*3.2. Ambient Air Pollution*

During the different stages of pregnancy, the immune system of pregnant women tends to change to ensure that the foetus which grows within the maternal uterus is not rejected by the mother's immune system (Förger and Villiger 2020). During this period, the mother's immune system becomes more sensitive to toxins and chemicals deposited in the environment through exhaust discharges, air congestion, and factory emissions. Inhaled toxins can influence the outcome of her current pregnancy via pre-term birth, low birth weight, and neurological disorders, and also future pregnancies due to adverse effects on her fertility.

Notwithstanding these experiences of pregnant women in the Caribbean, the reproductive health of all women, regardless of if she is pregnant or not, can be adversely affected by several climate change variables such as humidity, precipitation, and temperature of the environment, as well as changes in gonadal function and neuroendocrine regulation due to changes in health and socioeconomic status (Choudhari 2022; Jegasothy et al. 2020).

In addition to the health of pregnant women, ambient air pollution in the form of exhaust fumes, forest fires, and agricultural production exacerbates climate change. It is also widely hazardous to children's health (Brumberg and Karr 2021). These fumes worsen respiratory diseases in children and babies sensitive to changes in air quality. In the case of the Caribbean, the major contributors to air pollution in the region are produced by the areas of manufacturing, oil refinery, electrical power generators, transportation, and lead production.

In the Caribbean, the average exposure to ambient air pollution remains high, about 18.3 µg/m<sup>3</sup> with a household air pollution exposure of 0.413 µg/m<sup>3</sup> in 2019 (Health Effects Institute (HEI) 2020). In both cases, the concentration of air pollution poses a threat to pregnant women, young children, and Caribbean economies. If sources of pollution are left unchecked, this can lead to not only public health crises in terms of a surge in the maternal problems mentioned earlier and respiratory illnesses, but it can put a significant strain on all sectors. Financial resources would be diverted away from health, education, and infrastructure to the environmental sector to treat the problems of air pollution.

#### *3.3. Droughts*

In the Caribbean, with a defined wet and dry season, droughts can be caused by a failed rainy season with a dwindling of freshwater resources. Climate change events such as droughts tend to significantly impact pregnant women's health because the threat of famine implies that the risk of hunger and malnutrition is great.

In the Asia-Pacific and Caribbean regions, such a threat impacts not only the dietary needs of women but also their overall health and sanitary needs because droughts often cause the price of food, water, and basic amenities to increase at an alarming rate (Algur et al. 2021). As a result, during periods of drought, inadequate access to water is further complicated by poor sanitation, which in turn, can contaminate water sources, leading to a recurrence of childhood respiratory, fever, and gastroenterological illnesses in pregnant women and children (Singh et al. 2006).

The lack of a frequent, accessible, and clean supply of water poses a great risk to the foetus, as pregnant women from low-income households may not have easy access to bathroom facilities (i.e., toilet, shower, bathtub, or sink for washing) with running water, as well as clean cooking facilities (Patel et al. 2019). As a result, economically poor pregnant women may experience adverse pregnancy outcomes under drought conditions, increasing the maternal mortality ratio of women in the Caribbean. As economic resources become constrained in developing countries and regions like the Caribbean, it is also possible that fewer pregnant women may access antenatal care, and more will become malnourished. This malnourishment leads to medical conditions such as anaemia, premature birth, obstructed labour, postpartum haemorrhages, and underdeveloped organs (Parrotte 2015).

#### *3.4. Flooding*

At the other extreme of weather conditions, like drought, are the temperature changes, which create excess rainfall and a high probability of flooding. In the Caribbean, flooding has become an annual problem because the number of intense rainfall occurrences has increased due to climate change events such as extreme temperatures and meteorological events such as hurricanes and tropical storms (Fontes de Meira and Phillips 2019). These events, as expected, can cause significant socioeconomic disruption to the lives of many, as some households may be ill-prepared to deal with such events due to the rising cost of resources such as personal protective equipment.

From the perspective of maternal and child health, during these events, pregnant women, small children, and several other vulnerable groups like the elderly are likely to become victims of flooding, landslides, and high winds accompanying extreme rainfall (Bartlett 2008). In the Caribbean and other low-income developing countries like Nepal where most citizens from low-income households have an uncertain and sometimes precarious source of income, the probability of experiencing adverse outcomes such as the loss of life is shockingly high for women and young children, especially girls, during flood events. For example, in Nepal, preschool girls are five times more likely to die from a flood-related death (Pradhan et al. 2007).

Oddly enough, during heavy periods of rainfall, the flooding of outdoor toilets can also increase the spread of water-borne diseases such as cholera and enteric viruses. With little access to piped water and rotavirus vaccines, these viruses can also impact the mortality of babies and young children in the Caribbean (Delahoy et al. 2021). As the risk of such water-borne diseases rises, this can become a burden to pregnant women living in low-income households as they may not have sufficient funds to access healthcare as needed. In this instance, public health facilities will need to be outfitted with the necessary resources and made available to pregnant women who may not be able to access private healthcare.

