Midwives in Climate-Vulnerable Countries Prepare for a Future of Disaster Response

As horrific flooding struck Uganda’s Ntoroko District in 2024 – leaving schools, homes, crops, and communities underwater just a few years after the last round of severe flooding – Penenah Kiconco wondered who was going to care for pregnant women.

“Thousands of families were displaced because of the floods,” the Ugandan midwife recalled. Experience told her there wouldn’t be nearly enough providers to monitor pregnant women, attend deliveries, monitor mothers and babies postpartum, or ensure displaced women had access to family planning services. “These climate crises make women so vulnerable.”

Kiconco traveled to the district with a group of fellow midwives, where they found empty health facilities damaged by landslides—local health workers had fled to safety. They offered prenatal and postnatal health services, and distributed maternal health kits to pregnant women who were nowhere near the nearest health facility, so they’d have the medical supplies they needed for a delivery nearby.

She particularly remembered caring for pregnant women sheltering in primary schools without even a mattress, surrounded by their other children. “Even privacy was a problem,” she said. “We improvised with what little we had.”

Neha Mankani is a Pakistan-based midwife, and humanitarian engagement and climate advisor at the International Confederation of Midwives. She explained that, when pregnant women and new mothers are displaced by disaster, their ability to access care often depends on whether there is a practicing local midwife.

“The midwife is part of the community. She knows what the needs are,” she said.

When widespread flooding killed more than 1,700 people in southern Pakistan in 2022, and left millions homeless, Mankani was working in Karachi, Pakistan’s capital city. She and a colleague traveled to one of the affected provinces, planning to distribute kits with sterile birthing equipment and help provide continuity of care.

“The need was much greater,” she recalled. Pregnant women and babies in displacement camps were ill or malnourished, or needed routine antenatal and well-baby care. Traveling around to 23 displacement sites in just three months, “we were on the ground providing these services.”

Now, the goal for both Kiconco and Mankani – and for midwives worldwide who work in communities threatened by climate change – is to make midwifery widely available during disasters, and ensure that midwives are specially trained to care for patients in crisis settings.

“A safe, easy birth becomes something else”

The International Confederation of Midwives – a global organization that works with midwives and midwifery groups to build greater access to reproductive, maternal, and child health services – has chosen “Midwives: Critical in Every Crisis” as its theme for 2025’s International Day of the Midwife on May 5.

“Midwives are trusted first responders, who if enabled can strengthen health systems to be well-prepared to face any crisis. They can provide up to 90% of sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) services, even in the most complex humanitarian settings,” ICM’s website explains.

Mankani said midwives are already used to providing community care in low-resourced settings, such as rural villages, and that many already care for patient populations struggling with the growing impacts of climate change: long droughts, catastrophic flooding, crop die-off, habitat loss, unsanitary conditions that cause diarrheal disease, cholera, and scabies, and extreme heat that can be especially dangerous for pregnant women and vulnerable newborns, just to name a few.

But in a world where disasters like tropical storms, large-scale floods, and wildfires are growing ever more frequent and extreme, more needs to be done, she explained. Midwifery needs to be integrated into disaster preparedness and response measures. Midwives need training to respond to crisis situations, and payment that will allow them to stay with their communities and oversee vulnerable patients during a disaster.

Often, “a safe, easy birth becomes something else because there’s no skilled provider” during disasters, she said. The stress a pregnant woman experiences, and the unsanitary conditions that often come with displacement and extreme weather, also pose serious risks.

For Mankani, a woman she saw during the 2022 flooding vividly illustrates the need for a broader approach to maternal and child care.

At a camp for people displaced by the flooding, Mankani was providing walk-in care in a tent. A woman who was pregnant with twins came in for an examination, and Mankani immediately noted that both babies had “very elevated” heartbeats. The woman herself had a fever, and Mankani suspected malaria.

She immediately offered to send her patient to a hospital, explaining that “the babies are not safe right now.” But the pregnant woman had three other children, and knew no one else in the camp with whom she could safely leave them.

“She refused care after that, so we don’t know what happened to her,” Mankani recalled. “This is how people are having to go through this.”

“She’s the one who feels that pain”

In addition, Mankani said, midwives need to better understand the impacts of climate change, so they can educate their communities about what’s coming and how best to prepare. A farming community may need to grow new crops to address malnutrition, develop new, more resilient water systems, or know the most effective ways to cool down, especially in cultures where women cover their heads and bodies.

Kiconco explained that in Uganda, where subsistence farming is a necessary activity for most families, educating people about climate change is essential. Long droughts have damaged crops and farmlands; floods can sweep whole harvests away.

“For the past three days we’ve had floods in the city,” she observed. “It’s destroyed even my garden.”

Teaching families what to expect in coming years, and how to grow and store more resilient crops like beans and millet, will be essential. Kiconco explained that midwives have an essential role to play. “We are in touch with most of the community members,” she said.

Moreover, she said, Ugandan women are often eager to learn how best to ensure their families are fed. If a woman’s children go hungry, “she’s the one who feels that pain as a mother,” Kiconco explained. “That’s their culture.”

“They knew exactly”

Many climate-vulnerable countries train midwives to work in small community clinics, Mankani said, but may not provide sufficient training for disaster response or care outside clinic walls.

“They don’t have birthing kits, they don’t know disasters are in their scope of work, they don’t have resources,” she explained. Her plan is to change that: “They also need to have that flexibility to pivot.”

For Kiconco, responding to disasters without sufficient supplies is a source of distress. “We don’t have what we need to use to help them,” she said of her patients. “That affects us mentally. You have the knowledge, you have the skills, but you don’t have the resources to fight for this mom.”

Mankani conducts trainings with midwives in disaster-vulnerable countries, teaching them how to create a portable cache of disaster supplies and helping them develop responses to different scenarios. Frequent impacts of climate disasters, such as sexual violence and obstetric emergencies, are discussed as well.

Some things have to be adapted from place to place, she said, but many elements of the training are universal.

At a training for midwives in Kenya, Mankani showed photos of the flooding in Pakistan, and of people displaced and severely affected by the disaster, asking them, “What do you think will happen to women in these communities?”

“They knew exactly,” she recalled. “These kinds of things are happening all over the world in different shapes and forms.”

“We just want to see…”

However, Mankani emphasizes that individual or small-scale actions aren’t, and shouldn’t be, enough.

“Midwives should not be doing their response in isolation,” she said. Even the most dedicated provider cannot work without recompense, in dangerous conditions, with inadequate supplies. Systemic training, equipment and supplies, mental health support, large-scale planning and response measures, and greater awareness are all needed.

“Midwives are resilient and they’re working in all kinds of situations,” Mankani explained. “But they still need to have the resources.”

Kiconco said she sees tremendous dedication in the midwives she encounters. They’re willing to respond to disasters; they just want to do it well.

“We just want to see a healthy mother, a healthy baby, a healthy community,” she said.

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Direct Relief supports midwives’ associations around the world with grants and material medical support for both community and in-the-field care.

The organization also provides emergency grants to midwifery organizations working in emergency settings, including the National Organisation of Nurses & Midwives of Malawi, Hope Foundation for Women & Children of Bangladesh, and the International Confederation of Midwives.

In the past year, the organization provided 900 full midwife kits and 500 resupply kits – enough to support 70,000 safe births – to 17 countries, including Yemen, Haiti, Uganda, Kenya, and Paraguay, all of them vulnerable to climate impacts.