Considering climate in studies of fertility and reproductive health in poor countries


Factors related to fertility such as population size, composition and growth rate may influence a community’s ability to adapt to climate change, particularly in poor countries. This Perspective describes theories and analytic strategies that can link climate to reproductive health outcomes.

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Figure 1: Conceptual framework linking short-term and long-term observable parameters to FRH outcomes.
Figure 2: Merging data of different spatial and temporal scales.


  1. 1

    World Population Prospects: The 2015 Revision. Key Findings and Advance Tables Working Paper ESA/P/WP.241 (UNDP, 2015).

  2. 2

    Bongaarts, J. Africa's unique fertility transition. Pop. Dev. Review (2016).

  3. 3

    Gerland, P., Biddlecom, A. & Kantorová, V. Patterns of fertility decline and the impact of alternative scenarios of future fertility change in sub-Saharan Africa. Pop. Dev. Rev. (2017).

  4. 4

    Cleland, J. & Machiyama, K. The challenges posed by demographic change in sub-Saharan Africa: a concise overview. Pop. Dev. Rev. (2016).

  5. 5

    Hunter, L. M. & O'Neill, B. C. Enhancing engagement between the population, environment, and climate research communities: the shared socio-economic pathway process. Pop. Environ. 35, 231–242 (2014).

    Article  Google Scholar 

  6. 6

    Brown, M. E. & Funk, C. C. Climate — food security under climate change. Science 319, 580–581 (2008).

    Article  CAS  Google Scholar 

  7. 7

    Brown, M. E. et al. Climate Change, Global Food Security, and the US Food System (US Department of Agriculture, 2015).

    Google Scholar 

  8. 8

    Jones, P. G. & Thornton, P. K. The potential impacts of climate change on maize production in Africa and Latin America in 2055. Global Environ. Change 13, 51–59 (2003).

    Article  Google Scholar 

  9. 9

    Morton, J. F. The impact of climate change on smallholder and subsistence agriculture. Proc. Natl Acad. Sci. USA 104, 19680–19685 (2007).

    Article  Google Scholar 

  10. 10

    Hertel, T. W. Food security under climate change. Nat. Clim. Change 6, 10–13 (2016).

    Article  Google Scholar 

  11. 11

    Becker, S., Chowdhury, A. & Leridon, H. Seasonal patterns of reproduction in Matlab, Bangladesh. Pop. Stud. 40, 457–472 (1986).

    Article  Google Scholar 

  12. 12

    Macdowall, W., Wellings, K., Stephenson, J. & Glasier, A. Summer nights: a review of the evidence of seasonal variations in sexual health indicators among young people. Health Educ. 108, 40–53 (2007).

    Article  Google Scholar 

  13. 13

    Wellings, K., Macdowall, W., Catchpole, M. & Goodrich, J. Seasonal variations in sexual activity and their implications for sexual health promotion. J. Roy. Soc. Med. 92, 60–64 (1999).

    Article  CAS  Google Scholar 

  14. 14

    Levine, R. J. Male factors contributing to the seasonality of human-reproduction. Hum. Reprod. Ecol. Interact. Environ. Fertil. Behav. 709, 29–45 (1994).

    CAS  Google Scholar 

  15. 15

    Basso, O., Olsen, J., Bisanti, L., Juul, S. & Boldsen, J. Are seasonal preferences in pregnancy planning a source of bias in studies of seasonal-variation in reproductive outcomes? Epidemiology 6, 520–524 (1995).

    Article  CAS  Google Scholar 

  16. 16

    Grace, K. & Nagle, N. N. Using high-resolution remotely sensed data to examine the relationship between agriculture and fertility in Mali. Prof. Geogr. 67, 641–654 (2015).

    Article  Google Scholar 

  17. 17

    Darrow, L. A. et al. Seasonality of birth and implications for temporal studies of preterm birth. Epidemiology 20, 699–706 (2009).

    Article  Google Scholar 

  18. 18

    Ghimire, D. J. & Hoelter, L. F. Land use and first birth timing in an agricultural setting. Popul. Environ. 28, 289–320 (2007).

    Article  Google Scholar 

  19. 19

    Weinberg, C. R., Moledor, E. & Baird, D. D. Is there a seasonal pattern in risk of early-pregnancy loss. Epidemiology 5, 484–489 (1994).

