Kilwa District is Real Evidence of Climate Change Impacts on Maternal, and Child Health

 

By, John Kabambala - Partner of UN News Kiswahili 

"It began as ordinary rain in March 2024. The people of Kilwa were accustomed to seasonal rains, which brought blessings to their farms and life to their livestock. But the rain did not stop. It continued falling day after day, week after week, until it became an unstoppable threat. Rivers overflowed their banks, houses began to fill with water, and residents woke up one morning to find themselves surrounded by water that had swallowed everything. When Cyclone Hidaya arrived in May 2024, it brought not only wind but destruction that erased generations of history. In the ten most affected villages, pregnant women began experiencing labor pains while trapped at home, crying out for help, but roads were cut off and bridges had been swept away by water. One mother sent her young daughter to fetch water from the well, but the girl did not return. When they searched for her, they found her lying under a tree, her clothes torn, her eyes dried of tears, oh! she had been raped. And other women, after losing all their crops and lacking food to feed their families, walked to health facilities and requested family planning implants. They said they did not want to bring more children into a world that drowns them in floods every year. These are painful testimonies, not fabricated stories or imagination, but the clear reality for the community of Kilwa and how this situation of climate change is transforming the image of society and the face of the world."

Study Concept: Examining the Relationship Between Climate and Maternal and Child Health

Welcome to understand what has been revealed in this document, which is testimony recorded through a scientific study conducted by the Climate Action Network Tanzania (CAN Tanzania) in collaboration with experts from Muhimbili University of Health and Allied Sciences (MUHAS), published in the international journal “BMCPublic Health” in September 2025. The aim of this study was too deeplyexamining the perspectives of women themselves and healthcare providersregarding how climate change affects reproductive health, manternal health, and child health in the real environments of villages that frequently experincefloods and groughts. This study sought to fill the knowledge gap existing in Tanzania, where many studies had focused on climate-sensitive diseases such as malaria, but had not examined the direct effects on pregnant women and young children.

Research Methodology: Listening to the Voices of Those Living with Disasters

This study, titled "Community and health workers' perspective on impacts of climate change on reproductive, maternal, and child health outcomes in Kilwa district council, Tanzania: a qualitative study," was conducted in October 2024, just months after Cyclone Hidaya and the major floods that occurred between March and May of the same year. The choice of this timing was intentional because the researchers wanted to capture the direct experiences of the community while memories of the disaster were still fresh and the health and economic impacts were still unfolding. The researchers used professional qualitative research methods, conducting ten Focus Group Discussions (FGDs) with four to eight participants per group, involving a total of 87 women aged between 18 and 65 years. Additionally, they conducted Key Informant Interviews (KIIs) with 15 healthcare providers working in health facilities and the district hospital, including nurses, clinical officers, and district health managers. The selection of ten villages to participate in this study was done purposively because these areas were the most affected by the recent floods and had a history of recurrent natural disasters. These villages included Kipindimbi, Nakongombe, Miguluwe, Mavuji, Tingi, Somanga, Kinyonga, and others within the district, which has a population of over 297,676 according to the 2022 census. The study sought to generate scientific evidence that would help policymakers understand the magnitude of the problem and take urgent action to integrate maternal and child health into national climate change strategies.

Community Perspective: Climate Change Through the Eyes of the People

When the researchers sat down with the women of Kilwa to talk, what emerged was more than statistics it was the cries of an entire community. The study findings begin by providing a real picture of how the people of Kilwa understand and interpret climate change based on their everyday experiences. The majority of respondents reported that they had observed significant changes in weather patterns compared to previous years. They said that in the past, rain had its season it began in December and ended in March, and the cold season was between May and August. But now, according to one participant from Kipindimbi, "the rain is no longer predictable, you expect rain in March but you find no rain, or sometimes the rain falls with unusual force and causes massive floods."

Another participant from Nakongombe added that the cold season, which previously had intense cold from May to August, has now become warmer, a situation that makes them no longer see clear seasonal changes. The ongoing extreme heat was also mentioned by many as a sign of climate change, with one participant saying "now even in June, it is as hot as November." Furthermore, residents of Kilwa mentioned that they have seen an increase in emergency events such as massive floods, cyclones, and prolonged droughts. Many were able to explain that the 2024 floods were larger than anything they had ever witnessed in their lives, a situation that shows that climate change is not just scientific theory but a reality that directly affects their lives. The purpose of collecting this testimony was to show that the people do not need to be educated about the existence of climate change they live it every day, they see it with their own eyes, and they hear it with their own ears.

