The American College of Obstetricians and Gynecologists (ACOG) noted that the lack of resources including food, water, and shelter in the aftermath of a disaster adversely impact pregnancy and pregnancy outcome. Women and children are the most vulnerable members of societies. The social, political, and cultural norms of societies very commonly set women and children up to be disproportionately harmed in a catastrophe. The disaster environment increases pregnancy-related morbidities. ACOG called for emergency preparedness that should include maintaining prenatal care, preparing emergency delivery kits for patients, developing evacuation plans, providing shelters that are safe, and contraception. There are many challenges to women’s health in a disaster. All aspects of the care for pregnant women-prenatal, intrapartum, and postpartum care can be compromised. Contraception options may be reduced. Sexual violence can lead to a rise of sexually transmitted diseases and injuries. Mental health issues, both acutely and chronic posttraumatic stress disorders, impacts the health and welfare of women and their families. Risk for violence against women increases for many reasons. Male perpetrators have dominance over female victims and single females can be separated from male family members. There are psychological strains in refugee camps. Absence of support systems for protection, general lawlessness, alcohol and drug abuse, and politically motivated violence against refugees increases dangers for women The first responders of disaster teams will confront these complex, humanitarian issues that disproportionately harm women. Current training and selection of disaster response teams has not uniformly addressed this crucial need. The needs during a disaster can be divided into three phases. In the first phase I, which lasts five to seven days, acute injuries are predominant, especially orthopedic catastrophes. In phase 2, which occurs one to three weeks after the event, injuries treated by responders include those from mob violence and motor vehicle accidents. The third phase, three weeks and longer after the disaster, includes management of general surgical care, wounds ready to be grafted, and definitive care. In addition, ongoing care must be provided for chronic medical conditions such as diabetes, heart disease, hypertension given the disruption of available services and medications. Throughout all these phases, the specific healthcare concerns of women and the management of pregnant women make up at least 10 percent of the care delivered by rescue workers. There are immediate and long-term consequences to natural disasters. Reproductive health concerns are important during the different phases of a disaster and can compound risks of morbidity and mortality of women. While women face the same constellation of injuries from orthopedic injuries, infections, and food insecurity as men, they also have inherently unique risks by virtue of their social roles and vulnerability to sexual predators. These unique risks during disasters include pregnancy loss, long-term consequences on pregnancy outcome and future fertility, sexual violence, and sexually transmitted diseases. The World Health Organization (WHO) definition of a disaster is any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community. From 1990-1999 approximately one billion people were affected by natural disasters. During that decade, there were 600,000 fatalities. Eighty-six percent of people killed worldwide succumbed to natural events, which included 35% fatalities from wind storms. Floods make up three fourths of all disasters and affect largest proportion of people. People in low income countries are four times more likely to die. Two thirds of deaths from disasters occur in Asia. Commonly, earthquakes and natural disasters significantly weaken the pre-existing medical and legal infrastructure of a egion. The lack of pre-existing safety features of buildings and overcrowded conditions and immense poverty in some low income countries lead to a higher proportion of injured and dead in these countries.

With Regards,
Sara Giselle
Associate Managing Editor
 Journal of Critical Care Obsestrics & Gynocology