Heat, Housing, and Vulnerability: The Silent Crisis of Urban Pregnancy in India
Facing oppressive heat, they return to homes that trap warmth, hindering recovery during critical moments of pregnancy.
4 mins read
Context: When the City Becomes a Heat Trap
India's urban poor have long lived with inadequate housing. But as extreme heat events become more frequent and intense, what was once a livelihood problem has become a medical emergency — particularly for pregnant women in dense, low-income settlements.
In Chennai's resettlement colonies of Perumbakkam and Ezhil Nagar — built by the Tamil Nadu Urban Habitat Development Board (TNUHDB) to rehabilitate families from informal settlements — rows of concrete tenements stand packed tightly together, with narrow corridors, minimal green cover, and almost no airflow. These are not temporary shelters. They are permanent homes. And they are dangerously ill-equipped for a heating planet.
What the Science Says
A 2024 study published in BJOG by researchers from Sri Ramachandra Institute of Higher Education and Research, Chennai — tracking 800 pregnant women in Tamil Nadu between 2017 and 2022 — found:
Heat Exposure & Pregnancy Risks (Tamil Nadu, 2017–2022)
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Outcome Finding
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Women exposed to unsafe heat Nearly 50%
Risks identified Miscarriage, preterm birth,
low birthweight, IUGR
Dehydration & heat strain Significantly higher in
heat-exposed group
Temperature sensitivity Risk of preterm delivery
rises with every 1°C increase
────────────────────────────────────────────────────────
A 2025–26 Climate Trends study monitoring 50 low- and middle-income households in Chennai found indoor temperatures frequently exceeding 32°C, rarely dropping below 31°C even after sunset — with concrete walls absorbing heat through the day and releasing it through the night.
Lead researcher Vidhya Venugopal explains the physiological mechanism:
"Heat stress impairs the body's ability to regulate temperature during pregnancy, restricts blood flow to the placenta and reduces oxygen to the foetus."
Lives Behind the Data
The women of Perumbakkam and Ezhil Nagar carry these statistics in their bodies:
- Priya, 24 — five months pregnant, anaemic, underweight at 47 kg, wakes between midnight and 4 a.m. unable to sleep due to trapped heat; spends mornings scraping medical waste equipment, then returns home to cook, clean, and care for a four-year-old
- Nilofer — third pregnancy feels harder than the first two; exhausted after simply walking to the PHC
- Anandhi, 31 — diabetic, insulin-dependent, fourth pregnancy; quit her canteen job due to exhaustion; struggles to afford adequate drinking water
- Durga, 24 — post-cervical cerclage, confined to a third-floor apartment with a table fan, staircase too steep to descend regularly
- Abirami, 27 — homeless, sells flowers on the pavement with three children, chasing shade through the day, waiting for a TNUHDB allotment
Dr. Jaishree Gajaraj, senior obstetrician at MGM Healthcare Chennai, underlines a critical distinction:
"Walking around the house while doing chores is different from purposeful walking or exercise" — yet most women here get only the former, never the latter.
The Housing Design Problem
Urban planners and housing activists identify design failure as a structural cause:
- Concrete construction absorbs and radiates heat — no passive cooling
- Windows open into adjacent building walls, not open space
- Staircases trap heat; corridors stay dim even at noon
- Density far exceeds ideal levels, restricting airflow
- Almost no trees, green cover, or shaded outdoor spaces
The TNUHDB's own policy documents acknowledge that public housing has historically prioritised cost and efficiency over liveability. Financial constraints are real — Union government contributions require states to bear a substantial share, forcing compromises between affordability and climate resilience.
As IRCDUC founder Vanessa Peter cautions: "The resilience of people should not be taken for granted."
