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