BACKGROUND:
Climate change threatens health, food, and nutrition, particularly in low- and middle-income countries. Pakistan is especially vulnerable due to its limited resources and preparedness. Women and infants are particularly at risk, as pregnancy and childbirth increase vulnerabilities. While some interventions are suggested, maternal health targets remain largely unmet due to a lack of a stakeholder-informed research agenda that guides research, policy and practice.

OBJECTIVES:
This study aimed to identify and rank research priorities for maternal and infant nutritional health in the context of climate change in Sindh, Pakistan. We sought input from communities, service users, healthcare providers, and policymakers to guide future research strategies toward achieving the country’s SDGs.

METHODS:
We used a mixed-methods exploratory design, integrating a survey with workshops to gather quantitative and qualitative perspectives. In total, 133 people participated in the survey (n=88) and the co-production workshops (n=45). The participants included community members, doctors, lady health workers, nurses, nutritionists, climate change experts, advocates, and researchers. The qualitative data, including qualitative comments in the survey, were analysed using thematic analysis, and the survey data were analysed using the STATA statistical package.

RESULTS:
The study highlights food insecurity, malnutrition, and maternal mental health as top priorities. Climate-related stressors, such as extreme heat, floods and poor food access, exacerbate these vulnerabilities. Sustainable, culturally appropriate, climate-resilient interventions and policy responses that account for structural determinants of health were identified as top recommendations.

CONCLUSIONS:
Climate change is deepening health inequalities in Pakistan, particularly for vulnerable women and infants. Rising food insecurity, growing poverty, and disrupted health services contribute to poor health outcomes. Our study underscores the urgency of developing climate-informed research, policy and practice to protect the health of mothers and infants.

KEY MESSAGE:
Collaboratively identifying and addressing climate-related priorities for maternal and infant health is essential to strengthening health equity and resilience in vulnerable communities. Climate change 1