Way Forward
The 2025 NDMA advisory and Tamil Nadu's Heat Mitigation Strategy together point toward actionable solutions:
- Climate-resilient housing design — cool roofs, cross-ventilation, reflective materials, insulation built into all new public housing
- Green cover mandates — trees, urban forests, and water-sensitive planning in resettlement colonies
- Cooling infrastructure — shaded spaces, functional cooling centres, and reliable water points within walking distance
- Heat-specific maternal care protocols — PHCs in heat-vulnerable zones must screen for dehydration and heat strain, not just standard obstetric indicators
- Electrolyte-aware hydration guidance — buttermilk, citrus, and salt-based traditional drinks must be formally incorporated into maternal health advisories
- DAY-NULM shelter activation — address safety concerns and family separation fears that prevent homeless women from using available shelters
- Early warning systems — geo-tagged shelters, heat helplines, and NGO-government coordination before peak summer, not during it
Conclusion
India's urban heat crisis has a gender dimension that policy has barely acknowledged. Pregnant women in dense, concrete resettlement colonies face a convergence of risks — poor housing, physical labour, nutritional deficiency, and relentless heat — with no recovery window between day and night. Their bodies, as Prof. Venugopal puts it, "never get the chance to recuperate." Addressing this requires treating heat not as a seasonal inconvenience but as a chronic public health threat — one that demands climate-resilient urban design, targeted maternal health interventions, and housing policy that measures success not just in units built, but in lives protected.
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GS1UrbanisationQuick Q&A
What is heat stress, and why are pregnant women in urban resettlement colonies particularly vulnerable to it?
Heat stress refers to the physiological strain placed on the human body when it is unable to regulate internal temperature due to prolonged exposure to high temperatures and humidity. During pregnancy, the body’s metabolic rate naturally increases, leading to greater sweating, dehydration and electrolyte loss. In extreme heat conditions, the body struggles to maintain normal core temperature, increasing risks such as dehydration, fatigue, heat exhaustion and complications in pregnancy.
Pregnant women living in urban resettlement colonies face compounded vulnerabilities. The article highlights how poorly ventilated concrete housing, overcrowding, lack of green cover and inadequate airflow trap heat both during the day and at night. Women such as Priya and Durga are unable to recover physically because indoor temperatures remain above safe levels even after sunset. Factors such as anaemia, undernutrition, long working hours and lack of access to affordable cooling intensify these risks. Studies cited in the article, including the BJOG 2024 study, found higher risks of miscarriage, preterm birth and low birthweight among women exposed to unsafe heat levels.
The issue reflects a broader intersection between climate change, urban poverty and public health. Heat exposure is not merely an environmental issue but a social justice concern affecting economically weaker populations disproportionately. Women in informal or resettlement housing often lack access to healthcare, hydration, safe public spaces and climate-resilient infrastructure. Therefore, heat stress among pregnant women must be addressed through integrated urban planning, healthcare interventions and climate adaptation policies.
Pregnant women living in urban resettlement colonies face compounded vulnerabilities. The article highlights how poorly ventilated concrete housing, overcrowding, lack of green cover and inadequate airflow trap heat both during the day and at night. Women such as Priya and Durga are unable to recover physically because indoor temperatures remain above safe levels even after sunset. Factors such as anaemia, undernutrition, long working hours and lack of access to affordable cooling intensify these risks. Studies cited in the article, including the BJOG 2024 study, found higher risks of miscarriage, preterm birth and low birthweight among women exposed to unsafe heat levels.
The issue reflects a broader intersection between climate change, urban poverty and public health. Heat exposure is not merely an environmental issue but a social justice concern affecting economically weaker populations disproportionately. Women in informal or resettlement housing often lack access to healthcare, hydration, safe public spaces and climate-resilient infrastructure. Therefore, heat stress among pregnant women must be addressed through integrated urban planning, healthcare interventions and climate adaptation policies.
Why are climate-resilient housing and urban planning becoming critical public health priorities in Indian cities?
Climate-resilient housing has emerged as a major public health priority because urban heatwaves are becoming more frequent and intense due to climate change. Indian cities are witnessing rapid urbanisation characterised by dense concrete structures, shrinking green spaces and inadequate ventilation. Such environments create urban heat islands, where temperatures remain significantly higher than surrounding areas. The article demonstrates how housing colonies in Chennai trap heat throughout the night, exposing vulnerable groups such as pregnant women, children and the elderly to continuous physiological stress.
Poorly planned housing directly affects physical and mental health outcomes. In resettlement colonies such as Perumbakkam and Ezhil Nagar, narrow corridors, limited airflow and lack of shade increase heat exposure. Residents face sleep disruption, dehydration, respiratory stress and reduced productivity. Pregnant women face additional risks including miscarriage, intrauterine growth restriction and preterm delivery. Public health experts increasingly recognise that healthcare outcomes are influenced not only by hospitals and medicines but also by living conditions and environmental design.
