3.1. Sources retrieved

The PRISMA [25,26] flow diagram illustrated in Fig 1 summarizes the study selection process for the review. Ultimately, 50 studies met the inclusion criteria and were included in the final review.

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Fig 1. PRISMA flow diagram.

https://doi.org/10.1371/journal.pclm.0000984.g001

3.2. General characteristics

The included studies cover a diverse range of settings (refer to Fig 2), with the highest number of studies conducted in Bangladesh (n = 10) [28–37], Pakistan (n = 7) [38–44], India (n = 6) [40,45–49] and Kenya (n = 5) [40,50–53]. In total, studies covered 43 countries, reflecting broad regional representation across Asia, Africa, and parts of Latin America. Only two studies investigated multiple countries [40,54].

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Fig 2. Geographical distribution of included studies.

Note: The base map is made available under a CC BY 4.0 license from Runfola and colleagues [27]. CC BY 4.0 source of the ADM0 (Countries) shape file: https://www.geoboundaries.org/globalDownloads.html.

https://doi.org/10.1371/journal.pclm.0000984.g002

The distribution of study types across the 50 included studies demonstrates a predominance of qualitative research (n = 31), followed by mixed methods (n = 11) [29,31,33,37,55–61], and a smaller number of quantitative studies (n = 8) [40,47,54,62–66].

Overall, the qualitative evidence base is dominated by qualitative descriptive (n = 17) and ethnographic approaches (n = 9) [30,32,36,39,43,46,67–69]. Qualitative descriptive studies do not ascribe to the main traditions (case study, ethnography, phenomenology, grounded theory) and rely on content or thematic analyses to describe patterns. Other qualitative designs included phenomenology (n = 2) [28,70], case studies (n = 2) [34,71], and grounded theory (n = 1) [72].

Quantitative studies, mainly adopted cross-sectional methods (n = 5) [40,62–64,66]. Ecological studies (n = 2) [47,54] and longitudinal studies (n = 1) [65] were less common. Among the 11 mixed-methods studies, the most common design combined cross-sectional and qualitative descriptive approaches [29,31,33,37,55–61].

The studies examined a variety of climate change exposures, with floods (n = 28) emerging as the most frequently studied hazard, followed by storms (including cyclones and hurricanes) (n = 14), droughts (n = 13), and temperature-related events (heat waves, chronically rising temperatures, cold snaps) (n = 10) [29,32,41,51,53,60,62,64,66,68]. Other exposures included water insecurity (n = 6) [38,50,52,57,58,69], sedimentation (n = 4) [29,30,37,46], rainfall (n = 2) [40,63], and salinity (n = 2) [32,37]. These exposures were linked to disruptions in living conditions, health service access, food and water systems, and displacement: factors that can influence SRH and mental health outcomes.

In relation to mental health experiences, the most explored SRH domains were gender-based violence, harmful practices, and stigma/discrimination (including menstrual health related stigmas and related harassment) (n = 34) and maternal-infant health outcomes during the antenatal, intrapartum, and postnatal periods (n = 24). Other SRH domains in which mental health experiences were investigated included fertility/infertility (n = 7) [31,37,39,43,48,60,66], HIV and other sexually transmitted infections (n = 4) [34,46,58,72], menstrual health (n = 3) [33,50,66], sexual function and psychosexual health (n = 3) [37,45,46], contraception (n = 2) [60,73], and comprehensive education and information (n = 1) [59].

Our meta synthesis revealed that climate change functioned as a structural determinant of mental health and SRH. We highlight three ways in which a changing climate is related to mental health and sexual and reproductive health. First, climate change worsens mental and emotional health, leading to SRH adversities (situating mental health as a mediator). Second, climate change worsens SRH, leading to mental and emotional health inequities (positioning SRH as a mediator). Lastly, mental health and SRH adversities and inequities co-occur and cluster in contexts of climate change and related disasters.

Three interlinked thematic domains further illustrate this nexus between mental health, climate change, and SRH: (1) Navigating motherhood under intensified domestic care giving burdens, (2) Fatherhood and coping under resource scarcity, and (3) Adolescent girls’ mental and menstrual distress under water and resource scarcity. These three themes demonstrate distinct but interconnected experiences. For mothers, climate events intensified domestic and care giving burdens, contributing to anxiety, trauma, and social isolation. For fathers, climate-induced resource scarcity contributed to emotional dysregulation, substance use, and in some cases, violence and harmful practices. For adolescent girls, climate-related displacement and inadequate water and sanitation disrupted menstrual health management and dignity, increased stigma, and worsened emotional distress. Table 2 summarizes each theme and its link to mental health, climate change, and SRH in LMICs. The extracted data for each study is presented in S2 Text.

