w omen & infants service package (wisp): planning for emergencies lisa summers, cnm, drph...

WWomen & Infants Service Package (WISP): omen & Infants Service Package (WISP): Planning for Emergencies Planning for Emergencies

Lisa Summers, CNM, DrPHLisa Summers, CNM, DrPHDirector, Professional ServicesDirector, Professional Services

American College of Nurse-MidwivesAmerican College of Nurse-Midwives

On behalf of the On behalf of the

White Ribbon Alliance &White Ribbon Alliance & National Working Group for Women & Infant Needs in EmergenciesNational Working Group for Women & Infant Needs in Emergencies

American Public Health AssociationAmerican Public Health Association134134thth Annual Meeting Annual MeetingNovember 8, 2006November 8, 2006

Hurricane Katrina: Hurricane Katrina: A Wake-up Call?A Wake-up Call?

No plan was in place to evacuate and care for pregnant No plan was in place to evacuate and care for pregnant women, new mothers and infants when Hurricane women, new mothers and infants when Hurricane Katrina hit. Katrina hit. Responders struggled to assess damage and Responders struggled to assess damage and evacuate patients and residents to regions with water, evacuate patients and residents to regions with water, electricity, and staff. electricity, and staff.

Women and infants are disproportionately and adversely Women and infants are disproportionately and adversely affected by emergencies, yet public policy does not affected by emergencies, yet public policy does not reflect this. reflect this.

Many organizations and first responders are not Many organizations and first responders are not prepared to deal with special needs of these populations.prepared to deal with special needs of these populations.

What’s in place now?What’s in place now? Nothing????Nothing????

Federal and state emergency preparedness Federal and state emergency preparedness plans don’t address the special needs of plans don’t address the special needs of pregnant women, new mothers and new infants pregnant women, new mothers and new infants during a disaster during a disaster

Most programmers do not have the tools Most programmers do not have the tools (training/kits/etc.) on hand to care for pregnant (training/kits/etc.) on hand to care for pregnant women, new mothers and infants when a women, new mothers and infants when a disaster strikesdisaster strikes

Learning from International EffortsLearning from International Efforts

Lessons learned from tsunami response in Lessons learned from tsunami response in SE AsiaSE Asia

Medecins Sans Frontieres: Refugee Medecins Sans Frontieres: Refugee HealthHealth

UNFPA: MISPUNFPA: MISP SPHERE StandardsSPHERE Standards CDC: Promoting Health for Women CDC: Promoting Health for Women

Before, During and After PregnancyBefore, During and After Pregnancy

Formation of a Working GroupFormation of a Working GroupInitial meeting: February 22, 2006Initial meeting: February 22, 2006

The mission of the National Working Group for Women and The mission of the National Working Group for Women and Infant Needs in Emergencies is to ensure that the health Infant Needs in Emergencies is to ensure that the health care needs of pregnant women, new mothers, fragile care needs of pregnant women, new mothers, fragile newborns and infants are adequately met during and newborns and infants are adequately met during and after a disaster situation. after a disaster situation.

Members use their expertise to create resources for Members use their expertise to create resources for government and NGOs to raise awareness of the government and NGOs to raise awareness of the specific needs of pregnant women, mothers, fragile specific needs of pregnant women, mothers, fragile newborns and infants in an emergency, and advocate for newborns and infants in an emergency, and advocate for policies that will improve outcomes for mothers and policies that will improve outcomes for mothers and infants affected by disaster.infants affected by disaster.

Working Group ObjectivesWorking Group Objectives Develop guidance documents for emergency preparedness Develop guidance documents for emergency preparedness

planners at both the federal and state levels.planners at both the federal and state levels.

Develop and distribute kits and guidance documents for responders Develop and distribute kits and guidance documents for responders to use in the field during a disaster.to use in the field during a disaster.

Advocate for federal legislation to encourage state and local Advocate for federal legislation to encourage state and local governments and NGOs receiving federal funding to include governments and NGOs receiving federal funding to include mothers and infants as special populations in emergency mothers and infants as special populations in emergency preparedness plans.preparedness plans.

Create an advocacy/media campaign to inform the public and Create an advocacy/media campaign to inform the public and policymakers of the special health care needs of pregnant women policymakers of the special health care needs of pregnant women and infants during a disaster and partners' efforts around these and infants during a disaster and partners' efforts around these issues.issues.

