Climate stress as a caregiving crisis for mothers of children with disabilities in Tamil Nadu, India

Climate change threatens maternal, newborn, and child health, but one pathway remains undermeasured: how climate-related stressors intensify unpaid caregiving and maternal mental health burden in households caring for children with disabilities. Heat, air pollution, food insecurity, water insecurity, service disruption, and income shocks do not enter all households equally. In low-income families where a mother provides daily care for a child with a disability, these stressors can disrupt sleep, feeding, therapy, medication management, transport, and routine care. Climate stress should therefore be understood not only as an environmental exposure or health-system shock, but also as a caregiving crisis. Drawing on emerging evidence from Tamil Nadu and the broader literature on climate-health, disability, unpaid caregiving, and maternal mental health, this Perspective proposes a household-centered framework for climate-health equity. The framework has five priorities: identify high-burden caregiving households as climate-vulnerable units; integrate maternal mental health into climate adaptation; protect continuity of child disability and primary care services during climate stress; measure unpaid care burden; and fund practical household supports such as cooling, food, transport, counseling, respite, and community health worker follow-up. Climate adaptation that ignores unpaid caregiving labor risks mistaking household exhaustion for resilience. A just climate-health response in low- and middle-income countries must protect not only facilities, supply chains, and emergency systems, but also the mothers whose unpaid care keeps vulnerable children alive.