The administration of United States President Joe Biden should take concrete action to ensure that the country's maternal health crisis, dominated by racial inequities, is a central focus of US domestic climate policy, a coalition of 54 organizations said today in a letter to President Biden.
Government agencies should use Biden's directives to include the risk to maternal health in their assessments of risks from the climate crisis and plan their policies and actions through a reproductive justice lens that centers on racial and economic disparities, the groups said. The organizations work in reproductive justice, maternal and child health, environmental justice, climate justice, and human rights.
"President Biden has encouraged many of us by including racial and environmental justice when talking about the climate crisis in the US," said Kelly Davis, vice president of global birth equity and innovation for the National Birth Equity Collaborative. "But pregnancy creates additional vulnerability to heat and natural disasters, and low-income, Black, Indigenous, and other women of color are especially at risk. US climate policy should specifically address these needs."
President Biden signed an Executive Order on Tackling the Climate Crisis at Home and Abroad in late January 2021, instructing US government agencies to reassess how to build resilience to the climate crisis and to calculate the financial and other costs of climate change to people and their communities.
The executive order requires the Department of Health and Human Services to establish new bodies to address the climate crisis, including an Office of Climate Change and Health Equity and an Interagency Working Group to Decrease Risk of Climate Change to Children, the Elderly, People with Disabilities, and the Vulnerable. The executive order also established the White House Environmental Justice Advisory Council, to bring greater visibility across the US federal government for environmental justice issues, including for climate change mitigation, resilience, and disaster management.
Biden is planning to announce a new US 2030 emissions target under the Paris Agreement ahead of an international climate summit hosted by the US on April 22 and 23.
Maternal mortality and morbidity, premature birth rates, and other adverse birth outcomes in the US are among the worst in the industrialized world and are continuing to trend worse. Premature birth rates and rates of severe illness during pregnancy are twice as high for Black women as for white women. Ending racial disparities by identifying and addressing factors that contribute to systemic racism is necessary to address the maternal health crisis, the groups said.
A White House proclamation issued on April 13 said that the Biden-Harris administration is committed to "addressing these unacceptable disparities, and to building a health care system that delivers equity and dignity to Black, Indigenous, and other women and girls of color."
The climate crisis threatens to make efforts to improve US maternal health more difficult and to exacerbate economic and racial inequities in public health. Studies and reports have shown links between exposure to heat, wildfire smoke, flooding, hurricanes, and fossil fuel extraction, and poor maternal health and birth outcomes.
These include premature birth and low birth weight, both linked with higher rates of infant deaths and lifelong health consequences. Significant changes in their hormonal, respiratory, circulatory, and other systems during pregnancy put pregnant people at greater risk of climate associated or exacerbated illness, for example from heat (see below for resources).
The US government study of domestic climate science and impacts, the 2018 National Climate Assessment, noted: "Climate-related exposures may lead to adverse pregnancy and newborn health outcomes, including spontaneous abortion, low birth weight (less than 5.5 pounds), preterm birth (birth before 37 weeks of pregnancy), increased neonatal death, dehydration and associated renal failure, malnutrition, diarrhea, and respiratory disease."
New federal offices and advisory bodies should include people with maternal health expertise, and consult with maternal and child health groups, reproductive justice advocates, and frontline birth workers operating in communities hit hardest by hurricanes, floods, heat, wildfire, and other events worsened by the climate crisis. Human Rights Watch research has found that pregnancy health has been largely omitted from heat awareness efforts.
The groups said that President Biden should address climate health impacts, gender equality, racial and economic equity considerations, and human rights in the upcoming new US Nationally Determined Contribution (NDC) that governments are due to submit under the Paris Agreement. The document should specify the domestic maternal health crisis as an area of concern and action.
The administration should also appoint a national gender and climate change lead to support the integration of gender considerations into all aspects of White House climate change policymaking and coordination.
The Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights (ICESCR) provide for the right to health. The ICESCR obligates governments to respond to foreseeable threats to public health, and to show they are taking steps toward improving maternal health. The International Convention on the Elimination of Racial Discrimination obligates the US to act affirmatively to eliminate policies and practices with discriminatory impacts even if they appear to be neutral. Governments also have a human rights obligation to address climate change, including its impact on the rights of marginalized communities.
"Independent and government research and reports increasingly acknowledge the dangers of climate change in the US to maternal health, but what to do about it is missing," said Skye Wheeler, senior women's rights researcher at Human Rights Watch. "We need more public health information for people who are pregnant and their families, more services to protect them, and to include maternal health experts in addressing the growing problems of heat, hurricanes, wildfire, and flooding."
