Midwives' Climate Change Awareness, Planetary Health Literacy, and Psychological Preparedness for Climate-Related...

To synthesise and critically appraise empirical evidence on midwives' climate change awareness and planetary health literacy, the psychological attributes underpinning their readiness for climate-related maternal and newborn risks, the educational interventions targeting these attributes, and the systemic factors shaping their preparedness.

Climate change threatens maternal and newborn health through extreme heat, flooding, and disruption of services. Midwives are well positioned to deliver climate-responsive care, yet the constructs used to describe their preparedness-awareness, literacy, resilience, and readiness-are inconsistently defined and measured, and no prior systematic review has synthesised and appraised this evidence with explicit attention to what individual studies actually assessed.

A systematic review was conducted according to PRISMA 2020 and registered with PROSPERO (CRD420251135183). Six databases (PubMed/MEDLINE, Embase, Web of Science, Scopus, PsycINFO, and CINAHL) were searched for primary empirical studies published between January 2000 and July 2025 involving practising midwives, student midwives, or midwifery academics. The Capability-Opportunity-Motivation-Behaviour (COM-B) model guided the synthesis. Constructs and instruments were extracted exactly as reported and mapped transparently to review domains. Risk of bias was assessed with RoB 2 and Joanna Briggs Institute tools.

Six studies met the eligibility criteria: two randomised controlled trials, three qualitative studies, and one consensus study, together involving 333 midwives, student midwives, and midwifery academics in Türkiye, Australia, and the Democratic Republic of the Congo. No study directly measured planetary health literacy with a validated instrument, and none measured psychological readiness as a defined construct; the available evidence comprised proxy indicators, principally climate change awareness, resilience, and perceived stress. Interactive climate change education significantly improved midwifery students' awareness, and resilience-based training improved practising midwives' resilience and reduced stress. Qualitative evidence indicated that midwives recognise climate-related threats to mothers and newborns but respond through improvised strategies in the absence of formal training, protocols, and institutional support. Both trials were rated at low risk of bias; the four non-randomised studies carried some concerns.

Direct evidence on midwives' planetary health literacy and psychological readiness does not yet exist. A small, geographically concentrated body of evidence on related proxy constructs suggests that educational and resilience-focused interventions are promising, while systemic supports remain largely absent. Construct-explicit measurement, validated instruments, and system-level preparedness research are priorities.

Educators and professional-development providers can draw on validated curricular competency content and two trial-tested pedagogies-interactive climate change education and resilience-based training-while recognising that transfer to clinical practice remains untested.

Policy should prioritise the development and validation of measurement instruments for planetary health literacy and psychological readiness in midwifery, the integration of climate-related competencies into curricula and accreditation, and investment in the institutional protocols and supports whose absence this review consistently identified.