Working Group MembersWorking Group Members American Association of Birthing Centers (AABC)American Association of Birthing Centers (AABC) American College of Nurse-Midwives (ACNM) American College of Nurse-Midwives (ACNM) American College of Obstetricians and Gynecologists (ACOG) American College of Obstetricians and Gynecologists (ACOG) Association of Maternal & Child Health Programs (AMCHP) Association of Maternal & Child Health Programs (AMCHP) DC Rape Crisis CenterDC Rape Crisis Center Centers for Disease Control and Prevention Centers for Disease Control and Prevention George Washington University Dept. of Health Sciences & Global HealthGeorge Washington University Dept. of Health Sciences & Global Health March of Dimes March of Dimes Midwives Alliance of North America (MANA) Midwives Alliance of North America (MANA) National Association of Certified Professional Midwives (NACPM) National Association of Certified Professional Midwives (NACPM) National Association of County & City Health Officials (NACCHO)National Association of County & City Health Officials (NACCHO) Perinatal Programs at MIEMSS (Maryland Institute for Emergency Medicine Perinatal Programs at MIEMSS (Maryland Institute for Emergency Medicine

Services/Systems) Services/Systems) Sacopee Rescue Inc. Sacopee Rescue Inc. SaferMaternity.org SaferMaternity.org University of Maryland, School of NursingUniversity of Maryland, School of Nursing White Ribbon Alliance for Safe Motherhood (WRA)White Ribbon Alliance for Safe Motherhood (WRA) Women’s Commission for Refugee Women and ChildrenWomen’s Commission for Refugee Women and Children

WISP - “Women and Infants WISP - “Women and Infants Service Package” Service Package”

guidelines to provide the framework for the guidelines to provide the framework for the minimum and initial actions neededminimum and initial actions needed

to respond to the essential health care needs of to respond to the essential health care needs of pregnant women, new mothers, fragile newborns pregnant women, new mothers, fragile newborns and infants and infants

in a crisis or emergency, i.e. natural disaster, in a crisis or emergency, i.e. natural disaster, epidemic, or terrorist event. epidemic, or terrorist event.

Objectives of the WISPObjectives of the WISP IDENTIFYIDENTIFY the organizations or individuals who will be the organizations or individuals who will be

responsible for the coordination and implementation of responsible for the coordination and implementation of the WISP and advocate for the unique needs of women the WISP and advocate for the unique needs of women and newborns and newborns

PREVENTPREVENT excess neonatal and maternal morbidity and excess neonatal and maternal morbidity and mortalitymortality

PREVENTPREVENT and and MANAGEMANAGE the consequences of sexual and the consequences of sexual and gender-based violence;gender-based violence;

PREVENTPREVENT unplanned pregnancies unplanned pregnancies REDUCE REDUCE HIV and STI transmission HIV and STI transmission

COLLECTCOLLECT, , ANALYZEANALYZE and and USEUSE information for better information for better management of maternal and infant health care management of maternal and infant health care programs in emergencies through monitoring and programs in emergencies through monitoring and surveillance surveillance

Remember that. . .Remember that. . .

In the United States, 99% of all births occur in a hospital setting. In the United States, 99% of all births occur in a hospital setting. During an emergency, however, this setting is not always During an emergency, however, this setting is not always immediately accessible. In the case of pandemic flu, hospitals may immediately accessible. In the case of pandemic flu, hospitals may be overwhelmed with flu victims. be overwhelmed with flu victims.

During disasters, women experience greater rates of health During disasters, women experience greater rates of health complications associated with pregnancy, including premature complications associated with pregnancy, including premature births, low-birth-weight infants and infant deaths.births, low-birth-weight infants and infant deaths.

Over 3 million unplanned pregnancies generally occur in the United Over 3 million unplanned pregnancies generally occur in the United

States each year. The interruption of access to contraceptives for States each year. The interruption of access to contraceptives for couples as well as the increased incidences of sexual violence can couples as well as the increased incidences of sexual violence can occur in the aftermath of an emergency, heightening the number of occur in the aftermath of an emergency, heightening the number of unplanned pregnancies. unplanned pregnancies.