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Table 2. Summary of three main themes.

https://doi.org/10.1371/journal.pclm.0000984.t002

3.3. Theme 1: Navigating motherhood under intensified domestic caregiving burdens

Regarding the first theme, motherhood, pregnancy, and stress were interrelated within the wider environmental context of extreme heat and extreme weather events. Mothers struggled to breastfeed due to heat and related anxiety, which was worsened by their infants’ distress [32,36,74]. High temperatures amplified pregnant women’s domestic responsibilities and physician strain [51,53,68]. Impaired care giving and domestic responsibilities due to climate related events culminated in feelings of distress. In many studies, many women were left to manage their households alone, even during pregnancy, as men were absent or unable to help due to emotional disengagement or economic migration [28,30,32,34,36,38,41,42,45,48,49,51,64,65,68]. Overall, this theme highlights how climate change magnified women’s caregiving and domestic labour, leading to emotional and physical strain and worsened mental health.

Quantitative evidence from China indicates that pregnant individuals experience significant mental and emotional strain, measured using the Global Severity Index, when exposed to elevated temperatures. Women exposed to extremely high temperatures (31.2–34.1 ℃) were more likely to experience high emotional stress (measured as the highest tertile) at 0–1 lagged days (OR = 2.9, 95% CI: 1.9, 4.6; p < 0.001), and 0–2 lagged days (OR = 2.9, 95% CI: 2.1, 4.2; p < 0.001) [64]. Thus, expecting mothers can face an elevated risk of emotional stress as temperatures rise to more extreme levels.

Participants in Burkina Faso described how extreme heat exacerbated stress for new mothers and infants, leading to adverse maternal-infant outcomes. Heat contributed to impaired breastfeeding, culminating in mothers’ heightened anxiety and emotional distress. For example, in Burkina Faso postpartum women reported that impaired breastfeeding was a major source of maternal anxiety, particularly when mothers were confined indoors where heat was most intense. For example, a mother-in-law expressed her observation of maternal heat exposure, impaired breastfeeding, and maternal anxiety:

“The child cries so much that you yourself [the mother] can’t eat. You must fan him to calm him down. You can’t sit down. You take him to go back and forth, you’re just going in circles… In any case, the heat is very tiring for the baby, and it’s tiring for the mother too. The child cries and you, the mother, don’t have time to sit down either. What’s more, he can’t even suckle. As soon as he latches on, he stops because the heat makes him tired. He can’t suckle properly, so he doesn’t get into shape. He can’t suckle properly! Mom’s not happy either, she’s worried. It’s not going well.” [68].

Extreme weather events also posed mental health harm among expecting mothers. In rural Bangladesh, a mixed methods study reported that flooding was associated with a higher prevalence of self-harm thoughts and depression. Compound flooding (when two or more flooding sources occur simultaneously) was associated with a 8.40-fold (95% CI 4.19, 16.10) higher prevalence of experiencing thoughts of self-harm. Focus group discussions revealed the that flooding events prevented pregnant women from bathing and relieving themselves, exposed them to unhygienic latrines with minimal privacy, and increased exposure to domestic violence and sexual harassment in emergency shelters, resulting in mental health challenges [33]. For example, in a focus group a 40 year old woman expressed the interconnection between damaged water and sanitation infrastructure, lack of privacy, and women’s internalized shame:

“Women face challenges in using toilets. Women cannot defecate anywhere. They need privacy. When woman goes to the toilet of others, the surrounding people tease them. We feel shy. This is really challenging. People do not make fun of it when men go to the toilet of others. When infants defecate, it can be thrown away outside. Men can do in any where or on the roadside areas. But, women cannot do that without privacy. We feel shy in going to people’s house for toilet. So, we go to people’s house secretly for using the toilet. Moreover, not so many people can go to the same house. It does not look good.” [33].

Within a climate change context (whether due to chronically rising temperatures or extreme weather events), caregiving and domestic responsibilities intensified for women and restricted the ability to support household recovery. One Iranian woman described managing flood damages during pregnancy alone, highlighting how male emotional withdrawal and substance use compounded the physical and emotional burden of caregiving:

“I was alone during the flood because my husband struggled with addiction and could not help with the housework. Despite being eight months pregnant, I managed to tidy up our home alone. However, the furniture was completely soaked.” [73].

Women also described how climate-related disaster events, such as floods, intensified existing gender inequities within households, sometimes leading to increased aggression and men’s propensity for violence. One woman from Fiji reflected on how limited resources and long-standing gender roles in the aftermath of a cyclones placed women at greater physical and mental risk during crisis: “There is already an unequal distribution of responsibilities within households... The men get aggressive... Women are more prone to violence when food is not provided.” [30].

