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Rising Extreme Heat Compounds the U.S. Maternal Health Crisis
Report

Rising Extreme Heat Compounds the U.S. Maternal Health Crisis

Policymakers must act to protect the health and safety of pregnant people—including by passing the Protecting Moms and Babies Against Climate Change Act, increasing access to indoor home cooling, and quickly adopting a federal occupational heat standard.

Strengthening Health, Tackling Climate Change and Environmental Injustice, Climate Change, +8 More

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In this article
A midwife picks greens for a pregnant mother and her daughter.
A midwife picks greens for a pregnant mother and her daughter after a prenatal visit at a birth center in Los Angeles on April 9, 2021. (Getty/Los Angeles Daily News/MediaNews Group/Sarah Reingewirtz)

This report is the fourth in a summer 2024 series of products from the Center for American Progress that focuses on policy recommendations to address the needs of populations that are particularly vulnerable to extreme heat.

Introduction and summary

Extreme heat, induced by climate change, is intensifying and increasing in frequency across the United States,1 with 2024 marking the country’s fourth-hottest summer on record.2 This is especially threatening to the health and safety of pregnant people, who are among those most vulnerable to the impacts of extreme heat:

  • Extreme heat increases pregnant women’s risk of severe maternal morbidity, life-threatening pregnancy complications,3 and maternal mortality. For example, extreme heat exposure throughout pregnancy is associated with a 27 percent increase in the risk of experiencing severe maternal morbidity—and a 28 percent increase during the third trimester alone.4
  • Extreme heat exposure increases the risk of hospitalization among pregnant women, with a disproportionate impact on Black pregnant women,5 exacerbating the already appalling state of maternal health in the United States.6 Black pregnant women already face worsened disparities in maternal health outcomes, which are compounded by systemic inequities7—such as barriers to housing, medical care, and employment—that may substantially expose them to the adverse effects of extreme heat.
  • Pregnant workers can be exposed to extreme heat conditions in low-wage indoor and outdoor jobs. High levels of occupational heat exposure have been linked to adverse pregnancy outcomes—specifically adverse fetal health outcomes, including more than double the likelihood of miscarriage and stillbirth.8

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To protect the health of pregnant people, policymakers must take the following actions to mitigate the impacts of extreme heat:

  • State policymakers should increase access to indoor home cooling for pregnant people by expanding Medicaid coverage for cooling technologies. To ensure pregnant people can afford to utilize these technologies, the U.S. Department of Health and Human services (HHS) should update its guidance that identifies at-risk populations for the Low-Income Home Energy Assistance Program (LIHEAP) to explicitly identify pregnant people as an at-risk population and urge states to target outreach to pregnant household members.
  • Congress should pass the Protecting Moms and Babies Against Climate Change Act, which would establish federal grants for community-based organizations to address the maternal health risks associated with climate change.
  • Congress and federal policymakers should protect pregnant workers by accelerating the development of a federal Occupational Safety and Health Administration (OSHA) workplace heat standard. To protect pregnant farmworkers in particular, state policymakers should adopt and protect legislation that allows farmworkers the right to collectively bargain for safe workplace conditions.
  • The U.S. Environmental Protection Agency (EPA) should appoint a reproductive justice expert in its Office of Environmental Justice and External Civil Rights (OEJECR) to help institutionalize a reproductive justice framework within the federal government’s environmental justice agenda.
  • Local policymakers should leverage federal funding opportunities to build community resilience by establishing climate resilience centers and decreasing urban heat islands for pregnant people who live in areas vulnerable to extreme heat.
  • Federal policymakers should speed the transition to a 100 percent clean energy economy to slow the progression of climate change.

The threat of extreme heat is only growing more dangerous to pregnant people and the next generation of Americans

In 2023, average temperatures on Earth reached 1.35 degrees Celsius, or 2.43 degrees Fahrenheit, above preindustrial temperatures from 1850 to 1900.9 Indeed, the planet is quickly warming to the 1.5 degrees Celsius, or 2.7 degrees Fahrenheit, limit that scientists, climate experts, and world leaders warn will cause catastrophic impacts around the globe.10

The steady rise in global temperatures throughout the past two centuries led almost half of the U.S. population to experience at least 10 days of heat exacerbated by climate change between November 2022 and October 2023.11 If greenhouse gas emissions continue to spike, scientists predict that every region of the United States will endure extreme temperatures throughout the 21st century.12 As a result, most of the country will face an additional 20 to 30 days of extreme heat each year, with the Southeast region—which already has some of the worst rates of maternal mortality in the United States13—expected to experience even longer heat waves, with 40 to 50 more days of extreme heat.14

