Quite. It is high right now. We will have more kidney disease. We will have more heat strokes. Only if we work can we have food on our plates. The World Health Organization says its pregnant women and Young Children who will face some of the gravest consequences of all from climate change. But Simple Solutions to better protect women are there. This is a big challenge, which we anticipate, and everyone has got a role to do. Teach them about the recipes that can cool their body. And before, this was all open . Open, open. So the sun would just be on the workers . Yeah. Translation i consider being pregnant a great blessing. Every morning, lavanya wakes at 5am and heads to the fields of flowers close to her home. There she spends three hours picking some of the thousands of delicate tube roses that have sprung up overnight. Translation only through work can we have food on our plates. L thats our situation. One persons income is not enough to feed the whole family, so its important that i contribute. It gives me immense satisfaction. Lavanya gets paid around 300 rupees for her efforts. Thats just under £3, or 4. Her in laws own the fields she works in. But now she carries more than just her collection buckets. Lavanya is six months pregnant, when the test came back positive, i was so happy. I had some dizziness in the first couple of months, but i was ok. At five months, i started feeling the baby kicking. It is tough working in the heat. I wear a shirt and a headscarf to protect myself from the scorching sun, but i sweat a lot. And that causes a Burning Sensation on my skin, in my eyes. I feel itchy all over my legs, and it can get painful. We know that extreme heat can cause significant strain on the body and can even lead to death. But theres now increasing evidence that pregnant women and their unborn babies face unique risks. A new study investigating the impact of heat stress on pregnant women here in tamil nadu followed 800 mums to be. Researchers found that those who worked in extreme heat faced double the risk of stillbirth, premature birth, miscarriage and low birth weight. The mechanisms around why this is happening are not well understood. One theory is around possible reduced blood flow to the baby, because when the mother gets too hot, blood could be diverted away from the foetus to cool the mother down. The study took into account the various workloads of the women, but they still found that heat was a key risk factor. Its already getting so hot here. How are you going to cope when the summer really kicks in . Translation it will be tough doing this work i with a big bump. Even now, i get severe back pain. I will try and take lots of breaks and drink plenty of water. Another day, another field, another young woman works hard to put food on the table for her family. Hacking down the thick stems of sugar cane is backbreaking work. These workers start early In The Morning to avoid the worst of the hot sun. Its around 28 degrees at the moment, and very humid. Ive been sweating quite a lot all morning. The workers earn around 600 rupees a day. Thats around £6, 8. And almost all of it is spent on feeding their extended families each day. By mid morning, its time for the workers to take a well earned is minute break. They gather together, cool down in a shady spot, and share their breakfast. Nearby, 28 year old sandhiya and i also find a covered area to chat. She has two children, but her first pregnancy ended in tragedy. Translation | used| to work the whole day when i was pregnant. I wouldnt take much rest. My legs would get so swollen and painful. I remember being thirsty all the time and out of breath. One day, i was cutting the crops in the paddy fields. I had felt some pain in my abdomen In The Morning, but i came to work anyway. I tied up the bags of paddy and tried lifting them onto my head, and i suddenly felt an intense pain in my stomach. I started bleeding heavily. I went to see the doctor in the evening and they told me my baby had died. Most of us women who have miscarriages never find out why their babies died. But do you think that working out in the heat could have had anything to do with it . Translation i think so. I think standing in the heat for hours could have had an impact. Sandhiya had to take several months off work after her loss. She tells me the family built up huge debts during that time, which theyre still paying off. Translation | still think about that baby a lot and wonder why the child isnt with me. Was it because i worked so hard in the sun . I dont know. I think about it and just feel so bad. India is one of the countries most exposed and vulnerable to heat globally. The number of hot days and hot nights are projected to double or even quadruple by 2050, according to indias centre for policy research. I wanted to better understand how the researchers behind the study on heat stress and pregnancy have reached their troubling conclusions. We pick up rekha shanmugam, whos from the sri ramachandra Research Institute in chennai. Shes been investigating the impact of heat stress on pregnancy for the last seven years and wanted to show me how shes been doing it. Throughout her study, her team would set up this temperature gauge, measuring the level of heat workers were exposed to during their shifts on several days throughout their pregnancies. This is environmental heat stress monitor. This gauge doesntjust measure your standard temperature. It also takes into Account Humidity and radiant heat. The safe threshold for people working in a field like this one, measured in whats called wetbulb globe temperature, is 27. 5 degrees celsius. Now the temperature is 29. 