1112289

research-article2022
WHE0010.1177/17455057221112289Women’s HealthDeYoung et al.

Advancing Maternal Health Equity – Editorial

Women’s Health

Maternal and infant health in disasters: Volume 18: 1­–3

© The Author(s) 2022
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DOI: 10.1177/17455057221112289
https://doi.org/10.1177/17455057221112289
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Disasters are events in which “widespread disruption and shared by maternity product companies and sold to infant
damage to a community exceeds its ability to cope and formula companies. (The first iteration of this paper was
overwhelms its resources.”1 The people of Texas have written before the shortage of infant formula in the United
experienced more than disruptions—they know that disas- States in 2022. The shortage highlights the importance of
ters can impact their families and communities. Disasters furthering research on infant feeding in emergencies
can also cause physical trauma for pregnant people and including aspects of logistics, distribution, and risk com-
infants2 and are associated with other complications in munication). This aggressive marketing is not unlike
pregnancy and birth.3 marketing by big tobacco used between the 1950s through
In 2017, approximately 100,000 homes along the the present, often specifically targeting minority and low-
Texas gulf coast were destroyed by Hurricane Harvey. income communities. The result of aggressive breast-
Many communities were still reeling from Hurricane feeding marketing tactics toward minority communities
Harvey when in February of 2021, Winter Storm Uri has resulted in lower baseline rates for breastfeeding for
caused millions to lose access to electricity during life- Hispanic, Black, and Indigenous women,6 who also expe-
threatening cold temperatures across the Northwest and rience higher rates of property damage, displacement,
into the Southern United States. The historic winter storm and death during disasters.7
was linked to the deaths of 210 Texans, primarily from In addition to marketing formula post-disaster, sup-
hypothermia, vehicle crashes, carbon monoxide poison- plies, support, and space for pregnant and lactating fami-
ing, and chronic medical conditions compounded by the lies are often not central in planning or preparedness within
severe weather. Of the deaths attributed to the storm, at evacuation shelters. Specifically, breastfeeding space
least one child froze, and three others died from a house should be included in emergency sheltering space, as well
fire after using their fireplace to keep warm after losing as supplies for sanitizing infant bottles. While WIC volun-
access to electricity. teers may be at some emergency shelters, it is also unclear
Disasters can exacerbate pre-existing structural vulner- what protocols are in place to ensure evacuees receive the
abilities4 which is a serious concern for maternal and infant specific support they need after leaving the shelter. Past
health in Texas. In addition to pediatric health concerns, research suggests that an evacuation can change access
maternal mortality doubled in Texas between 2011 and and decisions about infant feeding.8
2012, causing a renewed concern about the root causes of Evacuating far away from a health provider, such as
maternal deaths. However, there has been less attention on a trusted pediatrician or lactation support person, can
the topic of maternal and infant well-being in disasters, negatively impact breastfeeding. During the COVID-19
and how to prevent harm in disasters for this specific group pandemic, respondents in a more recent study indicated
of the population. that being discharged from a hospital earlier interrupted
One way to reduce disaster vulnerability is to promote their access to lactation support services.9 Lactation
public health practices prior to disasters happening. For support and infant feeding are not only of concern in
example, breastfeeding is the safest way to feed a baby in emergency shelters but for families who shelter-in-place
a disaster or crisis setting because it prevents dehydra- or who evacuate to hotels, family, or friends. Power out-
tion, facilitates bonding between the caregiver and infant, ages from disasters like Winter Storm Uri or Hurricane
and reduces the risk of infection.5 Despite the considera- Harvey can be devastating, resulting in thawed stored
ble safety of breastfeeding in emergencies, formula com- breastmilk and food insecurity for young children.
panies have used disasters for mass distribution and Power outages and subsequent effects like water quality
marketing of infant formula and remain unregulated in can also affect maternal access to healthy foods and
the United States context. Free infant formula samples clean water to support lactation, prepare infant formula,
arrive in the mail through lists of names obtained and or sanitize bottles.

