The research team, led by Adelaide Lusambili of Aga Khan University, Nairobi, together with colleagues from institutions across Africa, Europe and the United States, conducted in-depth interviews and focus group discussions with 22 pregnant and postpartum women, 19 mothers-in-law, 20 male spouses and 22 community health volunteers, alongside 16 key informants including health providers, religious leaders and government officials. Fieldwork took place during a season of extreme heat and drought, and the transcripts were analysed thematically using NVivo 12, combining deductive codes derived from the study objectives with inductive codes emerging from participants’ own accounts. The result is one of the most granular portraits yet assembled of how climate stress is absorbed, hour by hour, by some of the most physiologically vulnerable people on the planet.

The stakes are not abstract. Exposure to high ambient temperatures during pregnancy has been associated in the wider literature with increased risks of preterm birth, low birth weight, stillbirth and hypertensive disorders of pregnancy. Heat also drives dehydration, fatigue, sleep disruption and anxiety during pregnancy and the postpartum period. Newborns face their own dangers, because their limited physiological capacity to regulate body temperature makes them acutely sensitive to overheating. Yet the study found that many women in Kilifi did not frame extreme heat as a medical threat at all, and access to heatwave warnings and weather information was shaped by gendered patterns of communication that often left women the last to know.

What emerged from the interviews was a repertoire of five main coping strategies, each adapted in turn for infant care. Women reduced or removed clothing as temperatures climbed, sometimes sleeping unclothed and even arriving at clinics without underwear because, as one told researchers, they sweat. Mothers-in-law and health workers confirmed the practice was widespread rather than exceptional, with one public health officer observing that many women stayed bare except for a shawl and left their babies’ chests uncovered because the child was feeling hot. But clothing removal collided with norms of modesty and, for infants, with a local expectation that young babies be kept covered for fear of witchcraft. Women prioritised physical relief over social expectation, yet the trade-off brought increased exposure to insects and, where mosquito nets were abandoned because of the heat, potentially greater vulnerability to malaria.

The second strategy, seeking outdoor shade and fresh air, revealed perhaps the starkest contradiction in the data. Indoor temperatures in heat-retaining, poorly ventilated homes did not subside after sunset, and some women found sleeping indoors unbearable. One pregnant woman described resting under a tree with a mat because inside the house felt like the body was burning. At night, however, the same solution became dangerous: sleeping outdoors in remote areas raised personal-safety concerns and exposed families to mosquitoes without the protection of bed nets. One mother linked her baby’s malaria directly to sitting under a tree at night, and community health volunteers described the frustration of telling families not to sleep outside precisely because nets cannot be used there. Researchers identified this as a form of maladaptation, where coping with one climate-related risk generates another.

Ventilation, the third strategy, was constrained by both architecture and authority. Many homes lacked windows altogether, electric fans were very uncommon, and electricity was unreliable even where it existed. Opening a window could relieve heat, but in some households it was discouraged by long-standing beliefs that cold air or dust could harm a newborn. One mother described opening a window during a hot, dusty night because her baby was crying, only to be told by her mother-in-law that the infant’s subsequent red skin was her fault. Decisions about airflow, the authors note, are therefore not individual choices but relational ones, negotiated within family hierarchies where younger women may be blamed by elders when infant health problems arise. Rising temperatures are unsettling newborn thermal-care norms built largely around protecting infants from cold, forcing new intergenerational negotiations over clothing, bathing and ventilation.

Water emerged as the fourth and most culturally loaded coping tool. Women drank cold water frequently, including at night, bathed multiple times a day, and sponged or bathed their babies to calm irritability and relieve heat rashes. Yet water scarcity is a defining feature of daily life in Kilifi, with single boreholes serving as many as 700 people and becoming strained during drought. Cultural beliefs also policed water use: elders and religious leaders warned that cold water could harm the unborn baby, echoing similar restrictions documented in Burkina Faso. Some caregivers avoided bathing newborns for the first seven days, relying instead on sponging, salted water or leaf preparations, and a few gave small amounts of water to newborns to soothe them, a practice that contravenes World Health Organization guidance, which advises that infants under six months should not be given water even on hot days because of risks of diarrhoea and reduced breastfeeding.

