Climate change and sexual and reproductive health: what implications for future research?

Keywords:

• climate change
• eco-anxiety
• sexuality
• contraception
• family planning

Introduction

Climate change is widely recognised as one of the most serious threats to public health.¹ Climate-related concerns have never been as central to political, civic, and social discussions as they have in the past 20 years. Researchers are increasingly concerned with its impact on the mental health of individuals and communities.² The most recent Intergovernmental Panel on Climate Change (IPCC) report (2022) exposes the increased risks in North America of extreme weather events (e.g. heat waves, floods, hurricanes, wildfires), food insecurity, ecosystem pollution (e.g. air and water quality), limited water supply, and reduced economic activity that can result in many negative social impacts.³ Not all countries are equal in the face of climate change; while those in the Global North have more resilient systems for mitigating the impacts of extreme climate events, they also generate higher carbon footprints.³

One increasingly documented impact from climate change is eco-anxiety, which refers to mental distress or chronic fear associated with deteriorating environmental conditions.^4,5 Eco-anxiety generates an array of feelings, such as anger and fear, powerlessness and helplessness, trauma after extreme climate events,^2,4 and solastalgia, which refers to the distress caused by environmental degradation or transformation.⁶ Adolescents and emerging adults are especially likely to report eco-anxiety and climate-related distress that impact their daily lives.⁷ Some Indigenous communities, such as Inuit communities in Circumpolar regions, are witnessing rapid climate-related changes. Still contending with the harms of colonialism, which sought to eliminate their culture, languages, and identities, they are rebuilding the link with culture, which involves the relationship to land and resources, while their land is becoming more degraded due to the climate crisis.⁸ Women, people living in poverty, racialised people and other marginalised groups are more at risk from the effects of extreme climate events due to socioeconomic structures that perpetuate social inequalities,^9–11 which can generate more climate-related distress.

Without necessarily suffering from eco-anxiety, many people have environmental concerns that can influence their sexual and reproductive lives. The effects of climate-related concerns and eco-anxiety on dimensions of sexual and reproductive health are socially and scientifically relevant. However, while some media are reporting individuals’ stories about reappraising hormonal contraceptives and reproductive choices due to climate change concerns,¹² these concerns have been overlooked in scientific research.

The aims of this commentary are twofold: to illustrate the need for a comprehensive approach to the impacts of climate-related concerns on dimensions of sexual and reproductive health as a way to guide future research; and to explore how these impacts manifest in the lives of individuals and communities. To do so, four specific dimensions of sexual and reproductive health will be documented: (1) Climate concerns related to waste generated as bioproducts of contraceptives and menstrual products; (2) Partner choice and sexual practices through the lens of climate change; (3) Variable desire for parenthood based on climate-related concerns; (4) Climate change as another factor contributing to violence against women. Table 1 presents a non-exhaustive portrait of what is currently known in each of these dimensions and future avenues of research.

Table 1: Non-exhaustive summary of scientific knowledge on the influence of climate concerns on four dimensions of sexual and reproductive health

	What is known	What is yet to be known and future directions of research
1. Climate concerns related to waste generated as bioproducts of contraceptives and menstrual products	Extreme climate events increase risk for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) Difficult access to healthcare is contributing to this increase.^Citation13–15 To limit waste, some people choose hormone-free contraception or behavioural protection methods Climate-related concerns may lead some people to change the way they prevent pregnancy and protect themselves against STIs.^Citation16,Citation17 Ecofriendly products are not compatible with the reality of menstrual precarity shared by many people Ecofriendly options are not sufficiently safe and accessible.^Citation18–23	• To what extent do climate-related concerns lead people to change their contraceptive methods? • To what extent do people feel equipped and sufficiently educated to use non-hormonal or behavioural methods with a sense of security and without stress? • In what ways and to what extent do extreme climate events increase the risk of menstrual precarity? • Which groups of people (e.g. gender, age, class, education, race) are more likely to review their contraceptive choices and menstrual products in relation to their climate-related concerns?
2. Partner choice and sexual practices through the lens of climate change	No empirical data found on the subject	• How climate-related concerns modulate intimate relationships both before and during the relationship? • How are climate-related concerns changing sexual practices in terms of the use of sex toys and sexual products (e.g. lubricants, accessories)?
3. Variable desire for parenthood based on climate-related concerns	Influence of climate change (extreme heat, air pollution, extreme weather events, threats from vector-borne disease) on maternal health Environmental quality can influence the health of pregnant people.^Citation24 Choice to have children or not Climate-related concerns may influence the desire for parenthood.^Citation25,Citation26. Family size Climate-related concerns may be an incentive to have a smaller family.^Citation25 Family configuration Climate-related concerns lead people to look at parenthood differently (i.e. adoption, foster children, coparenting).^Citation26	• Which groups of people (e.g. gender, age, class, education, race) are more likely to reconsider their desire for parenthood in relation to their climate-related concerns? • How do concerns about having a child in a climate crisis vary across geographic regions? • What are the needs of parents who want to align their lifestyle to their environmental values? • How do climate-related concerns translate into attitudes and behaviours related to (non)parenting? • How to offer sustainable alternatives to parents who wish to integrate them without increasing women’s mental burden? • How is the mental health and well-being of people with climate-related concerns who have made the choice to have children or not?
4. Climate change as another factor contributing to violence against women	Extreme climate events increase the risk for violence against women. The disruption of daily life and the instability can increase economic, sexual, psychological and physical violence against girls and women.^Citation27–32	• To what extent a person’s climate-related concerns increase their control and violence towards their intimate partner? • Can one person’s climate-related concerns lead to a desire to control behaviour and coercively influence the other’s attitudes and values?

