Utilizing Intersectional Framework in Response to Perinatal Health Services at Times of Natural Disaster: A Systematic Review

Background and Purpose: The number of natural disasters occurring across the globe in any given year has dramatically increased to an annual average of 330 events in the last decade. Natural disasters lead to various consequences including lasting damage to the physical and mental health, social structures, and socioeconomic and physical environments of survivors. These effects have a differential impact on those who are most vulnerable; however, the culture of disaster-related health service provision has focused on an “all hazards” disaster management approach, addressing issues from a generalized perspective. This approach has overlooked the specific and time-sensitive needs of a variety of multiply-vulnerable populations. Applying intersectional frameworks of Black feminism, Queer theory, and indigenous perspective can dismantle some of the heteronormative approaches of disaster politics. This is especially true for pregnant people, as their health affects more than one generation, and their immediate health and service needs may be more complex than other disaster survivors. As such, this review examined existing literature on disaster response service provision for pregnant and postpartum people at the times of natural disaster and offer inclusive implications highlighting equity, social justice, and intersectionality.

Methods: This systematic review employed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) in reviewing 9 out of 2,411quantitative, qualitative and mixed-methods studies published between June 2005 and June 2020 with inclusion criteria focused on perinatal healthcare service provisions during times of natural disaster.

Results: Out of the nine studies, one study was quantitative, six were qualitative, and two were mixed-methods studies and used various study designs to understand the maternal health services and needs in times of disaster. Four of the studies were conducted within the context of earthquakes; four were related to typhoons and hurricanes, one was related to flood, and one was related to a volcanic eruption. Except for one study by Myers et al., 2018, all studies were carried out within the post-disaster context. Some of the immediate relief responses, during the primary response period of the disaster, were the deployment of medical and nursing staff with skilled birth attendance competencies, distribution of emergency reproductive health and dignity kits, and midwifery kits. Although these studies were carried out on global disaster settings with events occurring in local or regional contexts, none of the studies conceptualized the intersectional status of women and LGBTQIA+ persons, disaggregated samples by race, ethnicity, or class, and neither provided indigenous consultations perspectives in their disaster planning or response approach to research.

Conclusions and Implications: The findings from this study have implications for many disaster settings. Incorporating intersectional and non-binary gender voices and partnering with indigenous and local communities during various levels of disaster response, including planning and rebuilding efforts should be considered in policy, practice, and research. It is also critical to consider varied cultural approaches to pregnant people, and their practices surrounding childbirth. Strengthening community-based skills should be a key part of capacity building, especially in these times of intensifying natural disasters.