Amid funding cuts for environmental initiatives on a federal level and attacks on abortion access at the state level, experts are seeing the effects of a correlation between reproductive care and climate change impacts. 

Although scientists have studied the effects of extreme heat and pollution on fetal and maternal health for years, recent legislative action limiting reproductive rights and deregulation of environmental protection statutes are adding to growing concerns. 

Southern states where temperatures are rising and severe pollution threatens air and water are also the states that have passed some of the nation’s most restrictive abortion laws. In midwestern states like Iowa, toxic compounds from coal plants have been found in placentas. In western states, wildfire smoke is a main concern, with chemicals from smoke inhalation also found in placentas.And on the East Coast, disasters such as hurricanes threaten the safety of families. 

Earlier this month, Environmental Protection Agency (EPA) administrator Lee Zeldin announced that the agency would undertake 31 deregulatory actions targeting pollution limits. These actions will undo initiatives such as the Good Neighbor Rule, which protects Americans from air pollution originating in other states, and the mercury and air toxics standards that protect children’s developing brains, according to the Environmental Defense Fund. 

Since the Supreme Court overturned Roe v. Wade in its 2022 decision in Dobbs v. Jackson Women’s Health Organization, multiple states have attempted to limit access to abortion and some have succeeded. In Wisconsin, for example, Republican lawmakers could pursue legislation that would bar women from seeking abortions after 14 weeks of pregnancy if the state Supreme Court rules abortion is legal or upholds the state’s previous law. Indiana Gov. Mike Braun in January signed an executive order that would require terminated pregnancy report submissions to the state health department. Last year, Iowa prohibited abortion as soon as a fetal heartbeat is detected, usually around six weeks of gestation.

“We are already seeing the impacts, and have been for a long time,” said Renee Bracey Sherman, a reproductive justice activist and writer.“It’s not a question of [whether] you think we’re gonna see it or [whether] it will happen. It is happening,” she said. 

Residents in states like Iowa encounter the combined stresses of limited access to reproductive care and air pollution from industry and coal plants. 

Karin Stein, Iowa field organizer for Moms Clean Air Force, a national organization that advocates for efforts to reduce air pollution with a specific focus on children’s health, has studied the impacts of coal plants on maternal health specifically. 

“Iowa isn’t known for high concentrations of coal plants, but we still have among the most polluting coal plants in the whole country,” Stein said. She explained that the methyl mercury emitted from coal plants settles on water and moves downstream, meaning that anyone who consumes fish from this water could also consume the toxic chemical. 

This impacts pregnant people regardless of race and class. 

“We know that it transcends the placenta,” she said. “So now all of a sudden that methyl mercury lands in the developing brain of the fetus, because brains are mostly fatty tissue.” Stein added that there’s no exact data on the amount of methyl mercury that moves downstream and into humans, highlighting a gap in research. 

This is “just one concrete example where national pollution from climate polluters like coal plants becomes a reproductive issue,” she said.

Although this is something that impacts everyone, Stein emphasized the disproportionate impacts on Black and Latino communities, given that highly industrial areas, such as Louisiana’s Cancer Alley, are more likely to be located near communities of color. 

This is coupled with the fact that Black women have the highest maternal mortality rate in the United States, with 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention.

“African American and Latino families, a lot of them living in the South and the Southeast … that’s also where a lot of the oil industry is concentrated. So not only are they experiencing higher heat, but they’re also at the same time inhaling much more pollution. It becomes a self reinforcing cycle,” Stein said. “The newborns in these communities that are exposed to climate pollution … they’re already born with disadvantages before they even start developing. That’s not acceptable as a society, and that’s one thing that we fight for.” 

“Health care in this country is impacted by how much money you have and where you live, and it’s exacerbated by racism.”

— Renee Bracey Sherman, reproductive justice activist and writer

Within the first month of his second term, President Donald Trump signed multiple executive orders that targeted women’s rights. Namely, the administration signed an order on January 24 enforcing the Hyde Amendment, which prevents the federal government from using funds to pay for elective abortions. 

“It’s difficult to tell what the goal or intent of that executive order is,” said Allison Siebeneck, supervising attorney of the Reproductive Rights Project at the American Civil Liberties Union of Illinois. She added that the Hyde Amendment “is not novel,” and that many hospitals already haven’t been able to use federal funds for abortion. 

However, “abortion [restriction] has, in many ways, for the first time, started to be felt by middle class women and suburban women throughout many places in the United States,” said Ziad Munson, a professor of sociology at Lehigh University who has written several books about abortion and politics. 

Munson and Bracey Sherman acknowledged that maternal mortality, combined with the rollbacks of reproductive care and rights, disproportionately affects poor women and women of color due to racism in the medical field and the most restrictive laws getting passed in rural states where most of the population already lacks access to health care. 

“Health care in this country is impacted by how much money you have and where you live, and it’s exacerbated by racism, where we have a system in which people of color … do not receive the same care or access to care that white people receive, and that shows up with access to contraception, sex ed, abortion care, and maternal mortality,” Bracey Sherman said. 