1. Climate concerns related to waste generated as bioproducts of contraceptives and menstrual products

Scientific literature suggests associations between climate change and sexual health, especially regarding unequal access to health care, which can increase social inequalities.¹³ For instance, during extreme weather events, increases in sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) prevalence are observed due to barriers to protective behavioural strategies for safer sex and access to healthcare (e.g. prevention, screening, treatment), and due to food insecurity – all of which have complex links to HIV.¹⁴ For example, the risk of contracting HIV may increase due to the survival strategies of people living with food insecurity, which may include engaging in unprotected sex for pay or food.

Climate-related concerns may also lead individuals to make choices that will (in)directly impact their sexual health, such as contraceptive choices. For example, latex condoms generate waste and often end up in landfills or in waterways.³³ Hormonal contraceptives can contribute to the contamination of the water supply by synthetic oestrogens, even if they are not the primary source of oestrogenic compounds in the environment.³⁴ These concerns – in addition to those generated by the side effects of hormones on the overall health of individuals¹⁶ – can lead some people to opt out of hormonal methods, and instead use nonhormonal behavioural methods (e.g. calendar method, cervical mucus observation, luteinizing hormone (LH) levels, withdrawal), which can result in unwanted pregnancies, as the failure rates vary between 15% (fertility awareness-based methods) and 20% (withdrawal) with typical use,¹⁷ as well as STIs. These choices can be even more risky when access to safe abortion is compromised in some places.^35,36 Public health needs to play an active role in disseminating evidence-based information to enable – and support – informed individual choices. Since little empirical data are currently available, future research should explore, with large-scale studies using representative population-based samples and in-depth qualitative interviews, whether climate-related concerns influence the choice of hormonal and nonhormonal methods as contraception among people.

Due to environmental awareness, individuals increasingly want to use ecofriendly menstrual products to reduce waste (e.g. reusable menstrual pads, silicone cups). These products are expensive and not readily available. Moreover, some are not as ecofriendly and safe as they claim, while toxic chemicals have been found in menstrual products.^18,19 Ecofriendly – but expensive – menstrual products are not accessible to all, in a context where many menstruating people are faced with menstrual precarity.²⁰ Menstrual precarity or period poverty refers to not having the financial means to buy sanitary protection on a regular basis.^21,22 A US study found that 14.2% of university students reported experiencing menstrual precarity at least once a year, while a further 10% reported experiencing it every month.²³ There is an environmental, social and health relevance to developing strategies to make ecofriendly products accessible and safe for all. Future research should also focus on how extreme climate events are contributing to increases in menstrual precarity and aim to develop resilient systems to reduce this effect. This would reduce the gender financial gap that contributes to women’s – and menstruating persons’ – vulnerability to climate change.⁹

2. Partner choice and sexual practices through the lens of climate change

The scientific literature has not yet addressed the effects of climate change on intimate relationships. However, the media report that climate-related concerns are now being considered in intimate partner choice. One media survey reveals that young adults’ choice of partner was influenced by the individual’s level of awareness about climate change.¹² For example, lifestyle (housing, transportation, consumption habits) choices can reveal everyday (un)sustainable choices. While intimate partner choice has always been influenced by one’s values and worldview, perceived eco-citizenship and eco-responsibility may now be added to these considerations. A mismatch in climate-related values can lead to eco-dumping, a neologism identified as one of 2023’s top dating trends according to a dating site, which refers to ending a relationship or an online match when one person’s views on climate change don’t align with the other’s values.³⁷ This can also influence sexual practices, including the use of ecofriendly products (i.e. sex toys made of recycled materials, non-petroleum-based lubricants). Whereas no empirical data seem to be available yet, future research should explore how these climate-related concerns modulate intimate relationships both before and during the relationship. It is also important to propose free, accessible, and safe ecofriendly sexual practices. Access to high-quality information is essential in informed decision-making.