The fifth strategy, adjusting the timing and intensity of daily work, was practised by only a minority of women despite widespread awareness of its benefits. Some shifted chores and water collection to cooler early-morning hours, and one postpartum mother reported cutting her water-carrying trips from seven per day to fewer. But cultural expectations positioned women as responsible for domestic labour regardless of pregnancy, recovery or temperature, and reducing water trips also meant reducing the water available to the household at exactly the moment hydration needs peaked. Women were better able to protect themselves when male partners and mothers-in-law shared domestic tasks, yet such support was uneven, and men who took on domestic work could face social disapproval.

The study’s central conclusion is that coping in Kilifi is not a set of individual behavioural responses but an embodied, relational and socially negotiated process, one that frequently redistributes risk rather than removing it. Removing clothing, sleeping outdoors, opening windows, giving newborns water and skipping water-collection trips each relieved heat while introducing new exposures to malaria, insecurity, social judgement, blame, infant diarrhoea or household water shortage. The authors argue that protecting maternal and newborn health will require heat-health guidance embedded in routine antenatal and postnatal care, respectful engagement with mothers-in-law, male partners, religious leaders and community health volunteers, and structural investment in reliable water, thermally safe housing, tree cover and climate-responsive health facilities. Newborn care guidance, long focused on preventing hypothermia, may need complementary advice on safe infant cooling developed with caregivers and clinicians in hot settings.

As global temperatures continue to rise, the women of Kilifi offer a warning that resonates far beyond coastal Kenya. Across The Gambia, Burkina Faso, Zimbabwe, Pakistan and India, researchers have documented strikingly similar repertoires of low-cost behavioural coping, constrained by the same material realities and gendered expectations. The lesson of the CHAMNHA study is that awareness is not the bottleneck; women in Kilifi monitored heat closely and understood its effects on their bodies. What they lacked was control, over their time, their labour, their housing and their water. Until adaptation becomes a shared responsibility of households, communities and systems, the thermoregulation of two generations, mothers and their newborns, will continue to rest on the resourcefulness of women left to cope alone.

Subject of Research: Heat coping strategies among pregnant and postpartum women and newborns in rural Kilifi, Kenya

Article Title: Left to cope alone: how pregnant and postpartum women and their newborns manage extreme heat in coastal Kilifi, Kenya

Article References: Lusambili, A., Scorgie, F., Chersich, M., Nakstad, B., Luchters, S., Khaemba, P., Filippi, V., Hess, J., & Kovats, S. (2026). Left to cope alone: how pregnant and postpartum women and their newborns manage extreme heat in coastal Kilifi, Kenya. Frontiers in Global Women's Health, 7, Article 1825348. https://doi.org/10.3389/fgwh.2026.1825348

Image Credits: AI Generated

DOI: 10.3389/fgwh.2026.1825348

Keywords: extreme heat, maternal health, newborn health, climate change, Kenya, qualitative research, postpartum, pregnancy, water scarcity, maladaptation, CHAMNHA, heat coping strategies

The methodological rigor behind the review is worth appreciating. The research team searched five academic databases and applied pre-determined eligibility criteria, with two independent reviewers assessing each article before data extraction and analysis. This scoping review approach, following the framework first articulated by Arksey and O’Malley and reported against the PRISMA-ScR checklist, is designed not to statistically pool results but to chart the extent, range, and nature of an entire evidence landscape. The result is a cartographic snapshot of nearly two decades of research, showing where knowledge is dense, where it is thin, and where the field has quietly drifted away from what decision-makers actually need.

One of the most striking findings is temporal: the number of published articles describing climate actions with health co-benefits or risks has increased steadily over time, signaling growing scholarly recognition that climate policy is health policy. Yet the geography of that scholarship is lopsided. Most of the 183 articles originated in the United States, with comparatively less attention paid to Canada and Mexico. Because these three nations differ enormously in energy systems, urban form, agricultural practices, and health-care infrastructure, the review’s authors caution that findings from one jurisdiction cannot simply be transplanted to another. The concentration of evidence in one country leaves substantial blind spots for policymakers elsewhere on the continent.

