Pregnancy, birth, and postpartum under heat strain: Visibilising lived experiences and coping practices of women in rural Zimbabwe through an adapted participatory Photovoice approach

Extreme heat, intensified by climate change, is an escalating global health threat linked to preterm birth, stillbirth, hypertensive disorders, and low birth weight. Yet little is known about how pregnant and postpartum women in low-resource settings experience and adapt to heat as a lived condition. In sub-Saharan Africa, where livelihoods depend on outdoor labour and health systems remain fragile, women's thermal vulnerability is compounded by social and infrastructural inequities. This study explores how pregnant and postpartum women in rural Zimbabwe experience and adapt to extreme heat, and how these experiences reveal the entanglement of body, environment, and adaptation. Anchored in phenomenology and Karl Jaspers' concept of Grenzsituationen- la situation-limite, testing bodily and existential endurance-the study conceptualises extreme-heat not only as an external exposure but as a lived, embodied constraint. Using Photovoice, 23 women (13 pregnant, 10 postpartum) from three rural sites (Dotito, Chitse, Pfura) in Mt Darwin documented their encounters with heat between February and March 2024, when ambient temperatures ranged from 34 to 39 °C and perceived temperatures, measured by the Universal Thermal Climate Index, exceeded 41 °C. Participants captured images over 14 days, reflected on them through narrative interviews guided by the SHOWeD framework, and deepened these insights through dialogue at a Photovoice exhibition. Photographs, interviews, and field notes were thematically analysed. Photovoice rendered visible the embodied and structural harms of extreme heat during pregnancy and postpartum life. Extreme heat disrupts pregnancy, childbirth, and postpartum recovery, with no immediate reprieve. Homes built for shelter become heat traps, unsafe for gestation and newborn care, while facility deliveries evoke fear rather than safety in overheated rooms without shade, cooling, power, or supplies. Escalating heat reveals critical gaps in adaptation, showing that maternal resilience must extend beyond infrastructure to recognise adaptation as embodied endurance-demanding gender-responsive, socially grounded systems of care.