Building Reproductive Health Preparedness Science Together

1. Building Reproductive HealthPreparedness ScienceTogether Marianne Zotti, DrPH, MS, FAAN Lead Epidemiologist AMCHP Conference February 12, 2012 Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion

2. Purposes of Workshop • Provide background about disaster and reproductive health • Describe DRH Program for Emergency Preparedness and Response • Describe new tools for preparedness and response • Continue conversation about post-disaster reproductive health indicators

3. Pregnant Women and Catastrophic Events • Classified as ‘at-risk individuals’ • Post-event data often not collected • Disproportionate burden known for some infectious diseases • Few studies examined associations of US disasters and birth outcomes • Exposure associated with poor birth outcomes • Showed increases in maternal risk factors

4. Disaster and Women of Reproductive Age (WRA) • Inconsistent changes in birth rate after disaster • Increases after Hurricane Hugo and OK City bombing • Decreases after Hurricane Katrina and 1997 ND Red River Flood • Little known about disaster effects on WRA in US • No routine surveillance of disaster-affected WRA • Inconsistent reports of intimate partner violence • Inadequate studies on contraceptive use, access to medical and social services, risk behaviors, etc.

5. What is DRH’s role in emergency preparedness? FEMA Photos

7. DRH Emergency Preparedness and Response Program • Purpose: Prepare DRH to respond to reproductive health needs of the US population after natural or man-made catastrophic events by: • Gathering epidemiologic/surveillance data to guide action • Developing recommendations and tools to guide public health response specific to pregnant and lactating women and newborns • Developing a plan to reduce fertility risks, infertility, or inadequate contraception • Developing a plan to communicate with clinical, public health and government partners and pregnant women regarding preparedness and response • Developing a human resources preparedness plan for DRH • Target population: Pregnant/postpartum women, infants, women of reproductive age

8. DRH Emergency Preparedness and Response Program (continued) • Definition of catastrophic events • Extraordinary levels of mass casualties, damage, or disruption • Severely affects the population, infrastructure, environment, economy, national morale, and/or government functions • Pandemic illnesses • Types of Catastrophic Events • Meets at least 1 criteria below: • Affect >1 state • Affect a highly populated area • Are major acts of terrorism • Affect a large proportion or a whole state/territory • Unusual public health events that disproportionately affect pregnancy, infancy, or fertility • CDC Director directs the agency to respond

9. DRH Emergency Preparedness and Response Program (continued)

10. DRH Emergency Preparedness and Response Program (continued) • Examples of Science/Clinical essential activities • Solicit input from local and state health departments related to reproductive health needs they have identified after catastrophic events • Set a research and surveillance agenda related to catastrophic events and reproductive health • Develop a post-disaster surveillance module and assure funding that can be used in PRAMS • Prepare background information on basic needs of pregnant women and infants • Develop recommendations regarding vaccination and/or treatment for selected bioterrorism agents • Identify availability of and potential needs for Strategic National Stockpile medications and equipment for women and infants

12. New Tools & Activities • When There is an Emergency: Estimating the Number of Pregnant Women in a Geographic Area • Provides estimation tool for a jurisdiction • Calculates number of pregnant women at a point in time • Uses pregnancy rates Tell us what you think by emailing comments to drhinfo@ cdc.gov

13. New Tools & Activities (continued) • Reproductive Health Assessment After Disaster (RHAD) Toolkit http://cphp.sph.unc.edu/reproductivehealth/

14. What is Included in the RHAD Toolkit • Pre-tested questionnaires • Pregnant and Postpartum Women • Women of Reproductive Age • Topics include safe motherhood, infant care, family planning, family stressors and service needs, health and risk behaviors, and gender-based violence. • Variable codebooks • Sampling instructions • Interviewing training resources • Resources for data collection and analysis

15. New Tools & Activities (continued) • Development of PRAMS methodology for surveillance after a catastrophic event • Analyses of PRAMS preparedness questions

16. Synopsis of MCH EPI Symposium • Number of Attendees: 25 • Reproductive health needs were not a priority or focus of emergency response experiences • Most participants indicated their organization did not have a disaster plan about reproductive health • Pregnant and postpartum women should be the focus of any plan about reproductive health after disaster

17. MCH EPI Symposium: Topics for Potential Indicators • Pregnant women • Access to emergency services, including delivery • Social networks • Postpartum women • Breastfeeding • Access to clean water, formula, diapers • Access to contraception • Availability of childcare • Infants • Birth outcomes • Safe sleep environment • Pregnant or Postpartum Women • Access to food and potable water • Access to safe environment—shelters or other • Access to medications • Access to medical services • Barriers to care • Post-disaster mental health effects • Access to mental health services • Access to STD/STI services • Gender based violence • Access to WIC • Substance abuse