Districts classified as “highly climate vulnerable” showed significantly higher odds of children being underweight, stunted or wasted.
Published Dec 03, 2025 | 7:00 AM ⚊ Updated Dec 03, 2025 | 7:00 AM
An infant. (iStock)
Synopsis: A new study showed that children and women in climate-vulnerable districts face significantly higher health risks. Children in these areas are 1.25 times more likely to be underweight, 1.15 times more likely to be stunted, and have higher rates of wasting, while women are 1.38 times more likely to have non-institutional deliveries.
Across India, one in three children under the age of five is underweight, and nearly half of pregnant women still deliver outside medical institutions. New evidence suggests that climate change may be exacerbating these health disparities even further.
A new study on India’s health and climate vulnerabilities showed that children and women in climate-vulnerable districts face significantly higher health risks.
Children in these areas are 1.25 times more likely to be underweight, 1.15 times more likely to be stunted, and have higher rates of wasting, while women are 1.38 times more likely to have non-institutional deliveries due to barriers in accessing healthcare during extreme weather events.
Overall, 59 percent of women reported difficulties accessing healthcare, underlining how climate change compounds existing challenges in maternal and child health in rural India.
Published in the peer-reviewed journal PLOS, the study warns that India’s progress towards achieving its health-related Sustainable Development Goals (SDGs) is under threat unless climate risks are factored into health planning.
While previous research examined the impact of poverty or education on health outcomes, this study takes a step further, demonstrating that climate vulnerability itself acts as an independent determinant of health, affecting families regardless of their socio-economic standing.
For states in South India, where climate shocks such as heatwaves, water scarcity and erratic rainfall are becoming more frequent, the implications of these findings are profound.
The researchers analysed data from more than 154,000 children and 447,000 women across 575 rural districts, making it one of the most comprehensive attempts to map the intersection between climate vulnerability and public health in India.
Unlike traditional health studies that focus solely on socio-economic markers such as income, schooling or access to sanitation, this research incorporated district-level climate indicators — giving a more holistic picture of how environmental stressors shape health outcomes.
The results were stark. Districts classified as “highly climate vulnerable” showed significantly higher odds of children being underweight, stunted or wasted.
Mothers in these districts were more likely to deliver outside institutional settings, often relying on untrained birth attendants because extreme heat, floods or damaged roads made it harder to reach hospitals.
These vulnerabilities existed even when other factors, such as maternal education or antenatal care, were taken into account, proving that climate risk is not just an external pressure; it is now a core determinant of health.
The study merged two distinct datasets: The National Family Health Survey-5, which tracks maternal and child health outcomes, and the Climate Vulnerability Index, which assesses each district’s exposure to environmental risks such as temperature rise, rainfall variability, water stress, and infrastructure fragility.
By overlaying these datasets, the researchers demonstrated a measurable, statistically significant relationship between climate vulnerability and adverse health outcomes — a link rarely quantified at this scale in India.
The authors argued that unless India integrates climate vulnerability assessments into routine public-health planning, the health system will be unable to adapt to rapidly intensifying climate shocks.
This includes building climate-resilient infrastructure, strengthening rural healthcare access, and ensuring uninterrupted maternal and child services during extreme weather events. Without such steps, they said, the gains India has made in nutrition, maternal health and healthcare access could stagnate — or worse, reverse.
The study’s state-wise climate–water vulnerability graph laid out how districts across India differ in their exposure and sensitivity to water stress. The graph highlighted clear regional contrasts that shape climate-linked health risks.
West India showed a mixed pattern, balancing resilient areas with drought-prone districts. North India was sharply divided between highly exposed regions such as Rajasthan, Uttarakhand, and Jammu & Kashmir, and more secure pockets like Punjab.
Central India formed one of the country’s higher-risk zones, with Madhya Pradesh, Chhattisgarh, Jharkhand and Maharashtra dominated by medium to high vulnerability.
The Northeast, however, stood out as the region with the highest climate sensitivity overall, with Arunachal Pradesh, Meghalaya, Mizoram, Nagaland and Manipur consistently registering elevated exposure.
In comparison, South India presented a more balanced pattern, with fewer extreme hotspots and a broader distribution of moderate vulnerability.
