Executive Summary

India's rapidly growing cities are becoming dangerous for pregnant women as extreme heat combines with inadequate housing and fragmented health systems to create life-threatening conditions. The Heat in Pregnancy – India (HiP-I) project brought together leading experts to examine this escalating crisis and identify urgent solutions.

The Hidden Emergency
In Gurgaon, pregnant women face a hidden emergency where extreme heat, poor housing, and weak health systems combine to create life-threatening risks. Clinical evidence from Civil Hospital shows women arriving only when dehydration, kidney complications, or prolonged labour have escalated into emergencies—conditions that could have been prevented with timely care. Unlike rural areas, where community health workers provide a safety net, urban poor women are left to navigate complex health systems alone.
Housing conditions often worsen the danger. Corrugated metal roofs and poor ventilation can trap heat and pollution indoors, sometimes making homes hotter than the outside environment. Misconceptions that staying inside is protective further heighten risks. At the same time, fragile water infrastructure forces pregnant women into heavy physical labour to secure water, exposing them to contamination and additional heat strain.
Yet policy responses remain blind to these realities. Heat Action Plans, modelled on Western contexts, overlook pregnancy-specific vulnerabilities and focus narrowly on mortality rather than the spectrum of heat-induced complications with long-term consequences for mothers and children. Missed opportunities also persist in urban development: landlords who steadily upgrade informal rental housing could be mobilised to introduce heat-resilient designs, but remain absent from policy strategies.

A Path Forward

Protecting pregnant women from extreme heat requires coordinated action across multiple fronts. Health systems should designate dedicated officers to oversee maternal care in heat stress. Migrant women must be registered in local health and welfare systems to ensure access to antenatal services and entitlements. Frontline providers need targeted training to recognise and manage heat-related maternal complications, with screening integrated into routine antenatal visits and active outreach during heat alerts to reach high-risk or less connected women, including migrants.
Housing conditions demand urgent attention. Partnerships with landlords can support passive cooling measures such as reflective paints, better ventilation, and alternative roofing, while community-level water interventions such as public taps and improved storage, can ease women’s heat burdens. However, these efforts require strong policy backing, as local governments and public health authorities must allocate resources and sustain such infrastructure.

Policies must be tailored to local realities. India-specific research is necessary to understand the impact of heat on pregnancy, and early warning systems should incorporate humidity and nighttime temperatures, rather than focusing solely on peak daytime heat. Coordination across sectors is essential. Governance fragmentation leaves pregnant women in informal settlements without protection, while urban planning, health systems, water management, and housing policy continue to operate in silos. Breaking these silos is key to effective adaptation.