Causes of Climate Change: Deep Understanding from the Villages

When study participants were asked about the causes of climate change, many demonstrated a deep understanding of human activities contributing to this problem. One participant from Nakongombe stated plainly that "cutting down trees for large-scale sesame farming, along with smoke from industries, is what brings climate change." This shows that rural residents, despite lacking formal scientific education, have a deep understanding of what is causing their environment to deteriorate. Many described how deforestation is continuing rapidly in their areas due to sesame farming and charcoal production, and how this situation contributes to ongoing floods and droughts. According to environmental experts, deforestation removes the natural protection of land against erosion and causes rainwater to carry soil and cause flooding instead of being filtered and replenishing underground water sources. Additionally, residents of Kilwa mentioned that mining activities and large-scale commercial crop farming contribute to environmental destruction and accelerate climate change. This deep understanding provides an important opportunity for policymakers and environmental experts to collaborate with communities in finding solutions to address climate change using indigenous knowledge alongside modern science. It is clear that the people do not need to be educated about the existence of the climate change problem; rather, they need close collaboration with the government and other stakeholders to find solutions for dealing with the impacts of this problem that continues to confront them every day. The purpose of the study in this section was to confirm that communities have a deep understanding of the causes of climate change and therefore deserve to be involved in finding solutions.

First Impacts: When Floods Devour Food and Give Birth to Hunger

Among the disasters that struck them, perhaps one of the greatest pains revealed in the study is the direct relationship between floods and food shortage affecting maternal and child health. Residents of the affected villages described with sorrow how the 2024 floods completely destroyed their food farms, especially in low-lying areas where water stood for a long time. One participant from Kipindimbi said, "regarding food availability, it is now a major challenge because our farms have been flooded with water, we cannot cultivate, and food availability has greatly decreased." The effects of this farm destruction were immediately seen in the nutrition of pregnant women and young children. Participants explained that many families were forced to reduce the number of meals per day, with some eating only once a day.

Another participant from Miguluwe said, "you can find a mother preparing cassava porridge in the morning, at noon she has nothing to eat, and in the evening, she cooks stiff porridge for her children." This situation of hunger and lack of proper nutrition has serious effects on pregnant women who need sufficient nutrients for the growth of the fetus in the womb. Moreover, newborns and young children are at high risk of malnutrition that can affect their mental and physical development for a long time. This study clearly demonstrates that climate change, through floods and droughts, is directly translated into hunger and malnutrition in the most vulnerable communities in Tanzania. The purpose of examining this relationship was to show that climate change is not a distant problem, but it arrives in the families of Kilwa in the form of hunger that afflicts pregnant women and their children.

Anemia Exacerbated by the Lack of Green Vegetables

When hunger became more severe, women began to see other hidden effects behind food shortage. Beyond general food scarcity, the study found that climate change has greatly affected the availability of important iron-rich foods, especially green vegetables. Respondents explained that prolonged drought and floods have made vegetable farming very difficult, and this has led to an increase in the problem of anemia among pregnant women and children under five years of age. One participant from Tingi, who is a healthcare provider, stated clearly that "if you look at the list of the top ten diseases, anemia ranks first because there are no green vegetables." This is a statement of great weight because it shows that the problem of anemia, which is already a major public health challenge in Tanzania, can be exacerbated by climate change. Anemia during pregnancy increases the risk of miscarriage, giving birth to a low-birth-weight baby, and even maternal and child death during delivery.

Residents of Kilwa demonstrated a deep understanding of this relationship, with one participant from Mavuji saying, "giving birth to underweight children is increasing in our communities, and many cases occur during floods or drought, we believe that lack of adequate nutritious food contributes to this problem." This study provides the government and health stakeholders with important information that strategies to address anemia and malnutrition should not be separated from strategies to address climate change, but must be integrated to ensure that pregnant women and children receive adequate nutrition even during natural disasters. The purpose of examining this impact was to ensure that the voices of women suffering from anemia due to lack of green vegetables are heard all the way to the decision-making chambers.

When Stagnant Water Gives Rise to outbreak of Diseases

In the depths of stagnant water left behind after the floods, other disasters were born diseases that began to hunt pregnant women and young children. Another major impact of climate change revealed in the study is the increase in climate-sensitive diseases, especially malaria and diarrhea. Residents of Kilwa explained how changing seasons and extreme heat contribute to the spread of malaria-carrying mosquitoes for much longer periods than before. A participant from Kipindimbi said, "in the past, the cold season began in May and ended in August, but now it is very hot and the mosquito population is high in all seasons." This means that malaria, which in the past was only a problem during the rainy season, is now present year-round. Moreover, the 2024 floods worsened the problem by leaving stagnant water suitable for mosquito breeding.

