The burden of temperature-related stillbirths and neonatal deaths attributable to climate change – a global analysis across 29 Low- and Middle-income countries

Climate change is increasingly affecting the health of vulnerable populations, including pregnant women, the developing foetus and newborns. Despite growing epidemiological evidence on the effects of ambient temperatures on adverse birth outcomes and child survival, the role of climate change in the burden of temperature-related adverse birth outcomes has been insufficiently investigated. We combine data from the Demographic Health Survey (DHS) for 29 low- and middle-income countries with factual temperature data from the ISIMIP3a simulation round to quantify the non-linear association between daily mean temperature and stillbirths and neonatal deaths. We estimate the associations using a time-stratified case-crossover design. Based on the derived exposure-response functions and counterfactual temperature data we estimate the burden of stillbirths and neonatal deaths between 2001-2019 that can be attributed to climate change. The results both for stillbirths and neonatal deaths indicate a U-shaped curve, with risk of mortality increasing below and above an optimum temperature. We find that climate change has increased the burden of heat-related stillbirths across 28 of the countries (from 0.6% in Albania and Tajikistan to 4.1% in Philippines) and the burden of heat-related neonatal deaths – across 20 of the countries (from 0.2% in India to 1% in Philippines and Haiti). For 21 of the included countries climate change has also led to a reduction in the burden of cold-related stillbirths (from 0.2% in Tajikistan to 4.4% in Uganda) and neonatal deaths (from 0.5% in Tajikistan to 3.5% in the Philippines).