Compared to elevated temperatures and extreme heat, the study of mental health experiences within the context of cold snaps is more limited. Emerging quantitative evidence suggests a link between exposure to cold temperatures and mental health consequences. For example, in China, both extremely high and low temperatures were related to later emotional stress during pregnancy. Women exposed to extremely low temperatures (1.4–10.5 ℃) had a higher likelihood of experiencing worsened emotional stress (in the highest tertile) at 0–1 lagged days (OR = 3.5, 95% CI: 1.1, 10.6), 0–2 lagged days (OR = 3.1, 95% CI: 0.9, 10.4), and 0–5 lagged days (OR = 1.9, 95% CI: 1.0, 3.9) [64].

3.4. Theme 2: Fatherhood and coping under resource scarcity

The second theme examines how climate-related stress and resource scarcity, driven by floods and drought, intersects with traditional expectations of men as primary economic providers for their households. In some cases, household economic hardship and resource strain led to decisions like the early marriage or child marriage of daughters [28,46,47,54,70–72,78]. Further, traditional gender expectations place men in positions of authority while simultaneously distancing them from domestic responsibilities [37,57]. This form of masculinity magnified household tensions when climate-change needs and realities clashed with traditional (and often rigid) gender norms. Men’s alcohol use was employed as a coping mechanism in situations of climate induced economic and resource strain, in some cases leading to increased violence perpetration [28,52,67,79]. Economic pressures and strained household resources often resulted in men’s stress, frustration, aggression, and violence [29,37,56,57,80].

Evidence from northern Ghana describes how climate-induced resource scarcity places intense pressure on husbands and fathers, leading some to adopt harmful coping strategies such as child marriage. One father explained how child marriage was a strategy to reduce household size and stretch limited food supplies induced by flooding. Such experiences revealed how economic desperation can perpetuate gendered harm and compromise children’s wellbeing: “Sometimes we give them to marriage to make room for space and resources... When the 3 girls leave, we are now left with 6. The harvest can last longer [79].

Similarly, focus group participants from Ethiopia described how resource scarcity such as drought affected water access, thereby intensifying pressures to fulfill traditional gender roles that place women as unpaid domestic workers and men as economic providers. Unfulfilled gender roles led to men’s frustration and in some situations even violence perpetration. One woman explained that men’s anger was triggered when tasks like laundry were delayed due to the overwhelming domestic workload placed on women and water scarcity [50]. This experience reflected how societal norms tolerate men’s disengagement from domestic work and reinforce emotional tensions within the household:

“I don’t know the reason but the burden of all activities regarding water lies on women... Sometimes men get angry if we could not wash their clothes due to other workload... They do not care about activities at home.” [50].

Post-extreme weather events, marked by overcrowding, economic instability, and lack of privacy, intensified psychological distress for men. For example, a social worker from the Philippines recounted how pressures from a recent typhoon led to frustration and depression, which escalated to violence. This cascade of emotional dysregulation and violence reveals how climate induced disruption can exacerbate underlying emotional and gendered tensions within households: “People are living in makeshift houses... This leads to frustration, depression. Conflict arises, then violence. Women are most vulnerable to acts of violence by men.” [71].

Quantitative evidence from several LMICs triangulated the relationship between extreme weather events and violence perpetration, positioning men’s mental/emotional health and coping as an important intermediary. For example, the odds of women from Uganda (OR = 1.23, 95% CI: 1.09–1.38), Zimbabwe (Zimbabwe OR = 1.28, 95% CI: 1.09–1.51), and Mozambique (Mozambique OR = 1.91, 95% CI: 1.64–2.23) reporting any form of intimate partner violence were greater among women who lived in regions that experienced severe weather events [54].

Empirical evidence of alcohol use as a catalyst for violence during extreme weather events was present in India where states with the liquor bans had a 18.6 percentage point reduction in violence against women, during climate disasters such as drought and cyclones [47]. The authors explained that men’s substance use may increase in the aftermath of disasters due to unresolved mental and emotional health concerns [47].

In one study from Peru, the prevalence of experiencing physical intimate partner violence among women increased by 5–8 percentage points (representing an absolute difference) following an extremely dry rainfall shock during the cropping season (compared to periods of regular rainfall), equating to an increase of between 40 and 60 percent (representing a relative difference) in the prevalence of physical IPV [63]. The authors noted two complementary pathways for this effect. The first pathway involved magnified household economic insecurity and poverty-related stress (due to declined household income and expenditure) that eroded emotional and mental wellbeing and heightened alcohol-related aggression among men. The second concerned reduced female agency and empowerment (through reduced female paid employment and control over household finances) that reduced negotiating power in relationships [63].

