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Special Edition: Title V Technical Assistance MeetingExpand Special Edition: Title V Technical Assistance Meeting
Title V Technical Assistance Meeting

 Emergency Preparedness and Response: How CDC DRH Addresses Needs of Women and Newborns

By Wanda D. Barfield, MD, MPH, FAAPBarfield_W_93cc.jpg
Captain, U.S. Public Health Service Director, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion

At a Texas field medical station in the path of Hurricane Rita, effects of the disaster were already taking a toll. Young women were being treated for medical conditions such as depression and anxiety. Elderly people too sick to evacuate were being cared for by their daughters, sisters and nieces. Some pregnant women were being monitored while others were caring for their own families. As a medical epidemiologist and chief medical officer for Rapid Deployment Force of the U.S. Public Health Service, I was experiencing first-hand the challenges women face, particularly pregnant and postpartum women, when a disaster strikes.

Now 10 years later as director of the Centers for Disease Control and Prevention (CDC) Division of Reproductive Health (DRH), I oversee the division Emergency Preparedness and Response (EPR) activity that works with state and local health departments to meet the needs of pregnant and postpartum women and newborns.

DRH has responded to disasters for more than a decade, from the Sept. 11 attacks to the Ebola Virus outbreak in West Africa. Each disaster – whether it's a natural disaster, pandemic infectious disease or man-made hazard – poses a challenge for vulnerable populations. We focus our efforts on maternal health needs, whether it is creating the formal collaborative pandemic flu plan with the CDC National Center for Birth Defects and Development Disabilities or helping public health partners in Illinois collect reproductive health data after a tornado outbreak.

Research has shown that pregnant women may have increased post-disaster medical risks such hypertension, anemia, preterm birth, and low birth weight infants. We would like to know more about how disasters uniquely affect women of reproductive age, particularly pregnant
and postpartum women. Because pregnant women comprise a small proportion of the U.S. general population and require special post-disaster sampling approaches, surveillance is lacking among this population. DRH is actively involved in building scientific and emergency information on pregnant women and newborns for public health and health care professionals.

DRH emergency response and preparedness activities focus on developing materials for the health care audience as well as the public. For example, during the Pandemic H1N1 2009-2010 response, the DRH Maternal Health Team created nine maternal health guidance documents and addressed more than 4,600 maternal health inquiries. Additionally, as part of the Anthrax preparedness in 2012, DRH collaborated with the National Center for Emerging and Zoonotic Infectious Diseases to convene 77 national experts on anthrax and public health to guide the update of recommendations for pregnant and postpartum and lactating women exposed to the virus.

Examples of Emergency Preparedness Response Activities that Support Pregnant/ Postpartum Women & Newborns

Disaster Response

  • Compiled scientific evidence about disaster effects on pregnant women and birth outcomes through analyses and a systematic literature review. An article on Post-Disaster Reproductive Health Outcomes was published in the Maternal Child Health Journal in 2012.
  • Created online tools such as factsheets and checklists on disasters and pregnant women for state and local health department use (

Infectious Disease Response

  • Published an American Journal of Obstetrics & Gynecology supplement in 2011 pertaining to lessons learned in the Pandemic H1N1 response.
  • As part of its emergency response activities for Ebola, deployed 24 DRH staff members (10 to the field), created guidance for health providers in U.S. hospitals for Ebola issues related to maternal health, and addressed 80 Ebola inquiries related to maternal health and the pregnant/postpartum/lactating population.

Collaboration between agencies and state/local governments is a big part of disaster emergency response. To improve knowledge and collaboration, CDC is developing an online training (to be released in 2016) for maternal health professionals across the United States. This training course will help them plan for special needs of women and newborns before a disaster, improve the quality of emergency response during a disaster and identify important needs after a disaster.