Updated Evidence Base 2024–2026: Key Research for Funding Conversations

EXECUTIVE SUMMARY

This document compiles the most important new research findings (2024–2026) that UNFPA staff should cite in funding conversations. It focuses on evidence that has been published since the original knowledge base documents were written, with particular attention to: the climate-SRHR causal evidence (now significantly stronger), maternal mortality trends, stillbirth-climate links, GBV data, and economic arguments for SRHR investment.

1. LANDMARK: Heat Exposure and Pregnancy — Nature Medicine Meta-Analysis (November 2024)

Citation: Lakhoo DP et al., "A systematic review and meta-analysis of heat exposure impacts on maternal, fetal and neonatal health," Nature Medicine, Vol. 31, pp. 684–694 (2024).

This is now the definitive reference for the heat-pregnancy nexus. 198 studies across 66 countries, 23 outcomes.

Key Quantified Findings

Limitation: Studies skewed toward high-income (63.3%) and temperate-zone countries (40.1%). Asian-specific studies are emerging but underrepresented.

Why this matters for funders: This is peer-reviewed evidence in one of the world's highest-impact medical journals establishing that climate change directly harms pregnancy outcomes. The causal pathway previously cited in UNFPA-R-02 is now quantified at meta-analytic level.

2. AJOG Scoping Review: Climate Drivers and Maternal Health (2025)

Citation: Published in AJOG Global Reports (2025). 158 studies from 966 screened.

Key finding: 92.4% of included studies documented statistically significant associations between climate drivers and adverse perinatal outcomes — including preterm birth, low birthweight, preeclampsia, gestational diabetes, miscarriage, stillbirth, and maternal death.

Critical gap identified: No evidence-based clinical interventions yet established for preventing heat-related adverse pregnancy outcomes. No pregnancy-specific guidance exists in national heatwave plans globally.

3. Stillbirth and Climate Change: BJOG Expert Review (2024)

Citation: Published in BJOG: An International Journal of Obstetrics and Gynaecology (2024).

• ~2 million stillbirths per year globally; 80% in sub-Saharan Africa and Southern Asia
• Of 20 studies reviewed, 19 found an association between heat exposure and stillbirth risk
• Multi-country Africa study (Benin, Malawi, Tanzania, Uganda): 34% higher perinatal death risk at temperatures in 75th–99th percentile in week before birth
• One analysis: odds of stillbirth 1.9x higher at 30°C vs. 20°C
• Pathways: reduced placental blood flow, epigenetic changes, congenital anomalies, gestational hypertension

Global Stillbirth Data (UNICEF/UNIGME 2024)

• 2023: approximately 1.9–2.0 million stillbirths (~14 per 1,000 births)
• Since 2000: reduced by one-third (slower than child mortality which fell >50%)
• 40%+ occur during labour — directly preventable with skilled birth attendance
• In conflict-affected settings: stillbirth rate is twice as high

4. Climate Central: Pregnancy Heat-Risk Days (2024–2025)

• Climate change has at least doubled average pregnancy heat-risk days in 222 countries (2020–2024)
• In 78 countries: climate change added at least one full additional month of pregnancy heat-risk days per year
• Pacific Islands and Southeast Asia among the hardest hit
• Nearly one in three countries experienced at least an extra month of dangerous heat for pregnancy

Talking point: "Climate Central data shows climate change has doubled pregnancy heat-risk days globally. In Southeast Asia and the Pacific, pregnant women face additional months of dangerous heat exposure. This is not a future threat — it is happening now."

5. Maternal Mortality: Latest Global Estimates (2025)

Source: WHO/UNFPA/UNICEF/World Bank: Trends in Maternal Mortality 2000 to 2023 (published 2025)

WHO South-East Asia Region

• 41% MMR reduction between 2010 and 2020 (vs. 12% globally)
• Seven countries achieved below-140 target
• But institutional delivery remains a structural challenge in Myanmar, Bangladesh, Nepal, Timor-Leste

6. Bangladesh Khulna SRHR Study (2025) — Country-Specific Evidence

Citation: Dijkerman S, Hossain J, Persson M, Konika RA, Paul D. Published in Women's Health (SAGE Journals, 2025). DOI: 10.1177/17455057251339283.

The first study to apply an intersectional climate justice lens to SRHR in Bangladesh. Study site: four communities in Dacope upazila, Khulna — severely impacted by Cyclone Bulbul (2019) and repeated flooding.

Key findings:

• Climate events directly caused miscarriage, pregnancy complications, premature labour
• Disrupted contraceptive supply chains increased unintended pregnancies
• Child marriage, forced abortion, reproductive coercion documented as climate coping mechanisms
• Cyclone shelters lack women-friendly facilities — GBV exposure hotspots
• Menstrual health severely compromised by lack of supplies, privacy, clean water

Authors' conclusion: "Climate resilience cannot be achieved without addressing sexual and reproductive health and rights."