The quantitative evidence paints a compelling picture about the centrality of men’s emotional health relative to the gender role of economic provider within the family unit. Men’s emotional health and coping were important considerations regarding child marriage and IPV during disaster and drought exposures. Qualitative experiences of resource strain, having multiple mouths to feed, and frustration/ aggression when domestic chores are left unattended illustrate the potential for men’s unresolved mental, emotional and coping needs, during climate induced resource scarcity, to culminate in SRH inequities.

3.5. Theme 3: Adolescent girls’ mental and menstrual distress under water and resource scarcity

The third theme highlights how climate events lead to water resource scarcity, posing significant challenges for menstrual and mental health among adolescent girls. For instance, adolescent girls faced heightened vulnerabilities during disasters, particularly in managing menstrual hygiene in privacy within a wider context of inequitable water access [38,45,48,52]. Regarding climate disaster related forced displacement, the lack of privacy, poor sanitation infrastructure, and fear of harassment in temporary shelters resulted in shame, emotional distress, and disrupted menstrual health practices [28,38,39,43–45,48,63,66,81]. Water insecurity further complicated menstrual hygiene management and sometimes exposed girls and women to verbal or physical abuse like harassment [39,43,44,52,57,69,73]. Menstruating girls sometimes avoided school or opted to isolate, as a result of the mental health adversities and internalized stigma [31,35,37,50,52,55,69].

Regarding extreme weather events, displacement posed consequences for menstrual and mental health. For instance, a healthcare provider in Iran described how delays in accessing menstrual hygiene supplies created unique challenges for adolescent girls menstruating during flood-related displacement:

“Several teenage girls... said they had started menstruating earlier than expected and had bled through their clothes. They did not know what to do.” [73].

The same health care provider further explained that girls also experienced menstrual related embarrassment due to a lack of safe and private spaces:

“The young girl felt embarrassed about changing her pad inside the tent because her shadow would have been cast on the wall... she remained embarrassed.” [73].

Adolescent girls described menstrual and mental health hardships in vivid detail. After the 2022 super-floods in Pakistan, one adolescent girl recounted the feeling of being watched while tending to her menstrual needs:

“Due to the flood, we were displaced from our houses… We are living like beggars in community shelters. We lack access to quality water for drinking and we don’t have a separate washroom, so we go into the bushes for defecation and to change our menstrual clothes. We are under so much stress that most women think getting drowned in water is better than living a life like this, where there is no shelter for women and every second person has an eye on us. There’s an open place near the tent that we use for changing and washing cloth during menstruation, and we have to go all the way to the nearest tube-well to wash the cloth.” [43].

Her testimony depicts a reality where girls lack the basic necessities for menstrual hygiene. In these communal shelters, women and girls felt constantly watched (“every second person has an eye on us”), which not only violated their privacy but also heightened their stress.

Managing menstruation without proper support or privacy often leaves adolescent girls feeling anxious and irritable. One woman in Indonesia described how the water shortage during a crisis directly affected her emotional state: “I get stressed when I don’t have water during menstruation. It makes me easily irritable.” [69]. This link between resource scarcity and mood highlights that the struggle for basic hygiene was not just physical but emotional. Constant fear of leaks or public humiliation also weighed heavily on their minds. Health workers in disaster contexts recognized that “fear and anxiety due to blood stains on their [girls’] clothes are well documented.” [73].

In Peru, participants described how drought and desertification exacerbated water insecurity and limited access to private sanitation facilities, thereby heightening girls’ vulnerability to sexual harassment. A government official recounted that in the absence of adequate bathing infrastructure following a drought, “there is not much water to bathe, for hygiene…. many cases of sexual violence have involved children and adolescents bathing in irrigation channels. People see them and make nasty comments.” [69].

Overall, there is a lack of quantitative evidence concerning mental health experiences related to menstrual health and hygiene within a wider context of climate change. The relationship between mental health, sexual and reproductive health, and climate change warrants further investigation in two key ways. First, mental health can be understood as a parallel challenge experienced during menstruation in the context of rising temperatures. Second, mental health may act as a mediator: gender-insensitive water and sanitation systems following floods and displacement can lead to menstrual health and hygiene inequities that are interlinked with internalized shame. Emerging quantitative evidence is beginning to demonstrate the former linkage.

