India’s summers are growing hotter and air pollution remains stubbornly high, leaving pregnant women and children particularly vulnerable. The dual burden of extreme heat and toxic household air is harming health across the country, but climate responses continue to treat these crises in isolation.

Multiple studies show the dangers of heat exposure in pregnancy: higher risks of miscarriage, stillbirth, low birth weight, and preterm births^1,2,3 — the leading cause of childhood death worldwide. In India, household air pollution from burning solid fuels like firewood and cow dung remains widespread, compounding exposure to PM2.5 levels far above WHO’s safety limits^4,5.

India’s climate health policies do not account for this intersection of threats. Epidemiological models and heat-health guidelines largely stem from Western studies⁶, which often overlook local environmental, genetic, and socioeconomic conditions. Consider the PARIS birth cohort in France, a study linking heatwaves to adverse birth outcomes. Heat in Paris is not heat in Patna. In India, most people can’t afford air conditioning, leaving mothers and infants dangerously exposed.

Climate justice, in this context, means recognizing those differentials — and designing responses that actually match the lived realities of India’s diverse regions.

Access to and affordability of clean energy such such as liquified petroleum gas (LPG) is another barrier. In remote Himalayan villages, biomass remains the norm for heating and cooking. Unreliable electricity makes a switch to electric heating impractical. Meanwhile, countries in Europe and the Americas⁷ have already transitioned to cleaner fuels and technologies. Why hasn’t India? Regional differences in infrastructure, emissions, and the chemical makeup of air pollution require location-specific research.

On top of this is biology. Research shows that certain variants common in Indians — like GST and CYP450 — may heighten vulnerability to pollution-related health risks and pregnancy complications. Others, like heat shock protein genes (HSP), influence heat tolerance. Yet environmental and public health research still treats all populations as genetically similar^8,9,10.

As the COVID-19 pandemic made clear, systemic inequality amplifies risk. The same lesson applies to environmental health. The combination of air pollution and heat is not just a health issue. It’s an equity issue. India’s national and state-level health responses must reflect that.

This means going beyond siloed studies and toward integrated risk assessment. It means developing heat action plans and pollution mitigation policies that prioritize maternal and child health. And it means funding more region-specific research that reflects India’s complex genetic, cultural, and ecological realities.

India’s healthcare system, already strained, cannot afford to be reactive. Climate adaptation strategies must center the needs of the most affected, starting with mothers and children. Protecting them isn’t a side issue. It’s the frontline of climate resilience.