Extreme heat exposure during pregnancy increases the risk of severe maternal morbidity, pregnancy-related complications, and maternal mortality

Pregnancy affects the body’s capacity to regulate its temperature, making pregnant people particularly vulnerable to adverse health outcomes during extreme heat.15 Exposure to extreme heat throughout pregnancy can increase a woman’s risk of severe maternal morbidity by 27 percent—and by 28 percent in the third trimester alone.16 It can also cause hypertensive disorders and cardiovascular conditions during pregnancy, adverse health outcomes that are among the leading causes of maternal mortality in the United States.17 Notably, cardiovascular diseases are attributed to 26 percent of pregnancy-related deaths in the United States.18 For example, extreme heat exposure affects blood flow to the placenta19 and can cause cardiovascular conditions such as heart attacks and strokes20 as a result of heat stress on the heart.21

Exposure to extreme heat throughout pregnancy can increase a woman’s risk of severe maternal morbidity by 27 percent—and by 28 percent in the third trimester alone.

Extreme heat exposure is also linked to an increased risk of hypertensive disorders during pregnancy, including gestational hypertension, preeclampsia, and eclampsia.22 In fact, research finds that each additional day of extreme heat exposure in the third trimester increases the odds of a pregnant woman developing a hypertensive disorder at childbirth by nearly 3 percent.23

Defining maternal mortality and maternal morbidity in the United States

Maternal mortality refers to pregnancy-related deaths that occur while a person is pregnant, during childbirth, or within a mother’s postpartum period of one year following the end of pregnancy.24 Maternal morbidity, in contrast, includes unexpected short- or long-term health complications caused by pregnancy or childbirth,25 with severe maternal morbidity describing unexpected pregnancy complications during labor and delivery that can cause short- and long-term health consequences and even have fatal outcomes.26

The United States is facing a maternal health crisis, with approximately 22 pregnancy-related deaths per every 100,000 live births in 2022.27 America has one of the highest rates of maternal mortality among high-income countries, rising rates of complications during pregnancy and childbirth, and persistent racial and ethnic disparities in maternal health outcomes.28 Both maternal mortality and severe maternal morbidity in America are largely preventable.29

See also

Extreme heat drastically worsens disparities in maternal health, especially for Black women and pregnant workers in low-wage jobs

Systemic inequities, including poverty,30 employment barriers,31 inadequate housing,32 insufficient access to health care,33 and medical racism,34 may disproportionately expose pregnant people of color to extreme heat conditions and compound existing maternal health disparities.35 Decades of residential segregation have forced people of color to live in urban “heat islands”36 that are prone to sweltering temperatures,37 further perpetuating health disparities.38

This is especially problematic for pregnant Black women, who face higher odds of simultaneously experiencing extreme heat during pregnancy while having less access to cooling technologies such as air conditioning.39 As a result, each additional day of extreme heat exposure in the final trimester of pregnancy nearly doubles the risk of hospitalization for Black women relative to white women.40 At baseline, Black women are already three times more likely than white women to die from a pregnancy-related cause.41 Native American women also experience greater rates of maternal mortality,42 and Black and Hispanic women tend to experience higher rates of severe maternal morbidity compared with white women.43

Each additional day of extreme heat exposure in the final trimester of pregnancy nearly doubles the risk of hospitalization for Black women relative to white women.

Additionally, many women of color are disproportionately employed in low-wage jobs that may not have air conditioning or adequate ventilation.44 This is problematic to begin with but can be especially harmful when workers are pregnant.

Pregnant workers at risk from extreme heat include those working outdoors in agriculture, construction, landscaping, postal service, and waste collection jobs, as well as those working in indoor settings without adequate climate control, such as restaurants and manufacturing warehouses.45 One study on occupational health risks found that high levels of occupational extreme heat exposure can have adverse birth and fetal health outcomes, including more than doubling the risk of miscarriage and stillbirth for pregnant workers.46

Apart from risks to pregnancy health, unbearable heat has prompted pregnant workers to use sick time while pregnant to avoid working outdoors in the heat and draining their time off before even giving birth—or to quit their jobs altogether.47 As a result, heat exposure during pregnancy can lead to long-term reductions in women’s wages and labor supply as well as a higher likelihood of them working in low-wage jobs in the future.48

