Public Health Consequences of Terrorism on Maternal–Child Health in New York City and Madrid

Abstract

Past research provides evidence for trajectories of health and wellness among individuals following disasters that follow specific pathways of resilience, resistance, recovery, or continued dysfunction. These individual responses are influenced by event type and pre-event capacities. This study was designed to utilize the trajectories of health model to determine if it translates to population health. We identified terrorist attacks that could potentially impact population health rather than only selected individuals within the areas of the attacks. We chose to examine a time series of population birth outcomes before and after the terrorist events of the New York City (NYC) World Trade Center (WTC) attacks of 2001 and the Madrid, Spain train bombings of 2004 to determine if the events affected maternal-child health of those cities and, if so, for how long. For percentages of low birth weight (LBW) and preterm births, we found no significant effects from the WTC attacks in NYC and transient but significant effects on rates of LBW and preterm births following the bombings in Madrid. We did find a significant positive and sustained effect on infant mortality rate in NYC following the WTC attacks but no similar effect in Madrid. There were no effects on any of the indicator variables in the comparison regions of New York state and the remainder of Spain. Thus, population maternal-health in New York and Madrid showed unique adverse effects after the terrorist attacks in those cities. Short-term effects on LBW and preterm birth rates in Madrid and long-term effects on infant mortality rates in NYC were found when quarterly data were analyzed from 1990 through 2008/2009. These findings raise questions about chronic changes in the population's quality of life following catastrophic terrorist attacks. Public health should be monitored and interventions designed to address chronic stress, environmental, and socioeconomic threats beyond the acute aftermath of events.

Birth Outcomes in a Disaster Recovery Environment: New Orleans Women After Katrina

“…There were fewer direct associations with current disruption or perceptions of recovery, making them unlikely mediators. To our knowledge, only one previous study that has examined the long-term effect of disaster on pregnancy, finding mixed results on the long-term effects of the September 11 th attacks and Madrid train bombings (20). This study is generally consistent with previous research finding that disaster affects infant growth and gestational age (6), although our results were not always robust to adjustment for confounders.…”

“…This study examined both New York after the September 11 attacks and Madrid after the train bombing, and found a long-term increase in infant mortality in New York, but no increase in low birthweight or preterm birth, and no long-term effects on low birthweight, preterm birth, or infant mortality in Madrid (20). This study relied on vital records data, and so had no information about the individual experiences of the women either during or after the attacks.…”

Importance of Social- and Health-Related Problems: Do Spaniards Give Them the Significance They Actually Deserve?

“…In spite of this general perception, the objective data for 2003 were three casualties, reduced to zero in 2017. It is true, however, that terrorism is a health problem in terms of injuries, which causes social and emotional damage, and that Spain has a long terrorism-related history, which easily explains its importance in this country [47,48]. Actually, there were terrorist attacks in the year 2000 (26 casualties), 2001 (15 casualties), and 2002 (5 casualties) [19].…”

Obstetric complications on deployed operations: a guide for the military surgeon

“…Current Centers for Disease Control Guidelines recommend admission of pregnant patients in the second and third trimester after exposure to blast injury, but make no other specific recommendations for their care 7. Nevertheless, reports of pregnant women injured following terrorist activities8 9 recognise placental abruption and UR as complications of blast injury. Awwad et al 10 reported UR requiring perimortem CS as a complication of blast injury; however, we have not found a previous report of a blast injury causing placental abruption where both mother and baby survived.…”