"When you have stress because you don't have food": Climate, food security, and mental health during pregnancy among Bakiga and Indigenous Batwa women in rural Uganda

Climate change exerts wide-ranging and significant effects on global mental health via multifactorial pathways, including food insecurity. Indigenous Peoples and pregnant women inequitably experience the harms associated with climate change and food insecurity. This study explores food security and maternal mental health during pregnancy among rural Ugandan Bakiga and Indigenous Batwa women in the context of climate change. Using a community-based research approach, we conducted a series of focus group discussions about climate, food security, and health during pregnancy in four Indigenous Batwa communities and four Bakiga communities in rural Kanungu District, Uganda, as well as longitudinal follow up interviews later in the year. Data were evaluated using a qualitative thematic analysis. Women consistently identified mental health as an important factor affecting maternalfetal wellbeing during pregnancy. Many women identified that weather and climate extremes, such as prolonged droughts and unpredictable weather events, have made it more difficult for them to obtain sufficient food for themselves and their families during pregnancy, resulting in significant mental distress. More extreme weather conditions have made physical labour difficult or impossible during pregnancy, and resultant hunger further decreased ability to obtain food-a vicious cycle. Women described how anxiety was compounded by worry about future famine, as they anticipated further decreases in crop yields and rising food prices in a changing climate. Indigenous Batwa women experienced additional distress around their lack of access to Indigenous lands and its nutritious food sources. Overall, mothers in rural Uganda described food insecurity and climate extremes as major sources of stress during pregnancy, and they anticipate challenges will worsen. Interventions to enhance adaptive capacity to climate change are needed and should have a focus on the intricate connections with food insecurity and mental health as drivers of overall maternal health.