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Building Reproductive Health Preparedness Science Together. 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. Purposes of Workshop.

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building reproductive health preparedness science together
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

purposes of workshop
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
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
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.
drh emergency preparedness and response program
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
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 continued2
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
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@

new tools activities continued
New Tools & Activities (continued)
  • Reproductive Health Assessment After Disaster (RHAD) Toolkit

what is included in the rhad toolkit
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 continued1
New Tools & Activities (continued)
  • Development of PRAMS methodology for surveillance after a catastrophic event
  • Analyses of PRAMS preparedness questions
synopsis of mch epi symposium
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
mch epi symposium topics for potential indicators
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