Applying a climate lens framework to the World Health Organization's maternal and perinatal intervention recommendations.

Introduction: Climate change threatens global health, with pregnant individuals and newborns facing some of the gravest consequences. The World Health Organization (WHO) has published nearly 300 maternal and perinatal health recommendations; a structured approach integrating climate change considerations into guideline development has heretofore not been established. Methods: We developed and applied a six-criteria climate lens framework (climate sensitivity, sustainability, climate-improved alternatives, mitigation, community resilience, and accountability) through an iterative process involving experts in obstetrics and gynecology and public health. The framework includes standardized rating schema and a detailed approach to review the climate impacts of WHO maternal and perinatal health guidelines. The intent is to add climate as an additional consideration within the Evidence to Decision (EtD) framework utilized by the WHO to integrate evidence alongside other crucial criteria such as patient and community values, cost and resource implications, and equity and acceptability. Results: Eleven primary reviewers assessed 298 recommendations across 10 health topics through independent dual review and consensus adjudication using the six-criteria climate lens framework. As a representative example of how to apply the proposed framework, we detail its utilization to assess the WHO's recommendation on the use of oxytocin as first-line uterotonic for prevention of postpartum hemorrhage from a climate perspective. We identified climate-related vulnerabilities primarily related to temperature sensitivity, cold-chain dependence, and susceptibility to supply chain disruptions. When applied to the entire suite of WHO maternal and perinatal health recommendations, a climate lens evaluation revealed significant climate vulnerability to common obstetric interventions and also substantial evidence gaps. Conclusions: This proposed standardized framework adds climate as a crucial consideration to the current EtD framework for evaluating maternity and perinatal guidelines. Evaluation of new and re-evaluation of existing WHO maternity and perinatal guidelines through this climate lens will help inform global policymakers of climate realities that may impact implementation of clinical guidelines, making it especially useful in highly climate-impacted areas. Systematic integration of this framework into the guideline development process further exposes critical climate vulnerabilities of our clinical practices, highlights opportunities for climate resilience, imagines adaptation strategies, and sets research priorities to address evidence gaps.