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When heat waves hit, women - stuck indoors, wearing heavy clothing and refusing water to avoid toilet trips - are most at risk
Over the past few years, we have seen particularly deadly heat waves - increasingly a problem with climate change - in southern Asia, including India and Pakistan. While one might think heat is an indiscriminate killer, women in India, for example, are at much higher risk for heat-related illness and have higher death rates than men during heat waves.
This raises alarms for women in developing countries across the tropics, which face many of the same conditions. Before the problem becomes worse, officials in developing countries must implement policies to address the unique dangers that women face in our rapidly warming world.
Being a poor woman in India has never been easy. Girls in poor communities are systematically denied nutrition and medical care. Having little choice, marriage could mean being trafficked and "shared" with several men in the household. Pregnancy brings further risk. With the majority of women needing permission from their husbands to visit a health facility during pregnancy, many end up suffering through debilitating anemia for years.
Heat adds another layer of vulnerability. In India, analysis of death certificate data from a massive heatwave in Ahmedabad in 2010 shows women were far more likely to die than men. Another study by Umea University in Vadu, Pune, found that women had higher heat-related risks than men.
These alarming findings demand attention. While there is a dearth of data across poorer nations in the tropics and semi-tropics, insights from India strongly suggest that women in other countries are likewise at higher risk when brutal temperatures hit.
Why are more women than men dying if Indian men, generally speaking, go out and work and women stay at home doing housework, watching children, doing farm labor, and making small crafts? The study in Ahmedabad unraveled this paradox.
We found that the answer is deeply rooted in poverty, social norms, and gender discrimination.
As in many developing countries, most Indians live in rural areas where there is a lack of basic sanitation facilities. Furthermore, there is a cultural expectation that women stay inside their homes and focus on domestic tasks. But in the home there is no electricity, fan, running water, or toilet, and low ceilings leave little space for air circulation.
Perhaps the most surprising factor is the absence of an indoor toilet. Without one, women tend to relieve themselves outside early in the morning before sunrise and then late at night to avoid shame and sexual harassment. To avoid having to urinate during long days inside, they may drink no water at all. In a heat wave, this significantly increases the risks of dehydration and death.
A culture of silence surrounds women’s sanitation issues and leads to death.
Some 818 million people in India, and globally, do not have toilets or covered latrines. Among the countries with the worst sanitation facilities are India, Nigeria, Kenya, Ethiopia, Afghanistan, and Nepal. In addition, many households in developing countries, India included, have no indoor supply of potable water to drink, to shower or to cool oneself. Women can trek miles to carry a gallon of water on their heads for household consumption everyday - another reason to reduce domestic water consumption.
My colleagues and I surveyed women in slum communities in India to better understand risks from heat wave. We were told of several other factors - including the heat from indoor cooking and a lack of electricity to power fans - that exacerbate the dangers of heat waves.
Households without electricity or with inconsistent electricity can’t power fans. And even functional fans are often not used because they interfere with women’s economic activities: the construction of kites, brooms, or incense sticks and similar work requires the fan to be switched off. During high temperatures, ceiling fans throw down the rising hot air.
Indoor cooking presents another hazard exacerbated by heat waves. Most of the windowless shacks that pass as households don’t have a separate kitchen. Cow dung cakes, or wood dust commonly used as fuel cause the indoors to be hot and smoke-filled. This makeshift cookstove exposure compounds the environmental summer heat.
Even women’s clothes become a heat trap. A six-yard-long sari wrapped several times around the body with an inner petticoat and blouse is not comfortable to wear in the heat. It leaves little room for air circulation. Core body temperatures of the Indian women we measured tend to be 1-2 degrees Celsius higher during summer noon times.
To be sure, not all of these conditions are replicated in quite the same way in other tropical developing countries. But lack of indoor sanitation, clean water, and electricity are typical across rural and urban areas in many poor countries at increased risk from heat waves.
Prevention of heat illnesses and death are possible through efforts to improve electrification and cook stoves, and an investment in indoor toilets. However, an essential first step is to simply be aware that heat is deadly and that staying hydrated can be lifesaving.
Avoiding physically active tasks in afternoon and wearing lighter, loose clothing can save lives. Besides using fans, families can cover roofs with reflective material - even a white reflective paint - to cool the household. Wet jute mat curtains hung on windows are one of the many local innovative solutions.
At the end of a hot day, as the sun finally sets, life itself is also a matter of women’s rights: their right to personal security and safety; to work outside the home; and even to simply accessing a mobile phone to receive heat alerts or call for help. It is true that changing attitudes can take time, but it takes only minutes to die from extreme heat.
Gulrez Shah Azhar is a researcher passionate about health, the environment and development who helped develop India’s first heat preparedness plan in Ahmedabad, India. He is an Aspen New Voices Fellow. @gulrezdoc
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