Frequently asked questions about conducting a needs assessment among women of reproductive age and/or pregnant women
following a disaster
1. What type of disaster would necessitate a needs assessment among women of reproductive age?
A needs assessment among women of reproductive age (15-44 years) is appropriate following a federally declared disaster such as a hurricane, tornado, fire, flood, earthquake, or man-made disaster.
2. Why is it important to assess the post-disaster needs of women of reproductive age?
The literature is not clear regarding post-disaster needs of women of reproductive age. If there were a strong literature base, we would not need to conduct these assessments.
3. What are the health effects of disaster on needs of pregnant women?
Following a disaster, women of reproductive age may be vulnerable to physical, psychological, economic, and family stresses that can adversely affect their health. Disaster-related health effects on women of reproductive age may include irregular menstrual cycles, changes in nutritional intake, changes in health behaviors such as contraceptive use, increased substance abuse, and increased physical and sexual violence perpetrated by intimate partners. Furthermore, because women often serve as the primary caregivers for their family and extended family, meeting the needs of women is critical to ensure that they can continue to meet the needs of others.
In addition to the above effects on women, post-disaster studies in the U.S. have shown associations between disaster-affected pregnant women and poor birth outcomes, such as low birthweight and preterm births, and increases in medical risks among women giving birth. Also, the healthcare services providing prenatal, delivery, and postpartum care to pregnant women may be disrupted by disasters.
4. Can the CDC Pregnancy Risk Assessment and Monitoring System (PRAMS) be used to assess the needs of pregnant women following a disaster?
No, PRAMS is not suitable for rapid post-disaster assessments. Because the needs of pregnant women are pressing, we need a tool that can be easily implemented in the localized geographic area affected by disaster and a process that allows for flexibility and speed.
5. Can the assessment be conducted with women being seen in health clinics and other healthcare settings?
In contrast, PRAMS is a complex surveillance system that samples women who deliver a live infant from birth certificates by state of residence. Thus, PRAMS does not provide information about women who are currently pregnant. Furthermore, the PRAMS sample is from the entire state so conclusions about a specific geographic area in that state cannot be made. In addition, PRAMS samples only women who are residents of the state. Following a disaster, women may be displaced from their residence. Therefore, non-residents would not be included in the PRAMS sample, and the survey would not adequately represent the women who are living in the area at the time of the survey. Lastly, not all states implement PRAMS.
In the future it may be possible for states to adapt PRAMS to conduct surveillance of pregnant women affected by disaster but it would require conducting a parallel system to PRAMS that includes additional questions pertaining to exposure and sampling specific to the disaster-affected geographic area.
After a disaster women may be unable to access health services due to affected healthcare infrastructure (e.g., offices are destroyed and/or providers have moved out of the area) or personal circumstances that create access barriers. If you sample in health clinics or other healthcare settings, women in your sample are already accessing healthcare so their needs may be different from women unable to access health services. It is critical to identify access barriers when planning for public health programs. Furthermore, this sampling approach would only reflect the healthcare needs of women in that particular setting instead of all women of reproductive age in the community. Although it may require additional time and resources, using a strategy to obtain a representative sample of all women in your community may give you information you need for public health programming.
6. How can I collect information on a representative sample of women in my community?
The Community Assessment for Public Health Emergency Response (CASPER) gives general instructions for cluster sampling in a disaster-affected community. However, some adaptations are needed when surveying women of reproductive age or pregnant women. Because women ages 15-17 are considered minors and need parental permission to answer surveys, public health practitioners often choose to limit the sample to women 18 years old or older. Also, pregnant/postpartum women only comprise 5% or less of the women of reproductive age (about 1% of the general population) so this toolkit uses modified 2-stage cluster sampling with referral to increase the proportion of pregnant and postpartum women in your sample (see Sampling). There are also some strategies that can reduce nonresponse when surveying women of reproductive age. Lastly, one needs to consider the magnitude and distribution of damage when choosing geographic areas for surveying. For example, hurricanes and floods may cover a large geographic area while tornadoes often skip around so that the population in a geographic area, such as a census tract, may not have uniform exposure to the disaster.
7. What type of resources do I need to conduct an assessment?
This site includes a planning checklist, cost estimate, and budget template to assist in developing a customized budget. See the Planning section of the toolkit for more information.
8. What questionnaire options are available through this site?
The questionnaire choice depends upon the population in which the health department has primary interest. There are two questionnaires available through this site. One is designed to assess comprehensive reproductive health among a sample of women of reproductive age while the other is designed to assess reproductive health among a sample of pregnant/postpartum women.
9. How were the items on the questionnaires developed?
The majority of the questions were taken and adapted from the CDC PRAMS questionnaire. In addition, several demographic questions were taken from the CDC BRFSS questionnaire. Multiple questions from CDC's Reproductive Health Assessment Toolkit for Conflict-Affected Women were adapted and used to collect general information as well as information on reproductive health topics and violence. Disaster exposure questions were selected based on studies following Hurricanes Andrew and Katrina. We also used selected criteria for the Florida Healthy Start Program to identify high-risk pregnancies in the questionnaire for pregnant/postpartum women.