In light of the recent United Nations COP27 Climate Change Conference, the environmental impact of human activity is constantly being assessed under a microscope. It is widely accepted that the climate crisis is now a health crisis, yet the medical field seems to be lagging behind in adopting sustainable practices, instead fostering a culture of excess and normalising disposability.
Why should we be looking towards more sustainable practice, especially within reproductive healthcare?
While evidence is still preliminary (and due to the multifactorial nature of human reproduction the reports are not without their limitations), an increasing number of studies and systematic reviews are starting to find associations between factors of climate change with adverse reproductive and obstetric health outcomes.
To name just a few, air pollution and increased ambient temperatures have been suggested to increase the risk of preterm birth, low birth weight and stillbirth. Higher ambient temperatures have also been associated with increased prevalence of vector-borne diseases, and with reproduction in mind, zika and malaria would be of concern for their known severe complications with fetal development.
The abundant use of plastics is also thought to negatively impact our reproductive health due to their endocrine-disrupting chemical properties. Reports published in Environmental Research and Public Health and Environment International have detected microplastics in human tissues: testis, placenta and umbilical cord, as well as associating microplastic exposure to ovarian fibrosis and oocyte and semen quality.
Following these findings, it would be ethically irresponsible to continue as normal without any progression towards sustainability in the way we work. Arguably, without change, we would no longer be fully upholding the Hippocratic oath to 'do no harm'.
But where is the carbon footprint of healthcare coming from?
A 2019 report by Health Care Without Harm, reported over 70 percent of greenhouse gas emissions in healthcare are derived from the supply chain. This is because it is not only how we use and dispose of consumables, pharmaceuticals and equipment in our own clinical environments, but all the processes before that, such as sourcing the raw materials, product manufacturing and transportation. It is therefore key that we push our reproductive healthcare suppliers to act more sustainably in order to reduce our own carbon footprint.
In Australia and New Zealand, styrofoam boxes to transport media at refrigerated temperatures have been replaced with an unorthodox reusable, recyclable and biodegradable insulation alternative – sheep wool! It just shows sustainable options for packaging are available, we just need to use our purchasing power as reproductive healthcare professionals to encourage more of these changes from our suppliers.
The onus, however, is not all on manufacturers, individual clinics also need to take responsibility. Facilities need to look at optimising their use of resources across all departments, as each sustainable marginal gain collectively can help reduce their overall environmental impact. The easiest way to think about where to start is to look at key areas, such as: energy, water, transport and waste, and reflect on the waste hierarchy pyramid. This approach emphasises prevention, reducing, reusing and recycling (in that order), and deems recovery and disposal unfavourable options where alternatives are possible.
Approximately every four seconds a disposable hat is thrown away in healthcare – since there is no evidence to suggest the safe use of reusable hats has any increased risk of contamination or infection, laboratories and theatre spaces should be looking to implement this change. Virtual consultations ought to be encouraged to avoid emissions generated from patient transport while still being able to provide the same level of care. Clinics could even hold collection points for certain items, such as medication blister packets, which can then be sent on for recycling, reducing the amount of waste which would otherwise go to landfill.
Our carbon footprint can also be reduced by replacing virgin paper with recycled paper, which is 50 percent less energy consuming to produce, while also increasing digitisation both in-house and for patient communication to avoid the need for printing paper in the first place.
How can we ensure sustainability is a key feature of 'best practice' now and in the future?
I strongly believe this is where our national/international societies and governing bodies need to step up and enforce a stronger response to 'the environmental impact of reproductive healthcare. In July 2022, the Health and Care Act placed new responsibilities on the NHS in England to consider climate change, being the first country in the world to directly address its healthcare's response to climate change in national legislation. NHS England's aim is to be the world's first net zero national health service.
This law currently only applies to NHS trusts, but it shouldn't stop the private sector aspiring to reach the same targets. Just like the NHS, healthcare facilities should all be evaluating their environmental impact and generating short and long-term action plans to tackling the issues.
Ultimately, individual action is necessary to work towards a greener, more sustainable practice in reproductive healthcare, but it is only once paired with systemic change from all stakeholders: suppliers, clinics, societies, that we will be able to make the biggest impact in reducing reproductive healthcare's environmental impact.