Identify the organizations or individuals who will be responsible Identify the organizations or individuals who will be responsible for the coordination and implementation of the WISPfor the coordination and implementation of the WISP

Key activities to consider during planning and implementation:Key activities to consider during planning and implementation:

Outreach to engage governmental and non-Outreach to engage governmental and non-governmental organizations, hospitals, midwives and governmental organizations, hospitals, midwives and other health care providers, and women’s groupsother health care providers, and women’s groups

Build consensus for planning and adoption of an Build consensus for planning and adoption of an emergency planemergency plan

Identify responsible entities and a ‘chain-of-command’ Identify responsible entities and a ‘chain-of-command’ for disaster planning at the regional, state, and local levelfor disaster planning at the regional, state, and local level

Review regional, state, and local level planning Review regional, state, and local level planning documents for appropriate and consistent contentdocuments for appropriate and consistent content

Identify the organizations or individuals who will be responsible for Identify the organizations or individuals who will be responsible for the coordination and implementation of the WISPthe coordination and implementation of the WISP

(continued)(continued)

Assess needs, determinate how to utilize and share Assess needs, determinate how to utilize and share available resources of stakeholdersavailable resources of stakeholders

Provide outreach information to stakeholder Provide outreach information to stakeholder organizations and individuals in the community about the organizations and individuals in the community about the emergency planemergency plan

Engage women through multiple venues, including faith-Engage women through multiple venues, including faith-based communities, during health care visits, and based communities, during health care visits, and creative media to communicate the plancreative media to communicate the plan

PREVENT excess neonatal and maternal morbidity and mortalityPREVENT excess neonatal and maternal morbidity and mortality


Become familiar with local/regional birth data Become familiar with local/regional birth data Planning for crises and emergencies should take into Planning for crises and emergencies should take into

account birth rates, population demographics, and information about account birth rates, population demographics, and information about where births currently take place and who attends births. where births currently take place and who attends births.

Engage local/regional potential providers, including Engage local/regional potential providers, including CNMs, CPMs, OB-GYN and family practice physicians, CNMs, CPMs, OB-GYN and family practice physicians, L&D nurses, EMTs, NPs, PAs, emergency and first L&D nurses, EMTs, NPs, PAs, emergency and first responders, traditional birth attendants and doulas to:responders, traditional birth attendants and doulas to:

Translate homebirth skills, services and equipment to institutional-based Translate homebirth skills, services and equipment to institutional-based birth providersbirth providers

Acknowledge that providers might not have experience working with Acknowledge that providers might not have experience working with women who are not medicated/working with women who expected to women who are not medicated/working with women who expected to get an epiduralget an epidural

PREVENT excess neonatal and maternal morbidity and mortality PREVENT excess neonatal and maternal morbidity and mortality (continued)(continued)

Prepare maternal and infant health care information, Prepare maternal and infant health care information, education and communication (IEC) outreach among education and communication (IEC) outreach among communities using IEC tools, including interpersonal and communities using IEC tools, including interpersonal and mass media communications.mass media communications. Material can includeMaterial can include

• How to prepare for a home birth (all 3 stages of birth)How to prepare for a home birth (all 3 stages of birth)• Contents of an emergency home birth kit Contents of an emergency home birth kit • Breastfeeding methods (including relactation) and steps to Breastfeeding methods (including relactation) and steps to

prepare sterilized formula using powdered formula if prepare sterilized formula using powdered formula if breastfeeding is not an optionbreastfeeding is not an option

• Contact numbers or locations for emergency assistance and Contact numbers or locations for emergency assistance and methods of evacuation specifically catering to maternal and methods of evacuation specifically catering to maternal and infant health careinfant health care


Support, facilitate, and integrate into the primary health Support, facilitate, and integrate into the primary health care system during the acute phase of an emergency, as care system during the acute phase of an emergency, as able able prenatal careprenatal care postpartum carepostpartum care breastfeeding and re-lactation breastfeeding and re-lactation newborn care newborn care

Initiate the establishment of a referral system to transport Initiate the establishment of a referral system to transport and manage obstetric emergencies and manage obstetric emergencies


Determine how pregnant, laboring and Determine how pregnant, laboring and postpartum women will be triaged and cared for postpartum women will be triaged and cared for

Identify the safest place for pregnant and Identify the safest place for pregnant and laboring women, newborns and their familieslaboring women, newborns and their families

PREVENT excess neonatal and maternal morbidity PREVENT excess neonatal and maternal morbidity and mortality (continued)and mortality (continued)

Identify, compile, and provide equipment, supplies, and Identify, compile, and provide equipment, supplies, and practice guidelines for basic birth kits and normal practice guidelines for basic birth kits and normal deliveries, for use by mothers, midwives or health deliveries, for use by mothers, midwives or health professionals to promote safe deliveries outside of professionals to promote safe deliveries outside of traditional healthcare institutions. traditional healthcare institutions.