Even more consequential is what the reviewed studies were actually about. The vast majority described climate actions that were hypothetical, modeled scenarios rather than actions that had been formally proposed or concretely implemented. This is a critical distinction. Modeling a hypothetical coal-plant retirement and estimating the avoided cases of asthma is scientifically valuable, but it cannot tell us whether real-world programs deliver the promised benefits, how implementation barriers erode them, or whether unexpected harms emerge once policy meets reality. The review suggests the field has, in effect, been rehearsing on paper while the actual performance goes largely unmeasured.

The thematic balance also tilts heavily toward mitigation. Articles primarily focused on greenhouse gas emission reduction activities, and the energy sector dominated the literature, encompassing studies of renewable energy deployment, power-plant retirements, building efficiency retrofits, and transportation electrification. Adaptation articles were rare by comparison, and those that did exist primarily examined green infrastructure, such as urban tree planting, stormwater management, and vegetated spaces that cool cities and buffer floods. This asymmetry matters because adaptation actions, which are accelerating worldwide as climate impacts intensify, can carry their own health consequences, both positive and negative, and the evidence base to anticipate them remains sparse.

The health co-benefits documented in the literature are nonetheless substantial and often monetized. Studies of power-sector decarbonization consistently found reductions in fine particulate matter and ozone, translating into avoided premature deaths, fewer cardiovascular events, and reduced respiratory illness. Research on the Regional Greenhouse Gas Initiative and proposed decarbonization policies in the eastern United States quantified benefits specifically to children’s health, a population uniquely vulnerable to air pollution. Transportation studies modeling cleaner vehicles and expanded active mobility found gains from both reduced emissions and increased physical activity. Dietary shifts toward lower-emission food systems showed simultaneous benefits for chronic disease outcomes. Many articles went further and attached dollar values to these health gains, often finding that monetized co-benefits could offset a large share of mitigation costs.

Yet the review also surfaces a persistent gap between evidence and action. While many studies calculated the monetary value of health co-benefits, few provided actionable policy recommendations that decision-makers could directly use. This is a familiar critique of academic research: sophisticated modeling that ends where governance begins. The authors point out that translating findings into policy requires more than numbers; it requires framing health outcomes in terms that sectoral decision-makers, whether in energy, transportation, agriculture, or urban planning, can integrate into their own mandates and constraints. Without that translational step, even the most compelling co-benefit estimates risk remaining confined to journal pages.

The risks side of the ledger deserves equal attention. Climate actions are not automatically benign for health. The broader literature the review situates itself within includes cautionary concepts such as maladaptation, the phenomenon in which adaptation interventions inadvertently increase vulnerability. Energy-efficient building retrofits, for example, can alter indoor air quality in ways that require careful ventilation management. Forest management changes intended to reduce emissions can shift wildfire smoke regimes. Individual adaptation behaviors, such as staying indoors during pollution or heat events, carry their own equity and wellbeing implications. The review’s framing makes clear that identifying and limiting these health risks is as important as maximizing the benefits, and that both demand deliberate attention during policy design.

The authors’ central recommendation follows directly from their findings: engaging and collaborating with health professionals in the design, implementation, and evaluation of climate actions can help decision-makers across health-determining sectors identify and maximize health co-benefits while limiting health risks. This cross-sectoral collaboration echoes guidance from the World Health Organization, which has published frameworks for quantifying and economically valuing health outcomes from both health and non-health climate actions, and quality criteria for integrating health into nationally determined contributions. It also aligns with the growing Lancet Countdown enterprise, which tracks the health dimensions of climate change annually and argues for a health-centred response to a world facing irreversible harms.

