Extreme Weather and Healthcare Access in Malawi: The Impact of Precipitation on ANC Service Utilisation

Rachel E. Murray-Watson; Margherita Molaro; Rebecca J.  Murray-Watson; Sakshi Mohan; Bingling She; Tara Danielle Mangal; Joseph H Collins; Sangeeta Bhatia; Eva Janouskova; Timothy B. Hallet

doi:10.1101/2025.04.15.25325855

Extreme Weather and Healthcare Access in Malawi: The Impact of Precipitation on ANC Service Utilisation

Rachel E. Murray-Watson^*, Margherita Molaro, Rebecca J. Murray-Watson, Sakshi Mohan, Bingling She, Tara Danielle Mangal, Joseph H Collins, Sangeeta Bhatia, Eva Janouskova, Timothy B. Hallet

^*Corresponding author for this work

Centre for Health Economics

Research output: Working paper › Preprint

Abstract

Malawi is vulnerable to climate-related shocks, which are projected to worsen. Whilst some dimensions of this vulnerability have been characterised, little is known about healthcare sector resilience. Coupling facility-specific data on antenatal care (ANC) service provision in Malawi with gridded precipitation data, we use regression analyses to characterise the historic relationship between precipitation and healthcare access. We estimate that, between 2012 and 2024, precipitation negatively impacted ANC service utilisation in Malawi, with up to 1 in 20 appointments disrupted annually in some districts. Projecting further to 2060 indicates that, cumulatively, up to 250,000 pregnancies could be affected. Notably, if precipitation patterns from 1941–1953 had persisted into the 21st century, disruptions between 2012 — 2024 would be a hundred times less frequent, highlighting the significant influence of anthropogenic climate change on healthcare access. In a country already facing high maternal and neonatal mortality, such disruptions could further hinder access to care and worsen health outcomes.

Original language	English
Publisher	medRxiv
DOIs	https://doi.org/10.1101/2025.04.15.25325855
Publication status	Published - 17 Apr 2025

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title = "Extreme Weather and Healthcare Access in Malawi: The Impact of Precipitation on ANC Service Utilisation",

abstract = "Malawi is vulnerable to climate-related shocks, which are projected to worsen. Whilst some dimensions of this vulnerability have been characterised, little is known about healthcare sector resilience. Coupling facility-specific data on antenatal care (ANC) service provision in Malawi with gridded precipitation data, we use regression analyses to characterise the historic relationship between precipitation and healthcare access. We estimate that, between 2012 and 2024, precipitation negatively impacted ANC service utilisation in Malawi, with up to 1 in 20 appointments disrupted annually in some districts. Projecting further to 2060 indicates that, cumulatively, up to 250,000 pregnancies could be affected. Notably, if precipitation patterns from 1941–1953 had persisted into the 21st century, disruptions between 2012 — 2024 would be a hundred times less frequent, highlighting the significant influence of anthropogenic climate change on healthcare access. In a country already facing high maternal and neonatal mortality, such disruptions could further hinder access to care and worsen health outcomes.",

author = "Murray-Watson, {Rachel E.} and Margherita Molaro and Murray-Watson, {Rebecca J.} and Sakshi Mohan and Bingling She and Mangal, {Tara Danielle} and Collins, {Joseph H} and Sangeeta Bhatia and Eva Janouskova and Hallet, {Timothy B.}",

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AU - Murray-Watson, Rachel E.

AU - Molaro, Margherita

AU - Murray-Watson, Rebecca J.

AU - Mohan, Sakshi

AU - She, Bingling

AU - Mangal, Tara Danielle

AU - Collins, Joseph H

AU - Bhatia, Sangeeta

AU - Janouskova, Eva

AU - Hallet, Timothy B.

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N2 - Malawi is vulnerable to climate-related shocks, which are projected to worsen. Whilst some dimensions of this vulnerability have been characterised, little is known about healthcare sector resilience. Coupling facility-specific data on antenatal care (ANC) service provision in Malawi with gridded precipitation data, we use regression analyses to characterise the historic relationship between precipitation and healthcare access. We estimate that, between 2012 and 2024, precipitation negatively impacted ANC service utilisation in Malawi, with up to 1 in 20 appointments disrupted annually in some districts. Projecting further to 2060 indicates that, cumulatively, up to 250,000 pregnancies could be affected. Notably, if precipitation patterns from 1941–1953 had persisted into the 21st century, disruptions between 2012 — 2024 would be a hundred times less frequent, highlighting the significant influence of anthropogenic climate change on healthcare access. In a country already facing high maternal and neonatal mortality, such disruptions could further hinder access to care and worsen health outcomes.

AB - Malawi is vulnerable to climate-related shocks, which are projected to worsen. Whilst some dimensions of this vulnerability have been characterised, little is known about healthcare sector resilience. Coupling facility-specific data on antenatal care (ANC) service provision in Malawi with gridded precipitation data, we use regression analyses to characterise the historic relationship between precipitation and healthcare access. We estimate that, between 2012 and 2024, precipitation negatively impacted ANC service utilisation in Malawi, with up to 1 in 20 appointments disrupted annually in some districts. Projecting further to 2060 indicates that, cumulatively, up to 250,000 pregnancies could be affected. Notably, if precipitation patterns from 1941–1953 had persisted into the 21st century, disruptions between 2012 — 2024 would be a hundred times less frequent, highlighting the significant influence of anthropogenic climate change on healthcare access. In a country already facing high maternal and neonatal mortality, such disruptions could further hinder access to care and worsen health outcomes.

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