    Article  CAS  Google Scholar 

  20. 20

    Lee, R. Short-term variation: vital rates, prices and weather. Popul. Hist. Engl. 1541, 356–401 (1981).

    Google Scholar 

  21. 21

    Rayco-Solon, P., Fulford, A. J. & Prentice, A. M. Differential effects of seasonality on preterm birth and intrauterine growth restriction in rural Africans. Am. J. Clin. Nutr. 81, 134–139 (2005). Identifies statistically significant relationships between hunger season and small-for-gestational age infants in rural Gambia and highlights the importance of nutrition and physical-labour in early pregnancy.

    Article  CAS  Google Scholar 

  22. 22

    Stupp, P. W. & Warren, C. W. Seasonal differences in pregnancy outcomes — United States, 1971–1989. Hum. Reprod. Ecol. Interact. Environ. Fertil. Behav. 709, 46–54 (1994).

    CAS  Google Scholar 

  23. 23

    Warren, C. W., Gwinn, M. L. & Rubin, G. L. Seasonal-variation in conception and various pregnancy outcomes. Soc. Biol. 33, 116–126 (1986).

    CAS  Google Scholar 

  24. 24

    Nanama, S. & Frongillo, E. A. Altered social cohesion and adverse psychological experiences with chronic food insecurity in the non-market economy and complex households of Burkina Faso. Soc. Sci. Med. 74, 444–451 (2012).

    Article  Google Scholar 

  25. 25

    Bhutta, Z. A. et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 382, 452–477 (2013).

    Article  Google Scholar 

  26. 26

    McMichael, A. J. Globalization, climate change, and human health. New Engl. J. Med. 368, 1335–1343 (2013).

    Article  CAS  Google Scholar 

  27. 27

    Patz, J. A., Frumkin, H., Holloway, T., Vimont, D. J. & Haines, A. Climate change challenges and opportunities for global health. J. Am. Med. Assoc. 312, 1565–1580 (2014).

    Article  CAS  Google Scholar 

  28. 28

    Lam, D. A. & Miron, J. A. The effects of temperature on human fertility. Demography 33, 291–305 (1996).

    Article  CAS  Google Scholar 

  29. 29

    Grace, K., Davenport, F., Hanson, H., Funk, C. & Shukla, S. Linking climate change and health outcomes: examining the relationship between temperature, precipitation and birth weight in Africa. Global Environ. Change 35, 125–137 (2015). Reports significant relationship between temperature and birth weight outcomes while demonstrating a strategy for spatially linking micro-level health survey data and climate data with attention to growing season.

    Article  Google Scholar 

  30. 30

    Brown, M. E., Grace, K., Shively, G., Johnson, K. B. & Carroll, M. Using satellite remote sensing and household survey data to assess human health and nutrition response to environmental change. Pop. Environ. 36, 48–72 (2014). Articulates motivations and strategies for linking different types of remotely sensed data, including vegetation data, to individual-level health outcomes related to malnutrition.

    Article  Google Scholar 

  31. 31

    Billari, F. C. Integrating macro- and micro-level approaches in the explanation of population change. Pop. Stud. 69, S11–S20 (2015).

    Article  Google Scholar 

  32. 32

    Davis, K. The world demographic transition. Ann. Am. Acad. Polit. Soc. Sci. 237, 1–11 (1945).

    Article  Google Scholar 

  33. 33

    Notestein, F. W. in Food for the World (ed. Schultz, T. W.) 36–57 (Univ. Chicago Press, 1945).

    Google Scholar 

  34. 34

    Situating Fertility: Anthropology and Demographic Inquiry (ed. Greenhalgh, S.) (Cambridge Univ. Press, 1995).

  35. 35

    Knodel, J. & Van de Walle, E. Lessons from the past — policy implications of historical fertility studies. Popul. Dev. Rev. 5, 217–245 (1979).

    Article  Google Scholar 

  36. 36

    Watkins, S. C. in The Decline of Fertility in Europe (eds Coale, A. J. & Watkins, S. C.) 420–450 (Princeton Univ. Press, 1986).

    Google Scholar 

  37. 37

    Carter, A. T. in Situating Fertility: Anthropology and Demographic Inquiry (ed. Greenhalgh, S.) 55–85 (1995).

    Google Scholar 

  38. 38

    Boyle, P. Population geography: does geography matter in fertility research? Prog. Hum. Geogr. 27, 615–626 (2003). Argues for empirical spatial investigations of fertility outcomes with close attention to context and variation over time and space.