7. WHO/HRP Climate-SRHR Research Agenda (2025)

WHO issued a formal call for research proposals identifying ten priority research questions at the climate-SRHR intersection. Four priority outcome areas:

1. Maternal health
2. Gender-based violence
3. Contraception access
4. Abortion care

The WHO/HRP and UNFPA co-authored scoping review (BMJ Public Health, August 2024) confirmed: extreme temperatures, cyclones, floods, and droughts are associated with reduced birth weight, preterm births, stillbirths, pregnancy complications, and maternal deaths. Major gaps: abortion care, reproductive cancers, and contraception use.

8. Lancet Countdown SIDS Report (December 2024)

Citation: First comprehensive Lancet Countdown report on health and climate change in SIDS. 35 authors, 59 countries.

Pacific-specific findings:

• Pacific SIDS: highest average annual hours of at least moderate heat stress globally — over 3,000 hours/year (2019–2023), up 15–16% from baseline
• Heat-attributable deaths doubled from 2000–2005 to 2017–2022
• Climate disasters compound overburdened health systems
• Adaptation efforts significantly lag funding estimates

9. GBV and Climate: Updated Evidence

• Systematic reviews (Thurston et al. 2021 and subsequent) consistently confirm GBV rates increase during and after climate disasters
• Mechanisms: displacement, overcrowded shelters, male livelihood loss, alcohol, breakdown of social sanctions
• UNFPA Strategic Plan 2026–2029 projects: under worst-case climate scenario, intimate partner violence could nearly triple to 140 million by 2060 in sub-Saharan Africa
• Post-Typhoon Rai/Odette (Philippines): 95% of evacuation centres had no women-friendly safe spaces
• Economic cost of GBV: estimated at 1–4% of GDP in affected countries

10. Economic Arguments for SRHR Investment

Return on Investment

The Underinvestment Case

• Only 0.2% of global R&D targets SRHR in developing countries
• Only 2% of adaptation funding reaches health
• SRHR is "almost entirely absent" from climate finance
• Only 34% of countries integrate SRHR into national climate plans
• Donor family planning funding: $1.36B (2024) — one of lowest since 2012 London Summit

11. UNFPA Strategic Plan 2026–2029: Key Evidence Anchors

The new Strategic Plan (adopted July 2025) establishes:

• Climate change as a core "megatrend" in the polycrisis
• New fourth outcome on population dynamics and demographic change
• Annual financing requirement: $26 billion across all outcomes
• Commitment to integrate climate-SRHR into NDCs, NAPs, and DRR plans
• Heat stress and environmental shocks on maternal/newborn health explicitly addressed

MOPAN 2025 assessment gap: UNFPA lacks a dedicated climate strategy with clear objectives, indicators, and targets — being addressed through the new strategic plan.

HOW TO USE THIS EVIDENCE IN FUNDER MEETINGS

For Climate Funders

Lead with: Nature Medicine meta-analysis (heat → preterm birth OR 1.26 during heatwaves), Climate Central pregnancy heat-risk doubling, and the $19.3B GCF portfolio where SRHR is absent.

For Health Systems Funders

Lead with: 260,000 maternal deaths/year (stalled since 2016), 900,000 midwife shortage, 1.9 million stillbirths (40%+ preventable with skilled attendance), and UNFPA's $516M procurement capacity.

For Gender Equity Funders

Lead with: $4.5 trillion GDP opportunity from closing gender gaps, $1.7 trillion women's finance gap, and Gates Foundation's $2.5B women's health commitment signalling market validation.

For Impact Investors

Lead with: Utkrisht DIB (13,449 deaths averted, $9M), UNFPA's 34.9% localisation rate (above Grand Bargain target), and MAS 2x blended finance recognition making SRHR investments economically efficient.

SOURCES

All citations provided in-text. Key sources:

• Lakhoo DP et al. (2024) Nature Medicine 31:684–694
• AJOG Global Reports (2025): Climate drivers and maternal health scoping review
• BJOG (2024): Expert review on heat and stillbirth
• UNICEF/UNIGME (2024): Standing Up for Stillbirth
• WHO/UNFPA/UNICEF/World Bank (2025): Trends in Maternal Mortality 2000–2023
• Dijkerman et al. (2025): Khulna Bangladesh SRHR study, Women's Health/SAGE
• WHO/HRP (2025): Climate-SRHR research call
• Lancet Countdown SIDS (2024): Lancet Global Health
• Climate Central (2024–2025): Pregnancy heat-risk analysis
• UNFPA SWP 2024; Strategic Plan 2026–2029
• Guttmacher Institute: Adding It Up 2024
• MOPAN: UNFPA Assessment 2025

Evidence quality rating: Strong for heat-pregnancy nexus (Nature Medicine meta-analysis). Strong for maternal mortality figures (UN MMEIG). Moderate for climate-GBV causal pathways (systematic review level). Strong for economic returns (Guttmacher, McKinsey, WEF). Moderate for country-specific evidence (single studies, not replicated). The overall evidence base for the climate-SRHR nexus has strengthened significantly between 2024–2026.