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2 Women’s Health

Together, these findings suggest that when barriers to policies. Despite the widespread acknowledgment that
breastfeeding support are higher, infant feeding is COVID-19 has more severe consequences for pregnant
impacted and will require emergency managers, health women than non-pregnant women, the Texas Department
care professionals, and maternal health support providers of State Health Services does not currently collect vac-
to focus on infant feeding and maternal needs for emer- cination data on pregnant women or collect data on
gencies and disasters. This problem also reflects an over- COVID-19 hospitalizations or deaths for the vulnerable
all system of emergency management and disaster group.13 Without state data, it will be more difficult to
services that do not support the critical needs of pregnant track the effect of COVID-19 infection and vaccination
and birthing people, as well as infants. within the pregnant population in Texas.

The link between healthcare Future questions on the state of

legislation maternal and infant health maternal and infant health in crises
and disasters
Texas passed several aggressive abortion laws in
September 2021, including the “fetal heartbeat bill,” In a state like Texas that is prone to public health legisla-
which bans abortion at the point of the first detectable tion that harms reproductive care, hurricanes, and other
heartbeat, usually occurring around six weeks of preg- hazards, it is important to gather comprehensive data about
nancy. Then, in May of 2022, documents were leaked sug- the specific ways in which disasters impact maternal and
gesting Supreme Court support for overhauls in federal infant health. For instance, while there were secondhand
abortion policy.10 In addition to the passing of aggressive stories about infant sleep and warmth concerns during the
reproductive healthcare laws, some crisis pregnancy cent- Texas ice storm, it is not clear what the long-term impacts
ers used disasters like Winter Storm Uri or, more recently, might have been to families who experienced power out-
Hurricane Ida as an opportunity to outreach to potential ages and psychological stress. If hurricane or ice storm
clients in crisis. While some of these centers might pro- exposure increases instances of formula feeding, how will
vide free or low-cost diapers, support groups, or coun- this change long-term health outcomes for caregivers and
seling services, they also have significant harmful impacts infants? When patients are separated from their prenatal
on women, pregnant people, and teenagers. While some care providers in disasters, what are the long-term implica-
of the crisis centers provide infant formula, it is unclear to tions? What is the impact of psychological trauma associ-
what extent they have capabilities and expert training for ated with the pandemic and hazard events on maternal and
lactation support services. Instead of providing compre- infant well-being?
hensive, evidence-based care and clinical information to While federal programs such as Women, Infants, and
women regarding their pregnancy, crisis pregnancy cent- Children (WIC) and state health outreach programs such
ers remain free from regulatory oversight and license as Hear Her are designed to improve health outcomes,
requirements that traditionally apply to health care clinics there is still a lack of clarity around the specific impacts of
and hospitals,11 ultimately persuading women into mak- disasters on maternal and infant health. The guidance for
ing choices that best align with center beliefs, instead of Mass Care, Emergency Assistance, Temporary Housing,
that of the client. and Human Services should include specific guidance for
Findings from research suggest an association supporting maternal and infant health. This would include
between restrictive abortion policy and maternal health assessments at sheltering sites, comprehensive support
outcomes, specifically that states with stricter abortion services including lactation and feeding support, mental
policies showed higher maternal mortality rates.12 health referral services, and social services to connect
Regarding COVID-19, pregnant women have an evacuees and disaster survivors with the appropriate
increased risk for severe illness or death from COVID- maternal and infant health care.
19, which disproportionately affects Black and Hispanic Our call to action for Texas and disaster planning for
women and women with underlying medical conditions maternal and infant health includes four main steps:
like diabetes.
Pregnant women continue to have one of the lowest 1. Data collection by the Texas Department of State
vaccination rates in the country, around 25% of eligible Health Services on COVID-19 hospitalizations
women as of September 2021,13 with vaccine hesitancy and deaths among pregnant and birthing people.
and misinformation, primarily from social media, repre- 2. Comprehensive COVID-19 vaccine outreach for
senting common reasons for vaccine refusal. This may pregnant and birthing people.
also be why also as of September, Texas ranked among 3. Data gathering and analyses of maternal and infant
the nation’s highest for pediatric COVID death tolls.14 In stress indicators after disaster events such as Winter
Texas, mitigation of the coronavirus has been controlled Storm Uri, Hurricane Harvey, and other significant
by politicization rather than research-based mitigation hazard events.
DeYoung et al. 3

