Emergency Preparedness and Response: Pregnant Women and Infants
The United States has averaged 60 major federally declared disasters annually in the past 15 years.1 In this time period, each state and US territory has experienced a disaster. Nearly 850,000 people in the United States are affected by natural disasters yearly. However, that number does not include those affected by man-made events or pandemic diseases such as influenza.
Disasters disrupt people’s lives, families, and communities. Disasters can affect access to needed medical and social services, increase stress, intensify physical work, and expand caregiving duties.2 Any of these effects may result in poor health outcomes among women of reproductive age, especially pregnant and postpartum women and infants.
Research studies conducted after disasters in the United States have shown that pregnant women may have increased medical risks such as blood pressure disorders or anemia.3 Also, their infants may experience health issues such as low birth weight, or preterm birth, or both4,5
CDC’s Division of Reproductive Health (DRH) has a history of preparing for and responding to the needs of women and infants before, during, and after disaster events. This includes working in settings where disasters have occurred and developing emergency care information for pregnant women and their health care providers. CDC worked with local, state and federal partners to develop the following tools to assess the post-disaster reproductive health outcomes of women aged 15–44 years:
- In collaboration with the University of North Carolina (UNC) Center for Public Health Preparedness at the UNC Gillings School of Global Public Health, developed the Reproductive Health Assessment After Disaster Toolkit (RHAD) to assist health departments with assessing the reproductive health needs of women aged 15–44 years affected by natural and man-made disasters.6
- Worked with 23 nationwide partners to identify and publish a list of common post-disaster epidemiologic indicators for pregnant women, post-partum women, and infants: Health Indicators for Disaster-Affected Pregnant Women, Postpartum Women, and Infants: A Guide for Assessment and Surveillance of the Health of Disaster-Affected Pregnant and Postpartum Women and Infants by Using Common Epidemiologic Indicators to Affect Public Health Interventions [PDF - 815KB]. This tool incudes proposed indicators and questions for measuring them. For more information about how they were developed, see "Post-Disaster Health Indicators for Pregnant and Postpartum Women and Infants". We want to hear about your experience. If you or your organization will implement this tool, please e-mail us to share your experience and lessons learned. A sample protocol [PDF - 219KB] demonstrates how these indicators could guide supplemental data collection on pregnant women when conducting post-disaster morbidity surveillance.
- Created a tool for public health practitioners to estimate the number of pregnant women [PDF - 495KB] in a United States jurisdiction at any given point in time. The tool also includes an example [PDF - 74KB] and point-in-time [PDF - 41KB] calculator form.
- Summarized the evidence for contraceptive need to prevent unintended pregnancy during an emergency response with the publication of the article “Contraceptive Availability During an Emergency Response in the United States” in the Journal of Women's Health in 2013. This article also recommends the most appropriate types of contraceptives for disaster situations and describes the current provisions in place to provide contraceptives during an emergency response.
- Worked to expand disaster surveillance using the Pregnancy Risk Assessment Monitoring System (PRAMS) or PRAMS-like projects to collect disaster-specific data. PRAMS has been used to obtain information on women using specific services or recommendations during pregnancy such as the "Seasonal Influenza and 2009 H1N1 Influenza Vaccination Coverage Among Pregnant Women—10 States, 2009–2010 Influenza Season".
- Preparedness Planning
In 2009, the Arkansas PRAMS team added a question about whether women who gave birth that year had an emergency plan. The article “Preparedness Planning for Emergencies Among Postpartum Women in Arkansas During 2009” examines the associations between socio-demographic characteristics and disaster experience and the presence of an emergency plan. In 2014, CDC created a new pretested standard question about preparedness to assess the level of preparedness for a disaster among postpartum women in PRAMS-participating states. This new question can benefit your state by providing data to better understand what elements of preparedness are lacking among postpartum women and may help public health officials to plan and review strategies to reach this population. For more information, please contact CDC-INFO.
In 2012, CDC's DRH collaborated with CDC's National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) to convene 77 national experts on anthrax and public health to guide the update of recommendations for pregnant and postpartum women exposed to the bacteria. Guidelines on "Special Considerations for Prophylaxis for and Treatment of Anthrax in Pregnant and Postpartum Women" were published to provide updated clinical information to health care providers and public health professionals caring for these women in a bioterrorist event involving anthrax.
- Ebola Virus Disease (EVD) - CDC's DRH provided domestic and global support to CDC’s Ebola efforts and helped in the Ebola response by providing information through the following guidance documents and article.
- Guidance related to Breastfeeding/Infant Feeding in the Context of Ebola, released in September 2014, provides recommendations about breastfeeding if a mother has probable or confirmed EVD.
- Guidance for Screening and Caring for Pregnant Women with Ebola Virus Disease for Healthcare Providers in U.S. Hospitals was released in November 2014 to help US hospitals plan for screening and treating pregnant patients under investigation for or patients with confirmed EVD.
- The article, "What Obstetrician–Gynecologists Should Know About Ebola: A Perspective from the Centers for Disease Control and Prevention", published in November 2014 in Obstetrics & Gynecology, provides general Ebola information, addresses what is known about it in pregnancy, and explains the implications for practicing obstetricians and gynecologists (Ob-Gyns) in the United States.
During the Pandemic 2009 H1N1 response, CDC’s Maternal Health Team created nine maternal health guidance documents and addressed more than 4,600 maternal health inquiries. A supplement to the American Journal of Obstetrics and Gynecology titled: “Emerging Issues in the Prevention, Detection, and Treatment of Influenza among Pregnant Women in the United States, Pandemic Influenza Revisited: Special Considerations for Pregnant Women and Newborns” was published in June 2011.
Pregnant women are classified as a population with special clinical needs in the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 [PDF - 189KB]. The needs of pregnant women during pandemic influenza and other emergencies are also emphasized by the US Department of Health and Human Services (DHHS) in the Special Medical Needs: Definitions and Related Terms [PDF - 77KB] document.
CDC developed a factsheet to help pregnant women and women with infants or young children in planning for an emergency or disaster. Partners across CDC have also compiled critical all-hazards preparedness information for these women.
CDC created a web page for non-obstetric health care providers in caring for pregnant women during disasters.
- FEMA. Declared disasters by year or state. FEMA website. Accessed February 17, 2015.
- Zotti ME, Tong VT, Kieltyka, L, Brown-Bryant, R. Making evacuation decisions: the case of high risk pregnant and postpartum women. The Women of Katrina: How Gender, Race, and Class Matter in an American Disaster. 2012; 90-104.
- Tong VT, Zott ME, Hsia J. Impact of the 1997 Red River Catastrophic Flood on Women Giving Birth in North Dakota. Matern Child Health J. 2010;15:281-288.
- Zotti, ME, Williams AM, Robertson M, Horney J, Hsia J. Post-disaster reproductive health outcomes. Matern Child Health J. 2012;17(5):783-796.
- Callaghan WM, Rasmussen SA, Jamieson DJ, Ventura SJ, Farr SL, Sutton PD, et al. Health concerns of women and infants in times of natural disasters: lessons learned from Hurricane Katrina. Matern Child Health J. 2007;11(4):307-11.
- Horney, J, Zotti ME, Williams AM, Hsia, J. Cluster sampling with referral to improve the efficiency of estimating unmet needs among pregnant and postpartum women after disasters. Women’s Health Issues. 2012;22(3):253-7.
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