PRB

Natural disasters focus the collective imagination on images of community devastation. Beyond the obvious external signs of disaster, such as destroyed homes and ruined infrastructure, are more intimate impacts, such as impeded access to reproductive health services. These impacts may influence women’s and families’ decisions about childbearing and can affect fertility (the number of births per 1,000 women).

Natural Disasters Disrupt Health Services and Family Planning

The disruption of health services resulting from natural disasters can reduce women’s access to family planning and lead to unplanned pregnancies. Such a disruption may have played a role in the fertility spike two years after Hurricane Mitch devastated Nicaragua in 1998. In the most severely impacted areas of the country, women of reproductive age were nearly 200 percent more likely to give birth than those in other areas. Post-storm fertility may also have jumped if storm-induced miscarriages motivated women and their partners to conceive again in response to their loss.1

But disasters may also dampen fertility. Devastated local economies result in diminished household assets and security. Individuals and families uprooted from their homes by natural disasters often experience increased financial instability and loss of social ties.2 As a consequence, women and their partners may delay childbearing.

Furthermore, natural disasters can disrupt health services. Puerto Rico offers a powerful recent example. Severely impacted by Hurricane Maria in 2017, Puerto Ricans were left without power and access to medical care for months after the storm. Of 69 major hospitals on the island, only three were still functioning in the storm’s immediate aftermath. These closures put additional strain on the remaining three hospitals, with one health care specialist reporting that, nine days after the storm, her facility saw a 33 percent increase in deliveries compared to September 2016.3 She reported that, although her facility was open, it lacked a consistent water supply, affecting staff’s ability to sanitize surgical instruments. Infants in need of specific surgeries had to be transferred to the U.S. mainland. She noted that some pregnant women left the island following the storm to avoid potential medical crises. While the evidence suggests that Hurricane Maria had significant impacts on Puerto Rico’s health service infrastructure, it is too early to understand the extent to which these disruptions influenced its residents’ short- and long-term reproductive health.

Racial and Socioeconomic Differences in Fertility Are Related to Inequitable Disaster Recovery

The evidence of natural disasters’ effects on fertility shows they are not equitable across all groups. For example, when Hurricane Katrina struck the southern United States in 2005, its effects revealed strong racial and socioeconomic inequalities. Black neighborhoods in New Orleans, highly-segregated and often lower-income, were more vulnerable to flooding and faced slower rates of infrastructure restoration compared to other areas. 4 Black residents who lost their housing or were displaced also had less access to financial resources and capital in the wake of the storm and received less money from insurance payouts and recovery assistance than their white counterparts.

Neighborhoods with higher percentages of African Americans also contained more rental and public housing units, incurred more housing damage, received less federal assistance following the storm, and had the greatest population losses five years after Katrina.5 These dynamics are among those that stymied population recovery for the city’s black communities.6For example, in 2010 the repopulation of predominately black neighborhoods, such as Tremé and the Lower Ninth Ward, were less than 50 percent, while other storm-affected neighborhoods recovered between 60 to 90 percent of the population.7

The dynamics created by Hurricane Katrina’s disruption may have contributed to decreased fertility rates among New Orleans’ black population. A 2017 study by Seltzer and Nobles showed that fertility rates were 4 percent below expected levels for black women between 2006 and 2010, while non-Hispanic white fertility increased by 4 percent.8 The authors describe these differences as contributing to the unequal recovery of the city’s black community. Further research is needed to pinpoint the mechanisms behind these differences, but the possibilities include black residents’ separation from their neighborhoods and loss of financial assets, which may have undermined partners desires for children.9

Disaster Recovery Must Be Responsive to Women’s Reproductive Health Needs

Extreme events and natural disasters, both in the United States and globally, are projected to become more severe because of climate change.10 In the United States, the 2017 hurricane season alone caused an estimated $200 billion in damage.11 But these costs focus on the most visible disaster impacts—the same impacts on which public dialogue and disaster response planning often focus, such as devastated infrastructure. Efforts to rebuild and maintain a healthy population must also be responsive to women’s reproductive health needs. Disaster response and recovery planning should pay attention to ensuring equitable access to health services, so that those most affected by a disaster are able to access the same reproductive health resources despite social and economic barriers.