Nuh (Haryana): “My throat was drying up, everything started to go dark…” were her last memories before losing consciousness. Satram, 22, was pushed to the brink last year. Her anemic body, unable to withstand the 42-degree heat, had to be rushed to Sudaka PHC. A blood transfusion saved her life.

The National Family Health Survey 5 (2019-21) reveals that over 60% of non-pregnant and over 55% of pregnant Indian women aged 15-49 are anaemic. According to the District Fact Sheet for Mewat, Haryana, 68.6% of women aged 15–49 in the district are anemic, and 79.9% of pregnant women in the same age group are anemic.

Anemia plagues female farmers in Mewat, and the ongoing heatwave delivers a double whammy of hardship.

Miskena, 35, is a mother of four—three daughters and one son. She is anemic with a hemoglobin level of 8.5 grams per decilitre. She is also breastfeeding her nine-month-old son while working under the scorching sun for seven to eight hours, “It’s hard. I’m constantly exhausted and get these tingling sensations all over my body.”

Under the harsh sun of Mewat, Miskena, 35, an anemic women, with her four children, while breastfeeding her youngest in Mewat. Photo: Zoya Hussain/HoA

She begins early so that she can be back home by 3 p.m. to care for her newborn. “By the time I return, I’m often irritable, but what can I do? The frustration sometimes gets directed at my children,” she says.

Dharamwati, 39, a farmer battling anemia for four years, knows she is risking her life by working in the heat. Her hemoglobin count hovers at a dangerous 5 grams per decilitre – less than half the normal range. Working with fever and body aches in the heat is normal for her. “Last summer,” she admits, “I needed at least two painkillers a day just to survive.”

Mewat’s Ujina PHC now has a separate room for the influx of heatstroke and heat wave patients. Dr. Hemraj says that most patients arriving in May and June are women. They often complain of rashes, nausea, vomiting, diarrhea, and chest discomfort. Anemia makes them especially vulnerable. “Last week, a 21-year-old anemic farmworker came in breathing heavily,” he recalls. “Her body, already struggling to carry oxygen, couldn’t handle the heat. Her heart raced, making her dizzy and faint.”

Laboratory Report for Miskena, 35, showing a critical hemoglobin count of 8.5 rams per decilitre, highlighting the severe anemia challenge faced by women farmers in Mewat. Photo: Zoya Hussain/HoA

Heat, Hunger, and Hardship: A diet of deprivation

Although Satram has been taking her medicines regularly, her diet reveals the extent of the deprivation women here face.  Lemon juice passes as breakfast for her.

“We don’t own a buffalo, otherwise I could have made tea for myself, but lemon water is good enough; it gets me through the day.”

Satram works about seven hours a day and does not have the luxury of a lunch break. When she returns home, her meal typically consists of one or one and a half rotis (flatbreads) with whatever vegetable is available.

“One roti is usually enough for the day. If there’s any leftovers, or if no one else ate it, I might have half more,” she remarks.

A healthcare card from Nuh district shows treatment details for a woman farmer facing the added strain of Mewat’s heatwave. Photo: Zoya Hussain/HoA

Similarly, Miskena’s day begins with a simple breakfast of roti soaked in tea. She often skips both lunch and dinner.

Their primary source of income is grueling farm labor. During sowing and harvesting seasons, they might receive a minimal share of the crops as payment.

42-year-old Anita’s diet primarily consists of locally grown produce. “Due to extreme heat and water scarcity, the quality of locally grown produce is very poor. Much of the crop burns before harvest, and pests infest what survives,” she says.

Heatwave, anemia, reproductive crisis: A call to action

With one of the nation’s highest maternal mortality and fertility rates, Nuh exemplifies the tragic cost women pay when societal, biological, and environmental factors collide. As men seek work in transport and construction fields, women are left behind to shoulder the crushing burden of farming in a water-scarce region.

Mewat’s women farmers complain that the quality of locally grown produce is very poor due to extreme heat and water scarcity. Much of the crop burns before harvest, and pests infest what survives. Photo: Zoya Hussain/HoA

The systemic deprivation faced by women in Mewat directly harms their reproductive and menstrual health. Repeated pregnancies strain their already weakened bodies. In this conservative region, contraception is gaining cautious acceptance. However, social taboos and limited access restrict options like condoms, placing the burden of family planning squarely on women. Miskena, after four children, finds some relief in birth control pills:  “Now I’m taking these pills every month so I don’t get pregnant. My husband gets them for me.”

Many women struggle with irregular menstrual cycles, a side effect often attributed to birth control pills. Doctors confirm this link between the pills and disruptions in women’s cycles. Meanwhile, water scarcity compounds the challenge of menstrual hygiene.

“I bleed in the fields,” Anita reveals, “and there’s not enough water to even wash my hands, let alone keep myself clean.”

Dharamwati, says, “My periods are so unpredictable – They come and go as they please, and sometimes there’s no end to the bleeding. They can last the whole month.”  The relentless heat and her irregular, painful periods leave her short-tempered and exhausted.

Heatwaves are increasingly recognized as a risk factor that can trigger or exacerbate early menopausal symptoms, including hot flashes, irregular periods, fatigue, and irritability. The full extent of the link between heat waves and their impact on menstruating and pre-menopausal women remains to be understood.  However, emerging research suggests a disturbing connection. A 2023 Maturitas study indicates climate change can directly worsen menopausal symptoms.  The impact isn’t limited to older women; climate change has also been linked to girls starting their periods earlier, even as young as 10, according to a study in the International Journal of Environmental Research and Public Health.

Dr. Shehla Jamal, a gynecologist from New Delhi, explains, “Heatwaves disrupt the hypothalamic-pituitary-ovarian axis, which regulates menstruation and reproduction. Our bodies try to cope, sweating to cool down, but in extreme heat, these defenses can be overwhelmed.”

For women already navigating health challenges, climate change is the final straw.  Dr. Vikas Kaushal, who works tirelessly on women’s health issues, warns, “This isn’t just about hot flashes. Heat-induced disruptions can lead to infertility, agonizing periods, and worsened menopausal symptoms. Women’s mental health suffers too.”

“I tell myself, ‘Just a few more years’,” says Anita, clinging to the hope that menopause might bring her respite. “Until then, I have to labor under the heat where after just 20 minutes in the sun, my iron sickle becomes too hot to touch,” she adds.

No solution due to local apathy, taboo 

The brutal 2023 heatwaves, intensified by climate change, were a grim preview of the future. Those who work the land will be hit hardest, their bodies strained beyond endurance. As a UN report highlights, the world’s most vulnerable bear the brunt of climate change, and for women, the burden is unique. “They are more dependent on threatened natural resources,” the report notes, their health and livelihoods bound to the changing climate.

For the women of Mewat, climate change isn’t a distant threat. While they may not have the scientific vocabulary, they know their world is changing. They shield themselves with scarves, and work in the fleeting cool of dawn and dusk…yet the heat pushes them to their bodily limits. They need solutions but find little societal or administrative support.

Local health officials seem unaware of this critical reality: heatwaves disproportionately harm women, demanding targeted interventions. At the community health center, Dr. Kapil Dev seems unaware of the specific challenges women face –  the way heat and water scarcity worsen their struggles. When pressed on advisories for women during heatwaves, he has no answers.

The situation is further compounded by enduring stigma around menstruation.”Women here don’t talk about periods or menopause,” Dr. Rama Rani of Baroji PHC explains. “They endure the pain in silence, never seeking help.”