On a sweltering morning in June, as temperatures in Delhi soared to nearly 44°C (111°F), Baby Kumari, pregnant with her fifth child, collapsed on her way to a local health centre. For a moment, she feared the worst—a miscarriage brought on by the relentless heat.
Fortunately, she wasn’t alone. Kalyani Karan, a trained community health worker under India’s Accredited Social Health Activist (ASHA) program, was nearby. Karan responded quickly, recognizing that Kumari was severely dehydrated. She used a wet scarf to cool her down, fanned her, and gave her a homemade oral rehydration solution (ORS) she always carries. Kumari stabilized and was then rushed to a district hospital, where doctors confirmed she was suffering from heat exhaustion—an illness that could have escalated into a life-threatening heat stroke without intervention.
Kumari, who works as a cleaner and cook in the densely populated area of Najafgarh on Delhi’s outskirts, later recovered. But the experience left her shaken. “My previous pregnancies were nothing like this. The heat just overwhelms me,” she said.
ASHAs: India’s Frontline Heat Defenders
Karan is one of the million ASHA workers across India—a largely female workforce that serves as a critical bridge between underserved communities and the public health system. These workers offer essential services, especially maternal and child healthcare, in areas where access to hospitals or clinics is limited.
In rapidly warming cities like Delhi, where heatwaves are becoming more severe and frequent, ASHAs have taken on the added role of protecting vulnerable pregnant women from the health risks posed by rising temperatures.
Delhi alone has experienced more than 4,200 days above 35°C (95°F) in the last 30 years, the highest among the world’s major capital cities. And experts warn that India may be one of the first countries where outdoor conditions cross safe heat thresholds for human health—even in the shade—by 2050.
Pregnancy and Extreme Heat: A Dangerous Mix
Medical professionals are sounding the alarm over the impact of heat on maternal health. High temperatures during pregnancy have been linked to increased risks of complications such as high blood pressure, gestational diabetes, cardiac stress, preterm labor, stillbirth, and lower birth weights.
“Pregnancy increases body temperature naturally,” explains Dr. Deepali Rana, a gynecologist in Delhi. “When that’s combined with intense heat, it puts women under serious physiological stress.”
Each degree Celsius of warming is estimated to raise the risk of preterm birth and stillbirth by around 5%. With global temperatures expected to rise nearly 3°C above pre-industrial levels by century’s end, the risks are multiplying.
Still, few countries—including India—have policies that address maternal health specifically in the context of climate change. Most public health guidelines lack specific advice on heat safety for pregnant women, especially those who work outdoors or in poorly ventilated environments.
Local Solutions, Global Crisis
Karan, who previously worked as a schoolteacher, began educating herself on heat-related illnesses through online videos after noticing more pregnant women struggling in summer. She joined the ASHA program in 2019 and now provides antenatal support to over two dozen women—many of whom have high-risk pregnancies.
To help her community cope, she created a simple guide for pregnant women, with practical tips: drink plenty of hydrating fluids like lime water or buttermilk, avoid sun exposure, wear light cotton clothes, and carry ORS. She even asks her patients to send photos showing they’re following her advice.
In 2023, Karan started a WhatsApp group for expectant mothers, where she shares heat safety videos in Hindi. That’s how she learned Kumari was experiencing extreme discomfort during her pregnancy. After counseling her, Karan helped Kumari shift her work hours to cooler parts of the day. “Quitting work wasn’t realistic,” Karan says. “We had to find a solution that respected her reality.”
Kumari earns around ₹7,000–7,500 ($85–$90) per month—barely enough to support her family. “I couldn’t afford to stop working,” she says, “but Kalyani didi helped me stay safe.”
ASHAs Face Their Own Heat Risks
Despite their critical role, ASHA workers remain classified as volunteers in official records. They receive modest stipends—around ₹3,000 ($35) monthly in many states—plus task-based incentives. Their workloads are intense: conducting home visits, collecting health data, organizing immunizations, and responding to emergencies, all while often working in extreme heat themselves.
“I fainted from heat last May while heading to check on a newborn,” Karan recalls. “Someone recognized me from my pink uniform and helped me home.”
Although ASHAs receive regular training, Karan says they are rarely taught how to protect themselves—or their patients—from rising temperatures. “We once requested umbrellas,” she adds. “I never got one.”
Ambulances for pregnant women are supposed to be air-conditioned, but most only have a small fan. “That’s why I always carry my own hand fan when I travel with someone in labor,” she says.
Health System Under Strain
Experts like Dr. Ajay Chauhan at Delhi’s Ram Manohar Lohia Hospital—where a dedicated heat stroke unit was set up in 2024—believe ASHA workers are essential for building community-level resilience. “We need local knowledge, like what ASHAs bring. Their insights are critical, especially when scientific understanding of how heat affects pregnancy is still developing,” he says.
Official figures often underestimate the scale of the crisis. In 2024, government records listed 374 heat-related deaths, but the non-profit HeatWatch documented 733 deaths and more than 40,000 heatstroke cases across 17 Indian states.
Dr. Rana believes that simple interventions like hydration, sun protection, and proper nutrition can go a long way—if applied consistently. “ASHAs are doing exactly that, but they need more support and recognition,” she says.
Still Waiting for Recognition
Despite the burdens they carry, ASHA workers continue to serve with dedication. Dalal, another ASHA from the Najafgarh area, says: “We’re available day and night. Illnesses and childbirth don’t follow a timetable. But we’re still treated like part-timers, not professionals.”
Back in Najafgarh, Karan remains focused on one goal. “All I want is to help these women have safe pregnancies and healthy babies,” she says.
Baby Kumari safely delivered her child in December. “I recovered faster this time,” she shares. “I had someone looking out for me—someone just a phone call away.”
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