Contraceptive Availability During an Emergency Response in the United States

Abstract

This article provides the evidence for contraceptive need to prevent unintended pregnancy during an emergency response, discusses the most appropriate types of contraceptives for disaster situations, and details the current provisions in place to provide contraceptives during an emergency response.The impact of a disaster on women's access to reproductive health services is not fully known. Limited evidence indicates that many women have difficulty accessing contraception during a disaster situation. At the same time, the need for such services may be heightened during a mass emergency. Stress caused by a disaster can create comfortseeking behaviors, which can lead to unprotected sexual encounters. 1 Additionally, disasters may create social disruptions that reduce women's personal safety and protection from sexual violence. 2,3 Contraception is an important consideration in disasters for both victims and first responders. This document outlines the evidence for contraceptive need to prevent unintended pregnancy during emergencies and the most appropriate types of contraceptive availability in such situations. Why Contraceptives are Needed in DisastersFew studies have examined the impact of a disaster on women's access to reproductive health services; however, studies that do exist have found many women have difficulty accessing contraception during a disaster situation. Before Hurricane Katrina devastated the U.S. Gulf Coast in 2005, it is estimated that more than one million women of reproductive age (15-44 years) resided in the affected area. 4 Women participating in a vaginal douching prevention study conducted at two family planning clinics in New Orleans before Hurricane

Post-disaster fertility: Hurricane Katrina and the changing racial composition of New Orleans

“…This has arisen in part because of wider acknowledgement that disasters are not uncommon (over 6,000 events worldwide since 2004, IFRC 2015), and that their fertility effects may have negative implications for population welfare. For example, disaster-induced reductions in contraceptive access may align an increase in unintended births with unstable or resource-poor conditions (Ellington et al 2013; Hapsari et al 2009). Social scientists have pursued these questions in part because unexpected disasters may provide a tool through which to learn about fertility behavior more generally (Lin 2010) and because, as we argue here, fertility in the aftermath of mortality and out-migration is a fundamental part of the recovery process (Hill 2005).…”

“…An additional mechanism by which fertility rates might increase after a natural disaster is the decreased availability of contraceptives (Ellington et al 2013). In a cross-sectional study of birth control access administered after Hurricane Ike in 2008, which made landfall along Galveston, Texas, Leyser-Whalen et al (2011) find decreased levels of access to contraceptives for women who had evacuated.…”

“…Even in the immediate aftermath of natural disasters, children are born, gestated, conceived, and considered. Disasters shape these outcomes through a number of mechanisms, including miscarriage, partnering, the availability of economic resources, and the accessibility of reproductive health services (Carballo et al 2005; Evans et al 2010; Hamoudi et al 2012; Ellington et al 2013). Such fertility effects, in turn, have intergenerational implications for populations by shaping the size and composition of new birth cohorts.…”

Meeting Summary: State and Local Implementation Strategies for Increasing Access to Contraception During Zika Preparedness and Response — United States, September 2016

“…Currently, many states bundle payment for contraception under one global fee, particularly for immediate postpartum LARC, limiting reimbursement for the full cost of a device and specific insertion procedures ( 4 ). State policies that allow reimbursement for comprehensive client-centered counseling services are always important, but particularly during an emergency response ( 5 ), as such policies are implemented in part to prevent coercion of clients to choose any method, including LARC, by supporting informed, autonomous client decisions based on women’s individual needs and preferences ( 6 ). §§§ During an emergency response, it is also especially important to have straightforward and replicable campaigns to increase access to contraception to prevent unintended pregnancy.…”

Gender, disaster, and women's access to contraception and reproductive health care

“…Several researchers have examined patient perspectives in disaster settings (Bethel et al, ; Ellington et al, ; National Council on Disability, ; Nour, ; Peek & Stough, ; Rooney & White, ). In terms of emergency preparedness, chronically ill and disabled respondents are less likely to have general emergency preparedness items, but they are more likely to have medication supplies on hand in case of a disaster (Bethel et al, ).…”