Mississippi is getting hotter. Experts say it’s hurting moms and babies

By Sophia Paffenroth and Joanne Kenen | Originally published by Mississippi Today

CLEVELAND – Going for nearly a year with broken heating and air conditioning has been miserable for Ashley Matthews. But the last few months have been unbearable – and potentially dangerous. Matthews, 27, is six months pregnant with her third child.

Her car didn’t have air conditioning, either, so Matthews financed a new one in May to get relief from the heat.  

“I can imagine if I’m this hot, how hot she is,” Matthews said about her daughter who is due to be born in October. 

A single mom of a 1-year-old and a 4-year-old, Matthews works as an early childhood educator. She said she intuitively knew what research in recent years has brought to light: Exposure to extreme heat can be harmful to pregnant women and the babies they are developing.

The danger is acute in Mississippi, which typically has long, hot and muggy summers and a high rate of people who might not be able to afford air conditioning. The state leads the nation in preterm births, with 1 in 7 babies born before 37 weeks. It also has the highest – and worsening – rate of infant mortality, babies who die before their first birthday. More than twice as many Black infants die as white ones. The gap, in fact, is growing wider.

The causes for the poor outcomes, in Mississippi and across the country, are many. But some risk comes from the warming planet. The last few years in Mississippi have been among the hottest on record, and the National Weather Service forecasts that trend is likely to continue.

A landmark JAMA Open report on the topic in June 2020 was led by Dr. Bruce Bekkar, who stopped practicing obstetrics after 20 years and turned to climate research and advocacy a few years back. It brought attention to extreme heat’s many hazards: preterm birth, low birthweight, stillbirth and more. Women in communities of color, such as Matthews, faced higher risk.

Research since that report has only lengthened the list of possible harms, including to expectant mothers. Some research has even suggested that as little as one day of extreme heat might elevate the risk of pregnancy complications, often linked to dehydration.

Those findings made headlines, in both the medical world and in the general media. But that knowledge hasn’t translated consistently into clinical care.

Many maternal healthcare providers don’t routinely address heat, or how to minimize its potential risks with their pregnant patients, according to providers, researchers and patients interviewed in Mississippi and across the country.

Matthews said her doctor never talked to her about high temperatures or asked about her living conditions.

“What can they do about it?” she asked on July 1, as a deadly heat wave descended over much of the United States ahead of its 250th birthday. She was attending a “Beat the Heat” event hosted by community organizer Pam Chatman and held at an assisted living facility in Cleveland within the Delta. Alongside 120 other Mississippians, Matthews received a free 20-inch box fan. 

Three other pregnant women at that event told Mississippi Today that their doctors had not talked to them about heat exposure, either.

Major medical groups were slow to emphasize heat, and maternal health and climate scientists are still working on defining precisely how much heat, and for how long, triggers risk. They want women to be careful and certainly know warning signs, but not worry excessively if they do have some heat exposure.  

“It’s not a ton (of risk). But it’s not zero,” said Dr. Blair Wylie, chair of obstetrics and gynecology at Beth Israel Deaconess Medical Center in Boston and an internationally recognized leader on climate change and pregnancy.

She noted that heat still doesn’t get a lot of attention as a pregnancy risk for several reasons – including that there’s a long list of things to discuss, test and monitor in prenatal visits that often only last 20 minutes or so. 

“We need to get more innovative in how we educate the population and our pregnant patients,”  Wylie said. “Not all of it has to be at that 20-minute visit.” 

Some health systems are trying tactics such as sending messages in patient portals, or handing out patient information packages. But it’s not a consistent practice across the country.

In the clinic

Low-income pregnant women, often living in subsidized housing without adequate air conditioning or money to keep their air conditioning running, are likely to show up at health appointments with dehydration, contractions and pre-term labor, said Dr. Rashad Ali, the obstetrician at the Family Health Center Women’s Clinic in Laurel.  

“Heat leading to dehydration has a lot to do with the preterm contractions and preterm birth problems that we see in our state,” Ali said. During summer, he estimated, about 1 in 5 pregnant women walking into his clinic have those early contractions, a precursor to premature labor and high-risk births.