For a continent grappling with wildfire smoke, extreme heat, aging grids, and transportation systems that remain stubbornly carbon-intensive, the review arrives at a pivotal moment. Its message is ultimately optimistic but demanding: the health dividend of climate action is real, large, and increasingly well quantified, but it is not automatic. It must be designed in, measured in practice rather than only in models, and evaluated with health expertise at the table from the start. The 183 studies charted here represent a foundation, and the field’s next chapter, the authors imply, should be written less in hypothetical scenarios and more in the messy, instructive reality of policies actually put to work in North American communities.

Subject of Research: Health co-benefits and risks of climate change adaptation and mitigation actions in North America

Article Title: What are climate change adaptation and mitigation actions that have health co-benefits and risks? A scoping review in North America

Article References: Schnitter, R., Berry, P., Gokiert, R., Banuet-Martinez, M., Gerend, S., Terreros-Rodriguez, A., Jackson, E., & Harper, S. L. (2026). What are climate change adaptation and mitigation actions that have health co-benefits and risks? A scoping review in North America. Regional Environmental Change, 26(4), Article 205. https://doi.org/10.1007/s10113-026-02679-8

Image Credits: AI Generated

DOI: 10.1007/s10113-026-02679-8

Keywords: climate change, health co-benefits, scoping review, mitigation, adaptation, North America, green infrastructure, air quality, energy sector, public health, policy, maladaptation

The review, led by Danian Singh of the University of Auckland with colleagues Meg Parsons and Karen Fisher, employed an integrative critical narrative review methodology, combining a structured Boolean search of Scopus and Google Scholar with targeted retrieval of grey literature from Pacific regional agencies and national adaptation plans. After screening, the authors identified a core corpus of thirty-four empirical studies of gendered traditional knowledge, most published since 2020 and concentrated in Fiji and the Solomon Islands, which they read alongside twenty-five theoretical, comparative and policy works. The analysis was framed by feminist political ecology and decolonial scholarship, and the authors were explicit about their own positionality as partial insiders and outsiders to the communities whose knowledge they synthesised.

Geographically, the review resists treating the Pacific as an ecological monolith. Its primary evidence comes from the volcanic high islands of Fiji, Tonga and Samoa, where larger land areas, richer soils and extensive reef and mangrove systems shape one set of gendered knowledge practices. Against this, the authors set the low-lying atolls of Kiribati as a deliberate analytical counterpoint, where acute groundwater vulnerability and constrained nearshore gleaning grounds produce adaptive practices that differ in kind rather than merely in degree. This comparative design guards against the common error of generalising from Melanesian cases to atoll nations facing fundamentally different ecological constraints.

The first domain of evidence concerns agriculture and food security. Across Fiji, Tonga and Samoa, the literature documents a culturally defined division of labour in which men typically undertake land clearing and large-scale cropping while women manage household gardens, seed selection, weeding and the maintenance of crop diversity. In Fiji, women cultivate quick-maturing tuber crops to avert shortages and restore farms after cyclones, and on Totoya Island they combine traditional food-processing knowledge with solar-drying technology to produce cassava and breadfruit flour that substitutes for imported wheat. During cyclone seasons, Fijian women have been documented preserving cassava through traditional drying techniques and drawing on drought-resistant crops such as wild yams and sweet potatoes that remain available when water is scarce.

The Tongan case reveals both the depth of this expertise and its colonial reshaping. Before colonisation, Tongan agroforestry cultivated root crops, trees and shrubs together in mutually sustaining systems of nutrient exchange, pest defence and climate buffering, a system progressively displaced by commercially promoted monocropping. Within the customary arrangement, men cultivated the plants while women transformed them through cooking, medicine and the making of koloa, the valued textiles that secure social relationships, so that food security rested on the interlocking of both genders’ contributions. Development interventions, however, misread these arrangements entirely, promoting an urban horticulture that encouraged women to plant Western vegetables in house plots never organised for food provisioning, on the mistaken assumption that Tongan women gardened on a Western model.