Healthcare providers who participated in the study explained that they witnessed a significant increase in malaria patients after the floods, especially among displaced residents who were living in temporary shelters such as schools where they did not have mosquito nets for protection. One participant from Tungi said, "during that period, malaria was very high, and some pregnant women who contracted malaria gave birth prematurely." Malaria during pregnancy is a serious danger as it can cause severe anemia, miscarriage, low birth weight, and maternal and child death. Regarding diarrheal diseases, residents explained that the main source of drinking water was mixed with floodwater, and this caused outbreaks of diarrhea and cholera. A healthcare provider from Kinyonga said, "this year there has been an outbreak of diarrhea due to the heavy floods, something we had almost forgotten about here in Kilwa." The purpose of highlighting these diseases was to show that the health system of Kilwa was overwhelmed by the burden of disasters, and pregnant women paid the highest price.

When Roads Are Cut Off, Service Delivery is Compromised

When pregnant women tried to reach health facilities for assistance, they found the roads blocked. The study found that floods cause major disruptions in access to maternal and child health services, a situation that endangers the lives of pregnant women and newborns. Residents of the affected villages described with pain how roads and bridges are destroyed by floods, causing pregnant women to be unable to reach health facilities for antenatal care, safe delivery, and postnatal care. One participant from Tingi said, "pregnant women face health risks because sometimes roads become impassable, therefore some pregnant women deliver at home, and some may even lose their babies." This situation is worse for women living in areas far from health facilities, who already face transportation challenges even during normal times. A healthcare provider from Somanga shared his personal experience during the floods, saying, "I participated in attending to three cases of pregnant women who could not reach the health facility, I was forced to assist with home deliveries.

There was a period when even healthcare workers could not reach the facility because of the floods." Beyond disruptions to delivery, floods cause women to miss important preventive services such as vaccinations, deworming medications, and iron and folic acid supplements. Another healthcare provider explained that "when a mother comes to the clinic, she does not come only for check-ups but we also provide health education, we give them preventive medications and supplements. If the mother does not come to the clinic, it becomes a major challenge, and some may even lose their pregnancies." The purpose of the study in examining this disruption was to provide evidence that the health system needs to be strengthened to function even during disasters.

When Fertility Becomes a Choice Against Disasters

After enduring floods, hunger, and diseases, the women of Kilwa began making decisions that will affect future generations. One of the most striking findings in this study is how climate change affects fertility intentions of women in rural communities. Women who participated in group discussions clearly explained that they are afraid to become pregnant again because of the challenges brought by increasingly severe floods and droughts. One participant from Miguluwe said, "yes, we are afraid of getting pregnant because of the road conditions during the rainy season. Therefore, you go to the health facility and get an implant that will last five years, others may prefer injections or pills. If the roads are impassable, there is no way you may choose to take the risk of getting pregnant." This is a powerful statement showing that climate change directly affects women's reproductive rights, including their freedom to decide the number of children they will have and when to have them.

Beyond fear of transportation, women mentioned the poverty caused by crop destruction and loss of income sources as another reason for changing their fertility intentions. The same participant added, "you are living with your husband, and you do not have five thousand shillings. What will happen when you get pregnant? Nowadays, getting pregnant is expensive, in just the first week you must incur costs until you complete nine months." This study reveals the important truth that climate change is not just an environmental problem, but a problem that interferes with the fundamental decisions of women's lives, including family planning and the well-being of their children. This should be a call to policymakers to ensure that family planning services are included in emergency plans and climate change adaptation strategies. The purpose of examining these changes in fertility intentions was to show that climate change has the capacity to change the demographic future of Tanzania.

Gender-Based Violence: The Price Women Pay

In this series of disasters, the most affected group was women and girls, whose gender roles assigned by society placed them at the forefront of coping with disasters, but also made them more vulnerable. The study found that women and girls are the most affected by climate change due to the gender roles assigned by society. In the communities of Kilwa District, women are responsible for fetching household water, collecting firewood, cooking, and caring for children and the elderly. During drought, water sources diminish and women are forced to walk longer distances to find water. One participant from Miguluwe explained, "sometimes the mother may be overwhelmed with other household tasks and thus may request help from her young girl. When she goes there, she may find a lot of containers lined up, and other people may not consider that she will be late going back home. These water sources are located in distant areas, and recently, pastoralists have moved into our areas, and their minds are different from ours. When they see young girls, they take advantage and rape them."

