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Natural disasters and maternal health
Natural disasters can be detrimental to families, communities and entire regions, disproportionately affecting the most vulnerable groups. Due to biological, social, cultural and reproductive health differences, disasters do not affect men and women in the same way. Women and children often bear the greatest burden, especially when natural disasters occur in low-resource settings.
During the immediate response phase, natural disasters have resulted in pregnancy and birth complications including maternal mental health issues, breastfeeding challenges and poor perinatal health outcomes. Post-disaster, women in particular may be prone to sexual violence, sexually transmitted infections and inadequate access to family planning and high quality antenatal, intrapartum and postpartum care. The long-term effects of disaster on maternal and newborn health can be substantial as families recover from physical and emotional trauma and reallocate finances from health expenses to rebuilding their homes.
The 2015 earthquake in Nepal
The Nepal earthquake of 2015, also called the Gorkha earthquake, exemplified the widespread effects of natural disasters on maternal and newborn health. On 25 April 2015, a severe earthquake occurred near the city of Kathmandu in central Nepal, killing an estimated 9,000 people and injuring thousands more. About two-and-a-half weeks later, a strong aftershock that struck about 50 miles from Kathmandu killed over 100 people and injured nearly 2,000.
Amid considerable progress in reducing maternal mortality in recent decades, the state of sexual, reproductive, maternal and newborn health in Nepal suffered severely after the earthquake. In the country’s 14 hardest hit districts, 1.4 million women and girls of reproductive age were affected by the earthquake, and an estimated 126,000 pregnant women were among the survivors.
A vulnerable context for maternal and newborn health
Facilities providing essential maternal health care sustained extensive damage following the earthquake, which contributed to overcrowding at hospitals and poor health outcomes. The earthquake destroyed over 80% of health facilities in affected districts, which likely exacerbated Nepal’s existing low rates of facility-based delivery and skilled birth attendance.
Additionally, damage to primary health care facilities and birthing centers, which can serve as a first contact point for women seeking maternal health services, further limited the availability of basic obstetric care. The effects of the earthquake also disrupted access to comprehensive emergency obstetric and neonatal care.
The natural disaster took a toll on maternal mental health amidst Nepal’s preexisting shortage of mental health care providers. Women who were pregnant during the earthquake reported being fearful that it may have damaged their fetuses and remained concerned about the living conditions their newborns would face. Many living in poorly-insulated structures in relocation camps post-earthquake feared that their infants and children were exposed to dangerously cold temperatures at night, leaving them vulnerable to poor health outcomes.
Exclusive breastfeeding practices—which have important implications for both maternal and newborn health—may have suffered following the earthquake as well. Some women living in relocation camps throughout the Kathmandu Valley area expressed concerns about not producing enough breast milk. This perception, along with the typical rise in donations of breast milk substitutes during humanitarian emergencies and unrestricted distribution of such products, may have led to an increase in formula feeding.
As Stephanie Kayden, Chief of the Division of International Emergency Medicine and Humanitarian Program at Brigham and Women’s Hospital, reflects,
“Many people who respond to humanitarian crises simply don’t prepare for the needs of pregnant women. I’ve seen earthquake field hospitals staffed with orthopedists and neurosurgeons, but no one who could do a cesarean section for obstructed labor. Women don’t stop having babies during disasters.”
An opportunity for the future
Researchers have noted that the period following natural disasters such as the 2015 Nepal earthquake serves as an opportunity to expand universal health coverage, rebuild better health facilities and strengthen the capacity of skilled birth attendants. Promoting health system resilience by investing in earthquake-resistant structures and developing evidence-based disaster response plans is crucial. Implementing community-based interventions and enhancing health worker training are also promising approaches for improving maternal and newborn health in the wake of natural disasters.