    Article  Google Scholar 

  39. 39

    Dewey, K. G. Energy and protein requirements during lactation. Annu. Rev. Nutr. 17, 19–36 (1997).

    Article  CAS  Google Scholar 

  40. 40

    Dewey, K. G. & Cohen, R. J. Does birth spacing affect maternal or child nutritional status? A systematic literature review. Mater. Child Nutr. 3, 151–173 (2007).

    Article  Google Scholar 

  41. 41

    Mosher, S. W. Birth seasonally among peasant cultivators: the interrelationship of workload, diet, and fertility. Hum. Ecol. 7, 151–181 (1979).

    Article  CAS  Google Scholar 

  42. 42

    Bailey, R. C. et al. The ecology of birth seasonality among agriculturalists in central Africa J. Biosoc. Sci. 24, 393–412 (1992).

    Article  CAS  Google Scholar 

  43. 43

    Levine, R. J. Seasonal variation of semen quality and fertility. Scand. J. Work Environ. Health 25, 34–37 (1999).

    Google Scholar 

  44. 44

    Carlsen, E., Petersen, J. H., Andersson, A. M. & Skakkebaek, N. E. Effects of ejaculatory frequency and season on variations in semen quality. Fertil. Steril. 82, 358–366 (2004).

    Article  Google Scholar 

  45. 45

    Grace, K., Lerner, A. M., Mikal, J. & Sangli, G. A qualitative investigation of childbearing and seasonal hunger in peri-urban Ouagadougou, Burkina Faso. Popul. Environ. (2017).

  46. 46

    Pasternak, B. Seasons of birth and marriage in two Chinese localities. Hum. Ecol. 6, 299–323 (1978).

    Article  CAS  Google Scholar 

  47. 47

    Panter-Brick, C. Proximate determinants of birth seasonality and conception failure in Nepal. Popul. Stud. 50, 203–220 (1996). Provides a theoretical model for investigations of reproductive health outcomes with attention to environmental and food contexts and finds significant associations between season and pregnancy experiences and outcomes.

    Article  CAS  Google Scholar 

  48. 48

    McCabe, J. T. Cattle Bring us to our Enemies: Turkana Ecology, Politics, and Raiding in a Disequilibrium System (Univ. Michigan Press, 2004).

    Google Scholar 

  49. 49

    Homewood, K. Ecology of African Pastoralist Societies (James Currey, 2008).

    Google Scholar 

  50. 50

    Hampshire, K. & Randall, S. Pastoralists, agropastoralists and migrants: interactions between fertility and mobility in northern Burkina Faso. Popul. Stud. 54, 247–261 (2000).

    Article  CAS  Google Scholar 

  51. 51

    Peterman, A., Quisumbing, A., Behrman, J. & Nkonya, E. Understanding the complexities surrounding gender differences in agricultural productivity in Nigeria and Uganda. J. Dev. Stud. 47, 1482–1509 (2011).

    Article  Google Scholar 

  52. 52

    Doss, C. In Gender in Agriculture (eds Quisumbing, A. R. et al.) 69–88 (Springer, 2014).

    Google Scholar 

  53. 53

    Carr, E. R. Men's crops and women's crops: the importance of gender to the understanding of agricultural and development outcomes in Ghana's central region. World Dev. 36, 900–915 (2008).

    Article  Google Scholar 

  54. 54

    Atreya, K. Pesticide use knowledge and practices: a gender differences in Nepal. Environ. Res. 104, 305–311 (2007).

    Article  CAS  Google Scholar 

  55. 55

    Brauner-Otto, S. R. & Axinn, W. G. Natural resource collection and desired family size: a longitudinal test of environment-population theories. Popul. Environ. (2017).

  56. 56

    Biddlecom, A. E., Axinn, W. G. & Barber, J. S. Environmental effects on family size preferences and subsequent reproductive behavior in Nepal. Popul. Environ. 26, 183–206 (2005).

    Article  Google Scholar 

  57. 57

    Ghimire, D. J. & Axinn, W. G. Community context, land use, and first birth. Rural Sociol. 75, 478–513 (2010).

    Article  Google Scholar 

  58. 58

    Laux, P., Kunstmann, H. & Bardossy, A. Predicting the regional onset of the rainy season in West Africa. Int. J. Climatol. 28, 329–342 (2008).

