The climate crisis is coming for ‘the CEO of the family’s health’

The increasing incidence of climate change-induced heat spikes, wildfires and life-threatening flash floods is engulfing pregnant and postpartum individuals in a wave of eco-anxiety and depression.

“The mom is kind of guiding the ship,” Jennifer Barkin, an expert on maternal mental health, told The Hill. “You’re already worried about — are your kids eating enough vegetables? Are kids getting school on time? How are their grades? And now you’ve got this additional worry.”

Barkin, a professor of community medicine and obstetrics and gynecology at the Mercer University School of Medicine in Georgia, characterized the influence of climate change on maternal mental health as “a global issue,” while noting that “it hits the disadvantaged in a more dramatic way — and quicker.”

The issue appears to be going largely unnoticed, however.

Although the concept of climate despair has attracted some media attention, there has been little coverage of the unique mental health impacts that occur during the perinatal period, Barkin and colleagues found in a December 2022 study. The perinatal period spans from pregnancy to a year following childbirth.

That stage in a mother’s life “is a time of increased vulnerability to negative mood symptoms due to various changes within the mother and her environment,” the authors noted in the study, published in the Journal of the American Psychiatric Nurses Association.

Extreme weather events, which often result in disruptions of support networks as well as health care, jobs and education, can all become “possible downstream effects that exact a significant toll on mental health,” the authors noted.

In a July 2022 editorial for Frontiers in Psychiatry, Barkin argued that more pregnant and postpartum women will be shouldering such outcomes, noting that “there is a looming threat (risk factor) on the horizon and its name is the climate crisis.”

The physiological effects of heat risk, which are intertwined with its mental health impacts, are amplified in pregnancy — when symptoms like dehydration can take a particular toll on all organ systems, Barkin told The Hill.

A November 2023 advocacy brief from the World Health Organization stressed that “climate hazards, including extreme heat, are associated with increased risks of developing complications that lead to adverse maternal and perinatal outcomes.”

Such effects, the brief said, could “affect mental health and contribute to intergenerational trauma,” while causing an increase of “stress, anxiety and depression — known risk factors for adverse perinatal outcomes.”

When families either choose or are forced to migrate due to climate change, the mental health effects on pregnant individuals are especially severe, as they have a fetus to consider, Barkin stressed.

“If you’re pregnant, and you’re in an evacuation center, two other kids and no obstetric care what if you have an emergency?” Barkin asked. “Or if you have your prenatal care, and you’ve got your child’s pediatrician lined up, and you need to move suddenly? I mean, it’s a major stressor, and it’s a disruption in care.”

“Depression and anxiety are related to the severity of the exposure,” she continued. “Were you wading through floodwaters, were you directly breathing in the wildfire smoke? All of that is linked to the severity of the mental health consequences.”

In an evacuation center, Barkin continued, there’s also the question of cleanliness, infectious diseases or the inability to find dry clothing.

A January 2023 literature review likewise found that “climate change-related environmental exposures, including extreme temperatures, air pollution and natural disasters, are significantly associated with adverse perinatal and maternal health outcomes across the United States.”

These effects included mental health issues, such as the development of maternal depression following a natural disaster event like Hurricane Katrina, per the review, published in the International Journal of Environmental Research and Public Health.

Laura Geer, the senior author of that review, explained that “a post-climate related event can go in two different directions.”

In the first, she explained, a mother can be thrown into a position of social isolation in which she finds herself managing a family without appropriate access to care, while also facing a potential “intimate partner violence increase during this stressful period.”

“Or you’re highly resilient, you’ve got a lot of social support, you can kind of manage and weather, and it actually kind of makes you stronger,” added Geer, chair of the department of environmental and occupational health sciences at SUNY Downstate Health Sciences University.

But in so many cases, severe climate disruptions can influence food and housing security, while sometimes leading to unhealthy coping mechanisms like illicit drug use, according to Geer.

“Somebody’s ability to be resilient is so directly tied to their mental health,” she said.

Even for those families not likely to face imminent displacement or natural disaster, the mental gymnastics connected to keeping kids protected from escalating heat can be exhausting.

“I can think from a mother’s perspective: Do I want to send my kids to a summer camp?” Barkin asked, noting that it’s difficult to gauge whether individual camp counselors are “aware how to handle heat risk.”

Detailing her own internal debate as a mother, Barkin said that she discouraged her son from playing football — which requires wearing heavy equipment — in the Georgia weather, while adding that her daughter once fell ill from the heat at tennis camp.

Mothers, she added, also often grapple with the fact that their kids are “going to inherit something they didn’t create.”

More and more women, she has found, are raising questions like, “Do I want to bring kids up necessarily? Is it even ethical to get pregnant?”

Geer echoed these sentiments, thinking back to the 2016 Rio de Janeiro Summer Olympics and the coinciding surge in the Zika virus — a mosquito-borne pathogen known to cause birth defects. The virus’s spread in the region prompted many athletes of childbearing age to reconsider their attendance, she explained.

“I definitely think it led to anxiety around decisions about family planning, even in our country,” Geer said, noting the increased concern that this vector of Zika could move up to the Southeast U.S. as well.

Another quandary Barkin has found mothers facing is that while green spaces are supposed to be good for mental health, there is now increased uncertainty as to whether certain green spaces have become “inhospitable or inhabitable.”

Barkin cited several repeat complaints on the subject: “We’re trapped inside. I’ve got these kids running around going crazy. I want to get them outside, but I can’t breathe, or it’s so hot, or I’m worried about breastfeeding the baby.”

In addition to those of childbearing age, much older women may be suffering similar mental health impacts from climate change. 

Earlier this month, the European Court of Human Rights sided with a group of more than 2,000 older women, who had filed a complaint against the Swiss government demanding health protections from the effects of climate change.

Members of the Swiss association, Verein KlimaSeniorinnen, or Climate Seniors, argued that they are uniquely vulnerable to the effects of surging heat waves — citing significant, climate-related health impacts on their daily routines. Among the effects they named were various heat-related physical symptoms, as well as social consequences— due to their inability to leave their homes.

While these women may be from a different generation, the mental tumult they have been enduring bares similarities to the struggle that many young mothers experience during the perinatal period.

Asked what clinicians can do to ensure that maternal eco-anxiety doesn’t fly under the radar, Barkin said “the good news is a lot of the infrastructure for screening for depression is already in place.”

Within that infrastructure is her own Barkin Index of Maternal Functioning, a patient-centered measure of postpartum functional status.

In the July 2022 editorial, Barkin advised organizations that assist new mothers to “strongly consider incorporation of climate change effects into their programming,” adding that health care providers should include environmental factors into mental and physical health assessments.

She acknowledged that most OB-GYNs and pediatricians working with perinatal women do conduct depression screenings — which Barkin said is “going to work to everyone’s advantage.” 

“But the bottleneck is, do they have somewhere to send them? And can they afford it?” she asked. “If you just had your home wiped out or you’re injured, or your whole family’s on the run, can you afford to stop and address your mental health?”

Stressing that natural disasters are considered traumatic events, Barkin noted that such occurrences are poised to happen more frequently in the future.

“That’s going to impact mothers,” she said, noting that they are often primary caregivers, regardless of whether they also work full time outside the home. “They’re often kind of like the CEO of the family’s health.”