Within the South, each state carried its own climate signature. Tamil Nadu was largely characterised by moderate vulnerability, and it also stood out as the only southern state that contains a clear low-vulnerability zone — an indication of how its climate risk varies across districts.
Kerala, too, sat largely in the moderate bracket, shaped by its sensitivity to shifting rainfall and recurrent flooding. Karnataka showed a roughly similar pattern, with moderate vulnerability being the most prominent, especially in its interior and northern regions.
Andhra Pradesh also fell mainly within the moderate zone, although its coastal districts added layers of cyclone-related exposure. Telangana, likewise, was characterised by medium to higher vulnerability linked to recurring drought patterns.
In contrast, Pondicherry stood out as one of the least vulnerable regions in India, maintaining consistently low climate–water sensitivity across the board.
This southern profile — defined by predominantly moderate vulnerability rather than extreme exposure — provides an important backdrop for understanding how climate-linked water stress is beginning to shape health outcomes, especially for children and mothers.
As districts face recurring heatwaves, floods, dengue cycles and periods of water stress, these pressures are beginning to show up most clearly in children whose nutritional status is already fragile.
Speaking to South First, Dr Sampat Kumar Shettigar, senior consultant in paediatrics and neonatology at Kinder Women’s Hospital in Bengaluru, said that “borderline children are the first to slip,” because even minor illnesses disrupt their efforts to gain weight and grow.
According to him, every episode of fever, diarrhoea or dengue acts like “a setback to their catch-up growth,” and repeated infections gradually shift borderline children into undernutrition.
He explained that the appetite drop that follows every illness — often lasting 10–14 days — makes recovery even harder. These vulnerabilities become sharper in economically weaker households, where climate-linked events such as floods or heatwaves reduce income and food security.
Vector-borne diseases are another climate-sensitive threat shaping child health. Dr Shettigar pointed out that while malaria has virtually disappeared in cities like Bengaluru, “certain pockets of South India now see high dengue and chikungunya seasons,” affecting children’s health stability.
He said the immediate concern during these outbreaks is often survival, but the long recovery phases contribute indirectly to declining nutrition.
Water scarcity, though less acute than in other parts of India, still influences child health outcomes. During heatwaves or supply disruptions, families may be forced to use unsafe water sources, increasing the risk of infections.
Dr Shettigar stressed that these layered risks — illness, poor appetite, unsafe water — are precisely how moderate climate vulnerability translates into significant nutritional setbacks for children.
Maternal health is closely intertwined with these climate-linked stresses. Dr Shettigar highlighted that “maternal undernutrition remains one of the most common reasons for low birth weight in India,” and climate shocks amplify that risk by limiting women’s access to hospitals during delivery.
Flooding or heatwaves often disrupt mobility, forcing some families, especially in low-income communities, to rely on unsafe home or makeshift delivery spaces, which raises neonatal risks.
He also drew attention to the indirect but serious consequences of disrupted infrastructure.
Power outages during extreme weather can compromise delivery centres and neonatal ICUs. “A newborn ICU simply cannot run without stable power or backup,” he explained, describing such failures as uncommon but potentially catastrophic. These challenges intersect with the growing climate pressures South India is experiencing.
On the preparedness front, Dr Shettigar believed that South India’s government health infrastructure is strong, but staffing and emergency transport remain the weakest links.
While private hospitals maintain well-organised neonatal referral systems, government facilities often lack specialised ambulances or trained teams for critical transfers.
He noted that “mobile ICUs or mobile delivery units are still missing,” and general ambulance services, though accessible, are not equipped for complex maternal or neonatal emergencies.
Looking ahead, he recommended two major policy directions: robust district-level emergency protocols and guaranteed supply chains for essential items such as ORS during heatwaves or flooding.
“Just like vitamin A supplementation was woven into the routine vaccination schedule, disaster-linked child and maternal care protocols should also be embedded into the system,” he suggested.
With South India’s moderate vulnerability offering a window of preparedness, he argued that strengthening Primary Health Centres, Community Health Centres and Taluk hospitals ahead of future climate stress will be essential for protecting mothers and children.
(Edited by Muhammed Fazil.)
