Health SDGs are at risk from climate change: Evidence from India

PLOS One | https://doi.org/10.1371/journal.pone.0335529 November 26, 2025 3 / 17 and is available in the public domain. Standard statistical and econometric techniques are used for the analysis. The health-related targets have been selected from those enshrined under the SDG 2 on Zero Hunger and SDG 3 on Good Health and Wellbeing. The specific targets which were studied include reduction in malnutrition in terms of stunting, wast- ing, and being underweight for kids under the age of 5 from SDG 2, and, decrease in the share of non-institutional deliv- eries and problems in accessing healthcare for women under SDG 3. The impact of climate change is taken from district level climate vulnerability data while health and socio-economic data at the district level are available from a demographic survey. By examining the relationship between climate vulnerability, socio-economic indicators and health indicators, the study seeks to shed light on how vulnerability to climate change impacts efforts to reduce disparities and promote well- being in health outcomes. Relevant findings from a desk review The literature on non-climatic determinants influencing the attainment of health-related targets is well-established. We present below some of the key findings from the literature on these key determinants. Malnutrition alone is responsible for 45 percent of deaths among children under the age of five [30] and continues to be a significant challenge in many parts of the world, with an estimated 149 million children under the age of five stunted, 45

million wasted, and 37 million overweight or obese as of 2022 [30]. It is concentrated in low- and middle-income countries, particularly in sub-Saharan Africa and South Asia. For India, the SDG 2 index score is 52, much below the target score of 100 [31]. The prevalence of stunting, being underweight, and chronic malnutrition in India is high, with significant regional disparities [32,33]. Around 36% of children under the age of five years were stunted, 32% were underweight, and 19% were wasted in India as per the National Family Health Survey 2019–2021 [34]. Poverty, poor sanitation, lack of access to healthcare, and inadequate education are among the key factors that contribute to the high burden of malnutrition in India, and elsewhere [35]. Malnutrition indicators also vary by demographic factors such as gender, age, education of the mother and the birth order of the child. The understanding on the socio-economic and cultural determinants of malnutrition has advanced significantly. Studies, both globally and in India, have found that female children (under the age of 5 years) are relatively more vulnerable to malnutrition than males due to various socio-economic and cultural factors that lead to prioritization of the needs of male children [36,37] Lower levels of parental education, particularly maternal education is also significantly associated with higher malnutrition rates among children [38] with education providing mothers with better knowledge of nutrition, health

practices, access to healthcare [39,40] and implementation and utilisation of these for enhancing nutritional outcomes for children [41]. In India and elsewhere, maternal education, employment and socioeconomic status interact in many ways [42,43], for instance, higher maternal education can reduce the negative effects of low household wealth on child nutrition [44]. A study in Uttar Pradesh, India, found that the prevalence of stunting was significantly lower among children whose mothers had completed at least primary education [45]. Globally, evidence indicates that stunting, wasting, and being underweight are more prevalent among male children born to mothers with no schooling, and amongst those from lower-income quintiles [46]. Studies in some African countries found that children with siblings or with a higher birth order were more likely to be stunted and underweight [47]. A few Indian studies report similar findings that a higher birth order increases the likelihood of children being stunted and underweight [48,49]. Global evidence shows that in many households, resources such as food, attention and healthcare are spread thinner with more children and in some cases, are distributed based on birth order [50,51]. Globally, studies indicate that increased antenatal care (ANC), particularly when provided by skilled healthcare profes- sionals, correlates positively with reduced risks of malnutrition among children, especially in low and middle-income coun-

tries [52], reducing neonatal and infant mortality [53], low birth weight [52], stunting [54], and prevalence of underweight children [55].