Farmwork, in particular, is plagued by temperatures that can rise as high as 120 degrees Fahrenheit.49 As a result, farmworkers are 35 times more likely to die from heat-related stress than other workers,50 and pregnant farmworkers are especially vulnerable. In the United States, there are more than 320,000 women of childbearing age (16 to 44) working in agriculture and related industries.51 Additionally, pay in agricultural jobs is typically tied to production, which can force pregnant workers to work beyond their heat tolerance limits to avoid losing pay.52 One devastating example is the case of María Isabel Vásquez Jiménez, a pregnant farmworker who died of heat exhaustion in 2008.53 Farmworkers who worked alongside María at a California grape farm reported that they were not provided adequate breaks or even nearby access to water.54

Related read

Extreme heat worsens infant health

By Hailey Gibbs

Researchers have demonstrated links between extreme heat and gestational age. A meta-analysis of the association between extreme heat and risk of pregnancy health complications found that during heat waves, pregnant women experience a 16 percent higher risk of preterm birth and can have up to a 46 percent increase in stillbirths.

Those numbers are double for pregnant Black and Hispanic women.55 Shortened pregnancies are associated with lower fetal maturity, or the degree of fetal development needed for the organs to function properly, at birth.56 High temperatures are also associated with low birth weight and an elevated risk of dehydration; chronic respiratory conditions; organ dysfunction, including kidney failure; and congenital defects.57 Compared with adults, infants and young children are less able to regulate their body temperatures, and chronic exposure to extreme heat, particularly early in life, has been associated with gut problems, muscle breakdown, organ dysfunction, and heat-related deaths.58

Local, state, and federal policymakers play a crucial role in protecting pregnant people from extreme heat and in safeguarding newborns and infants. Policymakers must support better community outreach to ensure prospective parents and caregivers understand the risks of extreme heat to their newborns and adopt techniques that will protect them. This engagement, which can be supported by community health workers, child care providers and early educators, local advocacy groups, and other community stakeholders, should help parents recognize the symptoms of heat stress in their babies—when the body’s critical functions begin to deteriorate.59 Relatedly, policymakers should also increase access to pediatric and community health care—including telehealth options, such as through state Medicaid programs—to allow for more consistent perinatal care throughout pregnancy and to support caregivers whose newborns suffer from heat stress.

16%

Percentage increase in the risk of preterm birth resulting from extreme heat

46%

Percentage increase in the risk of stillbirth resulting from extreme heat

2x

Greater likelihood Black and Hispanic pregnant women face such pregnancy complications resulting from extreme heat

Policy recommendations

As climate change induces above-average heat across the United States, policymakers must take crucial steps to provide protections for pregnant people.

Increase access to indoor home cooling for pregnant people

State policymakers should expand Medicaid benefits to include air conditioners and electric heat pumps for cooling

Pregnant people are consistently advised to stay home during heat waves, but this is only effective if their home is cool enough to keep them safe. State lawmakers can help save lives and reduce health care costs by proactively preventing extreme heat illness. State Medicaid programs cover nearly 17 million adult women of childbearing age60 who may be less likely than others, based on income, to have air conditioning in their home.61 The Centers for Medicare and Medicaid Services’ Section 1115 demonstration waiver program can grant states the ability to waive certain Medicaid requirements and additional flexibility to support Medicaid beneficiaries’ health-related social needs.62

For example, in an attempt to address the risk of extreme heat and poor air quality stemming from wildfires, Oregon became the first state this year to leverage Section 1115 waiver flexibility to explicitly dedicate Medicaid funding for climate-related costs—part of its $1.1 billion effort to address health-related social needs.63 Oregon’s Air Conditioner and Air Filter Program provides technologies such as air conditioners for certain Medicaid beneficiaries, including those with specific medical conditions, who are at risk of heat-related illness.64 As Oregon and other states that emulate its policy model consider the requirements for qualification,65 they should include pregnant people at risk of heat-related illness.