Climate-resilient urban planning therefore requires a multi-dimensional approach. Measures such as cool roofs, reflective materials, green spaces, water-sensitive planning and improved ventilation can reduce heat exposure significantly. The National Disaster Management Authority’s 2025 advisory emphasises integrating heat resilience into building standards and housing schemes. Long-term urban sustainability depends on balancing affordability with liveability. If climate resilience is ignored, vulnerable populations will continue to bear the heaviest burden of climate-related health crises.
Poorly planned housing directly affects physical and mental health outcomes. In resettlement colonies such as Perumbakkam and Ezhil Nagar, narrow corridors, limited airflow and lack of shade increase heat exposure. Residents face sleep disruption, dehydration, respiratory stress and reduced productivity. Pregnant women face additional risks including miscarriage, intrauterine growth restriction and preterm delivery. Public health experts increasingly recognise that healthcare outcomes are influenced not only by hospitals and medicines but also by living conditions and environmental design.
Climate-resilient urban planning therefore requires a multi-dimensional approach. Measures such as cool roofs, reflective materials, green spaces, water-sensitive planning and improved ventilation can reduce heat exposure significantly. The National Disaster Management Authority’s 2025 advisory emphasises integrating heat resilience into building standards and housing schemes. Long-term urban sustainability depends on balancing affordability with liveability. If climate resilience is ignored, vulnerable populations will continue to bear the heaviest burden of climate-related health crises.
Critically analyse the strengths and limitations of India’s current approach towards heat mitigation and vulnerable urban populations.
India has increasingly recognised extreme heat as a major public health and disaster management challenge. Policy initiatives such as Heat Action Plans, NDMA advisories and State-level heat mitigation strategies demonstrate growing institutional awareness. Tamil Nadu’s State Planning Commission has identified pregnant women as a vulnerable group, while the Union Ministry of Housing and Urban Affairs has directed States to improve access to drinking water, cooling facilities and shelters. Such measures represent an important shift from viewing heat merely as a seasonal inconvenience to treating it as a governance issue.
However, implementation gaps remain a major concern. The article illustrates how many vulnerable populations continue to live in poorly ventilated housing without adequate green cover, cooling spaces or affordable hydration. Awareness regarding shelters and heat-relief facilities remains limited, while safety concerns discourage homeless populations from using them. Financial constraints often force governments to prioritise cost efficiency over climate-sensitive design in public housing projects. Consequently, infrastructure meant to improve living conditions may inadvertently worsen heat exposure.
A critical limitation is the lack of integration between urban planning, healthcare and climate policy. Heat mitigation efforts are often reactive rather than preventive. For example, while emergency water points and cooling centres provide temporary relief, long-term resilience requires redesigning cities themselves. Policies must move beyond short-term disaster response towards sustainable urban ecosystems that incorporate green infrastructure, ventilation standards and inclusive planning. Stronger coordination between local governments, healthcare institutions, NGOs and urban planners is essential to ensure that vulnerable populations are protected effectively.
However, implementation gaps remain a major concern. The article illustrates how many vulnerable populations continue to live in poorly ventilated housing without adequate green cover, cooling spaces or affordable hydration. Awareness regarding shelters and heat-relief facilities remains limited, while safety concerns discourage homeless populations from using them. Financial constraints often force governments to prioritise cost efficiency over climate-sensitive design in public housing projects. Consequently, infrastructure meant to improve living conditions may inadvertently worsen heat exposure.
A critical limitation is the lack of integration between urban planning, healthcare and climate policy. Heat mitigation efforts are often reactive rather than preventive. For example, while emergency water points and cooling centres provide temporary relief, long-term resilience requires redesigning cities themselves. Policies must move beyond short-term disaster response towards sustainable urban ecosystems that incorporate green infrastructure, ventilation standards and inclusive planning. Stronger coordination between local governments, healthcare institutions, NGOs and urban planners is essential to ensure that vulnerable populations are protected effectively.
How does urban design contribute to the creation of heat islands and health inequalities in Indian cities?
Urban heat islands are created when cities absorb and retain excessive heat due to dense construction, reduced vegetation and extensive use of concrete and asphalt. In many Indian cities, rapid urbanisation has replaced natural landscapes with buildings, roads and paved surfaces that absorb solar radiation during the day and release it slowly at night. The article highlights how resettlement colonies in Chennai experience persistently high indoor temperatures because concrete structures trap heat and restrict airflow.
