SEED Madagascar

As the world moves through 2025, the effects of climate change are becoming increasingly evident - particularly here in Madagascar. Four years after facing a severe drought that raised fears of leading to the first climate-induced famine,¹ communities in the Anosy region of south-east Madagascar are now contending with the aftermath of the driest October-to- December on record,²  followed by the arrival of Tropical Storm Jude.

Despite producing less than 0.01% of the world’s annual carbon dioxide emissions,³  Madagascar is among the 10 most vulnerable countries to climate change.⁴  Frequent extreme weather events and flooding continue to damage health and education infrastructure and block road networks, while prolonged droughts drive up food prices. As a result, Madagascar ranks 124th out of 127 countries in the Global Hunger Index, facing an ‘alarming’ level of hunger.⁵  Low-income countries contribute a fraction to global greenhouse gas emissions,⁶  but bear the greatest burdens from harmful practices.

Furthermore, increasing evidence shows that climate change has a gendered impact, as women and girls often face heightened risks to their health and wellbeing.⁷ Pregnant women, unborn children, and newborns are among the most vulnerable to environmental changes.⁸ Consequently, Malagasy women and families endure adverse Maternal and Child Health (MCH) outcomes, including high rates of preeclampsia / eclampsia,⁹ stillbirth,¹⁰ and premature birth.¹¹ As climate crises intensify, understanding the effects on maternal and child health is essential when supporting communities to strengthen resilience and protect those most at risk. So, how does a changing climate affect MCH outcomes?

Unsafe water and excessive heat

As global warming accelerates, rising sea levels and more frequent cyclones are leading to flooding, erosion, and saline intrusion in Madagascar.¹² Increased exposure to saline water -through drinking, washing, and other daily activities - has been linked to reproductive infections, including uterine diseases,¹³ as well as elevated blood pressure, which can raise the risk of pregnancy complications such as eclampsia.¹⁴ Many Malagasy women spend significant time in and near open water while washing clothes and dishes, making them more vulnerable to these reproductive health risks.¹⁵ Despite this, little to no research has been conducted on the impact of saline water on MCH in Madagascar.

Climate change is also altering precipitation patterns which creates ideal conditions for the Anopheles mosquito; a carrier of diseases like malaria and dengue.¹⁶ This has contributed to the sharp rise in malaria cases in Madagascar, increasing from 1.7 million in 2022 to 2.8 million in 2023.¹⁶ As women are frequently exposed to standing water, they face a heightened risk of vector-borne diseases which can contribute to maternal and child health complications, such as spontaneous abortions, eclampsia, premature birth, and stillbirth.¹³

Beyond water-related challenges, Malagasy women also face health risks associated with excessive heat exposure. Over the past 50 years, air temperatures in Madagascar have risen by 10%,¹⁷ with projections indicating a further increase of at least 1.1 to 2.6 degrees by 2065.¹⁸ Pregnancy naturally reduces the body’s ability to regulate temperature,¹⁹ making expectant mothers particularly vulnerable to extreme heat. This can exacerbate the spread of water-, food-, and vector-borne diseases, and increase the risk of respiratory, mental health, and diarrhoeal illnesses.¹⁵ Heat exposure also affects newborn health, as research suggests that a rise in body temperature by just one-degree in the week before delivery can increase the risk of stillbirth by 6%.¹⁵ 

Food Insecurity and Disrupted Healthcare Services

Across the world, frequent droughts, heatwaves, and floods continue to threaten access to food and safe drinking water, including in southern Madagascar. Described as the ‘arid south’,²⁰ a chronic lack of water, worsened by climate change, exacerbates high levels of food insecurity and malnutrition.²¹ This year’s lean season (typically from January to April) has been intensified by a prolonged drought which reduced crop yields and has led to increased food prices. As a result, an estimated 1.94 million people are facing food insecurity in Madagascar this year - 310,000 more than during the 2024 lean season. ²² Among them, hundreds of thousands of pregnant women will face heightened health risks. Both dehydration and malnourishment are linked to conditions such as eclampsia and anemia, which also increase the risk of preterm birth and restricted fetal growth. ²³ Additionally, research suggests that food insecurity contributes to long-term maternal challenges, including gestational diabetes and antenatal depression and anxiety.¹⁹

In the face of these serious risks, access to healthcare is more critical than ever. However, extreme weather events, such as cyclones and floods, often damage health infrastructure, sometimes leaving healthcare centres irreparable and making services harder to reach. Madagascar’s healthcare system is among the lowest funded, with per capita healthcare spending declining from $24.42 in 2016 to $17.82 in 2023.²³ On top of this, 40% of the population lives more than 5km from a basic healthcare facility.²⁴ Excessive flooding further restricts access - only 53% of healthcare centres remain accessible year-round due to road blockages. ²⁴

These disruptions deprive women and families of essential MCH services, including antenatal care, skilled attendance at birth, family planning, and childhood vaccinations. As the climate crisis intensifies, Malagasy communities continue to face significant challenges in exercising their right to basic health care.

So, What Can We Do?

At the local level, community-led initiatives are key to addressing the underlying causes of vulnerability to climate change, such as limited access to health information and high-quality services. In the Anosy region, SEED Madagascar’s Community Health Department implements targeted initiatives to help communities mitigate the impact of climate change on MCH through knowledge sharing, awareness-raising, and behaviour-changing projects.

To improve access to essential MCH information, Project Votsira trains 28 community health workers to deliver a comprehensive curriculum to caregivers across the town of Fort Dauphin. The health workers lead community-based education sessions on topics including breastfeeding practices, healthy and affordable foods for pregnant women, and malaria awareness and prevention. Household visits reinforce these messages, ensuring entire families receive the same knowledge so that women feel supported when making informed health choices for themselves and their children. To address food insecurity, Project Miatrika distributes nutrient-rich food to 22 communes in Anosy, and provides community health workers with training to monitor and respond to malnutrition. To promote long-term improvements in child nutrition, Miatrika has also piloted the ‘positive deviance’ model - identifying and promoting successful nutrition strategies already being used by some families within the community. Both projects work closely with local health centres to enhance the quality of care by providing essential resources such as birthing beds and surgical lamps, and offering training to staff on key curricula such as Infant and Young Child Feeding (ANJE). Investing in climate resilience at the community level enhances people’s ability to better protect their health in the face of climate adversities.

While projects like Votsira and Miatrika support local communities, addressing the many ways climate change affects maternal and child health requires a holistic approach on the international level. This means investment in research efforts to strengthen awareness and understanding, and greater collaboration among climate, health, and women’s rights advocacy communities. ²¹  Most importantly, decision-making when shaping international climate policy must be gender-balanced. Women made up only 34% of national delegates at COP29, which also had an all-male organising committee until backlash led to the inclusion of 12 women - forming just 29% of the committee. ²⁵ Without equitable representation, policies risk overlooking specific challenges faced by women in the wake of climate disasters.

As climate disasters intensify, women and young children continue to face disproportionate risks to their health and well-being. To drive real change, the international community must recognise that women’s health is central to sustainable development, and gender-equal representation is crucial in climate discussions. Unified, decisive action is improbable in the current political climate, however, non-governmental organisations (NGO) like SEED will continue working to ensure that people most affected by adversities like climate change are not forgotten, and communities are still supported in strengthening their resilience and protecting those most at risk.

References

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