Safeguarding maternal health against extreme heat in India: A policy analysis of state-level heat action plans.

OBJECTIVE: This study identifies and characterizes policy measures across Indian states to protect pregnant and lactating women from extreme heat exposure through a thematic analysis of state-level heat and climate adaptation plans. METHODS: Using content analysis, we systematically reviewed publicly available Heat Action Plans (HAPs) (N = 19) and, when unavailable, the State Action Plan on Climate Change (N = 16) from all Indian states and union territories. Strategies referencing pregnant and lactating women, either directly or indirectly (i.e., as part of a group identified as vulnerable), were extracted, categorized and coded. RESULTS: Twelve of 35 state plans (33%) contained no recommendations for pregnant or lactating women. The remaining 23 plans listed 214 strategies, comprising 102 unique strategies (no repetitions). However, only 40 directly addressed this group. Karnataka (16), Telangana (11), and Delhi (10) had the highest number of unique strategies. Strategies were categorized using the four-category climate adaptation framework of Chersich et al. and fell into behavior change actions (n = 100), structural/policy, and climate-financing support measures (n = 51), health system interventions (n = 38), and built environment/cooling solutions (n = 25). CONCLUSION: Strategies specifically addressing pregnant and lactating women during extreme heat remain limited across Indian states, with most focusing on behavioral interventions rather than structural solutions. Critical gaps exist in 12 states with no targeted measures. Very few strategies focus on pregnant and lactating women in the HAPs. Strengthening evidence-based, targeted adaptation policies and implementing comprehensive structural interventions are critical to protecting them from the increasing heat exposure risks.