Why SA’s Health Department will send flood and heatwave warnings to pregnant women

Nobuntu Malgas,* (24) lost her balance when a torrent swept her off her feet, pulling her into a gushing stream. 

She was almost eight months’ pregnant and on her way to the shops in her hometown, Port St Johns in the Eastern Cape, to buy clothes for her unborn baby.

But what was meant to be an ordinary trip into town turned into a gut-wrenching ordeal.

“It’s a miracle that I survived that day. When I tried to cross the street, the water was already above my knee,” she remembers.

It was a Monday in mid-October 2023, but she’s “not sure of  the exact date”. She remembers it was pouring, though. 

Weather warnings and news reports from Monday, 16 October show heavy downpours had quickly turned roads into what looked like rivers. 

That kind of rainfall was unexpected for early spring. Data from the past 30 years shows the area usually gets at most about 90mm of rain in October, but in 2023, 156mm fell that month, records show – almost twice as much as what’s typical for that period. 

This was the second time in just more than six months that Port St Johns experienced heavier-than-normal rains. At the end of March 2023, torrential rains in the seaside town and surrounds disrupted electricity supply, destroyed road infrastructure and left three people dead.

Malgas had reason to worry. 

Data from 33 developing countries published in the journal Nature in January shows that the chance for a miscarriage or stillbirth can be up to 8% higher during extreme weather events such as floods than in normal times. A brief, one-off event is not so risky, but if the flood lasts more than two weeks or flooding is experienced more than once during the pregnancy, chances of losing a baby can be up to twice as high.

Pregnancy puts extra demands on a woman’s body to support her growing baby. For instance, her heart has to work harder to pump enough blood around her body, blood pressure is often lower than normal, the kidneys work harder, lots of energy is needed from food and breathing can be strained. 

Having to face even more  stress – physically or mentally – during this time can be bad news. The authors of the Nature study write that floods can put pregnancies in danger because there’s a bigger chance of moms getting injured in poor weather conditions or falling ill with infectious diseases (such as cholera or malaria) because of standing water and services like electricity and sanitation being disrupted. Roads or clinics being washed away also means that it can be hard for pregnant women to get medical help and studies show that stressful events like storms and floods can lead to complications including low birth weight or early birth. 

Back in Port St Johns, Malgas was grabbing onto a street pole as the gushing torrent, already up to her knee, swept her off her feet.

She couldn’t swim. 

“When I started to float, I thought it was the end of me. Was it not that I was able to hold onto something, I probably would have drowned. The water was very strong.” 

Dangerous weather ahead

Climate scientists say we’ll see events like this happening more and more as weather patterns start to change because of (mostly) our burning of fossil fuels causing the air around the planet to warm. In fact, the world’s average air temperature is already at least 1°C higher than it was about 150 years ago – and time’s running out for us to try to keep the rise below 2°C in order to keep our planet at a temperature that would support life as we know it. 

But it’s not just floods putting pregnant women in danger – it’s heat too.

Studies show that long periods of hot days are linked to a higher chance of early births, babies being born too small or stillbirths – and even more so in low-income countries. 

During pregnancy, a woman’s body already struggles to keep cool because of the extra heat generated by the growing foetus, by carrying more weight and building more fat, which essentially insulates the body. So, when outside temperatures rise too, like on very hot days or during a heatwave, it’s even more difficult to keep body temperature in check. 

In such situations, pregnant women can easily become dehydrated, which in turn can put extra pressure on the heart and kidneys to try to keep salt and water levels in balance so the body’s chemical reactions work as they should. Stresses like these can make it difficult for enough blood and oxygen to reach the foetus, which can cause damage to body cells and set in motion a host of chemical reactions to try to counter this – all of which can increase the chance of early labour, miscarriage, stillbirths or birth defects in the baby. 

You’ve got a message

That’s why the Clinton Health Access Initiative (Chai) and the Health Department are working on a pilot project that will send early warnings about dangerous weather to pregnant women and mothers of young children using the department’s popular mobile maternal health text messaging system, MomConnect. 

