Reproductive Health in Emergency Preparedness and Response
CDC’s Division of Reproductive Health (DRH) prepares for and responds to the needs of reproductive-aged women and infants before, during, and after public health emergencies. DRH’s priority activities include working in settings where disasters have occurred and developing emergency care information for pregnant and postpartum women and their health care providers.
Public Health Emergencies disrupt lives, families, and communities. These emergencies fall into the following three categories:
Public health emergencies can affect access to medical and social services, increase stress, intensify physical work, and expand caregiving duties. This may affect access to medical services and health outcomes among women of reproductive age (15 to 44 years), especially pregnant and postpartum women and newborns. The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 pdf icon[PDF–320 KB]external icon classifies pregnant women and infants as a population with special clinical needs. The health of pregnant, postpartum, and lactating women and their infants might be significantly impacted by new or emerging threats such as Zika virus that can cause birth defects. These threats may warrant further investigation and/or response efforts.
Below is a list of available tools and resources that can assist when preparing for and responding to the needs of reproductive-aged women and infants before, during, and after public health emergencies. Many of these were developed collaboratively with local, state, and federal partners.
- Increasing Access to Contraception: A Toolkit for Program Development, Implementation, and Evaluationexternal icon. The Zika Contraception Access Network (Z-CAN)external icon includes information and tools used in during the 2016–2017 Zika virus outbreak in Puerto Rico. It provides “how to” information for others who are interested in learning about, replicating, or adapting key components of the Z-CAN program. Z-CAN was developed by the CDC Foundation, in partnership with CDC, and established a network of trained physicians across Puerto Rico that provided women with client-centered contraceptive counseling and same-day access to the full range of FDA-approved reversible contraceptive methods at no cost.
- Pregnancy Estimator pdf icon[PDF–1.17 MB]: This tool estimates the number of pregnant women in a jurisdiction in the United States at any given point in time. It includes a simulated example pdf icon[PDF–195 KB], a point-in-time calculator form pdf icon[PDF–73.1 KB], and a geographic calculator excel icon[PDF–17.3 KB] to estimate the number of pregnant women in a jurisdiction using Excel software. The tool can be used for preparedness and response efforts.
- Post-disaster Indicators for Pregnant and Postpartum Women and Infants pdf icon[PDF–816 KB]: This list includes common epidemiologic indicators for pregnant and postpartum women and infants who are affected by disasters and offers suggested measurement approaches. This publicationexternal icon describes the process for developing the post-disaster indicators.
- Sample Protocol for Using Post-Disaster Indicators for Pregnant and Postpartum Women and Infants pdf icon[PDF–463 KB]: Provides information on how post-disaster health indicators can be used when collecting supplemental information on pregnant and postpartum women.
- Reproductive Health Assessment After Disaster (RHAD) Toolkit: This web-based set of tools is designed to guide users through the planning, implementation, and analysis stages of conducting a reproductive health assessment after a disaster. This toolkit is undergoing revision, please contact the DRH’s Emergency Preparedness and Response Team at firstname.lastname@example.org for updates, questions, or comments.
- Disaster Safety for Expectant and New Parents Feature: These general tips and safety messages help to keep expectant and new parents safe before, during, and after a disaster.
- Sample Scripts to Counsel Parents and Caregivers pdf icon[PDF–106 KB]: This document outlines steps parents and caregivers can take before and during a disaster to provide a safe sleep environment for their baby.
- Coordinated Anthrax Emergency Guidelines: Clinical information for health care providers and public health professionals caring for pregnant, postpartum, and lactating women in the setting of a bioterrorist event involving anthrax. In addition, this reportexternal icon describes the recommendations pertaining to communication about anthrax exposure and treatment for lay and professional audiences and training for health professionals.
- Pregnancy Risk Assessment Monitoring System (PRAMS) Standard and Supplemental Questions: These questions help to understand the effects of emerging infections and major natural disasters on maternal and infant health.
- Pretested Standard Question About Preparedness: This pretested question pdf icon[PDF–938 KB] (see Question KK4, page 72) helps to assess the level of preparedness for a disaster among postpartum women. Responding to Public Health Emergencies
CDC’s Division of Reproductive Health (DRH) has provided domestic and global public health response support for emerging or pandemic diseases, such as COVID-19, Zika and Ebola outbreaks. Some major accomplishments are discussed below.
CDC is supporting multiple efforts to better understand the impact of COVID-19 during pregnancy on both the mother and infant. Data collected as part of these efforts can help direct public health action and inform clinical guidance for the care of affected pregnant women and their infants. Subject matter experts (SMEs) at the Division of Reproductive Health (DRH) are collaborating with other SMEs to provide guidance on activities such as surveillance, epidemiology capacity, messaging for at-risk populations, and the development of resources addressing maternal-infant-child health issues for different types of audiences, such as healthcare professionals and the general public. Learn more about Tracking Data on COVID-19 during Pregnancy, Clinical guidance, and resources on pregnancy, breastfeeding and caring for young children in the context of COVID-19.
In collaboration with other CDC subject matter experts, programs and partners, such as CDC Foundation and Puerto Rico Department of Health, the Division of Reproductive Health (DRH) did the following:
- Established surveillance systems to collect information on pregnant women infected with Zika virus in the United States and associated territories.
- Partnered with Puerto Rico Department of Health to implement the Zika Postpartum Emergency Response Surveys.
- Used the Behavioral Risk Factor Surveillance System (BRFSS) to implement, analyze and disseminate findings from four surveys: Contraceptive Assessment in Puerto Rico during Zika (CAPRZ)—2016, BRFSS Family Planning Module—2016 Early Start, Zika Call Back Survey in Puerto Rico—2017, and Reproductive Health Call Back Survey in states—currently being conducted in 2020.
- Established the Zika Contraception Access Network, and developed a toolkit external iconfor increasing contraceptive access during public health emergencies.
In collaboration with other CDC subject matter experts, the Division of Reproductive Health (DRH) prepared guidance documents on breastfeeding and recommendations for screening and treating pregnant women 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. Learn more about CDC’s Maternal Health Response to 2014-16 Ebola outbreakexternal icon.
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)external icon to learn more about lessons learned during the Pandemic H1N1 response and special considerations for pregnant women and newborns.