and contraceptives and maternal-health supplies remain available before, during and after an emergency.
The likely effects of changing adaptation finance would depend on implementation, local governance and reliable supply chains. The article presents a case for making health systems a recognised part of climate resilience, while the scale and timing of benefits from the proposed funding model remain matters for future programmes and evaluation.