    Article  Google Scholar 

  59. 59

    Ingram, K. T., Roncoli, M. C. & Kirshen, P. H. Opportunities and constraints for farmers of west Africa to use seasonal precipitation forecasts with Burkina Faso as a case study. Agric. Syst. 74, 331–349 (2002).

    Article  Google Scholar 

  60. 60

    Roncoli, C., Ingram, K. & Kirshen, P. Reading the rains: local knowledge and rainfall forecasting in Burkina Faso. Soc. Nat. Resour. 15, 409–427 (2002).

    Article  Google Scholar 

  61. 61

    Tschakert, P. Views from the vulnerable: understanding climatic and other stressors in the Sahel. Global Environ. Change 17, 381–396 (2007).

    Article  Google Scholar 

  62. 62

    Food Insecurity and Vulnerability Information and Mapping Systems (FAO, 1998).

  63. 63

    Black, R. E. et al. Maternal and child undernutrition 1 — Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371, 243–260 (2008).

    Article  Google Scholar 

  64. 64

    Bongaarts, J. W. Does malnutrition affect fecundity — a summary of evidence. Science 208, 564–569 (1980).

    Article  CAS  Google Scholar 

  65. 65

    Frisch, R. E. W. Population, food-intake, and fertility. Science 199, 22–30 (1978).

    Article  CAS  Google Scholar 

  66. 66

    Huss-Ashmore, R. W. Seasonal patterns of birth and conception in rural highland Lesotho. Hum. Biol. 60, 493–506 (1988).

    CAS  Google Scholar 

  67. 67

    Dorelien, A. M. Birth seasonality in sub-Saharan Africa. Demogr. Res. 34, 761–796 (2016).

    Article  Google Scholar 

  68. 68

    Rizzi, E. L. & Dalla-Zuanna, G. The seasonality of conception. Demography 44, 705–728 (2007).

    Article  Google Scholar 

  69. 69

    Montgomery, M. R., Gragnolati, M., Burke, K. A. & Paredes, E. Measuring living standards with proxy variables. Demography 37, 155–174 (2000).

    Article  CAS  Google Scholar 

  70. 70

    Upadhyay, U. D. et al. Women's empowerment and fertility: A review of the literature. Social Sci. Med. 115, 111–120 (2014).

    Article  Google Scholar 

  71. 71

    Hogan, D. P., Berhanu, B. & Hailemariam, A. Household organization, women's autonomy, and contraceptive behavior in Southern Ethiopia. Stud. Fam. Plann. 30, 302–314 (1999).

    Article  CAS  Google Scholar 

  72. 72

    Goldstein, J. R., Kreyenfeld, M., Jasilioniene, A. & Orsal, D. K. Fertility reactions to the “Great Recession” in Europe: Recent evidence from order-specific data. Demogr. Res. 29, 85–104 (2013).

    Article  Google Scholar 

  73. 73

    Sobotka, T., Skirbekk, V. & Philipov, D. Economic recession and fertility in the developed world. Popul. Dev. Rev. 37, 267–306 (2011).

    Article  Google Scholar 

  74. 74

    Rutstein, S. O. & Johnson, K. The DHS Wealth Index (ORC Macro, MEASURE DHS+, 2004).

    Google Scholar 

  75. 75

    Filmer, D. & Pritchett, L. H. Estimating wealth effects without expenditure data — or tears: an application to educational enrollments in states of India. Demography 38, 115–132 (2001).

    CAS  Google Scholar 

  76. 76

    Bollen, K. A., Glanville, J. L. & Stecklov, G. Economic status proxies in studies of fertility in developing countries: does the measure matter? Popul. Stud. 56, 81–96 (2002).

    Article  Google Scholar 

  77. 77

    Howe, L. D., Hargreaves, J. R. & Huttly, S. R. Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerg. Themes Epidemiol. 5, 3 (2008).

    Article  Google Scholar 

  78. 78

    Fisher, M., Reimer, J. J. & Carr, E. R. Who should be interviewed in surveys of household income? World Dev. 38, 966–973 (2010). Demonstrates inconsistencies when comparing men's and women's reports of household resources when considering surveying the household head.

    Article  Google Scholar 

  79. 79

    Casterline, J. B. & Sinding, S. W. Unmet need for family planning in developing countries and implications for population policy. Popul. Dev. Rev. 26, 691–723 (2000).

