To gain insights into heat adaptations among women during the antenatal period in India -The Heat in Pregnancy Project (HiP-I) India- Qualitative Study Protocol

<ns3:p>Background Climate change is increasing the frequency and severity of heatwaves across South Asia, with disproportionate impacts on vulnerable populations. Pregnant and lactating women face heightened health risks due to physiological changes, gendered social responsibilities, and constrained access to adaptive resources. Despite this, women's lived experiences and adaptation practices during pregnancy remain understudied and largely absent from institutional climate responses. This knowledge gap hampers the development of effective, gender-sensitive adaptation policies. Methods This qualitative study, embedded within the Heat in Pregnancy (HiP)-India project, will be conducted in three climatically vulnerable locations—Gurugram (Haryana), Bilaspur (Chhattisgarh), and Puducherry. Using a socio-ecological framework, we will conduct in-depth interviews with pregnant and lactating women, focus group discussions with family caregivers, and key informant interviews with health workers and local officials, alongside non-participant observations. Interviews will be conducted during and shortly after the heat season to capture both real-time and reflective experiences. We will use purposive sampling to recruit approximately 20–25 women per site, with additional caregivers and stakeholders. Recruitment will occur primarily through PHCs; if community-based recruitment is not feasible, we will clearly position PHC users as our study population. Where possible, frontline workers will support outreach to women who may have limited facility access. Data will be thematically analysed in NVivo, and reporting will follow the COREQ checklist. Anticipated Results The study will generate contextualised insights into women’s heat-adaptation practices during pregnancy and lactation across diverse agro-climatic zones, document traditional and emerging coping strategies, and identify structural, social, and institutional barriers shaping adaptation capacity. Conclusion By centering women's lived experiences, this research will inform the design of culturally appropriate, gender-responsive heat adaptation interventions suitable for low-resource settings. Findings will support both practical community-based solutions and evidence-based advocacy for more inclusive climate adaptation policies at local and national levels.</ns3:p>