Climate change is increasingly being recognised not just as an environmental threat, but as a significant driver of adverse health outcomes. Studies over the years have linked climate-related events to health challenges such as cancers and maternal complications, and have said it can even fuel anxiety, depression, and stress because of a concept called solastalgia.
Against this backdrop of growing evidence on climate and health, a new study published in PLOS One has shown that women and children in climate-vulnerable districts experience significantly poorer health outcomes, raising concerns about India’s ability to meet key Sustainable Development Goals (SDGs). This finding underscores the urgent need to integrate climate vulnerability into public health planning and interventions.
How does climate change exacerbate the malnutrition crisis?
While India has made progress on several Sustainable Development Goals (SDGs), the growing risks from climate change can undermine these achievements, particularly in rural areas where infrastructure and access to healthcare are limited. "Districts that are highly vulnerable to climate change consistently underperform on the studied health targets as compared to districts which are less vulnerable to climate change," according to the new study, which examines how climate vulnerability affects health-related targets under SDG 2 (Zero Hunger) and SDG 3 (Good Health and Well-being).
This is of particular significance when you take into account that an estimated 80 per cent of the Indian population lives "in areas highly vulnerable to extreme events, such as cyclones, floods and heatwaves."
Researchers employed statistical and econometric methods, including multivariate logistic regression, to study the relationship between climate vulnerability, social and economic determinants of health, and health outcomes across 575 rural districts in India. This is approximately 74 per cent of all administrative districts in the country.
The analysis, which drew on the National Family Health Survey and a climate risk and vulnerability assessment, revealed a highly significant and negative relationship between climate vulnerability and attainment levels of health outcomes. Districts that are highly vulnerable to climate change consistently underperform on key health metrics compared to less vulnerable districts. "For instance, the chance of children being underweight and that of women having non-institutional deliveries is 1.25 and 1.38 times higher, respectively, in districts that are highly vulnerable to climate change than in districts that are less vulnerable," it said.
Even after accounting for socioeconomic factors such as maternal education, birth order, and access to healthcare, children in highly climate-vulnerable districts were significantly more likely to be stunted, wasted, or underweight. Similarly, women in these districts faced greater difficulties accessing healthcare and were more likely to deliver outside medical facilities.
“This study reveals that climate change has a significant and distinct association with poor health outcomes even after accounting for other well-established determinants for good health such as mothers’ education, birth orders of children, and access to health care facilities,” the researchers wrote. “Districts that are highly vulnerable to climate change tend to underperform on health metrics, including stunting, wasting, being underweight, non-institutional deliveries, and difficulties accessing healthcare.”
The dataset also highlighted the broader scale of the challenge. Despite improvements in maternal care and institutional deliveries nationwide, India continues to struggle with high child malnutrition rates: 37 per cent of surveyed children were stunted, and 33 per cent were underweight. Climate pressures appear to exacerbate these challenges, particularly in rural regions already facing developmental gaps.
The study also points to other climate-linked health risks, including spikes in vector-borne diseases due to rising temperatures and severe heat stress in rural areas. “Increasingly, climate change has become a major force disrupting health care delivery, undermining the social determinants of good health and reducing the capacity to provide health care, including universal health coverage, with the potential of significantly increasing health costs in LMICs,” the researchers noted.
Geography and infrastructure further compound these issues. Harsh terrain, long distances to health centres, limited transportation, insufficient services, a shortage of trained health professionals, and financial barriers all hinder equitable access to quality healthcare in climate-vulnerable areas.
Among Indian states, Rajasthan has the highest number of districts classified as “very highly or highly vulnerable” to climate change. Jharkhand, Chhattisgarh, and Uttarakhand follow as the next most climate-vulnerable states. The study also observed high within-state variability: in larger states such as Gujarat, West Bengal, Uttar Pradesh, and Uttarakhand, the distribution of districts by climate vulnerability varied significantly. Even the North Eastern states showed high vulnerability, with all districts in Arunachal Pradesh classified as highly vulnerable.
The researchers emphasised that “cost-effective investment decisions need to consider the differentials in climate vulnerability across sub-national regions in health sector decision-making for effective implementation. Tackling climatic vulnerability is essential for progressing on the SDG targets, and ignoring these can lead to delays and setbacks, most of which are avoidable. Effective climate resilient practices include communities in implementation and planning, empower local governance and strengthen self-help groups to enhance adaptive capacity.”
Implications for India: expert insight
Dr Amit Gupta, Senior Neonatologist and Paediatrician at Motherhood Hospitals, Noida, explained that India’s extreme climate plays a major role in worsening child nutrition. He pointed out that recurring heatwaves, floods and droughts directly affect children’s appetite, hydration and immunity. “In conditions of extreme heat and high humidity, appetite reduces, dehydration increases and caloric requirements go up. This imbalance often leads to undernutrition and wasting,” he said.