The second domain concerns water and marine resources, where women’s knowledge is perhaps most consequential and most invisible. Women’s knowledge of traditional well locations enables communities to find potable water during droughts, while in coastal Fiji’s Bua Province, women proved more likely than men to identify medicinal uses of mangroves, including seedling preparations used to treat children’s coughs and disinfect wounds. Elder women in the villages of Navunievu and Denimanu articulated mangroves’ coastal protection role in vernacular terms, describing how they hold the soil together, and recalled which species best stabilise eroding shorelines, guiding younger women to plant them in vulnerable areas. Meanwhile, the customary tabu system of temporary closures, including a five-year closure reported to have restored sea cucumber and fish populations, fuses ecological and cultural functions in ways formal marine protected areas rarely achieve.

Gleaning, the collection of shellfish, crabs and seaweed from shallow reefs and mangroves, is predominantly practised by women and functions as a disaster-resilience mechanism. In Kiribati, women use finely tuned techniques passed down through generations, watching for telltale holes, bubbles in the sand and particular tidal patterns, and employing specialised methods such as wai ibo and the nocturnal luring of ghost crabs. Elders emphasise that gleaning becomes crucial after storms, when open-sea fishing is dangerous and marine organisms wash into the shallows. Yet a Solomon Islands study found that women’s exclusion from marine governance led them to breach local management rules, because closures had been sited on their customary fishing grounds without their input, eroding both equity and the legitimacy of conservation itself. Researchers have coined the term womangroves to describe how women’s mangrove-based food knowledge is rendered peripheral within a conservation discourse oriented towards male-dominated fisheries and timber.

The third and fourth domains cover disaster risk awareness and caregiving. Women in rural Fiji read unusual flowering times and shifts in lunar cycles as early signs of droughts, floods or cyclones, complementing men’s knowledge of offshore fishing and infrastructure repair, and sustaining the solesolevaki system of pooled labour that becomes a lifeline during crises. After Tropical Cyclone Winston, women in several Fijian villages were among the first to undertake reconstruction, with rapid recovery attributed partly to collective care and local leadership. In Samoa, fa’afafine performed both men’s and women’s roles in disaster response after the 2009 tsunami, yet binary-organised evacuation facilities excluded some from aid distribution, illustrating how gender-blind planning fails even those who contribute most.

The review’s central argument is that these patterns of exclusion are not incidental but the contemporary expression of colonial restructurings of gender and authority. Colonialism and missionary Christianity displaced arrangements in which Pacific women held authority over land, food production and ritual life, imposing patriarchal norms and undermining matrilineal inheritance. Those legacies persist in governance structures that engage male chiefs and elders as the relevant knowledge holders, systematically omitting women’s expertise in agroecology, water security and medicinal plants. The authors warn that incorporating traditional knowledge without a gender lens risks maladaptation, since locally led governance that is not gender-inclusive may simply relocate the exclusion of women’s knowledge rather than remedy it.

The policy implications are concrete. The authors call for institutionalising women’s genuine decision-making power rather than token representation, adjusting consultation processes to address practical constraints of timing, language and childcare, documenting gendered knowledge through community-led oral history and seasonal calendars under protocols that secure Indigenous ownership, and designing adaptation to empower rather than overburden women, whose unpaid labour already sustains community resilience. Knowledge transmission itself faces compound threats from commercialisation, migration and the erosion of customary leadership, meaning that marginalisation and loss reinforce each other across generations. Centring gender in Pacific climate adaptation, the review concludes, is both an equity imperative and a practical pathway to more effective and just resilience, because a community that consults only half its knowledge holders forfeits half its capacity to survive what is coming.

Subject of Research: Gendered traditional knowledge in Pacific Island climate adaptation and disaster risk reduction

Article Title: Gendering traditional knowledge in Pacific climate adaptation and disaster management: a critical narrative review

Article References: Singh, D., Parsons, M., & Fisher, K. (2026). Gendering traditional knowledge in Pacific climate adaptation and disaster management: a critical narrative review. Regional Environmental Change, 26(4), Article 204. https://doi.org/10.1007/s10113-026-02676-x

Image Credits: AI Generated

DOI: 10.1007/s10113-026-02676-x

Keywords: traditional knowledge, Pacific Islands, climate adaptation, disaster risk reduction, gender, Indigenous knowledge, food security, marine resources, mangroves, colonial legacies, maladaptation, Fiji