On Baba Island, a densely populated fishing settlement off the coast of Karachi, pregnant women endure the harsh effects of climate change, including sweltering heatwaves and rising sea levels. The island, home to around 6,500 people in a mere 0.15 square kilometers, is among the most crowded in the world. Here, Neha Mankani, the only midwife, arrives by boat ambulance weekly to provide essential healthcare to expectant mothers.
Zainab Bibi, a 26-year-old resident, recalls her tragic experience during a previous pregnancy. Last summer, she suffered a second-trimester miscarriage on a scorching day. “It was a very hot day, I was not feeling well,” she said. Her husband struggled to find a boat to take them to the mainland hospital, and by the time they arrived, it was too late. “By the time I delivered my baby in the hospital, she was already dead.”
Heatwaves in Pakistan, exacerbated by climate change, are becoming increasingly severe, with temperatures reaching up to 52°C (126°F). Pregnant women are especially vulnerable to these extreme conditions. “Climate change doesn’t affect everyone equally,” said Mankani. “Pregnant women and newborns, postpartum women are definitely more affected.” Mankani has observed a rise in low birth weights, preterm births, and pregnancy losses during the hot summer months.
Research published in the British Journal of Obstetrics and Gynaecology last year corroborates these observations, indicating that women are at higher risk of stillbirth when exposed to temperatures above 90% of the normal range for their location. This scientific backing adds weight to the anecdotal evidence Mankani has gathered over the years.
Pakistan’s maternal mortality rate is high, with 154 women dying for every 100,000 live births. This rate is influenced by socioeconomic factors, limited healthcare access, and restricted decision-making power for women, particularly the young. Mankani, who started her career as a midwife in Karachi, has dedicated her efforts to addressing these issues. In 2015, she founded the Mama Baby Fund and established the first clinics on the islands to support expectant and new mothers. The introduction of a free, 24/7 boat ambulance last year has been vital in navigating the rough seas and providing timely medical assistance.
Sabira Rashid, 26, recently gave birth to a daughter, Eesha, after previously experiencing a stillbirth and a seven-month miscarriage due to delays in reaching the hospital. “At the dock, they make us wait because they don’t want to ferry only two or three people. They told us to wait for more passengers, no matter what the emergency,” she said.
On Baba Island, young girls often marry as early as 16, driven by the need for security in an area where polluted waters have devastated the fishing trade. “Most of these girls don’t know how to take care of themselves; they get severe infections from the dirty water they are constantly exposed to,” explained Shahida Sumaar, a clinic assistant.
With no access to running water and limited electricity, coping with heat stress is a significant challenge. Women, typically responsible for cooking over open flames in poorly ventilated rooms, are at particular risk. Ayesha Mansoor, 30, lives on the island’s fringes with her four children and faces just four to five hours of electricity daily. “Only those who have solar can deal better with the heat. We can’t afford it,” she said.
Despite these challenges, hope is on the horizon. Mariam Abubakr, an 18-year-old clinic assistant, aspires to become Baba Island’s first full-time midwife. “I used to wonder why we women didn’t have any facilities here, a clinic that could just cater to us,” she said. “When Neha opened her clinic, I saw a way that I could help the women of my community.”
The efforts of Mankani and her team highlight the critical need for accessible healthcare in vulnerable communities affected by climate change. Their work offers a glimmer of hope and resilience amid the harsh realities faced by the women of Baba Island.