State Medicaid programs should also prioritize the distribution and installation of electric heat pumps, an energy-efficient air conditioning and heating method that keeps homes cool in the summer by extracting unwanted indoor heat and transferring it outdoors.66 While traditional air conditioners contribute significantly to the climate crisis and extreme heat by increasing greenhouse gas emissions,67 heat pumps are a clean energy choice that utilizes far less energy and can help accelerate the long-term reduction of fossil fuels.68

HHS must identify pregnant people as an at-risk population for LIHEAP

Providing low-income pregnant people with cooling technologies will be most effective if they can afford the energy costs to use them. LIHEAP is a federal program administered through states that helps low-income households pay their energy bills. The program directs states to target households using a high percentage of income on energy costs, with a particular focus on “at-risk populations,” including, but not limited to, households with members who are elderly, disabled, and/or a child under 6 years old.69

Because a multitude of evidence shows a direct link between extreme heat exposure and adverse maternal health outcomes,70 HHS must update its guidance identifying at-risk populations to clarify that pregnant people in low-income households are also an at-risk LIHEAP population. HHS must also urge states to develop and conduct outreach strategies and activities specifically designed to reach pregnant people—including by providing information about LIHEAP at health clinics, hospitals, and day care centers that serve low-income families.

Between 2022 and 2023, the Infrastructure Investment and Jobs Act (IIJA) invested $500 million in grants for LIHEAP.71 These funds could be life-changing if pregnant people were able to access them, as approximately 8.5 million women of childbearing age (15 to 44) live in households with incomes below the federal poverty level.72 By explicitly identifying pregnant people as an at-risk LIHEAP population, states can more directly confront their energy assistance needs.73

Congress must pass the Protecting Moms and Babies Against Climate Change Act

The Protecting Moms and Babies Against Climate Change Act74 is a landmark bill and pillar of the Black Maternal Health Momnibus legislative package.75 It is the only legislation before Congress designed to comprehensively address the dire U.S. maternal health crisis through a climate approach. The bill would invest in improving maternal and infant health outcomes at the local level by reducing environmental threats—including extreme heat—specific to pregnant and postpartum people as well as their infants.

Under the provisions of the act, HHS would be authorized to:76

  • Develop a strategy, through the Centers for Disease Control and Prevention, to designate “climate change risk zones,” geographical areas where pregnant people, recent parents, and their infants experience disproportionately higher odds of adverse maternal and infant health outcomes attributed to the effects of climate change. The designation would involve a proposed rulemaking process where HHS would collect public feedback on criteria to identify and select these zones—including, but not limited to, race and ethnicity, poverty and income, social determinants of health, and adequate access to quality maternal health care, nutrition, quality housing, and transportation.
  • Create and fund a range of grant programs—upon finalizing the selection criteria to designate climate change risk zones—that would provide targeted supports to the most vulnerable pregnant people and their infants. Supports could include direct financial assistance and help accessing cooling systems, quality housing, and transportation services. These grant programs would be available to help entities such as community-based organizations and local and state health departments—particularly in communities of color—to identify and address climate-change-related risks that are associated with poor maternal and infant health outcomes. Grant programs would also provide funding opportunities to health professional schools to educate and train the future health care workforce, including maternal health providers and doulas who provide medical services that address climate change-related risks in maternal and infant health.
  • Establish a Consortium on Birth and Climate Change Research through the National Institutes of Health to advance agencywide research regarding the effects of climate change on the health of pregnant and postpartum people as well as their infants.

Protect pregnant workers

OSHA must expedite its rulemaking timeline to finalize a federal heat standard that can protect workers

The Occupational Safety and Health Administration must prioritize finalizing a federal occupational heat standard that safeguards protections for workers—including pregnant workers—during extreme heat. In August 2024, OSHA published its proposed rule to protect workers during extreme heat; however, it must not take years for OSHA to finalize the rule.

Workers cannot wait: Thousands of occupational heat-related injuries and illnesses already occur each year,77 and only five states—California, Colorado, Minnesota, Oregon, and Washington78—currently guarantee workers in some settings access to heat protections. Congress can speed implementation of a federal heat standard by passing the Asunción Valdivia Heat Illness and Fatality Prevention Act, which would require OSHA to expedite its timeline.79 If finalized, OSHA’s rule would be the first-ever national heat mandate that requires employers to train workers to prevent and report heat hazards; to monitor worksites; to provide control measures such as water, shade, and paid breaks; and to acclimatize workers to heat, among other protections.80

Read more

In the absence of a final rule, it is up to pregnant workers to leverage the Pregnant Workers Fairness Act (PWFA) for workplace protection.81 Under the PWFA, workers can request “reasonable accommodations” that do not cause “undue hardship” to the employer, including access to water, frequent breaks, cooling devices, and adjustments to work hours and assignments to avoid extreme heat exposure. However, in addition to placing the burden for action on pregnant workers, the PWFA does not apply to employers with fewer than 15 employees.82 In contrast, a federal heat standard would cover a wider range of pregnant workers in the private sector83—including those working for employers with 10 or more employees—and would trigger automatic required accommodations for extreme heat that can be dangerous to pregnant people.84