    Article  Google Scholar 

  80. 80

    Shively, G. E. Infrastructure mitigates the sensitivity of child growth to local agriculture and rainfall in Nepal and Uganda. Proc. Natl Acad. Sci. USA 114, 903–908 (2017).

    Article  CAS  Google Scholar 

  81. 81

    Shively, G. & Thapa, G. Markets, transportation infrastructure, and food prices in Nepal. Am. J. Agric. Econ. 99, 660–682 (2016).

    Google Scholar 

  82. 82

    Burgert, C. R., Colston, J., Roy, T. & Zachary, B. Geographic Displacement Procedure and Georeferenced Data Release Policy for the Demographic and Health Surveys (ICF International, 2013).

    Google Scholar 

  83. 83

    Perez-Heydrich, C., Warren, J. L., Burgert, C. R. & Emch, M. E. Guidelines on the Use of DHS GPS Data (ICF International, 2013).

    Google Scholar 

  84. 84

    Shively, G., Sununtnasuk, C. & Brown, M. Environmental variability and child growth in Nepal. Health Place 35, 37–51 (2015).

    Article  Google Scholar 

  85. 85

    de Beurs, K. M. & Henebry, G. M. Land surface phenology, climatic variation, and institutional change: analyzing agricultural land cover change in Kazakhstan. Remote Sens. Environ. 89, 497–509 (2004).

    Article  Google Scholar 

  86. 86

    Funk, C. & Budde, M. E. Phenologically-tuned MODIS NDVI-based production anomaly estimates for Zimbabwe. Remote Sens. Environ. 113, 115–125 (2009).

    Article  Google Scholar 

  87. 87

    Mertz, O., Mbow, C., Reenberg, A. & Diouf, A. Farmers' perceptions of climate change and agricultural adaptation strategies in rural Sahel. Environ. Manag. 43, 804–816 (2009).

    Article  Google Scholar 

  88. 88

    Nielsen, J. O. & Reenberg, A. Temporality and the problem with singling out climate as a current driver of change in a small West African village. J. Arid Environ. 74, 464–474 (2010).

    Article  Google Scholar 

  89. 89

    Niles, M. T. & Mueller, N. D. Farmer perceptions of climate change: associations with observed temperature and precipitation trends, irrigation, and climate beliefs. Global Environ. Change 39, 133–142 (2016).

    Article  Google Scholar 

  90. 90

    Owen, G., Harris, R. & Jones, K. Under examination: multilevel models, geography and health research. Prog. Hum. Geogr. 40, 394–412 (2016). Provides specific research design approaches and strategies for developing multi-level models of health outcomes that reflect spatial variability at different scales.

    Article  Google Scholar 

  91. 91

    Gelman, A. & Hill, J. Data Analysis Using Regression and Multilevel/Hierarchical Models (Cambridge Univ. Press, 2006).

    Google Scholar 

  92. 92

    Billingsley, S. & Ferrarini, T. Family policy and fertility intentions in 21 European countries. J. Marriage Fam. 76, 428–445 (2014).

    Article  Google Scholar 

  93. 93

    Axinn, W. G., Ghimire, D. J. & Smith-Greenaway, E. Emotional variation and fertility behavior. Demography 54, 437–458 (2017).

    Article  Google Scholar 

  94. 94

    Hastie, T. J. & Tibshirani, R. J. Generalized Additive Models Vol. 43 (CRC press, 1990).

    Google Scholar 

  95. 95

    Wood, S. Generalized Additive Models: an Introduction with R (CRC press, 2006).

    Google Scholar 

  96. 96

    Grace, K., Nagle, N. N. & Husak, G. Can small-scale agricultural production improve children's health? Examining stunting vulnerability among very young children in Mali, West Africa. Ann. Am. Assoc. Geogr. 106, 722–737 (2016). Very-high-resolution remotely sensed data is combined with micro-level health survey data (DHS) to reveal within-community variability in health outcomes associated with household-level and individual-level characteristics.

    Google Scholar 

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The author acknowledges J. Mikal, E. Wrigley-Field and D. Van Riper for their contributions to the development of this research. Comments and suggestions from M. Brown, G. Shively, N. Nagle and M. Bakhtsiyarava were also helpful.

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Grace, K. Considering climate in studies of fertility and reproductive health in poor countries. Nature Clim Change 7, 479–485 (2017).

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