Stacy Ann Walker could have died.

During what she thought was going to be a normal exam, Stacy learned that she would need to have a C-section. While recovering in the hospital, she began to have breathing problems and after some testing was told that her heart had been scarred by an earlier bout of rheumatic fever. Shortly after, she also learned that she had heart failure, an enlarged heart, and problems with multiple heart valves.

She was 29.

The urgency to address climate change is only growing. As youth step up and are increasingly vocal about climate change, international negotiations—most recently at COP25—fail to deliver the ambitious global action required for effective response.

Where does this leave the communities most at risk from climate impacts? How can they adapt and transform in the face of enormous threats, sometimes to their very existence? With researchers and policy experts often focused on technological fixes and pushing new solutions to specific threats, it’s easy to assume that transformation is underway to respond to the new climate reality. In reality, transformative change is tough—especially when up against ingrained habit, culture, and a lack of political and financial resources to support it. Perhaps most importantly, transformative change requires effective leadership and champions—those people who build political will and create momentum to move policy innovations or on-the-ground action.

The mental health of mothers cannot be studied in isolation, as just a psychological snapshot in time. Their complex lives both past and present must be taken into consideration. When I was researching marriage, motherhood, and social support in Korogocho, an informal settlement in Nairobi, stories I heard underscored how a range of life experiences conspire to affect a woman’s mental health. I heard life histories like this:

When Ann was 17, she met Fredrick, got pregnant and moved in with him when she was 18. Two years later, Fredrick got arrested and was gone for two years. When he came back, she got pregnant with child No. 2 within a month but then left the relationship seven months later because of ongoing conflict. When she was about 23 with a 2-month-old and 5-year-old, Frederick shot her. Two months later, he himself was killed. Four months later, she met the man who would become her second husband. After living together for three years, he took her back to his home to meet his family. She then had her third baby.

When childbirth takes place without skilled birth attendants or adequate emergency obstetric care, a woman may suffer from obstetric fistula. Women with fistula live with uncontrollable urinary and/or fecal incontinence, because a hole has formed between the birth canal and bladder or rectum. They have usually survived prolonged/obstructed labor, often lost their child to stillbirth, and frequently face severe social isolation and stigma. There are also now more and more women suffering from iatrogenic fistula caused by injuries during pelvic surgery, especially obstetric or gynecological surgery. Between 1 million and 2 million women currently need fistula repair, with thousands of new cases each year. However, most fistulas can be treated, enabling women to resume healthy, productive lives in their communities. Recognizing this, the United Nations has issued a call to end fistula by 2030.

Climate change is widely recognized as a “threat multiplier.” From the United Nations to the G7 to the US Department of Defense, there is emerging consensus that climate change poses risks to both human and natural security through a variety of complex and interrelated channels. The extent of those risks, and how they connect to armed conflict, however, remain widely debated.

We face the greatest environmental challenges ever relating to climate change, biodiversity, land use, and more. Humans are driving 1 million species to extinction, according to a report by the UN-backed Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services. Some $44 trillion of annual global economic product that depend on nature are in jeopardy. Fires have ravaged large swathes of the Amazon—Brazil and Bolivia in particular—and Australia.