State policymakers must adopt collective bargaining protections for pregnant farmworkers

Pregnant farmworkers—who often work in blazing temperatures without basic protections such as shade—lack the potentially lifesaving federal protections to collectively bargain under the National Labor Relations Act.85 As of 2022, only 14 states guarantee collective bargaining rights for farmworkers.86 Many farmworkers are unaware of their employment rights,87 and even when they are, the absence of union protections may contribute to pregnant farmworkers’ reluctance to voice workplace hazards for fear of losing their job or facing deportation88—considering that nearly half of farmworkers are undocumented.89

In 2023, the U.S. Department of Homeland Security took a critical step to address this gap through an expedited process that allows undocumented workers who report labor rights violations to request temporary protection from deportation, thus providing a safeguard from retaliation by exploitative employers.90 And in 2024, the U.S. Department of Labor enacted a rule that prohibits agricultural employers from hiring temporary foreign workers with H-2A visas unless they guarantee the right to organize without intimidation or discrimination.91

Institutionalize a reproductive justice framework within the federal government’s environmental justice agenda

The EPA should appoint a reproductive justice expert to the recently established Office of Environmental Justice and External Civil Rights. Environmental justice organizations and reproductive justice advocates have called for this change,92 which would allow the development of a comprehensive federal approach that explicitly prioritizes the threatening effects of climate change on the health of pregnant people. A reproductive justice expert in the OEJECR could:

  • Establish a clear connection between the intersection of reproductive justice and environmental justice within the federal government.93 Despite a multitude of research connecting climate change to poor health outcomes for pregnant people,94 addressing the impacts of climate change on reproductive health has generally not been prioritized. Appointing a reproductive justice expert could improve governmentwide coordination of environmental justice and reproductive justice obligations at the federal level.
  • Ensure the agency adopts a reproductive justice framework by promoting scientific and policy understanding of reproductive health vulnerabilities associated with climate change and environmental health issues. This framework could be strategically implemented within the EPA’s environmental justice obligations95 and utilized to address gaps in reproductive health and climate change research, particularly through the EPA’s multidisciplinary research program.96 Additionally, such an expert should be assigned to create partnerships and consult with front-line advocates in reproductive justice—including birth workers such as doulas and midwives as well as other health care professionals—who would help support the development of the EPA’s reproductive justice policy framework.
  • Help direct funding and resources to grassroots organizations working at the intersection of reproductive justice and environmental justice97 as well as community health clinics and birth workers, who play an important role in supporting pregnant people during extreme heat.98 This can include administering funding and grant programs—including the OEJECR’s recent $2 billion funding for environmental and climate justice community change grants as well as the almost $3 billion authorized by the Inflation Reduction Act (IRA) in environmental and climate justice block grants for the communities that are most vulnerable to these intersecting harms.99 Creating this level of support within the EPA can help equip organizations and advocates with the resources they need to directly reach vulnerable pregnant people in their communities and continue to drive community-based solutions to address the maternal health crisis exacerbated by climate change.

Additionally, Congress must appropriate funding for the Office of Climate Change and Health Equity (OCCHE), within HHS, to advance its goals toward mitigating the health threats of the climate crisis, including extreme heat.100 Beyond receiving funding, OCCHE must explicitly incorporate reproductive justice within its broader focus on environmental justice to help ensure a coordinated, all-of-government response to climate change that specifically prioritizes pregnancy and maternal health within climate adaptation and mitigation efforts.

See also

Leverage federal funding opportunities to build pregnant people an ecosystem of community resilience to extreme heat

Local policymakers must partner with climate-focused community organizations to create climate resilience centers

A meta-analysis of factors associated with heat wave-related deaths among American and European populations found that simply visiting an air-conditioned space during a heat wave can lower the risk of mortality.101 Accordingly, local policymakers can help increase access to cooled spaces for pregnant people in neighborhoods vulnerable to extreme heat. This involves building partnerships with community organizations advancing climate resilience in an effort to support the development of climate resilience centers—including by collaborating with community organizations to create strategies and plans for implementation, funding, and operations.