Urban design also contributes to social inequalities in heat exposure. Wealthier neighbourhoods often have better ventilation, larger living spaces, air-conditioning and tree cover, while low-income populations are concentrated in overcrowded housing with poor infrastructure. Pregnant women in Perumbakkam and Ezhil Nagar face heat stress not only because of climate conditions but also because of inadequate urban planning. Limited access to shaded public spaces, safe walking areas and affordable water worsens their vulnerability.
The issue demonstrates how environmental inequality intersects with economic inequality. Heat exposure becomes a structural problem linked to housing policy, labour conditions and access to public services. Urban planners increasingly argue that cities must be designed around human well-being rather than only cost efficiency. Integrating green cover, reflective building materials, natural ventilation and mixed-use planning can reduce urban temperatures while improving public health outcomes. Therefore, urban design must be viewed as a critical determinant of climate justice and social equity.
Urban design also contributes to social inequalities in heat exposure. Wealthier neighbourhoods often have better ventilation, larger living spaces, air-conditioning and tree cover, while low-income populations are concentrated in overcrowded housing with poor infrastructure. Pregnant women in Perumbakkam and Ezhil Nagar face heat stress not only because of climate conditions but also because of inadequate urban planning. Limited access to shaded public spaces, safe walking areas and affordable water worsens their vulnerability.
The issue demonstrates how environmental inequality intersects with economic inequality. Heat exposure becomes a structural problem linked to housing policy, labour conditions and access to public services. Urban planners increasingly argue that cities must be designed around human well-being rather than only cost efficiency. Integrating green cover, reflective building materials, natural ventilation and mixed-use planning can reduce urban temperatures while improving public health outcomes. Therefore, urban design must be viewed as a critical determinant of climate justice and social equity.
What are the socio-economic reasons that prevent vulnerable populations from adapting effectively to extreme heat?
Socio-economic vulnerability plays a central role in limiting people’s ability to adapt to extreme heat. Low-income households often lack access to adequate housing, cooling devices, reliable electricity and healthcare. In the article, women such as Priya and Anandhi continue physically demanding work despite pregnancy complications because losing daily wages is not financially possible. This demonstrates how poverty reduces adaptive capacity and forces vulnerable populations to remain exposed to harmful environmental conditions.
Financial constraints also affect basic survival measures such as hydration and nutrition. Many residents in Chennai’s resettlement colonies depend on purchased water cans, which become difficult to afford during summer months when consumption increases. Frequent power cuts and cramped living conditions further worsen discomfort. Inadequate public infrastructure, including the absence of shaded spaces and ventilation, leaves residents with limited options for physical recovery from heat exposure.
Social factors such as gender roles and safety concerns intensify these challenges. Women often bear the burden of unpaid domestic labour alongside income-generating work, reducing opportunities for rest during pregnancy. Concerns regarding safety and privacy discourage outdoor movement and physical activity. Thus, adaptation to climate change cannot be understood only in technological terms; it also requires addressing structural inequalities related to income, housing, healthcare and gender. Sustainable adaptation policies must therefore combine economic support, social protection and climate-resilient infrastructure.
Financial constraints also affect basic survival measures such as hydration and nutrition. Many residents in Chennai’s resettlement colonies depend on purchased water cans, which become difficult to afford during summer months when consumption increases. Frequent power cuts and cramped living conditions further worsen discomfort. Inadequate public infrastructure, including the absence of shaded spaces and ventilation, leaves residents with limited options for physical recovery from heat exposure.
Social factors such as gender roles and safety concerns intensify these challenges. Women often bear the burden of unpaid domestic labour alongside income-generating work, reducing opportunities for rest during pregnancy. Concerns regarding safety and privacy discourage outdoor movement and physical activity. Thus, adaptation to climate change cannot be understood only in technological terms; it also requires addressing structural inequalities related to income, housing, healthcare and gender. Sustainable adaptation policies must therefore combine economic support, social protection and climate-resilient infrastructure.
What policy measures can Indian cities adopt to protect vulnerable populations from the health impacts of extreme heat?