This is direct evidence of how climate change increases the risk of gender-based violence for girls and women. Beyond the risk of rape, drought and floods increase the workload for women, a situation that causes extreme fatigue and sometimes leads to conflict and domestic violence. Another participant said, "when women return from the farm, they go to search for firewood and vegetables, therefore they do not get adequate rest. Even when the husband wants sex, he will be frustrated as he thinks she is denying him sex, leading to verbal abuse and domestic violence." This study clearly shows that climate change has a gender dimension, and strategies to address it must be gender-sensitive and address the root causes of inequality between men and women. The purpose of examining gender impacts was to ensure that the voices of women and girls, who are the most affected, are heard and considered in policy development.

A Lesson in Resilience from Kilwa

Despite the many challenges brought by climate change, the study found that the communities of Kilwa have made efforts to find various strategies to cope with this worsening situation. One such strategy is the use of Maternity Waiting Homes that have been built at the district hospital and some health facilities. The District Medical Officer of Kilwa explained that "at our district hospital, we have a building called Mama Ngojea. This is a building that accommodates pregnant women who come from remote areas, they come early so that they may not face any barriers when it is time to deliver." This strategy has saved the lives of many women who would have struggled to reach the hospital during floods when roads were bad. Additionally, the community has begun implementing a plan to relocate settlements from flood-prone areas to safer areas. A healthcare provider from Kinyonga explained that "Njinjo is one of the villages that was completely wiped out two or three years ago. There is a river called Matandu which severely flooded the village and submerged it completely. Because of this, they decided to relocate the village to another safe area." This relocation measure shows that the community is taking deliberate steps to protect themselves from increasingly severe floods.

Furthermore, various organizations have provided psychosocial support to disaster victims, conducting counseling sessions and helping those who lost their property to rebuild their lives. These coping strategies show that although climate change brings major challenges, communities have the capacity to organize themselves and take steps to protect their lives, and they can do even better with support and collaboration from the government and other stakeholders. The purpose of highlighting these strategies was to show that despite the disasters, there is hope and communities have the capacity to cope if supported by appropriate policies and resources.

A Call to Prioritize Maternal and Child Health in Climate Policies

In conclusion, the study conducted by Climate Action Network Tanzania in collaboration with Muhimbili University has succeeded in highlighting the undeniable truth that climate change is not only an environmental problem, but also a public health problem with significant impacts on women, children, and entire families. The study findings clearly show that floods, droughts, and cyclones that are becoming increasingly severe in Tanzania directly contribute to food shortage and malnutrition among pregnant women, increased malaria and diarrheal diseases that endanger the lives of newborns, disruption of maternal and child health services that cause unnecessary deaths, and gender-based violence affecting girls and women during disasters. Moreover, the study found that climate change even affects women's fertility intentions, a situation showing that this problem penetrates the fundamental decisions of family and community life.

The main goal of this study was to provide scientific evidence that would help policymakers understand the magnitude of the challenges facing women and children in areas affected by climate change, and to take urgent action to strengthen the capacity of the health system to cope with disasters. The researchers call upon the government of Tanzania through the Ministry of Health, the Vice President's Office (Environment), and other development stakeholders to take urgent action to strengthen the capacity of the health system to cope with climate disasters, ensure that maternal and child health services continue at all times, and address the root causes of gender-based violence that increases during disasters. This study recommends that maternal and child health be prioritized in national climate change policies, including the Health National Adaptation Plan (HNAP) and the Nationally Determined Contributions (NDCs). As one study participant said humbly but truthfully, "God knows the challenges we face." But we cannot rely on God alone; we need deliberate action from the government, development stakeholders, and communities themselves to ensure that climate change does not continue to silently kill women and children in the rural areas of Tanzania. The time is now, and the evidence is in hand through this important study. The goal of the study has been achieved: to give voice to those who have been silenced by disasters, and to call upon those in authority to take action before the next cyclone arrives.

End of Article

This article has been prepared using information from the study titled "Community and health workers' perspective on impacts of climate change on reproductive, maternal, and child health outcomes in Kilwa district council, Tanzania: a qualitative study" published in BMC Public Health in September 2025. The study was conducted by Climate Action Network Tanzania (CAN Tanzania) in collaboration with Muhimbili University of Health and Allied Sciences (MUHAS). The main objective of this study was to examine the perspectives of communities and healthcare providers regarding the impacts of climate change on reproductive health, maternal health, and child health, and to provide scientific evidence to assist in the development of policies and national strategies to address these challenges.

The analysis and writing of this article from a journalistic perspective was done by John Kabambala - a journalist specializing in covering Environment and Climate Change issues affecting Women, Youth, and Children.