Climate resilience centers can be especially beneficial for pregnant people with limited to no access to cooling at home. In 2023, more than 84 million people experienced any level of energy insecurity, facing one or more of the following conditions in any month: unsafe temperatures in the home, inability to pay their energy bill, or the need to cut back on necessities, such as food, clothes, and medicine, to afford energy bills.102 This population includes low-income pregnant, postpartum, and breastfeeding women.103 For example, nearly 1.7 million women who received benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and had infants in the home were energy-insecure in 2023.104

To maximize effectiveness, local governments should collaborate with climate resilience centers to improve accessibility by implementing free transportation to and from centers for pregnant people and other populations at greater risk from extreme heat, as well as by establishing a hotline to call for transportation. For example, the District of Columbia created a free transportation service and hotline during heat emergencies to address obstacles residents had faced when accessing citywide cooling centers.105 Additionally, climate resilience centers should provide targeted multilingual resources in their social services for pregnant people.106 This could include a range of supports, such as information on pregnancy health risks during extreme heat; resources for maternal health care, including community-based doula care, midwifery care, and emergency obstetric care; housing and social programs; nutrition and sanitation initiatives; and emergency preparedness trainings that engage community response to extreme heat.

Several cities have already helped communities plan, fund, and build climate resilience centers.107 Miami is one example at the forefront: A multigovernment collaboration between Miami-Dade county and the cities of Miami and Miami Beach fostered a partnership with Atlantic Council’s Adrienne Arsht-Rockefeller Foundation Resilience Center (Arsht-Rock) to implement the Resilience Hub Network Strategy—a local government- and community-led initiative to pilot a network of resilience hubs and pods to create neighborhood resilience against environmental emergencies and disasters.108 In 2020, Arsht-Rock worked with residents, community leaders, and community-based organizations to launch the first of five “community resilience pods” in Miami-Dade County.109 The pod is a 40-foot shipping container that offers people a cooled, solar-powered place110 and is a “safe place to go in a time of crisis” to access preparedness programs as well as aid, including food, water, technologies, mental health support, and food security solutions, during extreme weather events and public health emergencies.111 Arsht-Rock expects its first pod will serve 5 million people by 2030.112

What are climate resilience centers?
  • Contrary to bare-bones cooling centers, climate resilience centers are “healing hubs” that provide social services and supports in addition to a safe and cool space. They target low-income people and people of color who are disproportionately affected by climate disasters.113
  • While climate resilience centers are typically supported by local governments and other partners, they are expected to be led and managed by communities—including residents and community members, community-based organizations, and faith-based organizations.114
  • Climate resilience centers are designed to support residents by coordinating emergency preparedness and response strategies for environmental disasters and the effects of climate change within local communities.115
  • The centers are often located within existing infrastructure such as libraries, churches, schools and universities, and community centers.116
  • All centers are energy-efficient and rely on solar power, battery storage, and electric heat pumps for cooling to reduce reliance on fossil fuels.117
State and local governments should implement strategies to eradicate urban heat islands.

Urban heat islands are significantly hotter than their suburban counterparts because of city infrastructure, such as concrete, that absorbs the sun’s heat.118 As a result, they have been linked to increased energy costs, heat-related illness, and even mortality.119

Reducing heat islands is particularly beneficial for maternal health outcomes: Research shows that decreasing heat islands through increased access to green spaces and green infrastructure can reduce the risk of severe maternal morbidity from extreme heat exposure.120 As states and localities continue to minimize urban heat islands, they should prioritize low-income and historically redlined neighborhoods facing the worst effects of extreme heat.121

Research shows that decreasing heat islands through increased access to green spaces and green infrastructure can reduce the risk of severe maternal morbidity from extreme heat exposure.

Strategies to reduce urban heat islands include increasing access to green spaces by planting trees and establishing vegetative covers, installing green and cool roofs, using reflective cool pavements, and implementing practices for development and conservation strategies to protect the natural environment.122 State and local governments can capitalize on the numerous funding opportunities made available through the Biden-Harris administration’s historic investments in the IRA—such as $1.5 billion for the Urban and Community Forestry Program—to reduce neighborhood temperatures and extreme heat conditions in urban heat islands across the country.123

