Abstract
Malawi is vulnerable to climate-related shocks, which are projected to worsen. Whilst some dimensions of this vulnerability have been characterised, little is known about healthcare sector resilience. Coupling facility-specific data on antenatal care (ANC) service provision in Malawi with gridded precipitation data from 2012-2024 we use linear regression analyses to characterise the historic relationship between precipitation and healthcare access. We estimate that precipitation negatively impacted ANC service utilisation in Malawi, with up to 1 in 20 appointments disrupted annually in some districts. Projecting further to 2060 indicates that, cumulatively, up to 250,000 pregnancies could be affected. Notably, if precipitation patterns from 1941 to 1953 had persisted into the 21st century, disruptions between 2012 and 2024 would be a hundred times less frequent, highlighting the significant influence of anthropogenic climate change on healthcare access. In a country already facing high maternal and neonatal mortality, such disruptions could further hinder access to care and worsen health outcomes. To mitigate this, interventions should focus on preserving or improving the physical accessibility of facilities, particularly through resilient transport services and road networks.