The heavy rains in Tumbes, Piura, and Lambayeque not only affected more than 400,000 people in these three departments but also limited access to essential services for pregnant women and women of reproductive age. Through the “Saving Lives” project, promoted by the United Nations Population Fund (UNFPA), women like Miryam Coello and 4,608 others were provided home check-ups and support from specialists in coordination with health centers.

Miryam Coello’s (30) joy for her third pregnancy immediately gave way to concern. Amidst the floods caused by the heavy rains in the Veintiséis de Octubre district in Piura and the main departments of northern Peru, attending her regular checkups at the nearest health center was very difficult. Waterlogged dirt roads, lack of money for transportation, and the impossibility of leaving her other children were daily challenges. 

The climate emergency at the beginning of the year affected more than 400,000 people in Piura, Tumbes and Lambayeque alone, but especially the most vulnerable: pregnant women. As was the case for many, the situation for Miryam was the least favorable: muddy mattresses, unusable shoes, and plywood walls rotten with humidity. “The water got all over the house. It soaked everything we had managed to obtain,” she recalls. But the worst was yet to come. Plagues of rats, flies, and mosquitoes brought the latent threat of disease. “We had to disinfect everything. But even I, during my pregnancy, caught dengue fever,” says Miryam.

The situation was becoming increasingly alarming. Without basic services, such as water and sewage, and enough money to pay for the increased prices of the basic food basket due to the climate emergency, Miryam prioritized the well-being of her young children, Liam Moisés (6) and Jesús (2). The meager income earned by her husband, the father of her third child to be born, was barely enough to provide them with the necessary food. “Women were most affected in this emergency because, as mothers and housewives, we had to clean a lot more and try to cook the same portions. And for expectant mothers like us, it was even more complicated because if we needed something, the pharmacies and the health center were not close by,” she says.

In her case, the news of her third pregnancy posed an additional concern. Because of her two previous C-sections, she required more specialized care. “The doctors suggested that I should not have any more children because a new surgery would be very risky for me and the baby,” she recalls. 

Miryam explains that her first pregnancy resulted from a lack of information. It was not until six months into her pregnancy that she started attending check-ups, and because of that delay, she suffered an infection. “I felt guilty. I didn’t attend because of embarrassment, shame, fear. Fear of being asked where the father was, why I didn’t take care of myself,” she now recalls that experience as a single mother.

With her third pregnancy underway, she felt more prepared this time, but the climate emergency prevented her from attending the nearest health center. One day, one of the midwives who are part of the brigades of the “Saving Lives” project promoted by the United Nations Population Fund (UNFPA) as part of the joint response of the United Nations System with funding from the Central Emergency Response Fund (CERF), knocked on her door. Miryam was already a few weeks pregnant, and the dizziness and nausea did not allow her to carry out her chores normally, much less leave the house. “I had no one to leave my children with because my husband was away working as a fisherman for several days. So, they knocked on my door and told me they were coming to see me for my check-ups,” she recalls.

From that day on, she began to receive regular visits, and every time she needed to go to the doctor’s office, the brigade members would facilitate her transportation. “If I feel any discomfort, for example, I can communicate with them through phone calls or Whatsapp. If I have an emergency or need an ultrasound, they make an appointment to avoid waiting in line,” she explains. Like Miryam, other 148 pregnant women could be identified by the brigade members and get access to prenatal check-ups to prevent maternal death and other possible complications. Overall, some 4,623 women affected by the floods in the departments of Piura, Tumbes, and Lambayeque have been able to access basic sexual and reproductive health services. In addition, 255,000 people have been reached by the communication strategy of the “Saving Lives” project, which aims not only to improve the quality of care for pregnant women but also to provide all the necessary information for women of reproductive age.

For Pablo Zacarías, Coordinator of the Regional Health Authority in Piura, the care of women, especially pregnant women, is a priority after the climate emergency. The impact of the rains is visible in the sexual and reproductive health conditions of the population. Of the 24 cases of maternal deaths during 2023, five were due to complications following dengue infection. “According to the technical standard for dengue at a national level, pregnant women, due to their pregnancy status, do not present a higher risk of death. However, in coordination with the infectologists of the region, we have shown that here, in the Piura department, being pregnant in the context of an epidemic does represent a greater risk,” explains Zacarías.

In addition, the lack of adequate care at the first levels within the health system has led to 50% of maternal deaths being related to hypertensive pregnancy disorders that could have been avoided with timely preventive treatment. This forced the authorities to issue an epidemiological alert in the Piura department at the end of September. The figures reached 120 cases per 100,000 live births. The alarm became widespread. “According to the latest epidemiological report, we are already at 80 per 100,000. We are reducing the figure compared to 2020, but our goal is to reach 70 cases, as suggested by the United Nations Sustainable Development Goals,” says Zacarías.

Although the percentage of care for pregnant women, despite the rains and the dengue outbreak, increased from 62% to 70% this year, according to Zacarías, the climate emergency continues to pose a risk for women. “It increases costs in care, and the floods have also led to the isolation of many sectors,” he explains. Miryam Coello knows this well. If it were not for the brigade midwives who came to her neighborhood, attending her checkups would be almost impossible. “My life has changed a lot since the brigade members arrived,” she says. And she is not exaggerating. For the first time, she feels that pregnancy is not a risk to her life and has already decided that she will not have any more children. “I made that decision with my husband as part of our family planning.”