To avoid dehydration, the Centers for Disease Control and Prevention advises people to carry a water bottle and limit beverages high in sugars, sodium and caffeine. Eating water-rich fruits and vegetables also helps. But as Ali noted, many low-income people in Mississippi live in “food deserts” where healthy fresh food is scarce – and expensive. And it’s often difficult for low-income people to stay inside during the hottest parts of the day, rest often or get time off from work. 

Malika Holifield, 27, is familiar with this scenario. A patient at Ali’s clinic, she is four months pregnant with her first child and worries about the heat outside and her ability to escape it. In April, when she was just one month pregnant, she began experiencing lightheadedness at her job. It was tough work, sanding doors and lifting heavy objects in a local manufacturing facility. It was hot indoors, without air conditioning.  

Mia Walker, a nurse-supervisor at Family Health Center, said about 90% of the clinic’s patients work manual labor jobs in industries such as electrical equipment manufacturing or poultry production. She knows because the clinic team asks patients about how they live and work, hoping to spot potential dangers early on. They encourage their patients to come in if they don’t feel well, without scheduling an appointment. They advised Holifield to get disability leave, which she successfully did. 

“When they’re not feeling well and they’re pregnant, they get carte blanche,” Walker said. “They come right to the door, and we see them.”

But the Laurel clinic might be an outlier. While there’s no landmark survey of how many women get advised about heat during their pregnancy, the gaps are clear. 

The American College of Obstetricians and Gynecologists didn’t stress heat on the public-facing portion of its website – other than avoiding hot tubs, saunas and intense exercise – until recently. It wasn’t until this broiling summer that ACOG disseminated its pregnancy guidance on climate and health, including heat, wildfire smoke and pollution as risks.

Similarly, neither the U.S. Preventive Services Task Force nor the American Academy of Family Physicians flag heat and pregnancy on their public sites. (The AAFP does address health threats from climate overall, and notes that air pollution or exercise in extreme heat can be harmful during pregnancy.) The CDC and the Environmental Protection Agency websites do address heat and pregnancy and they’ve been updated, despite the Trump administration’s public health cuts and its position that climate change is a “hoax.”

It’s impossible to know how many women who are pregnant or thinking about becoming pregnant turn to those government sites – or how they cut through such jargon as defining high heat as “above the 95th percentile of mean temperature.” Some health plans do link to those agency sites in the information they send to pregnant people they cover, according to a spokesman for the health insurer trade group, AHIP.  

No escape

Cities are supposed to operate cooling centers on the hottest days of the year. But opening a cooling center in Jackson requires two consecutive days of 100 degree temperatures or heat advisories, according to Nic Lott, communications director for the city of Jackson. 

And outside the capital city region, there is seemingly no concerted effort to do so – even in metropolitan areas on the coast. Communications officers in Gulfport and Biloxi said they were not aware of any efforts to open cooling centers this year or in recent years. 

When cities do open those centers, they are typically only accessible during the day.

Dominika Parry, an environmental economist who runs a Ridgeland-based climate resilience nonprofit, 2C Mississippi, had hopes of changing that. In 2024, her group was awarded a $20 million federal grant to bring a 24-hour cooling center and resiliency hub to Jackson. It would have housed up to 150 people and included tornado shelters, kitchens and showers. 

But Parry’s group lost that funding when the Trump administration ended grants for various environmental justice and climate resilience projects. Her nonprofit is one of 23 affected groups suing in a bid to reinstate funds. 

Unlike other catastrophic weather events that happen quickly and have concentrated effects, heat happens slowly and quietly. Still, extreme heat kills more people annually than flooding, hurricanes or tornadoes. 

“Heat is by far the most dangerous weather-related phenomenon,” Parry said. 

Translating between climate science and medical practice is difficult. Studying ambient temperature or changing rainfall isn’t the same as figuring out how heat affects a pregnant woman’s blood vessels, or a developing embryo. There’s a gap between the public health data being gathered, and the practical advice clinicians can use, said Lyndsey Darrow, a climate researcher at the University of Nevada, Reno, School of Public Health. 

