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

 Recovering from Disaster: Implementing the RHAD Toolkit to Improve MCH Services to Childbearing Women

By Mary Ellen Simpson, R.N., Ph.D.Mary Ellen Simpson 3-25-15 001 jpg.JPG
Instructor of Community Health, Graham School of Nursing, Canton, Illinois

The Reproductive Health Assessment After Disasters (RHAD) toolkit was developed to assess the reproductive health needs among women aged 15-44 years who have been affected by natural and/or man-made disasters. RHAD is part of an initiative by the CDC, Division of Reproductive Health, for use by local and state health departments or other organizations that provide reproductive health services to U.S. disaster-affected women. A modified RHAD survey was implemented to assess the reproductive health risks and psychosocial effects of the Nov. 17, 2013 tornado of women residing in four central Illinois counties. MCH issues pertinent to pregnant women, postpartum women and infants, family planning, family stressors, risk behaviors, and gaps of services were assessed. Data collection was conducted by teams of trained volunteers of student nurses, alumni, faculty, and staff from partnering schools of nursing. The sample population was derived by superimposing National Weather Service (NWS) field reports and U.S. Census data. If a community population was greater than 900, a two-stage cluster sampling method with referral, adapted from the CDC Community Assessment for Public Health Emergency Response (CASPER), was used to identify households. Finding displaced families was a challenge. In partnership with maternal and child health (MCH) coordinators, extensive outreach efforts were employed to obtain questionnaires and locate displaced families who were eligible to participate. Tapping into self-organized social media accounts facilitated outreach to women eligible to participate who were relocated from the targeted blocks selected in the first or second stage of sampling and verified by the MCH coordinators. As a result, 37 percent of the sample consisted of women who had lost their homes due to the tornado.

Results showed that immediate post disaster MCH needs such as access to formula and prenatal care were adequately addressed. However four months after the event, 15 percent of the respondents expressed a desire for counseling to help their families cope with multiple stressors. Women reported children demonstrating regressive behaviors, panic during thunderstorms, and fear during monthly siren testing. Several women indicated they could not afford mental health services and asked if any of the post-disaster funding could be used for that purpose. Although mental health services were available immediately after the tornado, no services were available in the recovery phase. Trauma and stress resulting from a disaster are not unique to victims of tornadoes and are applicable in most emergency settings. State and local MCH leaders can address short and long term service gaps and help families to recover from an emergency situation.

The RHAD is a valuable tool to identify the unmet MCH needs during the recovery phase of a disaster. RHAD findings can inform state emergency planning and strengthen preparedness recommendations. Ultimately, the results support the development of evidence-based services to improve the health of disaster-affected women and their families.

The Reproductive Health Assessment after Disaster (RHAD) in Four Illinois Counties report can be accessed at