Transcript E02 - Federal Initiatives - Part 2a

Building Reproductive Health
Preparedness Science Together
Marianne Zotti, DrPH, MS, FAAN
Lead Epidemiologist
AMCHP Conference February 12, 2012
National Center for Chronic Disease Prevention and Health Promotion
Division of Reproductive Health
Purposes of Workshop
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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
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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)
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Inconsistent changes in birth rate after disaster
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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
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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
DRH Emergency Preparedness and
Response Program
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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)
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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
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Types of Catastrophic Events
 Meets at least 1 criteria below:
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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 Program (continued)
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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
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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)
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Reproductive Health Assessment After Disaster (RHAD)
Toolkit
http://cphp.sph.unc.edu/reproductivehealth/
What is Included in the RHAD Toolkit
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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.
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Variable codebooks
Sampling instructions
Interviewing training resources
Resources for data collection and analysis
New Tools & Activities (continued)
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Development of
PRAMS methodology
for surveillance after a
catastrophic event
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Analyses of PRAMS
preparedness
questions
Synopsis of MCH EPI Symposium
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Number of Attendees: 25
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Reproductive health needs were not a priority or focus of emergency
response experiences
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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
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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
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Pregnant women
 Access to emergency services,
including delivery
 Social networks
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Postpartum women
 Breastfeeding
 Access to clean water, formula,
diapers
 Access to contraception
 Availability of childcare
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Infants
 Birth outcomes
 Safe sleep environment