Experts stake out climate adaptation to ensure sexual and reproductive health for all: 'Moving forward requires … innovative approaches to engage men and boys'

Sexual and reproductive health care access should be considered a priority of climate adaptation. That's according to a new paper published in The Lancet Obstetrics, Gynecology, & Women's Health. The article was co-authored by global health experts in India and the president of the Royal College of Obstetricians and Gynecologists in the United Kingdom — and they don't want to leave anyone behind.

As the co-authors suggest, projects at the intersection of climate and sexual and reproductive health — or SRH — are often ignored outside of academic research agendas and nongovernmental organizations. In fact, even inside these spaces, they can go underfunded and unaddressed. And that's despite a growing body of knowledge underscoring the threats that our warming world can pose to everything from menstrual health to fertility, birth outcomes, and bodily autonomy.

But even projects that do take on climate-responsive SRH still risk leaving people out of critical conversations. 

"Strengthening climate resilience of SRH for men and boys matters because climate shocks disrupt livelihoods, mobility, privacy, relationships, and health systems, affecting SRH outcomes across genders," lead author and global health consultant Medha Gandhi told Climate, Gendered, going on to identify issues "such as air pollution reducing sperm quality and heat waves impairing testicular function" as well as related mental health challenges.

The Lancet paper "Reframing sexual and reproductive health in the context of climate adaptation" goes far beyond the need to include men and boys in these efforts, but this bullet point is a notable feature of the publication in a world where "gender" is too often narrowly understood to mean only "girls and women" if not also transgender and non-binary people. As Gandhi told CG, the erasure of men and boys from such considerations can have numerous consequences — for everyone.

"Historically, SRH has been viewed as maternal health tied to childbearing and family planning. This placed the burden on girls and women, reinforcing the view that SRH decision-making and fertility planning are 'women's responsibilities,'" she said. "This framing has carried over into climate adaptation planning, where men's reproductive health needs and their role beyond being partners in women's reproductive journeys remain largely invisible."

Exploding this well-trod paradigm has the potential not only to open the aperture for girls, women, and gender-diverse people — whose sexual and reproductive health needs often exceed the realms, for example, of contraceptive and perinatal care. It also has the potential to proactively address sexually transmitted infections and gender-based violence, both of which can be exacerbated by extreme weather events as well as the population displacements and service disruptions they can cause.

"Moving forward requires intentional redesign with innovative approaches to engage men and boys as a core component of climate-adaptive SRH systems," Gandhi said, "recognizing that men's health outcomes directly affect their partners' well-being and that comprehensive climate resilience requires addressing the needs of entire communities."

Gandhi and her co-authors assert that local communities must be kept at the heart of climate adaptation efforts in support of sexual and reproductive health. 

The consultant, who previously worked at Ipas and the Gates Foundation before launching Counterpoint Impact Advisory, told CG the hyper-local evidence-generation efforts she would like to see include community-level surveys on how extreme weather events may compromise contraceptive and STI care, qualitative studies "examining whether climate-driven migration increases sexual health vulnerabilities and STI exposure," research into how intimate partner violence may be exacerbated by extreme weather, and "longitudinal tracking of seasonal flooding in coastal areas and its impact on adolescent girls' menstrual hygiene management and early marriage rates."

Gandhi sees the potential for localized data and locally-led efforts to drive effective adaptation strategies, such as routing mobile clinics where they're most needed and getting supplies, such as contraceptives and period products, to flood-prone locations in advance of major storms.

"Without this granular understanding of local pathways," Gandhi said, "we risk implementing generic interventions that fail to address actual mechanisms of climate impact in specific settings."