Cluster Sampling with Referral to Improve the Efficiency of Estimating Unmet Needs among Pregnant and Postpartum Women after Disasters

Abstract

Introduction and Background-Women of reproductive age, in particular women who are pregnant or fewer than 6 months postpartum, are uniquely vulnerable to the effects of natural disasters, which may create stressors for caregivers, limit access to prenatal/postpartum care, or interrupt contraception. Traditional approaches (e.g., newborn records, community surveys) to survey women of reproductive age about unmet needs may not be practical after disasters. Finding pregnant or postpartum women is especially challenging because fewer than 5% of women of reproductive age are pregnant or postpartum at any time.

Post-Disaster Reproductive Health Outcomes

“…Having this constellation of information would enable us to examine factors that may put pregnant women and their infants at risk. However, an obstacle to studying pregnant women post-disaster is that they are difficult to survey using a population-based approach [45] because they comprise only about 1 % of the general population [46] and <5 % of women of reproductive age [47]. Therefore we suggest that adapting the Pregnancy Risk Assessment Monitoring System (PRAMS) [48] for use in disaster-affected areas would be beneficial in building our knowledge of post-disaster effects on pregnant women.…”

Disaster Preparedness Among Women With a Recent Live Birth in Hawaii – Results From the Pregnancy Risk Assessment Monitoring System (PRAMS), 2016

“…[25][26][27][28][29] It may be difficult to estimate baseline measures of preparedness among pregnant and postpartum women through traditional population-based sampling since they are a small percentage of the general population. 30 The Pregnancy Risk Assessment Monitoring System (PRAMS) is an annual survey conducted by states and the US Centers for Disease Control and Prevention (CDC) which can be used to estimate baseline preparedness among women who recently had a live birth. PRAMS assesses maternal behaviors, attitudes, and experiences throughout pregnancy, including before and shortly after giving birth.…”

History of Disaster Epidemiology

“…The frequency and severity of complex humanitarian emergencies, defined as acute situations in which mortality substantially increases above the population baseline, either directly because of violence, or indirectly due to malnutrition or the transmission of communicable diseases, has also increased since the 1980s and 1990s (Salama, 2004). New areas for epidemiology investigations and studies postdisaster have also emerged, including reproductive (Horney, Williams, Hsia, & Zotti, 2012;Zotti, Williams, Robertson, Horney, & Hsia, 2013) and mental health (Galea, Nandi, & Vlahov, 2005;Neria, Galea, & Norris 2009). Changes in threatsdpandemic influenza, suicide bombersdand in health systems and policiesdemergency department overcrowding, the Patient Protection and Affordable Care Actdmean that the body of knowledge related to disaster epidemiology can quickly become outdated, requiring the design and implementation of new studies in response to future disasters to continue to build the knowledge base of disaster epidemiology (Noji, 2005).…”