“The ideal study to do, of course, would be to put monitors on hundreds of thousands of pregnant patients, monitor them and see what the outcomes are,” she said. “But that’s not realistic. Not only is it a major undertaking, it would cost a lot.”

That leaves some critical questions. Is a single 100-degree day dangerous, as some studies suggest? Are two 95-degree days worse? What about four days at 90? How early in pregnancy is it a factor? How late?

Even without complete answers, experts say the science is well enough established that prenatal care should routinely include guidance about alternatives to air conditioning, such as using cool towels and being extra careful to avoid dehydration, which triggers a cascade of physiological changes. 

The climate challenges, illustrated by the “heat dome” that recently enveloped so much of the country, are growing even as many women don’t get early prenatal care. Mississippi is among the states where the share of women getting prenatal care in the first trimester dropped in 2024, according to Georgetown University’s Center for Children and Families.

Mississippi State Health Officer Dr. Daniel Edney declared a public health emergency over infant mortality last August. He has addressed “maternity care deserts,” and introduced ways of proactively intervening in premature or other high risk births. But Edney’s department has no publicly-available plan for how to address the reproductive health outcomes caused by heat and extreme weather.  

Planting the seeds

Leading the charge to address climate disparities for families are two unlikely contenders: Librarians and doulas. 

Over her five years as director of the Laurel-Jones County Library, Karyn Walsh has watched the library transform into a center for the community. The resources stretch far beyond books: People can check out fishing poles, telescopes and tools, Walsh said. Public libraries remain among the last free, communal spaces in the U.S., especially critical for families.

About half of the people using her library have young children and about 1 in 5 are pregnant, Walsh estimates. Walsh said that during the summer, people often ask if they can come and sit for a while to avoid the heat. Walsh always says yes, and offers a book. 

Walsh and her team view these moments as a chance to reach those with the fewest resources and connect them to classes, programs, community and job opportunities.

“Hopefully, we’re planting the seeds to break the cycle,” Walsh said. 

About four hours northwest of Laurel and back in the Mississippi Delta, Jacqueline Lambert works as a doula not far from the community that raised her. Lambert runs an independent practice out of Merigold, and also leads the doula program at Delta Health Center in Mound Bayou, one of the nation’s oldest all-Black municipalities. 

Roughly 12% of the women Lambert serves don’t have access to consistent and adequate air conditioning, she said. Many of those pregnant women live with extended family and cannot afford more effective cooling systems, Lambert said. Regularly, she sees pregnant women and several of their family members cooling down around one oscillating fan, or sleeping together in a bedroom with an insufficient window unit. 

Lambert believes doulas can help move the needle on climate change and health inequity, because they act as a bridge between clinical care and community support. As a doula, she spends hours longer with patients than other providers do – and gets to see them in their homes, where she is better equipped to understand their situation. Mothers open up to her on a daily basis, Lambert said. 

“They begin to relate to you as a trusted friend, as a support person, somebody to laugh with or even cry with,” said Lambert. 

Lambert is proud to work at Delta Health Center, which offers free doula services to low-income women through maternal health grants. Often, these women find out about the doula services as existing patients, or through word of mouth. But it’s rare that low-income women can access doulas in Mississippi, where Medicaid does not cover those services. 

The March of Dimes, dedicated to reducing premature birth and birth defects – both of which have been linked to heat exposure – has urged Mississippi to change that restrictive policy. 

For most low-income mothers, assistance only comes from grassroots efforts, such as Chatman’s “Beat the Heat” event in Cleveland. 

Matthews, the single mother from Cleveland, hopes the box fan she received will bring her some relief. She’s felt anxious recently. She wonders if the abdominal cramping she’s experiencing lately is normal or a sign of something worse. With two small children, she said she is often up on her feet in her apartment where staying cool and lying down often feel nearly impossible. 

“I try to relax my mind and get in front of the small air (unit) in the house,” Matthews said.

This article was originally published by Mississippi Today and is republished here under a Creative Commons license.

Source: Original Article