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

PLOS One | https://doi.org/10.1371/journal.pone.0335529 November 26, 2025 7 / 17 for one or more of any of the four variables, are considered to have faced a problem in accessing health care. Out of the total respondents, 46% had a big problem with the non-availability of drugs and 44% with the non-availability of health care professionals at the health centers. Distance was a problem for 29% of individuals while 35% faced a problem with non-availability of female health care providers. (S3 Table provides details on the four underlying variables). Table 1 provides the descriptive statistics for the dependent variables used in the estimation. The percentage of chil- dren suffering from one or more forms of malnutrition ranges between 19% and 37%, constituting a fairly large share of the child population. While a relatively larger proportion of women are opting for institutional deliveries, challenges in accessing healthcare persist for approximately 50% of the respondents. Additionally, we incorporate several explanatory variables in the model, based on learnings from the literature review on determinants of health outcomes. The explanatory variables used for stunting, wasting, being underweight, and having non-institutional deliveries are the child’s age and sex, the mother’s education level, whether the mother received prenatal care from a doctor, the child’s birth order, and the number of ANC checkups. The explanatory variables for the access to health care estimation are the women’s educational level; age; marital status; availability of a person to accompany the

woman to the health facility, and availability of transportation facilities. State dummies are used to account for unobserved differences among states. (S4 Table provides descriptions for the variables) Table 2 presents the data for the explanatory variables. Overall, the sample comprises of 447,348 women, in the age range from 15 to 49 years, with a mean age of approxi- mately 30 years. Approximately, two-thirds of the women are educated beyond primary schooling which is a noteworthy progress made in the last decade. This is also relevant to the current analysis as education is a key determinant of child nutrition outcomes, maternal care and healthcare access. The sex ratio has also improved over time. The distribution of the children’s sample across age categories is also fairly uniform in the dataset varying between 19% and 20%. The share of children with birth orders beyond three are expectedly much lower in the sample. Majority of the women have had four or more than four visits for antenatal check-up during their pregnancy. About one-fifth of the women have problems in finding a companion to reach the health facility over one-fourth, face problems in getting transportation to reach health facilities. 3. Results In highly vulnerable districts, adverse health outcomes are seen to be proportionately higher in occurrence than in the other districts. Fig 2, maps the proportion of individuals with an adverse outcome in highly vulnerable districts versus those in the other districts, drawing upon the merged dataset. The blue bars represent observations from highly vulner-

able districts, and the orange bars include those from the other districts. The data clearly indicates higher occurrence of adverse outcomes in districts which are highly vulnerable as compared to other districts. The estimated log-odds coefficients corresponding to each health outcome and the standard errors from the estimated equations are presented in Tables 3 and 4. It may be noted that variance inflation factor (VIF) tests reveal that the values were less than 2, indicating very low multicollinearity among the variables (S5 Table and S6 Table Table 1. Descriptive statistics of dependent variables. Sustainable Development Goal Target Variables No. of Respondents in Dataset Percentage impacted adversely Percentage unimpacted SDG 2: Zero Hunger Stunting 136,959 37.22 62.78 Underweight 139,845 32.69 67.31 Wasting 134,255 19.02 80.98 SDG 3: Good Health and Well-being Non-Institutional Deliveries 154,547 14.93 85.07 Problems with Access to healthcare 447,348 59.10 40.9 https://doi.org/10.1371/journal.pone.0335529.t001