MomConnect, on which 95% of public sector clinics in South Africa have registered new mothers, sends women information about things like antenatal health, what to expect and look out for during labour, breastfeeding and childhood immunisation.  

Piggybacking on this system means up to about 420,000 people – the number of active users of the messaging service in September 2023 – could, in theory, be warned about coming floods or heatwaves, said Elizabeth Leonard, a researcher from Chai during a presentation at the Board of Health Funders’ conference in May.

Leonard says that linking weather warnings from the South African Weather Service to the messaging service will likely be rolled out to users in Limpopo “from the second half of 2024” to give them advice on what to do during extreme weather conditions such as heatwaves, floods or droughts. 

For example, alerts could help women look out for signs of heat stress and help them to know when it’s necessary to go to the clinic or how to keep cool or stay hydrated. (During heat stress the body starts to overheat and can’t cool down. This can lead to serious dehydration and complications during pregnancy.) 

“[Climate] disasters tend to discriminate against women and children,” says Leonard. But sending early alerts directly to women instead of only to clinics and hospitals can “enable them to take action to avoid risk”.  

Early warnings can save lives

The pilot project, for which the last planning is under way, will start in Limpopo, says Leonard. It will later be rolled out to other provinces, such as KwaZulu-Natal and the Free State. In all three regions the combination of how or where people live and changes in weather patterns in future, such as much less or much more rainfall than usual and rising temperatures, is likely to make life harder for people, for example by threatening food supplies, water becoming scarce, extreme heat or the spread of infectious disease. 

“We’re still in discussions around the actual implementation phase of the pilot, [but] it will be an opt-in feature [on the app] once someone has registered on MomConnect,” says Leonard.

Having early warning about possible weather-related disasters can help to keep people healthy. For example, in a study from the Ohangwena region in the north of Namibia, which is part of the Okavango Basin and where flooding often occurs, researchers found that health workers could give people with HIV a few months’ supply of their antiretroviral medication in advance when they knew floods were likely to happen. 

This means people don’t have to stop taking their medicine because they can’t get to a clinic or health workers can’t reach them, so there’s less chance that the virus can start weakening their immune system again and start multiplying, making people infectious again and increasing the risk of HIV spreading.

In South Africa, 27.5% of pregnant women are HIV positive, the country’s latest antenatal HIV report shows. 

Getting messages right

Adding a feature for warnings about weather threats to an existing system that tracks people’s health, such as MomConnect, can be a good step, says the World Health Organization, because it not only allows health workers to respond to problems faster but also prepares places like clinics and hospitals to deal with health problems that crop up during such events. 

But, says Gloria Maimela, director for climate and health at the Wits Reproductive Health and HIV Institute, it’s important that information reaches a wider group of people than just, say, pregnant women in a case like MomConnect. 

“When [not only] women but [also] their partners, mothers-in-law and aunties are given enough information and they understand the risks [of things like heat exposure], they tend to change their behaviour,” she says.

Findings from other early-warning projects about weather disasters, like in Peru and Nepal, show that messages should be delivered in the way people are most likely to respond to – and take into account how gender roles play out. 

For instance, if someone can’t read or has an eye problem, text messages delivered on a cellphone won’t help much. In the case studies from Peru and Nepal, women also preferred to receive alerts as voice notes or through loudspeakers, while men favoured SMS alerts. And because of the type of clothes women traditionally wear in, for example, Nepal, having to care for children and elderly family members, or not being able to swim also meant that they often couldn’t respond to the flood alerts in time. 

Maimela adds that when women don’t have smartphones with which to access an app, getting community health workers to share weather warnings could also help, like in Ohangwena. 

At Malgas’s two-bedroom home in Port St Johns, the young mother is nursing her now six-month-old daughter, Odwa. She was born – healthy – on 28 November, about six weeks after Malgas’s narrow escape. 

“I was lucky; things could have turned out so differently. Everyone was panicking. But two men – one who’s a taxi driver – helped me get out of the water and they took me home in the taxi,” she recalls.  

Malgas says the experience traumatised her other child, three-year-old Onwaba. “Whenever it rains hard, she always thinks that our house is going to flood and tells me to close the door so that the water won’t seep into our home.” DM

*Not her real name.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.