Reproductive Health in Emergency Preparedness and Response
An online course for federal, state, and local public health and other health professionals that highlights preparedness and response resources and tools specific to the field of reproductive health in emergencies.
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 public health emergencies. This includes working in settings where disasters have occurred and developing emergency care information for pregnant women and their health care providers. Core activities may include developing:
- Epidemiologic/surveillance data to guide action.
- Recommendations and tools to guide public health response.
- Partnerships with clinical, public health, and government partners; and (4) strengthening human resources for preparedness.
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.¹ This may affect health outcomes among women of reproductive age (15 to 44 years), especially pregnant and postpartum women and newborns. Pregnant women are classified as a population with special clinical needs in the Pandemic and All-Hazards Preparedness Reauthorization Act [PDF – 186KB] of 2013.
Understanding the Impact of Disasters on Reproductive Health
Generally, disasters can be placed into three categories: natural disasters (e.g., hurricanes, tornadoes, earthquakes, wildfires, floods), emerging or pandemic diseases (e.g., flu outbreak, Zika virus) and man-made disasters (e.g., terrorist attacks). The impact of disasters may include loss of life, injury, disease, or other adverse effects on physical, emotional, mental, and social well-being. Impacts can also include personal as well as community loss or damage of property, services, assets, and social and economic infrastructures.
The United States has averaged over 60 major federally declared disasters annually in the past 10 years.² 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.
Emergency Response Tools and Resources
In partnership with local, state and federal partners, CDC has developed the following resources.
- Increasing Access to Contraception: A Toolkit for Program Development, Implementation and Evaluation
This toolkit is a resource developed by the CDC Foundation, in partnership with CDC, and includes information and tools used in the Zika Contraception Access Network (Z-CAN) program during the 2016-17 Zika virus outbreak. Z-CAN established a network of trained physicians across Puerto Rico to provide client-centered contraceptive counseling and offered women same-day access to the full range of FDA-approved reversible contraceptive methods at no cost. The toolkit includes lessons learned as well as “how to” information for others who are interested in learning about, replicating or adapting key components of the Z-CAN program in emergency and non-emergency settings.
Web-based set of tools designed to guide users through the planning, implementation, and analysis stages of conducting a reproductive health assessment after a disaster.
Common epidemiologic indicators for pregnant and postpartum women and infants who are affected by disasters, and suggested measurement approaches. This article describes the process for developing the post-disaster indicators.
- Sample Protocol for Using Post-Disaster Indicators for Pregnant and Postpartum Women and Infants [219KB]
Sample protocol for inclusion of pregnant and postpartum post-disaster indicators can be used in post-disaster surveillance.
A tool that can be applied to estimate the number of pregnant women in a jurisdiction in the United States at any given point in time. It includes a simulated example [PDF – 74KB], a point-in-time calculator form [PDF – 41KB ] and a geographic calculator [XLS – 17 KB] to estimate the number of pregnant women in a jurisdiction using Excel. The article “Estimating the Number of Pregnant Women Infected with Zika Virus and Expected Infants with Microcephaly” shows how this tool was used during a public health response.
The Reproductive Health in Emergency Preparedness and Response course highlights preparedness and response resources and tools specific to the field of reproductive health in emergencies. It includes practical exercises and links to tools for collecting post-disaster data on pregnant and postpartum women. The course is available for federal, state, and local health care specialists and public health professionals. The estimated total time required for the course is 60 minutes.
Emergency Preparedness Activities
Learn more below about what CDC does to help prepare for emergencies.
- Created a sample script to counsel parents and caregivers [222 KB, 1 Page, 508] on the steps they can take before and during a disaster to provide a safe sleep environment for their baby.
- Developed the online course Reproductive Health in Emergency Preparedness and Response focused on post-disaster events and selected infectious diseases on women of reproductive age; and preparedness and response resources and tools specific to reproductive health.
- Coordinated anthrax emergency guidelines in collaboration with the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). CDC’s DRH led an investigation of the literature and an expert panel who gave input into the revised guidelines and prophylaxis recommendations. In addition, this document [500 KB, 17 Pages, 508] describes the recommendations pertaining to communication about anthrax exposure and treatment for lay and professional audiences and training for health professionals.
