INTRODUCTION:
Maternal health in rural Sindh is shaped by the convergence of climate-linked hazards, persistent nutritional stress, and culturally embedded reproductive practices. in district Dadu, extreme heat and recurrent floods disrupt daily life, limit mobility, restrict access to health facilities, and intensify food insecurity. this study examines how climate precarity, pregnancy-related food taboos, and patriarchal social structures intersect to influence women’s nutritional experiences and birthing practices in a climate-vulnerable village.

METHODS:
This ethnographic study was conducted under a collaborative initiative between Aga Khan university (Karachi) and Sheffield Hallam university (uk). a mixed-methods approach captured women’s lived experiences of pregnancy and childbirth. data were generated through four focus group discussions with women and community members, fifteen in-depth interviews with pregnant or recently delivered women and key informants, and a household survey of 250 respondents administered via kobo toolbox. thematic analysis was guided by a medical anthropological framework emphasizing embodiment, cultural norms, gendered power, and socioecological stressors.

RESULTS:
women described pregnancy as a period marked by heat-induced appetite loss, dehydration, restricted movement, and intensified fatigue. extreme heat and flood events limited physical access to health facilities due to damaged roads, lack of transportation, poverty and empowerment. food taboos—such as avoiding “hot” foods, eggs, fish, and nutrient-dense items believed to cause difficult labor—further constrained dietary intake. patriarchal household structures shaped decisions regarding nutrition, rest, and place of delivery, often restricting women’s autonomy. despite constraints, women relied on kinship support, local knowledge, and adaptive strategies to navigate reproductive challenges.

CONCLUSIONS:
maternal health interventions in climate-stressed regions must integrate biomedical care with an understanding of cultural food logics, mobility restrictions, and patriarchal decision-making. climate-responsive policies should consider women’s lived experiences and socioecological realities to improve maternal nutrition and safe birthing options in rural Sindh.