Climate-Resilient SRHR Services for Migrant Women in Bangladesh: Bridging Gaps and Empowering Vulnerable Populations

In the crowded, low-lying cities of South Asia, a quiet crisis is unfolding where the environment meets the human body. Climate change is no longer just a story of rising seas or hotter summers; it is a force that reshapes where people can live and how they survive. When extreme weather destroys homes and livelihoods in rural areas, millions of people are forced to move to cities. For women, this journey is often more dangerous and difficult than for men. They face a double burden: the trauma of losing their homes to floods or storms, and the struggle to find basic healthcare in a new, unfamiliar city. This is especially true for sexual and reproductive health, which includes everything from pregnancy care and birth to family planning and protection from violence. When a city's infrastructure cannot handle the heat or the rain, the most vulnerable people—those living in makeshift settlements without proper drainage or secure housing—are the first to lose access to the doctors, medicines, and safety they need.

A new study by Nafisa Mosaddek from the Bangladesh University of Professionals shines a light on this specific reality in Dhaka, the capital of Bangladesh. The research focuses on the women who have fled climate disasters and now live in the city's informal settlements, often called slums. These are areas where the population is growing faster than the city itself, characterized by overcrowding, insecure housing, and a lack of basic services. The study asks a critical question: when climate change pushes women into these neighborhoods, what happens to their ability to get care for their reproductive health? The answer reveals a system that is not just struggling, but actively failing a massive portion of the population.

The researchers found that the gap between women living in these informal settlements and those in the rest of the city is not a small difference; it is a chasm. In the non-slum areas of Dhaka, nearly six out of ten pregnant women receive care from a medically trained provider. In the slums, that number drops to less than three out of ten. The situation is even starker for giving birth. While two-thirds of women in the rest of the city give birth in a health facility with skilled help, only about one-third of women in the slums do the same. Instead, many rely on home births assisted by untrained attendants, a practice that carries significantly higher risks for both mother and child. The study confirms that for a climate-displaced woman arriving in Dhaka, the city does not offer a safety net; it offers a service environment that is roughly half as effective as the one available to her neighbors just a few miles away.

This disparity is not caused by a lack of desire for care, but by a collision of climate shocks and social barriers. The study details how the very weather that forced these women to move continues to block their access to help. When the monsoon rains turn the streets into rivers, roads become impassable, and clinics are cut off. When heatwaves strike, the extreme temperatures make it dangerous for women to travel, and the lack of cooling in their homes and workplaces drains their energy and health. These are not one-time events; they happen almost every year, creating a cycle where women are constantly recovering from the last flood while preparing for the next. This constant disruption breaks the continuity of care. A woman might start her pregnancy check-ups, but a flood or a heatwave can stop her from returning, leaving her without the support she needs until it is too late.

Perhaps the most startling finding is the role of violence in this equation. The study reveals that for women in these settlements, the threat of violence is a primary barrier to their health. More than eight out of ten women surveyed reported experiencing some form of violence from their partners in their lifetime. This includes physical, emotional, and sexual abuse. The research shows that this violence is not a separate issue from health; it is the reason many women cannot make their own decisions about their bodies. Even when family planning methods are available, a woman may be unable to use them if her partner forbids it or if she is too afraid to ask. The study notes that while many women know about contraception, the need for it remains unmet because of fear, shame, and a lack of power within the household. Only a small fraction of women who suffer violence ever tell anyone or seek help, leaving the cycle of abuse and poor health to continue in silence.

The researchers did not just identify the problems; they proposed a practical way forward that treats health services as essential infrastructure, much like roads or bridges. They suggest that to survive the changing climate, health services for these women must be redesigned. This means building clinics that are safe from floods, perhaps by elevating them or moving them to higher ground, and keeping them cool enough to operate during heatwaves. It means sending mobile teams on boats or foot to reach women when the streets are underwater. It also means using technology that works for this specific population; the study highlights that sending voice messages to women's phones has already proven effective in increasing the number of women who seek prenatal care. Because many women work outside the home or are too shy to visit a clinic, these digital messages can reach them where they are, providing crucial information about pregnancy dangers and when to seek help.

The study also points out that fixing this problem requires more than just building better clinics; it requires a change in how the system is funded and governed. Currently, the money and authority for these services are split between different government departments, making it hard to coordinate a response that includes climate protection. The researchers argue that health services for climate migrants must be explicitly included in national plans for climate adaptation, with dedicated funding to ensure they can operate even during disasters. They emphasize that the solution is not a new invention but a reorganization of existing tools. The technology to send health messages exists, the model of contracting non-governmental organizations to run clinics has worked before, and the framework for building climate-resilient health systems is already defined by global health experts.

Ultimately, this paper argues that the ability of Bangladesh to adapt to climate change will be measured by how it treats its most vulnerable women. If the country can build a health system that protects a woman's right to safe pregnancy and freedom from violence, even as the weather becomes more extreme, then its climate adaptation is real. If it cannot, then the millions of people projected to be displaced by 2050 will face a future where the city offers no refuge, only a continuation of the crisis that forced them to leave their homes in the first place. The path forward is clear: treat reproductive health not as a luxury, but as a critical piece of climate infrastructure that must be heat-proof, flood-accessible, and ready to serve everyone, no matter where they have been forced to go.