Jade Sasser, a gender and sexuality professor at the University of California, Riverside, whose research focuses on climate and reproductive justice, said that the southern U.S. faces the brunt of these issues. 

“There are specific regions where it is worse than others, because there are specific regions where you have less access to comprehensive reproductive care. … When the few clinics that do provide comprehensive services, including abortion, are disrupted in their functioning by an extreme weather event or other disaster, it’s disastrous because people who don’t have close access to a variety of clinics [and] are reliant on one clinic, and then that clinic goes down, then it really harms the people around it,” Sasser said. 

Recent research shows that human-caused warming has made natural disasters worse over the past two decades.  

Some of the states with the most restrictive laws on abortion also have the highest rates of pollution, such as Louisiana, home of Cancer Alley, an 85-mile stretch of 200 petrochemical plants and refineries. There, abortion is almost completely banned.

“It’s mind blowing that there’s a place in the United States just casually called Cancer Alley, and yet it’s allowed to exist. And the data on preterm birth and low birth weight are horrifying from that region,” said Dr. Nathaniel DeNicola, who serves as the American College of Obstetricians and Gynecologists’ (ACOG) environmental health expert. 

In 2020, DeNicola and three other researchers published a study that established significant links between environmental exposures exacerbated by climate change and serious adverse pregnancy outcomes such as low birth weight, preterm birth and stillbirth. 

Although DeNicola mainly practices in California, he said that intersection of reproductive care access and impacts of climate change extends beyond region and affluence, specifically regarding the impacts of high heat, which can lead to preterm contractions. 

“Preterm contractions are driven by dehydration and fatigue, so in extreme heat, you need extra hydration to protect,” DeNicola said. 

However, there is still a gap in research. 

“This is where the data isn’t as clear … but it looks like the mechanism that leads from dehydration to hormone release to contractions, that typically is reversed with rest and hydration, and it doesn’t convert into actual labor where delivery happens,” he said. 

“It looks like there’s a threshold of heat where the mechanism can’t be reversed, where hydration and rest doesn’t stop [the contractions], which ordinarily go away. They now organize and continue and produce preterm labor.” 

DeNicola advises his pregnant patients to take specific actions to combat certain effects of climate change and pollution. 

“Avoidance is typically the answer,” he said of high heat and pollution specifically. He frequently recommends patients use a free EPA app, “AirNow,” that monitors air quality index, for example, and a Heat Safety Tool app from the Occupational Safety and Health Administration that monitors heat index. He also advises patients to have a designated “cool area” in their homes during summer months for pregnant people to seek relief in during severe heat waves, and advises his patients to seek relief in public areas such as shopping malls and libraries in the summer months. ACOG developed specific guidance for pregnant people specifically to avoid pollutants, toxic chemicals and extreme heat. 

But he acknowledged that this might not be possible for everyone, and that many doctors still do not advise pregnant patients to take environmental concerns into consideration, leading to a gap in care.  

In areas where reproductive care access is difficult to obtain, doulas are filling this gap.

“I think doctors, nurses and clinicians need a bit more training about the public health impacts of climate change in general, but also the very specific, unique impacts on people who are pregnant, because the health impacts are not the same across the board,” Sasser said. 

Sasser said climate stress, such as having to evacuate during a disaster, impacts pregnant people differently. “Doctors and clinicians need to learn a lot more about that so that they can provide better services,” Sasser said. “But it’s not all just on doctors. We already know that doulas are filling in some of those gaps because doctors don’t have the knowledge, at least not consistently. It’s important to lift up and provide more resources to doulas and other community birth workers who are already stepping into those gaps.”

Both she and DeNicola emphasized the importance of civilian engagement and city-level response in addressing this. 

“Every city municipality has an emergency management plan,” Sasser said. “Those plans need to include and prioritize pregnant people and postpartum new mothers. We need to do all that we can to protect their health during moments of real vulnerability for them, and those moments are heat waves, storms, fires, all the things that come along with climate impact.” 

DeNicola said that even if doctors everywhere advised patients on climate change impacts, “individual actions are only one step,” and added that he’d rather see actions on a municipal level, such as cooling centers that Miami established where people can seek refuge from heat.

He also emphasized that although environmental impacts can vary based on region and impact communities of color differently, it is an issue everyone has to take into consideration. 

“Any risk of heat … can be more concentrated in urban centers [and] typically Black and brown communities live there, so there’s a heightened risk for them,” DeNicola said. “But overall, I want the message to come through very clearly that nobody is immune from this.”

Sarah Mattalian

Fellow

Sarah Mattalian is currently a graduate student at Northwestern University Medill, pursuing a master’s degree in journalism with a specialization in health, environment and science reporting. Currently based in Chicago, she previously covered environmental and labor policy in Washington, DC after receiving her undergraduate degree in journalism from American University. Sarah’s reporting focuses on how national policy intersects with public health, climate change and science on a local level, as well as how climate change impacts individuals and communities.