- Developed new preparedness planning questionnaire to improve the Arkansas Pregnancy Risk Assessment Monitoring System (PRAMS) team question that was added about whether women who gave birth that year had an emergency plan in 2009. 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, DRH 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.
Emergency Response Activities for Infectious Diseases
CDC’s Division of Reproductive health has provided domestic and global support public health responses to emerging or pandemic diseases, such as the Zika and Ebola outbreaks. Some major accomplishments are discussed below.
DRH co-led the Pregnancy and Birth Defects Task Force (PBDTF) to address maternal health issues and Zika.
- Released 48 publications, including 9 guidance documents for health care providers caring for pregnant women, women of reproductive age, and congenitally-exposed infants.
- Established and implemented Zika Pregnancy surveillance systems.
- US Zika Pregnancy Registry.
- Zika Active Pregnancy Surveillance System in Puerto Rico.
- Proyecto Vigilancia de Embarazadas con Zika in Colombia.
- Partnered with the Puerto Rico Department of Health during the Zika outbreak to better understand the effects of Zika virus infection during pregnancy, reduce the risk of Zika virus infection among pregnant women and women of reproductive age, and improve care for women and families infected by Zika. Learn more from this factsheet [PDF – 194 KB] about the Zika related activities in Puerto Rico.
- Completed more than 100 clinical outreach calls or presentations, including 6 Clinician Outreach and Communication Activity (COCA) calls.
- Contributed to development of 3 Medscape videos, 1 training video, and 12 Zap Zika videos.
In collaboration with other CDC’s subject matter experts, the Division of Reproductive Health (DRH) prepared guidance documents on breastfeeding and recommendations for screening and treating pregnant with suspected or confirmed Ebola virus. DRH also provided technical support for Rapid Ebola Preparedness visits to US hospitals preparing for possible Ebola infected obstetric cases and addressed inquiries from health care providers and the general public. See a list of publications and guidance documents coauthored by DRH staff.
During the 2009 H1N1 Pandemic response, CDC’s Maternal Health Team created 9 maternal health guidance documents and addressed more than 4,600 maternal health inquiries. See a Supplement to the American Journal of Obstetrics and Gynecology (AJOG) to learn more about lessons learned during the Pandemic H1N1 response and special considerations for pregnant women and newborns.
Publications on Ebola and Pregnancy with DRH Coauthors
- Recommendations for Breastfeeding/Infant Feeding in the Context of Ebola Virus Disease (released in September 2014)
- Screening and Caring for Pregnant Women with Ebola in the U.S. (released in November 2015):
Peer reviewed journal articles
- Jamieson DJ, et al. “What obstetrician–gynecologists should know about Ebola: a perspective from the Centers for Disease Control and Prevention.” Obstet Gynecol (2014).
- Meaney-Delman D, Koonin LM, Jamieson DJ. “US hospital preparedness for obstetrics patients with possible Ebola.” Am J Obstet Gynecol (2015).
- Kourtis AP, et al. “Ebola Virus Disease: Focus on Children.” Pediatr Infect Dis (2015).
- Johnson JL, “Bodies don’t sleep, neither do babies: Experiences at the only maternity hospital isolation unit in Sierra Leone during the 2014 Ebola epidemic.” Am J Obstet Gynecol (2015).
Case report concerning a pregnant patient with Ebola in Sierra Leone
- Oduyebo T, et al. “A Pregnant Patient with Ebola Virus Disease.” Obstet Gynecol (2015).
¹Zotti ME, Tong VT, Kieltyka L, Brown-Bryant R. Making Evacuation Decisions: The case of high risk pregnant and postpartum women. In: David E, Enarson E, eds. The Women of Katrina: How Gender, Race, and Class Matter In an American Disaster. Nashville, Tenn: Vanderbilt University Press; 2012;90–104.
²Federal Emergency Management Agency (FEMA). FEMA Disaster website. https://www.fema.gov/disasters?field_state_tid_selective=All&field_disaster_type_term_tid=All&field_disaster_declaration_type_value=DR&items_per_page=60&=GO. Accessed May 25, 2017.
- Page last reviewed: February 2, 2018
- Page last updated: February 2, 2018
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