Learn more about the IRA
How three cities have implemented strategies to decrease heat islands
  • New Orleans has expanded green spaces that will provide shade and cooling. In New Orleans, tree-planting community group Sustaining Our Urban Landscape (SOUL)124 is helping lead the city’s reforestation plan by identifying neighborhoods with a lack of green spaces and ensuring that every neighborhood has a minimum of 10 percent of tree canopy coverage.125 As a part of this initiative, the group has helped transform access to green spaces in Pontchartrain Park—a predominantly Black neighborhood in New Orleans—by planting a tree in front of every household that wants one.126 Now, a Pontchartrain Park community that once had practically no trees—contributing to the intense heat faced by residents—has trees in nearly every area.127
  • New York City is installing green and cool roofs to reduce roof temperatures and lower energy use and the cost of cooling. As part of the NYC CoolRoofs initiative,128 New York City has installed more than 10 million square feet of green and cool roofs since 2009, which has rapidly reduced annual greenhouse gas emissions in the city by 16,000 metric tons.129 NYC CoolRoofs indicates that cool rooftops can reduce indoor building temperatures by up to 30 percent,130 which can help minimize 10 to 30 percent of air conditioning costs.131
  • Los Angeles is utilizing cool paving materials on sidewalks, streets, and parking lots as part of infrastructure investments. Los Angeles has implemented cool pavements since 2015.132 Four years later, in 2019, the city launched its Cool Streets program—as a part of L.A.’s Green New Deal133 to improve community resilience and clean energy across the city—by administering 10 “cool streets projects” by 2025.134 After the reflective coating is applied to pavements, temperatures on individual streets can be cooled by 10 to 12 degrees Fahrenheit.135

Accelerate the transition to a clean energy economy

Policymakers at every level of government must enact and implement policies to bring the United States to net-zero greenhouse gas emissions by midcentury through building clean energy infrastructure, decarbonizing the economy, and significantly reducing carbon and local pollution from fossil fuels.136 Experts predict that heat waves will be reduced by half if the United States lowers greenhouse gas emissions by at least 33 percent by 2055.137 The Biden-Harris administration’s historic climate investments through the IRA and IIJA are already moving the United States toward a clean energy economy and will help create safer communities for pregnant people.

Conclusion

With heat waves rising in frequency and intensity due to climate change, policymakers must act urgently to protect the health and safety of pregnant women, who are among those most vulnerable to extreme heat.

Accordingly, state policymakers should expand Medicaid benefits to provide cooling technologies, which can help increase access to indoor home cooling for low-income pregnant people. And to expand access to energy assistance for low-income pregnant people, HHS should clarify that pregnant people are an at-risk population under LIHEAP and urge states to target outreach to pregnant household members. Additionally, Congress should pass the Protecting Moms and Babies Against Climate Change Act to prioritize reducing the threatening impacts of climate change on the health of pregnant people.

To address the urgency of extreme heat for pregnant workers, OSHA’s rulemaking process must be expedited to quickly establish a permanent federal occupational heat standard; and state policymakers should adopt and protect unionization rights that allow farmworkers to collectively bargain. Furthermore, the EPA should establish a reproductive justice expert in its Office of Environmental Justice and External Civil Rights to help institutionalize a reproductive justice framework within the federal government’s environmental justice agenda. Finally, on the state and local level, policymakers must increase community resilience by creating climate resilience centers and reducing urban heat islands for pregnant people living in the communities that are most vulnerable to extreme heat.

Addressing the maternal health consequences of extreme heat and reducing the effects of climate change is critical for ensuring the safety of all pregnant people.

* Author’s note: This report acknowledges that not all pregnant people identify as women and uses gender-inclusive language where possible, except where data only identify pregnant women due to limited maternal health data on gender-expansive and nonbinary people.

Acknowledgments

The author would like to thank Sabrina Talukder, Jill Rosenthal, Marquisha Johns, Andrea Ducas, Jamille Fields Allsbrook, Kate Kelly, Cathleen Kelly, Jasia Smith, Mariam Rashid, Rosa Barrientos-Ferrer, Karla Walter, and Emily Gee for their review of and contributions to this report, as well as Sophie Cohen, Mimla Wardak, and Kennedy Andara for their fact-checking.