(Information on birth kits is included in an Appendix)(Information on birth kits is included in an Appendix)

Identify, compile, and provide equipment, supplies, and Identify, compile, and provide equipment, supplies, and practice guidelines for high risk and difficult deliveries to practice guidelines for high risk and difficult deliveries to ensure safe deliveries in alternative sitesensure safe deliveries in alternative sites

PREVENT and MANAGE the Consequences of Sexual ViolencePREVENT and MANAGE the Consequences of Sexual Violence

Key activities to consider during planning and implementationKey activities to consider during planning and implementation::

Preventing sexual violencePreventing sexual violence Design and locate evacuee centers or shelters to enhance physical Design and locate evacuee centers or shelters to enhance physical

securitysecurity Ensure evacuees and disaster survivors are informed of the Ensure evacuees and disaster survivors are informed of the

availability of services for survivors of sexual violenceavailability of services for survivors of sexual violence Identify individual or groups who may be particularly at risk to sexual Identify individual or groups who may be particularly at risk to sexual

violence (single female heads-of-households, unaccompanied violence (single female heads-of-households, unaccompanied minors, etc.) and address their protection and assistance needsminors, etc.) and address their protection and assistance needs

Health care responses to sexual violenceHealth care responses to sexual violence Provide a medical and forensic response to survivors of sexual Provide a medical and forensic response to survivors of sexual

violence, as medically appropriateviolence, as medically appropriate Pregnancy testing must be available to confirm suspicions of Pregnancy testing must be available to confirm suspicions of

pregnancy when there is doubtpregnancy when there is doubt Make Sexual Assault Forensic Examiner (SAFE) and Sexual Make Sexual Assault Forensic Examiner (SAFE) and Sexual

Assault Nurse Examiner (SANE) kits availableAssault Nurse Examiner (SANE) kits available

PREVENT and MANAGE the Consequences of Sexual ViolencePREVENT and MANAGE the Consequences of Sexual Violence

Security and Legal IssuesSecurity and Legal Issues Ensure the presence of female protection and health staff and Ensure the presence of female protection and health staff and

interpretersinterpreters Assure medical evidence documentation for legal proceedingsAssure medical evidence documentation for legal proceedings

Assessment/Incidence Data CollectionAssessment/Incidence Data Collection Outreach and identification of sexual violence survivorsOutreach and identification of sexual violence survivors Use emergency workers that have knowledge of forensic exams Use emergency workers that have knowledge of forensic exams

and evidence chain of custody so that a woman's ability to pursue and evidence chain of custody so that a woman's ability to pursue legal channels after the disaster are protectedlegal channels after the disaster are protected

PREVENT Unplanned PregnanciesPREVENT Unplanned Pregnancies


Ensure immediate availability of condoms Ensure immediate availability of condoms

Access to the methods currently in use and how to link to Access to the methods currently in use and how to link to providersproviders

Ensure providers are have up to date knowledge of Ensure providers are have up to date knowledge of family planning methods, including exclusive family planning methods, including exclusive breastfeedingbreastfeeding

Ensure access to emergency contraceptionEnsure access to emergency contraception

How you can get involvedHow you can get involved

Contact your state and local offices tasked Contact your state and local offices tasked with emergency planning and offer your with emergency planning and offer your expertise and WISPexpertise and WISP

Write to your state and federal Write to your state and federal representatives to advocate for attention representatives to advocate for attention and resources for women and infantsand resources for women and infants

Join the WRA! Join the WRA! www.whiteribbonalliance.orgwww.whiteribbonalliance.org

w omen & infants service package (wisp): planning for emergencies lisa summers, cnm, drph...

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