OBJECTIVE: To understand how climate change vulnerability is associated with women and children's health (WCH) at the district level in India. METHODS: The district-specific climate change vulnerability index was mapped to the district level NFHS-5 data (N = 674). Fractional regression and spatial analyses were performed to examine the strength of association and the presence of geographic clustering. RESULTS: Bivariate analysis revealed that the levels of WCH indicators were lower in districts with a high vulnerability index than in those with a low vulnerability index. Multivariable analyses suggested that with a 1% increase in the vulnerability index, the proportion of modern contraceptive use was reduced by 0.22, four or more prenatal care visits by 0.14, postnatal care by 0.11, and full immunization by 0.12; whereas wasting and underweight proportions increased by 0.07 and 0.10, respectively. The spatial analysis found that in about 70-118 districts, mostly in eastern India, where climate vulnerability was high the WCH outcomes were also poor. CONCLUSION: There is a macro-level association between climate change vulnerability and WCH, as districts that had high levels of climate change vulnerability also performed poorly in WCH. There is a need for an integrated approach that considers geography-specific climate change threats to develop health programs.