The Impact of Climate Change and Environmental Hazards on Infant and Maternal Health

In 2022, for the first time in 20 years, infant mortality increased by 3%.1 Non-Hispanic Black, American Indian, and Alaskan Native infants are disproportionately impacted.2,3 These groups also have higher preterm birth rates.4 The most recent statistics for infant mortality, as of 2023, show no change.5 Non-Hispanic Black infants had the highest infant mortality rate, while the rate for Mexican American infants saw a significant increase.5 Our world is currently facing a polycrisis, where multiple interconnected crises affect society. Two of these are climate change and environmental hazards. Climate change, characterized by rising temperatures and hazards like air pollution, water toxins, and chemicals in household products, disproportionately impacts communities of color.6 This further worsens health inequities for women and infants of color. For this special series on how climate change and environmental hazards affect infant and maternal health, we invited manuscripts that explore these impacts on women and infants, focusing on practical solutions to safeguard the health of future generations. One critical but often overlooked environmental hazard is water insecurity. As highlighted in Lapsley & Rutherford’s manuscript, water insecurity—defined as the inability to access affordable and clean water for drinking, cooking, sanitation, and hygiene—has direct and intergenerational effects on neonatal health.7 In California’s San Joaquin Valley, rural and agricultural communities face disproportionately high rates of neonatal morbidity and mortality due to water insecurity, compounded by climate-driven droughts, contaminated groundwater, and systemic inequities. The Integrated Socio-Environmental Model of Health (ISEM) offers a framework for understanding how social and environmental determinants—such as racism, poverty, and climate-driven water scarcity—interact to influence neonatal outcomes.8 Nurses can use tools like the Household Water Insecurity Experiences (HWISE) scale to screen for water insecurity and guide interventions, particularly during neonatal intensive care unit (NICU) discharge planning.9 Simultaneously, disasters—whether climate-rela-ted or otherwise—pose unique challenges to breastfeeding mothers and NICU families. In this issue, Russell et al propose a structured approach using Kumpfer’s Resilience Framework and the CMIST Framework (Communication, Maintaining Health, Independence, Safety, Support, and Transportation) to support NICU mothers’ breastfeeding goals during disasters. These frameworks emphasize the importance of resilience-building, tailored interventions, and disaster preparedness in promoting maternal and infant health. For example, during Hurricane Maria, NICU families faced prolonged separation, emotional distress, and disrupted feeding routines.10 By integrating CMIST into NICU disaster planning, nurses can proactively address barriers such as transportation, access to lactation support, and safe feeding environments.11 The complexities of these crises necessitate an innovative, interdisciplinary approach in our nursing practice, research, curriculum, and policy to empower our patients with the knowledge and skills to navigate this polycrisis.12,13 Nurses can and should be at the forefront of this movement13—from having a voice in product selection in the NICU to educating families about environmental risks and disaster preparedness.12 These contributions highlight the urgent need for nursing leadership in addressing environmental and disaster-related threats to maternal and infant health. —Desi M. Newberry, DNP, NNP-BC, CHSE, CNEAssociate ProfessorDirector, Neonatal Nurse Practitioner MajorDuke University School of NursingDuke Intensive Care NurseryUNC Newborn Critical Care Center