4. Emergency management and shelter managers to systematic review of literature. J Hum Behav Soc Environ
outline clear protocols for supporting lactation and 2019; 29(2): 266–281.
infant feeding in disaster evacuations and provid- 5. Binns C, Lee M and Low WY. The long-term public health
ing long-term support after the disaster. Shelter and benefits of breastfeeding. Asia Pac J Public Health 2016;
28(1): 7–14.
disaster responders should be trained in Infant and
6. Louis-Jacques A, Deubel TF, Taylor M, et al. Racial and
Young Child Feeding in Emergencies (IYCFE).
ethnic disparities in U.S. breastfeeding and implications for
maternal and child health outcomes. Semin Perinatol 2017;
Through these steps, families will be healthier after dis- 41(5): 299–307.
asters. Supporting reproductive care is critical, especially 7. Bolin B and Kurtz LC. Race, class, ethnicity, and disas-
in areas prone to natural hazard events. These policies ter vulnerability. In: Rodriquez H, Donner W and Trainor
should also center on the needs of marginalized groups JE (eds) Handbook of disaster research. 2nd ed. Cham:
such as Black, Hispanic, and Indigenous people to ensure Springer, 2018, pp. 181–203.
health access and thriving communities, especially in the 8. DeYoung SE, Chase J, Branco MP, et al. The effect of mass
context of the on-going COVID-19 pandemic. evacuation on infant feeding: the case of the 2016 Fort
Mcmurray wildfire. Matern Child Health J 2018; 22(12):
1826–1833.
Author contribution(s) 9. DeYoung SE and Mangum M. Pregnancy, birthing and
Sarah E DeYoung: Conceptualization; Writing—original draft. postpartum experiences during COVID-19 in the United
Roni J Fraser: Conceptualization; Writing—review & editing. States. Front Sociol 2021; 6: 611212.
Logan Gerber-Chavez: Conceptualization; Writing—review & 10. Tanne JH. US abortion: Leaked document shows Supreme
editing. Court plans to overturn rights. BMJ 2022; 377: o1122.
11. Bryant AG and Swartz JJ. Why crisis pregnancy centers are
legal but unethical. AMA J Ethics 2018; 20(3): 269–277.
Declaration of conflicting interests
12. Vilda D, Wallace ME, Daniel C, et al. State abortion poli-
The author(s) declared no potential conflicts of interest with cies and maternal death rate in the United States, 2015-
respect to the research, authorship, and/or publication of this 2018. American Journal of Public Health 2021; 11(9):
article. 1696–1704.
13. Waller A. Texas doctors, seeing unprecedented numbers of
pregnant patients with COVID-19, urge pregnant people to
Ethical approval
get vaccinated. Texas Tribune, 16 September 2021, https://
No human subject data were gathered for this manuscript, and www.texastribune.org/2021/09/16/coronavirus-texas-preg-
therefore, ethics approval was not sought for the present paper. nancy-vaccine/
14. KERA News. In DFW Aug. 30–Sept. 5: Texas ranks among
Funding the highest in the nation for child deaths. KERA News, 7
September 2021, https://www.keranews.org/2021-09-07/
The author(s) received no financial support for the research,
covid-19-in-dfw-aug-30-sept-5-texas-ranks-among-the-
authorship, and/or publication of this article.
highest-in-the-nation-for-child-deaths
ORCID iD
Roni J Fraser https://orcid.org/0000-0002-6981-9677
Sarah E DeYoung1, Roni J Fraser1 and
Logan Gerber-Chavez2
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