Disaster Management in

Maternity

Yuni Astuti
Landslide, floods,
volcanic eruption
 Health Effects of Disasters

 These women are also at an increased risk for preterm

birth, low-birth-weight infants (Hamilton, Sutton,
Mathews, Martin, & Ventura, 2009)
 529 000 women die each year —one every minute —
from pregnancy-related causes. Ninety-nine per cent of
these deaths occur in developing countries.
 Insufficient facility Increase the unplanned pregnancy
causes of the minimal aces for contraception (Hapsari,
2009)
 Reproductive health in Disaster

Mater Comp
Minimum Adole Gend Sexual
nal rehens
initial scent Family er- transm
and ive
service reprod planni based itted HIV
newb aborti
packed uctive ng violen infecti
orn on
(MISP) health ce on
health care
Coordination MISP

 The health sector/cluster identifies a lead RH organization.

 The lead RH organization puts in place an RH officer, who functions
within the health sector/cluster. The RH officer, supported by the lead
RH organization,
 Operational and technical support is provided for health partners to
implement the MISP in all locations affected by the emergency. This
includes: (giving guidance on and technical support for the
coordinated procurement of RH supplies and identifying skilled staff to
implement MISP services)
 Prevent and manage consequences of
sexual violence

Putting in place measures to protect affected populations,

particularly women and girls, from sexual violence

Making clinical care available for survivors of rape

Ensuring the community is aware of the available clinical

services.
 Reduce the transmission of HIV

Ensuring safe blood transfusion practice

Facilitating and enforcing respect for

standard precautions

Making free condoms available

 Prevent excess neonatal and maternal
morbidity and mortality
 Ensuring availability of emergency obstetric care (EmOC) and
newborn care services, including: at health facilities and referral
hospitals

 Establishing a referral system to facilitate transport and

communication from the community to the health center and
between health center and hospital

 Providing clean delivery kits to visibly pregnant women and birth

attendants to promote clean home deliveries when access to a
health facility is not possible.
 Logistic of reproductive health

Personal Midewife
RH Kit
Kit kit

Community and
Hygiene Birth Kit primary healthcare
level
Primary health care
Pregnant
and referral hospital
Women
level

Postpartum Referral hospital level

Newborn
Supplies to implement the MISP  RH KIT
 Planning for comprehensive reproduction
health service

 Initiate comprehensive RH service delivery components as soon as the standards for

the MISP indicators are reached
 Plan for the provision of comprehensive reproductive health (RH) services,
integrated into Primary Health Care (PHC), as the situation permits
 Coordinate ordering RH equipment and supplies based on estimated and
observed consumption
 Collect existing background data
 Identify suitable sites for future service delivery of comprehensive RH
services
 Assess staff capacity to provide comprehensive RH services and plan for
training/retraining of staff.
Comprehensive reproductive health

Adolescent reproductive health care

Family planning

Maternal and newborn health care

Safe abortion care

Protection from and response to gender-based violence

Prevention and treatment of STI/RTI/HIV/AIDS

Adolescent reproductive health care

 Need assessment
 Provision of RH services at health facilities
 Provider questionnaire for adolescents
 Provision of RH services in the community
 Provide RH services in schools
Family planning

 Need assessment
 Contraceptive logistics
 Family planning method
 Postpartum family planning
Maternal and newborn health care

 Need assessment
 Antenatal care
 Childbirth care
 Postnatal maternal and newborn care
Safe abortion care

 Needs assessment
 Counselling and voluntary informed consent
 Infection prevention
 Pain management
 Uterine evacuation
 Prevention of tetanus
 Managing complications
 Post procedure counselling and follow-up
Protection from and response to gender-
based violence (GBV)

Needs assessment
Reproductive health care for GBV survivors
Psychosocial support
Prevention and treatment of
STI/RTI/HIV/AIDS
STI public health package
Needs assessment
Community interventions
STI/RTI case management
ARV and ART interventions
 MISP and Comprehensive RH Services
Reproductive Priority RH service Comprehensive RH services
health
Family * Provide contraceptives Source and procure contraceptive
planning such as condoms, pills, supplies
injectables and IUDS to Provide staff training
meet demand Establish comprehensive family
planning programming
Provide community education
Gender- Coordinate mechanisms to Expand medical, psychological,
based prevent sexual violence social and legal care for survivors
violence with the health and other Prevent and address other forms of
sectors/clusters GBV, including domestic violence,
Provide clinical care for forced/early marriage, female
Rape survivors genital mutilation
Provide community education
 MISP and Comprehensive RH Services…contd
Reproductive Priority RH service
health
Maternal and Ensure availability of emergency
newborn care obstetric and newborn care services
Establish 24/7 referral system for
obstetric emergencies
Provide clean delivery packages to
visibly pregnant women and birth
Attendants
STIs, Including Ensure safe blood transfusion practice
HIV Facilitate and enforce respect for
prevention standard precautions
and Make free condoms available
treatment *Make syndromic treatment available
as part of routine clinical services for
patients presenting for care
* Make treatment available for
patients already taking ARVs,
including for PMTCT, as soon as
Possible
Comprehensive RH services
Provide antenatal care
Provide postnatal care
Train skills attendant (midwives, nurses,
doctors) in performing EmOC and
newborn care
Increase access to basic and
comprehensive EmOC and newborn
care
Establish comprehensive STI prevention
and treatment services, including STI
surveillance systems
Collaborate in establishing
comprehensive HIV services as
appropriate
Provide care, support and treatment for
people living with HIV/AIDS
Raise awareness of prevention, care and
treatment services for STIs, including HIV
Provide community education
 Maternity health in emergency
response phase

Preparedness/ Readiness

Mitigation

Response/Implementation

Recovery
Hospital Preparedness/ Readiness in
Obstetric

 Health care institutions in disaster

 Consider for Obstetric care facilities
 Planning for Obstetrics surge capacity
 Make a Level of maternal care
 Triage of obstetrics patient in disaster response
 Special consideration for infectious disease outbreaks
 Temporary modifications in standard of care
 Remote of distance care with telemedicine
 RESPONES/IMPLEMENTATION

 Saving lives
 Triage
 Providing first aid
 Minimizing and restoring damaged systems
(communications and transportation)
 Meeting the basic life requirements of those
impacted by disaster (food, water, and shelter)
 Providing mental health and spiritual support and
comfort care
 RECOVERY
 Counseling to Breastfeeding following disaster
 Supplying the public with current information and health and safety
education
 Hospitals that reopen post disaster need to anticipate women and
their newborn infants using medical emergency services for routine
care due to disrupted clinics and pediatric services in the
community.
 Mental health clinics may need to be expanded to address long-
term stress in the community (pregnant and postpartum)
 Hospital-based social services will need referrals for women who
lack housing, food and infant supplies, or are in need of day care
services.
How to assess the reproduction
health in shelter?

Reproduction Health Assessment

After Disaster
Reproduction Health Assessment After
Disaster (RHAD)
Pregnant women Postpartum women
• Health problem • Breastfeeding
• Access to prenatal care • Access to infant care supplies
• Access special supplement • Access to contraception
• Disaster exposure and access • Access to postpartum care
to mental health
• Access to mental health
• Gender-based violence
• Family and social support

Infant
• Birth outcome
• Infant feeding
• Infant health and safety
outcome
• Safe sleep environment
Thanks You