Endnotes

  1. U.S. Environmental Protection Agency, “Climate Change Indicators: Heat Waves,” available at https://www.epa.gov/climate-indicators/climate-change-indicators-heat-waves (last accessed June 2024).
  2. National Oceanic and Atmospheric Administration, “U.S. sweltered through its 4th-hottest summer on record,” September 10, 2024, available at https://www.noaa.gov/news/us-sweltered-through-its-4th-hottest-summer-on-record.
  3. Yuval Baharav and others, “The Impact of Extreme Heat Exposure on Pregnant People and Neonates: A State of the Science Review,” Journal of Midwifery & Women’s Health 68 (3) (2023): 324–332, available at https://onlinelibrary.wiley.com/doi/10.1111/jmwh.13502.
  4. Anqi Jiao and others, “Analysis of Heat Exposure During Pregnancy and Severe Maternal Morbidity,” JAMA Network 6 (9) (2023), available at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809055.
  5. Jiyoon Kim, Ajin Lee, and Maya Rossin-Slater, “What to Expect When It Gets Hotter: The Impacts of Prenatal Exposure to Extreme Heat on Maternal and Infant Health” (Cambridge, MA: National Bureau of Economic Research, 2019), available at https://www.nber.org/system/files/working_papers/w26384/revisions/w26384.rev0.pdf.
  6. Jiao and others, “Analysis of Heat Exposure During Pregnancy and Severe Maternal Morbidity”; Latoya Hill, Samantha Artiga, and Usha Ranji, “Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them,” KFF, November 1, 2022, available at https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/.
  7. Christopher Flavelle, “Climate Change Tied to Pregnancy Risks, Affecting Black Mothers Most,” The New York Times, June 18, 2020, available at https://www.nytimes.com/2020/06/18/climate/climate-change-pregnancy-study.htm; Kim, Lee, and Rossin-Slater, “What to Expect When It Gets Hotter.”
  8. Shanmugam Rekha and others, “Heat stress and adverse pregnancy outcome: Prospective cohort study,” BJOG 131 (5) (2024): 612–622, available at https://pubmed.ncbi.nlm.nih.gov/37814395/.
  9. Rebecca Lindsey and Luann Dahlman, “Climate Change: Global Temperature,” Climate.gov, January 18, 2024, available at https://www.climate.gov/news-features/understanding-climate/climate-change-global-temperature.
  10. Martha Henriques, “Climate change: The 1.5C threshold explained,” BBC News, February 8, 2024, available at https://www.bbc.com/future/article/20231130-climate-crisis-the-15c-global-warming-threshold-explained.
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  35. Hill, Artiga, and Ranji, “Racial Disparities in Maternal and Infant Health.”
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  74. Protecting Moms and Babies Against Climate Change Act, S. 1601, 118th Cong., 1st sess. (May 15, 2023), available at https://www.congress.gov/bill/118th-congress/senate-bill/1601/all-info; Protecting Moms and Babies Against Climate Change Act, H.R. 3302, 118th Cong., 1st sess. (May 15, 2023), available at https://www.congress.gov/bill/118th-congress/house-bill/3302/text.
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  105. Dan McCue, “DC Extends Heat Emergency With Little Relief Expected Before Friday,” July 9, 2024, The Well News, available at https://www.thewellnews.com/weather/dc-extends-heat-emergency-with-little-relief-expected-before-friday/.
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  132. Katharine Gammon, “Los Angeles is becoming too hot to bear. Can it design its way cooler?”, The Guardian, January 3, 2023, available at https://www.theguardian.com/us-news/2023/jan/03/los-angeles-is-becoming-too-hot-to-bear-can-it-design-its-way-cooler.
  133. Ibid.
  134. City News Service, “LA’s ‘Cool Streets’ program to add 60 miles of cool pavement, 2,000 trees,” Los Angeles Daily News, October 4, 2021, available at https://www.dailynews.com/2021/10/04/las-cool-streets-program-to-add-60-miles-of-cool-pavement-2000-trees/.
  135. Ibid.
  136. Trevor Higgins, Rachel Chang, and Devon Lespier, “The Biden Administration Has Taken More Climate Action Than Any Other in History,” Center for American Progress, March 6, 2024, available at https://www.americanprogress.org/article/the-biden-administration-has-taken-more-climate-action-than-any-other-in-history/.
  137. Jill Rosenthal, Rosa Barrientos-Ferrer, and Kate Petosa, “Extreme Heat Is More Dangerous for Workers Every Year” (Washington: Center for American Progress, 2024), available at https://www.americanprogress.org/article/extreme-heat-is-more-dangerous-for-workers-every-year/.

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Author

Amina Khalique

Research Associate

Team

Women’s Initiative

The Women’s Initiative develops robust, progressive policies and solutions to ensure all women can participate in the economy and live healthy, productive lives.

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Vehicles are viewed above a ‘highway mirage’ caused by a thin layer of hot air above the roadway.

The rise in extreme heat events across the United States, spurred by climate change, kills more people than any other type of severe weather or climate disaster and leads to substantial heat-related injuries and illnesses. These health consequences also result in higher health care costs and lower economic productivity.

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