5 degrees centigrade. Quite. It is high right now. Were going to work for a prolonged period. With this temperature, they are more prone for heat related illnesses and other effects, especially for the pregnant women. They are more prone for adverse pregnancy outcomes such as miscarriages, low birth weight, preterm birth, stillbirth, and congenital birth defects, too. How surprised were you when those results came . Because thats a big difference. Double the risk. Actually, i was quite surprised. This result can be used as a basic, lay a foundation for the other studies. There is a long way to go to in order to find the exact biological mechanism behind this. That may help us to improve the Reproductive Health of the women globally. Although scientists dont know why this is happening, Previous Research by rekha and her team has found many women in general avoid drinking at work because they dont want to have to go to the toilet. Rekha thinks this could be an aggravating factor. We found that the prevalence of about 50 percentage of women have reported the urogenital issues such as Burning Sensation, changes in urine colour, changes in urine volume, too, because of inadequate toilet access in the workplaces. Avoiding drinking when working this hard for hours in the heat, especially when pregnant, can be extremely dangerous. Many women worry about being accosted by men when trying to use the loo. So there are no portaloos here. Theres nowhere specific to go to the toilet. But this, behind a bunch of bushes, is kind of the safest area that many of these women can come. Ive been pointed to this tree. This is where people tend to go. It can be very uncomfortable. Its actually not very private. And they said that they really worry about snakes and other insects here. So, many women have said that theyjust hold it in and they dont go during the day. Women make up the backbone of whats called the informal workforce, people who are generally low paid and have very few legal, social and financial protections. It can make it harderfor them to get access to government subsidies, including payments during pregnancy here in tamil nadu, aimed at improving Maternal Health. Its the poorer informal workers who are generally most at risk of suffering from the effects of heat. I also meet these women in each trimester. People like sumathy. She turns up to this Cucumber Field in between her otherjobs to earn what she can. She lost her baby three months into her pregnancy. Since they last met, sumathy explains, her husband has died. Shes now the sole breadwinner for her two Young Children and mother in law. Sumathy tells me shes been working in the fields since she was i2 years old and earns around 400 rupees or £4 a day. Picking the prickly cucumber, she says, burns my hands after a while, especially in the heat. Taking a breakfrom her work, sumathy told me about the day she lost her baby. Translation i used to feel so exhausted. | i also did not know how to look after myself as it was my first pregnancy. I felt very unwell. So i went to the doctor, who told me i had a miscarriage. I just lost it. I shouted and i cried. I could not tolerate the fact that my baby was no more. Im very sorry to hear about your loss. I have had miscarriages as well, and i. Know how hard it is. Translation my husband took care of me at that time. When i was helplessly crying. He would lay me on his lap and console me. I dont know what i would have done without him. Sumathy will never know whether working in this kind of extreme heat had anything to do with her losing her baby. But there is now increasing evidence that it can have an impact on pregnancies. And that is why this type of research is so important, because women need to know about these risks in order to be able to better protect themselves against them. Sumathy did get pregnant again within a couple of years. And having got advice on how to look after herself from rekha and doctors, she went on to have two healthy children. Tonight, after her long shift, she will return home to them. Exhausted, anxious, but so grateful they are there. Our beautiful planet. Precious. Delicate. Fleeting. Everything is balanced so perfectly to support life. But our world is predicted to warm by almost three degrees celsius by the end of the century, compared to pre industrial times. Resulting in more heatwaves, more droughts, which will impact food supplies, and widening areas where mosquito borne viruses can thrive. And it will be the most vulnerable, the young, the old, the poor. Women carrying new life inside them, that will and already are being hit hardest. India, with its massive population, remains one of the largest emitters of Greenhouse Gases globally. And theres little sign of things slowing down. The country is making Big Investments in renewable energy, but it continues to rely heavily on fossil fuels along with the rest of the world. India has made enormous strides in improving Maternal Health across the country in the last decade. Ive come to chennai to meet the director of Public Health for tamil nadu state. Today, hes leading a meeting on the roll out of a vaccine for cervical cancer. The number of persons which we are experience. Going to reach is a very huge. He helps look after the health of 82 million people, of which around one million are pregnant at any one time. All the Communicable Diseases are bound to increase when there is a challenge in the climate or the environment. This is a big challenge, which we anticipate, and everyone has got a role to do currently. Then only at least we can mitigate or we can prevent the further damage at least. What things can be done to help these women . Outdoor work, if there are no other options, definitely at a periodical interval. We can have them to get rehydrated and take sufficient rest in between. Weve been out. Weve met some women working in these kinds of environments. Actually, what all of them said was that they dont have access to toilets, that they are having to go outside or, and this is worse in a way, that they are holding it in. Is there part of a Health Strategy plan to implement more toilets . See, this is the basic rate which we should ensure to everyone, including the pregnant women. See, this type of employment or the employer, they should be given a responsibility or they should made to give this facility to all the working women. Much of the power to protect these low paid workers rests with