Wildfires’ unequal impacts on pregnant people

An interview with one researcher studying the effect of wildfire on pregnancy outcomes in the West.

In 2018, Amy Padula, a professor at the University of California, San Francisco, was pregnant in the midst of historic mega-fires tearing through California. An epidemiologist with a background in medical anthropology, she already knew that air pollution is bad for pregnant people and fetal development, but she wanted to know just how much worse wildfire was making things.

From heat events to air pollution and exposure to infectious diseases, climate change affects everyone’s health. But the risks are worse for pregnant people, which means that climate justice is also a reproductive justice issue. National activist organization SisterSong Women of Color Reproductive Justice Collective defines reproductive justice as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” 


But maternal health in the U.S. has been called a “public health crisis.” The country has the highest rate of maternal mortality among industrialized nations as well as one of the highest rates of infant mortality. Climate change only magnifies this crisis. Climate-change induced air pollution and heat exposure heighten the risk of things like preterm births, adverse birth outcomes and even birth defects. And all of these problems disproportionately affect communities of color. Black and Indigenous women are 2-3 times more likely to die in childbirth than white women and have higher rates of preterm birth, a leading cause of infant mortality. This carries over to climate impacts on reproductive health. Researchers in California found that for every 10 degrees Fahrenheit increase in weekly average temperature, the risk of premature birth goes up by almost 9% for everyone, but almost 15% for Black pregnant people.

Policies to address the climate impacts on reproductive health are lagging in the U.S. According to a review of 105 official documents on what to do during periods of prolonged and extreme heat conducted by Human Rights Watch in 2020, information on how to protect pets was around 10 times more likely to be included than information on how to protect pregnant people.

Aquilla Flemings holds her daughter Storie after giving birth, assisted by midwife Chemin Perez and her husband Will at New Life Midwifery Birth Center in Arcadia, California. Researchers in California found that for every ten degrees Fahrenheit increase in weekly average temperature, the risk of premature birth goes up by almost 9% for everyone, but almost 15% for Black pregnant people.

Some change may be on the horizon. The Black Maternal Health Momnibus Act, a bill included in President Biden’s proposed Build Back Better plan, would set aside $85 million for community-based initiatives to reduce climate change-related risks for moms and babies, such as improving monitoring and data sharing, and funding a research group on climate change and maternal and infant health. 

Since that summer of 2018, Padula has continued studying the various ways wildfire affects pregnant people and birth outcomes. High Country News recently caught up with her to connect the dots between climate change and reproductive health.

This conversation has been edited for length and clarity

High Country News: What do we know so far about the connection between wildfire and pregnant people, and why study it?

Amy Padula: Air pollution in general has been associated very consistently across the (scientific) literature with adverse birth outcomes. So, when these fires started occurring more regularly and more intensely, and affecting so many more people, this became a huge question: What are the impacts of these really extreme and really prolonged and, in some cases, high exposures to this wildfire smoke (on pregnant people)?

There’ve been a few studies on wildfire and preterm birth and a few on things like fetal growth. But what about other kinds of vulnerable groups within that group? Things we’re interested in studying are income inequality, and the degree to which different racial or ethnic groups may be more exposed to wildfire smoke, whether it's due to occupation or due to housing characteristics or other factors. 

Some of the big questions that we’re interested in are: What are the critical periods? How much worse is wildfire smoke from “usual” air pollution? 

Amy Padula, a professor at the University of California, San Francisco, studies the various ways wildfire affects pregnant people and birth outcomes.
Courtesy photo

HCN: How can combating climate change help lead to better reproductive health?

AP: Everything is so connected. It all comes back to our reliance on fossil fuels. If we were able to reduce that, we could solve so many problems. We could reduce greenhouse gases; that would slow climate change. We would also reduce traffic-related air pollution, which is, aside from these wildfire episodes, the largest source of air pollution in California. Of course, climate change is also leading to more wildfires.

But there are even more nuanced things that we’re working on. For example, removing perfluorinated compounds from products or reducing plastics and these harmful chemicals. All this is related to the same kind of industries that are really destroying our health. The degree to which we can reduce this kind of consumption and these kinds of nonrenewable products and energy, and all these things, the greater our health will be.

HCN: Black, Indigenous and people of color suffer much more from the effects of climate change and reproductive health disparities. How do you see climate justice and reproductive justice intersecting?  

The link that I see between climate and reproductive justice is racism.