Quantitative evidence from China highlights the constellation of mental health comorbidities that may be experienced alongside menstrual health in high temperature environments [66]. In this study, women from long term high temperature environments were more likely to experience anxiety and menstrual disorders, compared to women in normal temperature environments [66]. For women exposed to high temperatures anxiety, sleep quality, and temperature perception were significantly related to menstrual disorders, whereas for women exposed to normal temperatures, only depression was significantly related [66]. Mental health comorbidities can be considered alongside menstrual health when addressing challenges in high-temperature environments.

4.1. Implications for programs, policy, and research

In terms of programmatic implications, the present scoping review emphasizes the need to integrate mental health support with SRH programming and interventions in regions severely affected by climate change (both in terms of chronic climate changes and extreme weather events). For example, integrating perinatal mental health services into post-disaster care protocols ensures vulnerable mothers receive timely and appropriate support for anxiety, depression, and intensified domestic burdens [99]. Below we discuss the integration of mental health services in climate change contexts using task shifting and mobile/digital interventions. The evidence for task‑shifting, which consists of training non-specialist providers such as nurses, midwives, or community health workers to deliver mental health interventions, is compelling [100]. A 2025 trial indicated that task‑shifting combined with telemedicine improves access to psychotherapies for perinatal depression and anxiety symptoms across diverse settings [101]. Similarly, community-led volunteer models like Zimbabwe’s Friendship Bench illustrate the power of relatable, trusted Figs in delivering effective psychosocial support at scale [102]. Our findings point to the importance of climate-aware mental health task shifting in LMICs wherein climate change competencies at the intersection of gender-and life stage [101,103,104]. For example, climate-aware mental health task shifting can recognize altered emotional states or substance use following extreme weather events and altered gender roles [101,103,104]. Further, implementation strategies for community-based psychosocial support during and following extreme weather events also needed [101,103,104]. For example, community-based mother or adolescent girls groups can create safe spaces expressing and addressing the mental health impacts of climate change and extreme weather events on motherhood and menstruation.

Mobile and digital interventions offer promising avenues to address internalized stigma, access barriers, and disrupted service delivery in low-resource environments and especially among adolescents and youth. A recent scoping review shows adolescents in LMICs perceive mobile mental health platforms as acceptable and supportive, though challenges such as limited phone ownership, connectivity issues, and confidentiality remain [105,106]. Concurrently, mobile SRH platforms in rural LMIC settings demonstrate potential to overcome typical service barriers, enhancing youth-friendly access to SRH information [107]. Other scholarships suggests that digital mental health interventions in climate crises can include climate hazard notification and early warning systems that incorporate psychological first aid, brief behavioral interventions, and normalization of anticipatory anxiety [108].

Our findings also underscore the need for a gender transformative and life-course approach to programming: programs should anticipate distinct mental health needs among mothers, fathers facing livelihood loss, and adolescent girls. By promoting task-shifting, mobile mental health support, and community-based interventions tailored to different needs, health systems in LMICs can become more resilient and responsive to intersecting SRH and mental health during climate stress.

A second implication area concerns national and decentralized policy and the importance of developing integrated policy frameworks that explicitly connect climate adaptation, mental health, and SRH in LMICs. This should include embedding mental health into National Climate Adaptation Plans, health-sector adaptation strategies, and early warning systems in communities. Yet evidence reveals that 58% of national climate adaptation policies make no reference to mental health, and most mentions lack substantive action [109]. Effective policy must go beyond recognition: adaptation strategies must prioritize mental health by incorporating actions like psychological first aid training, capacity building for health workers, intersectoral care pathways, and inclusion of psychosocial support in surveillance and response systems [109]. Moreover, to ensure equity and accountability, policy frameworks must be supported by intersectional, disaggregated data that captures differences by gender, age, geography, and other vulnerabilities, to illuminate SRH and mental health risks and co-benefits of climate adaptation [3].

Third, in terms of research implications our review points to the benefit of prioritizing longitudinal, mixed-methods, and participatory approaches to better understand intermediary mechanisms. Studies like the Resilient-NEETs (R-NEET) project, which used a culturally grounded, longitudinal, mixed-methods design to investigate resilience to depression among African youth, demonstrates the value of combining quantitative tracking with qualitative, context-specific insights to capture both measurable trends and lived experiences [110]. Such approaches ensure that interventions are informed by the perspectives of those most affected, fostering both scientific rigor and community relevance [110].

Regarding limitations, this scoping review cannot establish causality or synthesize effect sizes through meta-analysis. While the data extraction/charting was conducted in duplicate, the thematic analysis leveraged an interpretivist analytical coding structure and was conducted by one researcher using a codebook developed in collaboration with the research team. Our search strategy by design excluded non-peer reviewed and non-English community-level perspectives, particularly those of local actors embedded within climate-affected regions.