Indian cities can adopt a combination of immediate relief measures and long-term structural reforms to address extreme heat. Short-term interventions include establishing cooling centres, shaded public spaces, water kiosks, oral rehydration stations and emergency helplines during heatwaves. Community awareness campaigns can educate people about hydration, heatstroke prevention and early warning systems. The article mentions recommendations by organisations such as IRCDUC and NDMA that emphasise street-level interventions like buttermilk stations and geo-tagged shelters.
Long-term solutions require climate-sensitive urban planning and housing reforms. Governments can promote cool roofs, reflective paints, insulation, cross-ventilation and tree-based urban cooling systems. Building standards should incorporate heat resilience, especially in public housing projects. Expanding urban forests, restoring water bodies and reducing excessive concretisation can lower ambient temperatures significantly. Healthcare systems must also integrate heat-risk monitoring for pregnant women, elderly citizens and outdoor workers.
Successful examples already exist in India. Ahmedabad’s Heat Action Plan, one of the first in South Asia, introduced early warning systems, inter-agency coordination and public awareness campaigns to reduce heat-related mortality. Similar strategies can be adapted for other cities while accounting for local socio-economic realities. Ultimately, heat adaptation policies must combine environmental sustainability with social inclusion to ensure that vulnerable communities are not left behind.
Long-term solutions require climate-sensitive urban planning and housing reforms. Governments can promote cool roofs, reflective paints, insulation, cross-ventilation and tree-based urban cooling systems. Building standards should incorporate heat resilience, especially in public housing projects. Expanding urban forests, restoring water bodies and reducing excessive concretisation can lower ambient temperatures significantly. Healthcare systems must also integrate heat-risk monitoring for pregnant women, elderly citizens and outdoor workers.
Successful examples already exist in India. Ahmedabad’s Heat Action Plan, one of the first in South Asia, introduced early warning systems, inter-agency coordination and public awareness campaigns to reduce heat-related mortality. Similar strategies can be adapted for other cities while accounting for local socio-economic realities. Ultimately, heat adaptation policies must combine environmental sustainability with social inclusion to ensure that vulnerable communities are not left behind.
Suppose you are a district administrator in a rapidly urbanising city facing recurring heatwaves. What integrated strategy would you adopt to protect pregnant women and low-income communities?
As a district administrator, I would adopt a multi-sectoral heat resilience strategy combining healthcare, urban planning and social welfare interventions. The first step would involve identifying heat-vulnerable populations through local surveys and GIS mapping. Pregnant women, elderly individuals, outdoor workers and residents of informal settlements would be prioritised. Primary Health Centres would be equipped with hydration facilities, heat-risk counselling and mobile medical outreach services during summer months. Early warning systems using SMS alerts and local announcements would help communities prepare in advance.
Urban infrastructure interventions would focus on reducing heat exposure at the community level. Temporary cooling centres, shaded shelters, drinking water kiosks and public rest areas would be established in high-density neighbourhoods. Public housing projects would incorporate cool roofs, better ventilation and tree plantation drives. Partnerships with NGOs and community groups could help distribute oral rehydration solutions, buttermilk and awareness materials in vulnerable areas.
Long-term resilience would require integrating climate adaptation into development planning. Building regulations should mandate heat-resilient designs, while urban planning must prioritise green spaces and water-sensitive infrastructure. Employment schemes could include climate adaptation work such as urban greening and restoration projects. Importantly, community participation must remain central to policy implementation, as local residents understand their vulnerabilities best. Such an integrated strategy would not only reduce heat-related illnesses but also strengthen social equity and urban sustainability.
Urban infrastructure interventions would focus on reducing heat exposure at the community level. Temporary cooling centres, shaded shelters, drinking water kiosks and public rest areas would be established in high-density neighbourhoods. Public housing projects would incorporate cool roofs, better ventilation and tree plantation drives. Partnerships with NGOs and community groups could help distribute oral rehydration solutions, buttermilk and awareness materials in vulnerable areas.
Long-term resilience would require integrating climate adaptation into development planning. Building regulations should mandate heat-resilient designs, while urban planning must prioritise green spaces and water-sensitive infrastructure. Employment schemes could include climate adaptation work such as urban greening and restoration projects. Importantly, community participation must remain central to policy implementation, as local residents understand their vulnerabilities best. Such an integrated strategy would not only reduce heat-related illnesses but also strengthen social equity and urban sustainability.
Practice questions
2 questions for mains preparation