3. Variable desire for parenthood based on climate-related concerns

The area of sexual and reproductive health most explored in climate science is reproductive health. Studies show the effects of climate change on pregnant women’s health due to extreme heat, air pollution, extreme weather events, and increasing threats from vector-borne disease.²⁴ Yet other aspects of climate-related concerns about reproductive health remain poorly documented. Reconsidering family planning is increasingly documented in the media^38,39 and several concerns are revealed: Does having a child negatively contribute to the climate crisis? Is it ethical and responsible to have a child considering they may not experience a healthy environment due to climate change? American media polls indicate that a large proportion of people share these climate-related concerns: a survey published in Business Insider in 2019³⁸ reveals that, among 1102 respondents, nearly 30% – and 38% of emerging adults aged 18–29 – agreed that couples should consider climate change when deciding whether to have children. This issue is relatively new in the scientific literature,²⁵ though some studies report that individuals who have climate-related concerns are those who seem inclined to reconsider their reproductive choices, either by not having children or by having a smaller family.^25,26,40 These concerns were based in part on the recognition that individuals in the Global North (in the case of this study, the United States) had a higher ecological footprint than those in the Global South, and that having a child perpetuated this pollution and high resource consumption.

Research would benefit from exploring the intersection and the interinfluence between climate change and family planning. It is important to consider the gendered and structured power relations that differentially influence women’s choices about whether to have children, and particularly racialised women’s, as certain groups are historically coerced to have fewer children, such as Indigenous women undergoing forced sterilisation.⁴¹ Research should include principles of reproductive justice and reproductive autonomy for all people to understand the issues raised by climate-related concerns from a holistic, flexible, and nuanced perspective, embodied in the complexity of human realities.

It is also necessary to explore this phenomenon from a collective and structural perspective, rather than solely as an individual responsibility. In fact, this phenomenon is part of a context where consumption and production systems at the community level only contribute to the high ecological footprint of individuals.⁴² Rethinking these systems from an ecological and health equity approach would enable sustainable alternatives in the context of parenthood and broader family planning. Indeed, a recent scoping review illustrated a growing commitment to the fight against climate change as individuals become parents.⁴³ Future research should investigate the links between climate-related concerns and their influence on the desire to have children or not, as well as on parenthood when people already have children. In this sense, exploring whether the application of ecocitizenship principles, facilitated by urban and rural environments, can reduce eco-anxiety in a parenting context would be an interesting avenue of research.

4. Climate change as another factor contributing to violence against women

There is scientific evidence to support the links between climate change and violence against women.²⁷ Extreme climate events can generate a disruption of daily life (e.g. loss of job and home), potential relocation, an increased risk of trauma and mental health issues, in addition to entailing significant socioeconomic costs.²⁷ These disaster-related events disproportionately impact girls and women,^28–30 with an increase in economic, sexual, psychological, and physical violence.^27,31 This aggravation of violence is exacerbated by gender norms and patriarchal structures which enable and normalise such violence.^27,32

The COVID-19 pandemic, which presents complex and still imprecise interactions with climate change,⁴⁴ is a recent example of the drastic increase of violence against women when a crisis occurs, where victims were confined with a violent and controlling partner (i.e. control of movements and access to information).⁴⁵ Lockdowns have created contexts of isolation conducive to the increase in the frequency and severity of violence, which has led to a drastic surge in femicides.^46,47

The disruption to daily life caused by the pandemic could certainly be compared to that caused by extreme weather events; associations between complex emergencies and gender-based violence have been demonstrated.⁴⁸ While we have data on the increase in violence against women after extreme climate events, we currently know very little about the complex links between intimate partner violence and climate-related concerns. Future research should be concerned with evaluating whether climate-related concerns and eco-anxiety also contribute to increases in control and violence, and with the ways in which it manifests in intimate relationships. The scientific community should address this issue to develop specific violence prevention strategies related to climate change.

Implications for climate change and sexual and reproductive health research

This commentary provides an overview of different blind spots in climate change research on the one hand, and in sexual and reproductive health research on the other. Eco-anxiety and climate-related concerns experienced by younger generations may influence their choices regarding sexual and reproductive health. Our aim is to encourage future research to cross these research areas to provide a comprehensive approach to the complexity of climate change and its influence on populations. Climate change should be understood as a social determinant of health.⁴⁹ This paradigm shift in the way people think about their sexuality should concern the scientific community, as research results can inform and guide population health prevention and promotion approaches. It is also necessary to move away from an individualising and pathologising vision of the impacts of climate change to understand this issue from a social and public health perspective.

Future research on sexual and reproductive health should emphasise a health equity approach to disaggregate data to make visible specific realities of certain groups that are more at risk from the consequences of climate change. As previously demonstrated, women, people living in poverty, and all community members facing social inequalities are more impacted in a variety of ways by climate change, both from an individual and a structural point of view. An intersectional framework is necessary to understand how sexual and reproductive health issues, in the light of climate change, are modulated by socioeconomic inequalities.⁵⁰ As researchers and policymakers, it is important to be proactive now to propose and implement relevant avenues and resilient systems that can adapt to new concerns related to climate change.

Ethics approval

Not applicable.

Acknowledgements

The author would like to thank Sylvie Lévesque for her revisions of the first version of the manuscript, Carole Boulebsol for her revisions of each version, and Fred Dion for their linguistic and content revision.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author has a doctoral grant from Fonds de Recherche du Québec-Société et Culture (FRQSC).