Through their lens: A photovoice study exploring pregnant and postpartum women’s experiences, coping strategies and barriers to heat adaptation in an urban township in South Africa.

Researchers: Solarin, Ijeoma, Fiona Scorgie, Rose Refilwe Lamola, Celeste Madondo, Isabelle L. Lange, Pascalia Munyewende, Shobna Sawry, Matthew Francis Chersich, and Gloria Maimela.

January 2026

What Is The Study About?

Rising global temperatures and heatwaves pose major health risks, particularly for pregnant women, infants and other vulnerable groups. Using Photovoice, we aimed to foreground how pregnant and postpartum women in an urban township in Tshwane, South Africa, experience and cope with heat stress. Fourteen women participated in two structured workshops held during the hot season (December 2023-January 2024). The first included reflective discussions on coping with heat and basic photography training. Over two weeks, participants captured over 300 images using disposable cameras or mobile phones. Selected images were reviewed and discussed in the second workshop. Thematic analysis of photographs and workshop transcripts identified three key themes: health impacts, coping strategies and structural challenges. In this study, challenges led to a state of “un-coping”—where adaptation efforts are insufficient or counterproductive. Viewed through the women’s “lens”, these findings highlight the need for targeted adaptation strategies to improve climate resilience.

Why Is This Important?

Extreme heat is increasingly recognised as a significant public health threat, particularly for vulnerable populations such as pregnant and postpartum women. Climate change has brought rising global temperatures and more frequent and intense heatwaves, with important implications for maternal and child health. Sub-Saharan Africa bears a disproportionate burden of maternal and infant mortality, accounting for approximately 70% of global maternal deaths, and the highest under-five mortality rates globally. Extreme heat may further compound these burdens.

What We Know…

The heightened vulnerability of pregnant women to heat stress may be influenced by physiological changes that occur during pregnancy, including impaired thermoregulation and increased cardiovascular strain. While the precise biological mechanisms linking heat exposure to adverse maternal and neonatal outcomes remain unclear, it is known that high ambient temperatures are consistently linked with an increased risk of obstetric complications, such as hypertensive disorders, preterm labour, and gestational diabetes. Heat exposure can also be associated with adverse neonatal outcomes, including low birth weight, stillbirth, congenital anomalies and increased neonatal intensive care unit admissions.

Beyond physiological susceptibility, social and environmental factors can further exacerbate pregnant women’s heat exposure and ability to cope. Urban townships present unique challenges for heat adaptation due to rapid urbanisation, poor infrastructure, and high population density. Informal housing, often built with heat-retaining materials such as corrugated metal, can lead to indoor temperatures that significantly exceed outdoor conditions. Limited access to electricity and water, space cooling, and healthcare services further compounds these risks.

What Was Discovered…

Symptoms such as fatigue, dizziness, and severe sweating were widely reported, alongside cognitive difficulties, as participants described their inability to “think straight” in extreme heat. These findings point to signs of heat exhaustion. Swollen feet were another symptom mentioned, although some women were uncertain whether this was due to heat as water retention is common in pregnancy.

Infants were also shown to be affected by the heat, leading to crying, restlessness, sleep disturbances, and heat rashes. Irritability in infants had a huge emotional effect on mothers, as they expressed feelings of frustration and sadness at being unable to console their children. Finding ways to soothe infants was a struggle as both breastfeeding or carrying and rocking babies,made both mother and infant hotter.

Staying at home was identified as a key strategy, as this was where women felt they had the most control over their environment and how they dressed. Many of women’s domestic cooling strategies involved the use of water. Frequent bathing was seen as highly effective, particularly for infants, and women cited strategies such as drinking cold water, wrapping themselves in wet cloths or soaking their feet in tubs of water. Using water to cool down has been highly recommended as a low-cost method for self-cooling, yet accessing water was a daily struggle in this setting and one of the biggest challenges for women.

Methods for cooling their environment were limited to relying on natural ventilation, mostly keeping windows or doors open or using fans, if available. Natural ventilation methods may also be more challenging in houses built with materials such as corrugated iron, which absorb and trap heat. Dumping sites also pose a further challenge, by not being able to open windows due to prevailing odours and flies, they impede the already limited coping options available to women.

The Future/ Possible Solutions…

With urban water scarcity projected to intensify due to the combined pressures of urban growth and climate change, it is essential that local government structures prioritise equitable water access as part of heat adaptation strategies.

The importance of green spaces and other nature-based solutions in urban environments, is feasible but is also highly dependent on context. For example, in a densely packed, semi-formal settlement, growing trees may not be practical. Developing community cooling spaces, could perhaps give women more options for spaces where they can seek relief from the heat.

In addition, these findings are an important consideration for the kind of messaging communicated in extreme heat alerts. Conventional advice during heatwaves includes recommendations such as staying indoors or closing windows during the day to prevent hot air from entering the home. However, for those living in the type of heat-trapping housing, this advice may not be practical or effective.

Suggestions have been made for using reflective white paint on roofs as a way to reduce temperatures within informal dwellings. “Cool roofs” work by reflecting sunlight back into the air, reducing the amount of thermal energy stored.