Extreme heat reduces antenatal care with highly unequal impacts across low- and middle-income countries

The World Health Organization (WHO) recommends a minimum of eight antenatal care visits during pregnancy, a target that has shaped global maternal health benchmarks and investment priorities since 2016. Rises in temperatures globally, however, threaten to stall or reverse progress in expanding antenatal care coverage by disrupting access to healthcare services. This study investigates the impact of extreme heat on antenatal care utilization across 52 low- and middle-income countries (LMICs) around the world. For this, Demographic and Health Survey data on more than 860,000 live births are linked with high-resolution, gridded temperature data for each pregnancy. The findings indicate that heat exposure above 35°C during gestation is overall associated with fewer antenatal care visits in LMICs, but particularly in Sub-Saharan Africa. Large inequities exist between world regions and within Sub-Saharan Africa, where ANC coverage is still comparatively low. Adverse heat impacts are particularly pronounced for mothers who have lower socioeconomic attainment, live in rural areas, and face significant barriers in accessing healthcare more generally. By contrast, in some world regions mothers are able to intensify antenatal care utilization under extreme heat, highlighting that responses are not uniform across contexts. The study underscores the need for targeted interventions to ensure maternal healthcare access in the most vulnerable populations across the world under intensifying climate stress.