Mapping research priorities related to maternal and infant nutritional health in the context of climate change in Pakistan: A mixed methods study

Climate change poses significant threats to health, food security, and nutrition, particularly in Pakistan, which is vulnerable due to its limited resources and preparedness. Maternal and infant health targets remain largely unmet due to several factors. However, there is a lack of a relevant people, institutions, and place-informed agenda from those most affected, such as rural women, that guides research, policy, and practice. We employed a mixed-methods explanatory design, engaging key individuals and groups, and integrating an online survey with workshops to gather both quantitative and qualitative perspectives. Overall, 127 people participated in the study: 88 in the survey, 24 in the priority-setting workshop, and 15 in the focus group session. The participants included community members, doctors, lady health workers, nurses, nutritionists, climate change experts, advocates, and researchers. The survey data were analysed using the STATA statistical package, and the qualitative data were analysed thematically. Priority ranking exercises revealed consensus across surveys and workshops on nutritional ("lack of awareness of proper nutrition") and maternal ("dehydration, weakness, and exhaustion") challenges. However, infant health priorities diverged; surveys ranked "heat exposure and low birth weight" highest, while workshop participants prioritised "heat waves and infant hospital admissions". Furthermore, half of the participants ranked developing climate-resilient nutritional interventions and addressing the nutritional needs of pregnant women in a changing climate as equally critical. Focus group narratives consistently highlighted how climate-induced events, such as extreme heat, unseasonal rainfall, and recurrent floods, disrupted agricultural cycles, displaced families, and cascaded into effects on families, particularly pregnant and breastfeeding women. There is an urgent need to address nutritional awareness, strengthen climate-resilient nutritional strategies, and provide targeted support for pregnant women. Adaptation and mitigation strategies are urgently needed and should be central to policy responses, alongside the impacts of climate extremes.