AP: The link that I see between climate and reproductive justice is racism. I’m often focused on it from an environmental justice perspective, but I think it’s at the core of both issues when it comes to health disparities. Our work looks at documented racist practices such as redlining, but we are also looking at measures of structural racism, including combined income inequality and racial segregation in relation to both wildfire exposure and its effects on preterm birth.

This also applies on a global scale, with those with the smallest carbon footprint often the most vulnerable to climate change. This idea that we really need to focus on and protect these communities that have been overburdened by pollution and general inequities, and also underserved by the government, is really the crux of where I see the biggest need for policy change — this need to reduce socioeconomic inequality and all of the things that often come with that. To improve health, we need to reduce these. 

HCN: Where are some of the ways we can reduce the impacts of climate change on pregnant people and reproductive health?

AP: We’re constantly trying to sort of peel the onion to find the really actionable changes that we can make in communities. For example, one of my postdoctoral researchers, Rachel Sklar, is looking at housing characteristics as a potential factor (affecting) infiltration of wildfire smoke. She’s looking at that in relation to race and ethnicity to see if there are enclaves that have certain housing characteristics that would lead to more infiltration and more harm because of the wildfire smoke.

HCN: You’ve mentioned housing a lot as a place where reproductive health and climate change intersect. Can you explain that?

AP: Housing is both where you live and what you live in. Where people live is very strongly related to their environmental exposures. Everything from air pollution to drinking water, pesticide exposures to how close you are to hazardous waste really depend on where you live. And then the degree to which your housing protects you from your surroundings is also important. It's kind of like your shell.

Where you are, what you’re contained in, can affect your health, and that’s not even to mention other kinds of social factors. How much violence is there? How much green space? Do people have a safe place to walk and exercise? When people are pregnant and have children, these things become even more important.

An aerial view shows neighborhoods enshrouded in smoke as the Bobcat Fire advances toward foothill cities on September 13, 2020 in Monrovia, California.
David McNew/Getty Images

There are certain, maybe more obvious (injustices) like redlining that have historically impacted where people live. But even housing characteristics such as how old the houses are, how big they are, how well their windows are sealed (are important). Having lived in the Bay Area and rented some really old homes that were not built to seal the air from the outside — this can lead to really disparate levels of infiltration of smoke into the house. So even if you say “oh, pregnant women, stay home, stay indoors,” your air pollution may be just as bad as if you were sitting outside and breathing the smoke.  

The other thing I think about often, too, is occupation. During the wildfires, some people are going to be like, “OK, I’m going to work at home,” or “I’m going to skip off to Hawaii.” But not everybody has that ability. People have jobs where they're outside; jobs that if they don't work, they don’t get paid. There are a lot of injustices also when it comes to occupation and (being able to take) sick days and things like that.

Where you are, what you’re contained in, can affect your health, and that’s not even to mention other kinds of social factors. 

HCN: Are there things pregnant people can do to reduce their risks? 

AP: Being around wildfire smoke and wildfires is a really stressful situation. And when you’re pregnant, it’s even more stressful because, of course, you have this big responsibility. To the extent that we can, it’s important to reduce exposure to smoke, whether that’s staying indoors or wearing masks when we go outside. Keep the windows closed. Get an air purifier or make one. These things are unfortunately becoming a little more part of our regular lives. 

HCN: What about bigger policy changes that address both climate and reproductive justice?

AP: In terms of policy, I’ve been mostly focused on air and water. The Clean Air Act for its first 40 or so years did a great job reducing the levels of air pollution in this country. And that’s to be commended. It really could use a remodel now, though, because what we’re finding is that, at least in California, we’re really not meeting the standards now with these wildfires. We are reducing the amount of gasoline used by cars, but we have more cars and more people. So, you know, things aren’t quite decreasing. There need to be drastic changes in terms of energy and transportation, and then with wildfires, of course, forest management. 

I really do see this intersection as being at a real crux of determining the future of our next generation and the generations that follow. Because pregnancy is such a critical time for the fetus and their development, I think that we really want to be a little bit more forward thinking. This focus on children and development in our future is also really tightly linked to climate change in the sense that it’s not so much about the here and now, but it’s about what are we doing to protect our future? 

Sarah Sax is the climate justice fellow at High Country News currently living in rural Washington. Email her at [email protected] or submit a letter to the editor.

Reporting for this story was supported by the Society of Environmental Journalists.