He added that floods, particularly in rural areas, contaminate drinking water and trigger a surge in water-borne diseases. “Diarrhoea, loose motions, malaria and similar infections increase rapidly during floods. These infections weaken a child’s immunity, leading to malabsorption of nutrients. This starts a vicious cycle where infection causes malnutrition, and malnutrition again makes the child more prone to infections,” Dr Gupta explained.
Linking climate stress to food insecurity, he noted that droughts and heatwaves often result in crop failure, especially among farming communities. According to him, “When crops fail, families face food shortages, and this directly affects women's and children’s nutritional intake and overall immunity as well.”
Dr Gupta also highlighted that “maternal heat stress and poor nutrition during pregnancy increase the risk of low birth weight and poor foetal growth. It affects the baby’s brain development and physical growth, and raises the risk of stunting.” He added that babies who should normally weigh between 2.5 to 3 kg often end up being born underweight in such settings. In low socio-economic households, this again becomes part of a vicious intergenerational cycle of malnutrition.
Initiatives to tackle malnutrition in India
According to a reply in the Rajya Sabha, Anganwadi Services, Poshan Abhiyaan and the Scheme for Adolescent Girls have been merged under Mission Saksham Anganwadi and Poshan 2.0 to address malnutrition through a life-cycle approach. The mission is a centrally sponsored scheme, implemented by States and UTs, and is described as “a universal self-selecting umbrella scheme where there are no entry barriers for any beneficiary to register and receive services.”
The government has stressed that nutrition goes beyond food, and is closely linked to sanitation, education and access to safe drinking water. Malnutrition, therefore, is being addressed through convergence across 18 ministries and departments. The mission focuses on maternal nutrition, infant and young child feeding practices, and the treatment of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM), along with wellness through AYUSH practices to reduce wasting, stunting, anaemia and underweight.
Under the programme, supplementary nutrition is provided to children (6 months to 6 years), pregnant women, lactating mothers and adolescent girls, in line with revised nutrition norms under the National Food Security Act, notified in January 2023. While earlier norms were calorie-centric, the updated standards now emphasise diet diversity, quality protein, healthy fats and seven essential micronutrients. As stated in the reply, “Fortified rice is being supplied to AWCs to meet the requirement of micro-nutrients and to control anaemia among women and children,” and millets are being included at least once a week.
To strengthen delivery, over 2 lakh Anganwadi Centres have been approved as Saksham Anganwadis, and 88,716 Mini-AWCs have been sanctioned for upgradation. Digital monitoring is being carried out through the Poshan Tracker, while the Facial Recognition System (FRS) has been made mandatory for Take-Home Ration distribution from July 1, 2025.
Special focus is also being given to tribal regions under the PM JANMAN, with 2,500 Anganwadi Centres approved for construction, along with the launch of Dharti Aaba Janjati Gram Unnat Abhiyan, under which 2,000 new Saksham AWCs and 6,000 upgradations are planned between FY 2024–25 and FY 2028–29.
Dr Gupta also acknowledged that several steps are being taken on the ground. “During floods and heatwaves, the government ensures supply of ORS, safe drinking water and energy-dense food through programmes like the mid-day meal. Anganwadi workers actively monitor pregnant women and promote iron, folic acid and regular antenatal check-ups. The intent is strong and the work is visible,” he said.
However, he stressed that these efforts alone are not enough. “What is being done is still just the tip of the iceberg. This cannot remain only the government’s responsibility. Doctors, paramedics and society as a whole must also take ownership,” he added.
According to the Poshan Tracker data for June 2025, malnutrition indicators for children aged 0 to 5 years show that 37.07 per cent of children are stunted, 5.46 per cent are wasted, and 15.93 per cent are underweight. Early childhood mortality also remains a concern, with the Sample Registration System (SRS) Report 2022 indicating that the under-five mortality rate in India is 30 per 1,000 live births, based on a three-year period from 2020 to 2022. Also, according to the National Family Health Survey (NFHS)-5, 57% of women aged 15–49 are anaemic, compared to just 26% of men. Nearly 1 in 5 women is underweight.
Dr Gupta pointed to gaps in implementation and awareness. “In some places, political will and last-mile delivery are weak. There are instances where the benefits do not fully reach the intended families. Along with this, lack of education is a major barrier. Until families understand the importance of nutrition, real change is difficult,” he said.
He concluded by emphasising that improving nutrition for children and women in climate-vulnerable areas requires a multi-dimensional approach. According to him, education, livelihoods, healthcare access and effective governance must move together “if we truly want to break this vicious cycle and protect them.”
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.
