El Niño could kill mothers in flood and heat zones, midwives warn

Midwives are bracing for a deadly stretch of weather. Floods, cyclones and extreme heat tied to El Niño are forecast to peak in the coming months, and the International Confederation of Midwives says pregnant women cut off from hospitals during labour will pay the highest price.

The numbers are brutal. About 15 million babies are due in November and December across countries the ICM rates as high risk for El Niño — two of every three births on Earth. Nigeria, Chad, Central African Republic, South Sudan, Somalia and Afghanistan are on the list, all already carrying some of the world's worst maternal and newborn death rates. Roughly 260,000 women die in pregnancy and childbirth every year, mostly from avoidable causes, and sub-Saharan Africa absorbs 70% of that toll.

ICM chief executive Anna af Ugglas put it bluntly: being female, pregnant, socially deprived and living in a climate catastrophe zone stacks the odds against a woman before she even conceives. El Niño, she said, lands on top of existing health risks — and for many it becomes the difference between life and death.

In Bangladesh, maternity teams are waiting on the floods. Christine Ewoi Eloto, a midwife mentor in the Rohingya refugee camps of Cox's Bazar, said childbirth does not pause for a cyclone, flood, heatwave or landslide, and that even a short delay reaching a facility during an obstetric emergency can cost a mother or baby their life. In past flash floods and landslides, she said, roads went under and vehicles got stuck.

Southern Malawi is fighting heat instead. Midwife Judith Mgogo reports temperatures above 40C most of the week, with daily electricity blackouts keeping women away from antenatal care — a failed rainy season has left farming families unable to afford bus fares to a clinic. Madalitso Malekano, a midwife in Phalombe district, said babies are delivered in sweltering wards or by torchlight, and that extreme heat is causing dizziness and fatigue in women, herself included. Past strong El Niño events left more than 4 million Malawians short of food, and Malekano warns malnutrition will follow, bringing low birthweight babies and heavy maternal bleeding from anaemia. The World Health Organization calls malnutrition almost certain in drought zones and a very high risk, especially for pregnant and breastfeeding women. Fellow midwife Emmie Mang'anda added that when households cannot cover basic necessities, some girls turn to risky survival strategies, including transactional sex, for money or food.

ICM has issued a manual on surviving extreme heat, which it labels an invisible disaster — a single day of overheating can raise the risk of premature birth, birth defects, high blood pressure and dangerous overheating in newborns. On life-threatening heat days, midwives are told to hang red flags outside clinics telling women to stop farm work and stay home, and women are urged to keep a heat action plan: a cool shelter, someone to take on chores and at least 15 litres of drinking water stored. In Chile, where floods knocked out communities and hospitals this year, midwife Natalia Acha Godoy of the Maternity Foundation said what stays with her is how fast reaching a hospital becomes uncertain. Campaigners argue the harm shows why governments must act at the UN climate summit Cop31 in Turkey this week.