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Natural disasters can restrict access to adequate medical care, including contraceptive services. Stress, social disruption, and living in close quarters can promote unanticipated (and often unwanted) sexual contact. Data about reproductive healthcare during emergencies are limited. To provide insight, researchers reviewed three studies about emergency responses.
Six months after Hurricane Katrina, 55 study participants in New Orleans responded to queries about contraceptive services. Since evacuating, 86% of these women had lived in ≥3 locations, 40% had not used contraception, and 31% experienced difficulty obtaining contraceptives. Another study showed that, after Hurricane Ike in 2008, 13% of 975 women who had been using contraception before the storm stated that procuring reliable contraception had become problematic. The third study involved 450 married women in Yogyakarta, Indonesia, 81% of whom were using contraception (primarily depot medroxyprogesterone or intrauterine devices) before the 2006 tsunami. Overall, 11% of participants experienced difficulties obtaining contraception after the disaster. Unintended pregnancy rates were higher in women who experienced barriers to access than in those who did not (13% vs. 5%).
Ellington SR et al. Contraceptive availability during an emergency response in the United States. J Womens Health (Larchmt) 2013 Mar; 22:189. (http://dx.doi.org/10.1089/jwh.2012.4178)
Comment
As the authors note, the Pan American Health Organization strongly supports provision of reproductive health care during emergencies or disasters. Depot medroxyprogesterone is preferred for its long-term efficacy and ease of administration; access to emergency contraception is also highly recommended. In the U.S., the Strategic National Stockpile is a supply of pharmaceutical agents, vaccines, and other medical supplies. It does not, however, include contraceptives (even emergency contraception). Federal Medical Stations are deployable medical facilities with formularies consisting primarily of medications for short-term management of chronic diseases. The only contraceptive options are condoms and three types of combined oral contraceptives.
Although I have been a clinician for more than 25 years, I have never heard of the Strategic National Stockpile or Federal Medical Stations. Decision making about providing contraception (particularly emergency contraception) during disasters seems not to have tapped women's health organizations. A consortium involving groups such as the American College of Obstetricians and Gynecologists and the Association of Reproductive Health Professionals is clearly in order.