US heat emergency plans missing pregnancy, racial justice

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Many plans by local, state, and federal authorities in the United States to respond to heat extremes and climate change miss the threat that extreme heat poses to pregnancy, particularly for low-income and Black and brown people, Human Rights Watch and partners said on Friday. Authorities should promote racial and reproductive justice and address stark racial disparities in health outcomes.

“We reviewed more than 100 heat and climate change adaptation plans or associated documents but found only a couple of references to pregnancy,” said Skye Wheeler, senior women’s rights researcher at Human Rights Watch. “Pregnant people, and especially Black and brown people, need to be at the table as we tackle the multiple harms to health from increasing heat.”

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A Better Balance, the Black Women’s Health Imperative, Human Rights Watch, the National Birth Equity Collaborative, and the National Latina Institute for Reproductive Justice-Florida released today a fact sheet, “Increasing Temperatures because of the Climate Change Crisis is a Reproductive Justice Issue in the United States.” Reproductive Justice is a global movement created by Black women’s rights activists in the US. It seeks to ensure the human right to legal and equitable access to comprehensive, high quality reproductive health services, and a healthy and safe environment for all women during pregnancy and while raising children.

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Human Rights Watch reviewed 105 official heat safety web pages, climate action plans, heat plans, heat advisories, disaster plans, and sustainability initiatives for 18 large US cities, including the 15 most populous, with a total of 32 million people. As of August 2020, only two of these documents, from Chicago and Philadelphia, explicitly addressed the danger heat poses during pregnancy. Since the review was conducted, Human Rights Watch has seen that New York City has also included this group in a list of vulnerable populations. Concerns about the dangers of heat for pets were found 37 times.

Heat-related illnesses range from heat rashes and cramps to heat exhaustion and heat stroke, which is a medical emergency and can be fatal or cause permanent disability. Every year, more people die in the US from heat than from any other weather-related cause, and the number of heat-related deaths is increasing. Heat stress threatens health during pregnancy and fetal health exposure to high temperatures results in higher rates of premature birth as well as other adverse birth outcomes.

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Because of systemic racism, Black women and other women of color in the US face dramatically worse pregnancy health and birth outcomes than white women. Some studies suggest that Black pregnant women may be especially vulnerable to the emerging threat of heat. Women of color and low-income women may also face more hours of dangerous heat, because they work in hot conditions – for example about one-fifth of US farmworkers are women – or because they live in parts of cities with less green space and higher average temperatures.

The 2020 summer was hotter than usual, a trend that is expected to continue, although some parts of the US have had bigger heat increases than others in the past decades. Predictions for extreme increases in heat by the end of the century can only be mitigated by rapid action to cut carbon emitted into the atmosphere. Regardless, temperatures are set to rise significantly in much of the US because of increased carbon, already present because of past emissions.

City studies of local dangers of extreme weather events such as hurricanes, flooding, or heat waves, and local climate change action plans did often note, correctly, that the impact of climate change varies greatly between individuals and communities. Many said that older people, people with pre-existing conditions such as heart and respiratory disease, as well as athletes and children, are especially vulnerable to illness and death from extreme heat.

Some plans or warnings cited outdoor workers as an at-risk group. There is no federal heat standard protecting US workers from extreme heat, although laws protecting access to cooling or water, shade, and rest in at least some circumstances are in place in CaliforniaMinnesota, and Washington states. An incomplete but increasing number of states provide accommodations for pregnant workers such as additional water breaks. In September 2020, the US House of Representatives passed a federal bill, the Pregnant Workers Fairness Act, that would provide explicit protections nationally, though it remains pending in the Senate.

Some climate change or heat plans reviewed discussed how low-income communities, communities with less access to air conditioning, or communities of color are more likely to be hit harder by heat or other extreme weather. Most did not include recommendations to address racial inequities and racism as part of the response to the climate crisis, although some did. Scholars, climate activists, and public health officials have cited these inequities and said that local plans addressing climate change should be as inclusive as possible.

A 2020 study estimated that there may have been 12,000 heat-related deaths a year during the last decade in the contiguous US and warned that the number could increase to 110,000 a year under high-emission “business-as-usual” scenarios by the year 2100. The US Centers for Disease Control and Prevention (CDC) has not published complete data on heat-related deaths over the last decade; from 1999 to 2010 it recorded around 618 heat-related deaths every year. But because the recorded cause of death is often another health event, such as a heart attack, this is an underestimation.

Many studiesshow that heat exposure is linked to premature birth and others also link exposure to heat to low birth weightbirthdefects, and stillbirth. Several reviews of studieswarn that more needs to be done to address these findings, especially given predictions of hotter days and nights as well as acute heat wave periods. Premature birth is a leading cause of infant death and linked to higher rates of lifelong intellectual and physical health problems. Premature birth can also create a heavy financial and emotional toll on families.

The rates of premature births in the US grew for a fifth year in a row in 2019. The CDC says that Black women’s pregnancies end in premature birth 50 percent more often than those of white women. Low birth weight is also twice as common among babies born to Black women, and stillbirth is more than twice as common for Black women as for white women. The March of Dimes, which fights premature birth in the US, provides analysis that shows that Hispanic and Native American women also have worse birth outcomes than white women.

The federal Environmental Protection Agency (EPA) has explicitly called for including pregnancy when “prioritiz(ing) the most vulnerable” to climate change. The US government should increase funding for efforts addressing the impact of climate change on human health. Cities, states, and Native American tribes should also ensure that their programming to prepare for climate impacts on human health includes pregnancy health and addresses reproductive injustice because of racism and poverty.

The US Congress should pass federal heat protection for all workers, for example through passing the Asuncion Valdivia Heat Illness and Fatality Prevention Act, and the Senate should pass the Pregnant Workers Fairness Act so that pregnant workers have an explicit right to accommodations, including to prevent heat-related illnesses during pregnancy. States should ensure that workers have and know about workplace protections for pregnancy already in place, including accommodations.

“The effects of climate change and extreme heat on pregnant people are a matter of racial, gender, and economic justice and cannot be ignored,” said Sarah Brafman, senior policy counsel and director of the DC office at A Better Balance. “One key step our lawmakers need to take is to pass the Pregnant Workers Fairness Act to ensure that pregnant people – especially low-income women and women of color who are too often exposed to higher rates of extreme heat – are able to seek accommodations so they don’t have to choose between their paycheck and their health by continuing to work in dangerously hot environments.”

Climate change impacts on health should be included in medical education. Doctors, midwives, and community birth workers can provide information about the importance of hydration and keeping cool during pregnancy. Doctors should ask pregnant patients about their work and exposure to heat and, where appropriate, provide letters to employers to help workers access reasonable workplace accommodations.

Cities and other US jurisdictions should revise their plans and websites before the next heating season to include pregnancy and to address the special needs in communities of color, Human Rights Watch and its partner groups said.

“Black women experience higher rates of premature birth and negative birth outcomes, which affect their and their children’s chances for a healthy life,” said Kelly Davis, Chief Equity Officer at the National Birth Equity Collaborative. “Climate change impacts, including heat, remains a challenge for Black people, along with other marginalized and minority groups, for achieving healthy pregnancies and supportive parenting environments. The movement to combat climate change must include addressing structural racism and gender oppression in service of birth equity.”

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