“When the climate changes, we feel it first”: Gendered perceptions of environmental change and women’s health in Pakistan

Background: Rural women in climate-vulnerable regions face intersecting health risks from environmental stressors, gendered labor roles, and limited access to health services. Understanding how men and women perceive climate change is critical for designing interventions that protect women’s health and well-being. Objectives: To examine gendered perspectives on climate change among smallholder farmers in rural Pakistan and explore how these perspectives influence health-related risks and adaptive capacity, with a focus on implications for women’s health. Design: This study employed a cross-sectional Q-methodology design to identify shared and divergent viewpoints within and between male and female participant groups. Methods: Thirty participants (10 women and 20 men) from South Punjab, Pakistan, provided written informed consent. They sorted 48 statements into a forced quasi-normal distribution from “most disagree” to “most agree.” These individual sorts were analyzed, through PCA and varimax rotation, for identifying shared perspectives (‘Factors’ in Q terminology) separately for men and women. The qualitative interpretation of the factors was based on most (dis-) agreed upon, distinguishing and consensus statements. Results: Women’s factors, such as Structural Health Vulnerability and Fatalistic Resilience, emphasized infrastructural deficits, funding gaps, and health risks to food systems and livestock, linking adaptation capacity to systemic reforms. Men’s factors, including Optimistic Techno-Adaptation and Economically Worried, Techno-Faithful, displayed greater confidence in technological and market-driven solutions, though often overlooking structural constraints. Conclusion: Gendered framings of climate change reveal distinct implications for women’s health in rural Pakistan. Women’s perspectives emphasize systemic barriers that heighten vulnerability, underscoring the need for interventions that integrate climate adaptation with women’s health programs. Addressing faith-based framings, economic insecurity, and infrastructure gaps can improve the design of culturally resonant, gender-sensitive health interventions.