Marianne Zotti, DrPH, MS, FAANLead Epidemiologist

AMCHP Conference February 12, 2012

Building Reproductive HealthPreparedness Science Together

Division of Reproductive HealthNational Center for Chronic Disease Prevention and Health Promotion

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

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

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.

FEMA Photos

What is DRH’s role in emergency preparedness?

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

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

DRH Emergency Preparedness and

Response Program (continued)

DRH Emergency Preparedness and

Response

Science/Clinical

Communications

Human Resources

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

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

New Tools & Activities (continued) Reproductive Health Assessment After

Disaster (RHAD) Toolkit http://cphp.sph.unc.edu/reproductivehealth/

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

New Tools & Activities (continued)

Development of PRAMS methodology for surveillance after a catastrophic event

Analyses of PRAMS preparedness questions

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

Synopsis of MCH EPI Symposium

MCH EPI Symposium: Topics for Potential Indicators

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

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