the bosses of these types of workplaces. Thank you for inviting us here. Thank you. The owner of this brick kiln on the outskirts of chennai was keen to show me the sheds hes built to provide shade for his workers. And before this was all open . Open, open. So the sun would just be on the workers . Yeah, yeah. Ah. Its made a big difference. Yes. He says using machines to make the bricks, instead of human hands, has also made the work safer for employees, and is making him more money. He also provides easy access to clean drinking water, and tells me hes planning to build women only toilets. Translation women no longer have to toil under the sun. This kind of work can be very difficult for them. They used to have more health problems, but since we started using the machinery and got these sheds, they dont suffer as much. Until recently, all of this was open air. These labourers would be doing this work under the glaring sun. But since this shed has gone up, these workers can be much more comfortable as theyre doing theirjobs. And the boss here tells me that productivity has increased significantly, too. She tells me its slightly cooler in the shade and feels much better, because outside is extremely hot. Life is still clearly tough for these workers and theirfamilies, most of whom live on site. Many of the children attend a nearby school, working hard in the hope that one day theyll be able to leave this level of poverty and achieve their full potential. 400 miles north of chennai in hyderabad, a busy mother and baby clinic is getting underway. And pakasri is six months pregnant and has come for a checkup with her daughter, brunali. We give checkup for the people who cant afford. Dr divhya says she and her staff see many problems associated with the heat come the summer months. They come with the dizziness, most common symptom is that. And they come with generalised weakness, or they say they cant do any work. And also, then we will go for a Blood Pressure checkup. After that, well get to know that those patients are under hypertension group. So. So, low Blood Pressure. Yeah. We advise them oral rehydration and. Or we inject normal saline for boosting up their energy. All is going well for pakasri and her baby. Shes been given advice on how to stay safe in the heat, keeping herself well hydrated, avoiding being out in the hottest time of day. Armed with this vital reminder, she heads home to rest. Now we have warmer nights, so that. Back in chennai, academics studying for their doctorates are trying to better understand the impact of heat on the body. So they are forced to continue working. And when the brain. Vidhya venugopal is a professor at the department of Environmental Health at the Sri Ramachandra Institute of Higher Education and research. Among her students is rekha, who has recently returned from the field where we last saw her. Professor venugopal oversaw the heat stress and pregnancy study which was funded by the Indian Government and is now leading these academics in the next set of studies. Cucumbers. Very, very, very cooling, but very cheap. One of the new studies is looking into low cost food and drinks, which can be recommended to workers. This is one of the best way to cool your water. How concerned are you about what youre seeing with more frequent heatwaves, both here and around the world, and our health . One needs to take this pretty seriously, is what i would say. We will have more kidney disease. We will have more heat strokes. We will have more heat exhaustion. And Productivity Losses will be there. Therell be lot of people who will be losing their wages. We will be losing working hours. So this will have a large impact not only on the health, but also on the economy of the countries. She tells me in the last decade alone, this city of chennai has seen temperatures rise by almost half a degree. Climate change is happening. We are seeing that globally, all the countries are warming. And then its going to be more. More difficult for people to be actually working outside, lets say about two or three decades from now. By 2050, people probably will not be able to work outside at all in the afternoons. Its water delivery day in a large slum in hyderabad city. These are some of the poorest communities in the country, and some of those most at risk to the impact of climate change. So the water tank has just pulled in. This brings water about every four days, and each family gets two of these large blue drums each. And thats for everything. Its for cooking, its for cleaning, its for staying hydrated. Once the precious water is collected, some of the women gather for an event put on by researchers and a climate and health group, aimed at better understanding womens experiences and offering Simple Solutions. Neloufer is leading todays session. Summer is on the way, she says. Come. We women are going to sit and discuss how the heat will affect us. The women talk about how hard it is to take a break at work. Most of them are domestic cleaners. One woman tells how some employers allow fans, but others switch them off because they dont want to pay for the electricity. Others tell how maids are often banned from using the toilets at employers homes, and one described how a friend ended up wetting herself, for which she was promptly fired. To them. To understand this heat risk is. And they cannot stay back in the home, because they have to go to the work. They have to go out under the sun, and they have to work for their children to fill their stomachs. And so what we are doing is. Through these sessions, we are making them aware that making little changes in their lifestyle, like carrying a water bottle and carrying an umbrella with them, will. May help them with the heat risk. Can we go and see where you live . All right. 0k. After the session, i meet with 18 year old esther. Shes six months pregnant. Esther tells me the scarcity of water means shes already limiting how much shes using. She wanted to show me how her and her husband will manage when the little one arrives. T