#### *3.5. Structural Racism*

Apart from the climate change events highlighted above, it has also been noted in the literature that pregnant women who are women of colour and those living in overpopulated rural and urban or less affluent communities are more vulnerable to climate change events. This is primarily the case because members of these communities in the Caribbean may experience discrimination during the distribution of resources needed to mitigate the effects climate change events. Thus, it forces many persons, including pregnant women, living in low-income households with less access to heat reducing resources such as air-conditioning, indoor fans, and proper housing infrastructure to address extreme temperatures.

Further to this, the problems experienced by pregnant women, people of colour, and impoverished communities may not be included in the discussion of climate change concerning climate justice, social and environmental justice for women of colour, social and economic equality, gender equality, and the inequitable distribution of resources to mitigate the effects of such events in the Caribbean. These issues contribute to the higher rates of pre-term labour in women of colour, and as a result, they are more likely to be hospitalised during their pregnancy.

Furthermore, apart from pregnant women, women of colour, and impoverished communities, structural racism and discrimination often exacerbate these community members' trauma and mental health needs in response to climate change events such as flooding and heat risks. They are frequently neglected by healthcare providers and governmental institutions responsible for dealing with these problems within these communities (Gutschow et al. 2021).

#### *3.6. Eco-Anxiety and Climate Anxiety in Children*

Exposure to such vector-borne and infectious diseases and climate change events often has more far-reaching effects than just the physical health of pregnant women and children in the Caribbean. One of the most under-studied areas in which climate change events have impacted maternal and child health is that which deals with their mental health.

Climate change is likely to have a significant impact on the psychological health of children in that they may develop anxiety, phobias, PTSD, and attachment disorders, which leads to abnormal development in their emotional responses, cognition, and language skills (Burke et al. 2018). Consequently, as these children become young adults, they will continue to show signs of mental health distress in response to climate change events in complex ways, such as eco-anxiety and climate anxiety (Gislason et al. 2021).

In countries like India and the Philippines, the continued exposure to extreme weather events such as cyclonic storms, monsoons, and typhoons, have led to significant behavioural changes in children and young adults. Feelings of extreme worry, powerlessness, helplessness, anxiousness, guilt, and betrayal can ensue due to their perceptions/beliefs that their respective government's policy response to climate change is inadequate (Hickman et al. 2021). Young children in the Caribbean from low-income households who exhibit signs of eco-anxiety and climate anxiety may not have access to the resources needed to help them cope with these problems. This anxiety can be due to the high cost of mental health resources and the stigma attached to conditions such as anxiety. In this case, the relevant authorities must help parents and children through free counselling and therapy at health institutions to ensure that the children experiencing anxiety have a safe space to speak and treat their concerns.

#### **4. Conclusions**

Climate change and the social and economic challenges to maternal and children's health have been discussed. One aspect almost always impacts the other. Socially, pregnant women and children are affected by extreme heat events, increasing frequency of climate-related disasters including hurricanes and flooding, food insecurity, and risks of waterborne diseases. These stated aspects impact and exacerbate gender inequality in vulnerable groups, especially in developing countries. Climate change and the occurrence of hurricanes, flooding and storm surges create havoc on SIDS, rendering destruction to infrastructure and disrupting water supplies, transportation, and electricity. Consequently, financial burdens are incurred by the government. The economic fallout can cause limited access to necessary resources and services for pregnant women and children. Governments must put the needs of this population high on their agenda to ensure that better living conditions are available.

Notwithstanding the importance of the discussion on maternal and child health in the Caribbean in terms of climate change, it must be noted that there are several specific challenges faced in collecting health data in the Caribbean, which, if available, would have added a greater depth to the argument put forward in this

manuscript. In particular, the inability of health and data collection institutions in the Caribbean to collect health data is often the result of such institutions lacking the basic infrastructure to collect such data, which ranges from limited physical and human resources to underdeveloped institutional frameworks to guide its collection. The inability to put effective structures in place often results in the inaccurate collection of health data, which in the Caribbean, can be either incorrect or faulty. The use of such faulty data can lead to a poor representation of national health statistics. Further to this, apart from data collection issues, there is also limited access to public health data from institutions for researchers in the Caribbean due to a lack of funding, high costs, and privacy concerns. As a result of this, there is very little empirical and applied research being undertaken in the Caribbean concerning maternal and child health. To address this issue, first there should be data collection measures in place to capture the impact that climatic events are likely to have on women and children in the Caribbean through ministerial bodies in the areas of health, education, and housing. Second, there should be greater inclusion of the views of women and children in regard to the design of climate change mitigation measures at the household, community, and institutional level. Finally, there should be greater institutional investment in terms of the provisions of grants and funding for researchers to conduct research in this specific area of study.

**Author Contributions:** Conceptualization, D.D.J. and R.A.D.; Methodology, D.D.J. and R.A.D.; Formal Analysis, D.D.J. and R.A.D.; Investigation, D.D.J. and R.A.D.; Resources, D.D.J. and R.A.D.; Writing—Original Draft Preparation, D.D.J. and R.A.D.; Writing—Review and Editing, D.D.J. and R.A.D. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest.
