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Investigating the linkages between pregnancy outcomes and climate in sub-Saharan Africa

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Abstract

Poor pregnancy outcomes include miscarriages, stillbirths, and low birth weights. Stress from heat and lack of resources play a potentially important role in producing these poor outcomes. Women and couples who experience these poor outcomes rather than a healthy birth suffer psychological, physical, social, and financial costs as well. We use detailed reproductive data in combination with fine-scale climate data to examine pregnancy outcomes among women in sub-Saharan Africa, a region that shelters some of the poorest families in the world. Fine-scale precipitation and temperature data allow each pregnancy to be matched to the relevant climate exposures. We investigate the linkages between climate and pregnancy outcomes using linear probability models with fixed effects to minimize confounding due to factors that vary by location, season, and year. We analyze retrospective pregnancy data from more than 65,000 pregnancies recorded in 23 surveys across 15 African countries. Our results indicate that pregnancy outcomes are indeed impacted by exposure to hot days even after considering other individual-level characteristics. This research provides insight into the linkages between climate and a major adverse health outcome faced by women. In doing so, this research expands scientific understanding of the impact of environmental factors on fertility outcomes.

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Notes

  1. Stillbirth is defined by the World Health Organization as a “baby born with no signs of life at or after 28 weeks gestation” (Lawn et al. 2016).

  2. Multinomial logistic regression models (MLM) were also used as these more closely matched the process of interest. The results from these models are not presented in this paper but are available from the authors. The results from the MLM and the LPM are consistent in terms of significance and direction of the relationship for the simpler models. One advantage that LPM had over MLM is that it could accommodate the large amount of fixed effects which we include in our most conservative model.

  3. As an additional sensitivity analysis, we estimated models using DHS cluster by calendar month fixed effects. We found similar results as in model 3, but they were not statistically significant due to a loss of statistical power; the number of observations dropped by more than 55% when we included cluster by calendar month fixed effects as opposed to country-specific livelihood zone by calendar month fixed effects.

  4. We find similar results, when we estimated a survival model, available from the authors. The largest impacts occurred during the first 4 months and the effects were larger the greater the proportion of hot days that occurred during the pregnancy.

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Acknowledgements

Dorélien and Grace gratefully acknowledge funding support from the Minnesota. Population Center which is funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Population Research Infrastructure Program (P2C HD041023). Grace also acknowledges support from the National Science Foundation Grant #1639214. Grace and Davenport were also generously supported through the United States Agency for International Development (USAID) cooperative agreement #72DFFP19CA00001. The author team is also thankful for the assistance of Rachel Magennis.

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Authors and Affiliations

  1. Department of Geography and Climate Hazards Center, University of California, Santa Barbara, Santa Barbara, CA, USA

    Frank Davenport

  2. Humphrey School of Public Affairs and Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA

    Audrey Dorélien

  3. Department of Geography, Environment and Society and Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA

    Kathryn Grace

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  1. Frank Davenport
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  2. Audrey Dorélien
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  3. Kathryn Grace
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Correspondence to Kathryn Grace.

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Audrey Dorelien, Frank Davenport, and Kathryn Grace authorship are shared equally.

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Appendix

Appendix

Table 6 Comparing birth outcomes based on pre-pregnancy and first trimester rainfall and temperature conditions (all pregnancies lasting more than 2 months)
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Table 7 Comparing birth outcomes based on pre-pregnancy and first trimester rainfall and temperature conditions (all pregnancies lasting more than 5 months)
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Table 8 Comparing birth outcomes based on pre-pregnancy and first trimester rainfall and temperature conditions (all pregnancies lasting more than 7 months)
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Davenport, F., Dorélien, A. & Grace, K. Investigating the linkages between pregnancy outcomes and climate in sub-Saharan Africa. Popul Environ 41, 397–421 (2020). https://doi.org/10.1007/s11111-020-00342-w

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