W omen & Infants Service Package (WISP): Planning for Emergencies

1. Women & Infants Service Package (WISP): Planning for Emergencies Lisa Summers, CNM, DrPH Director, Professional Services American College of Nurse-Midwives On behalf of the White Ribbon Alliance & National Working Group for Women & Infant Needs in Emergencies American Public Health Association 134th Annual Meeting November 8, 2006

2. Hurricane Katrina: A Wake-up Call? • No plan was in place to evacuate and care for pregnant women, new mothers and infants when Hurricane Katrina hit. Responders struggled to assess damage and evacuate patients and residents to regions with water, electricity, and staff. • Women and infants are disproportionately and adversely affected by emergencies, yet public policy does not reflect this. • Many organizations and first responders are not prepared to deal with special needs of these populations.

3. What’s in place now? • Nothing???? • Federal and state emergency preparedness plans don’t address the special needs of pregnant women, new mothers and new infants during a disaster • Most programmers do not have the tools (training/kits/etc.) on hand to care for pregnant women, new mothers and infants when a disaster strikes

4. Learning from International Efforts • Lessons learned from tsunami response in SE Asia • Medecins Sans Frontieres: Refugee Health • UNFPA: MISP • SPHERE Standards • CDC: Promoting Health for Women Before, During and After Pregnancy

5. Formation of a Working Group Initial meeting: February 22, 2006 The mission of the National Working Group for Women and Infant Needs in Emergencies is to ensure that the health care needs of pregnant women, new mothers, fragile newborns and infants are adequately met during and after a disaster situation. Members use their expertise to create resources for government and NGOs to raise awareness of the specific needs of pregnant women, mothers, fragile newborns and infants in an emergency, and advocate for policies that will improve outcomes for mothers and infants affected by disaster.

6. Working Group Objectives • Develop guidance documents for emergency preparedness planners at both the federal and state levels. • Develop and distribute kits and guidance documents for responders to use in the field during a disaster. • Advocate for federal legislation to encourage state and local governments and NGOs receiving federal funding to include mothers and infants as special populations in emergency preparedness plans. • Create an advocacy/media campaign to inform the public and policymakers of the special health care needs of pregnant women and infants during a disaster and partners' efforts around these issues.

7. Working Group Members • American Association of Birthing Centers (AABC) • American College of Nurse-Midwives (ACNM) • American College of Obstetricians and Gynecologists (ACOG) • Association of Maternal & Child Health Programs (AMCHP) • DC Rape Crisis Center • Centers for Disease Control and Prevention • George Washington University Dept. of Health Sciences & Global Health • March of Dimes • Midwives Alliance of North America (MANA) • National Association of Certified Professional Midwives (NACPM) • National Association of County & City Health Officials (NACCHO) • Perinatal Programs at MIEMSS (Maryland Institute for Emergency Medicine Services/Systems) • Sacopee Rescue Inc. • SaferMaternity.org • University of Maryland, School of Nursing • White Ribbon Alliance for Safe Motherhood (WRA) • Women’s Commission for Refugee Women and Children

8. WISP - “Women and Infants Service Package” guidelines to provide the framework for the minimum and initial actions needed to respond to the essential health care needs of pregnant women, new mothers, fragile newborns and infants in a crisis or emergency, i.e. natural disaster, epidemic, or terrorist event.

9. Objectives of the WISP • IDENTIFY the organizations or individuals who will be responsible for the coordination and implementation of the WISP and advocate for the unique needs of women and newborns • PREVENT excess neonatal and maternal morbidity and mortality • PREVENT and MANAGE the consequences of sexual and gender-based violence; • PREVENT unplanned pregnancies • REDUCE HIV and STI transmission • COLLECT, ANALYZE and USE information for better management of maternal and infant health care programs in emergencies through monitoring and surveillance

10. Remember that. . . • In the United States, 99% of all births occur in a hospital setting. During an emergency, however, this setting is not always immediately accessible. In the case of pandemic flu, hospitals may be overwhelmed with flu victims. • During disasters, women experience greater rates of health complications associated with pregnancy, including premature births, low-birth-weight infants and infant deaths. • Over 3 million unplanned pregnancies generally occur in the United States each year. The interruption of access to contraceptives for couples as well as the increased incidences of sexual violence can occur in the aftermath of an emergency, heightening the number of unplanned pregnancies.

11. Identify the organizations or individuals who will be responsible for the coordination and implementation of the WISP Key activities to consider during planning and implementation: • Outreach to engage governmental and non-governmental organizations, hospitals, midwives and other health care providers, and women’s groups • Build consensus for planning and adoption of an emergency plan • Identify responsible entities and a ‘chain-of-command’ for disaster planning at the regional, state, and local level • Review regional, state, and local level planning documents for appropriate and consistent content

12. Identify the organizations or individuals who will be responsible for the coordination and implementation of the WISP(continued) • Assess needs, determinate how to utilize and share available resources of stakeholders • Provide outreach information to stakeholder organizations and individuals in the community about the emergency plan • Engage women through multiple venues, including faith-based communities, during health care visits, and creative media to communicate the plan

13. PREVENT excess neonatal and maternal morbidity and mortality Key activities to consider during planning and implementation: • Become familiar with local/regional birth data Planning for crises and emergencies should take into account birth rates, population demographics, and information about where births currently take place and who attends births. • Engage local/regional potential providers, including CNMs, CPMs, OB-GYN and family practice physicians, L&D nurses, EMTs, NPs, PAs, emergency and first responders, traditional birth attendants and doulas to: • Translate homebirth skills, services and equipment to institutional-based birth providers • Acknowledge that providers might not have experience working with women who are not medicated/working with women who expected to get an epidural

14. PREVENT excess neonatal and maternal morbidity and mortality (continued) • Prepare maternal and infant health care information, education and communication (IEC) outreach among communities using IEC tools, including interpersonal and mass media communications. • Material can include • How to prepare for a home birth (all 3 stages of birth) • Contents of an emergency home birth kit • Breastfeeding methods (including relactation) and steps to prepare sterilized formula using powdered formula if breastfeeding is not an option • Contact numbers or locations for emergency assistance and methods of evacuation specifically catering to maternal and infant health care

15. PREVENT excess neonatal and maternal morbidity and mortality (continued) • Support, facilitate, and integrate into the primary health care system during the acute phase of an emergency, as able • prenatal care • postpartum care • breastfeeding and re-lactation • newborn care • Initiate the establishment of a referral system to transport and manage obstetric emergencies

16. PREVENT excess neonatal and maternal morbidity and mortality (continued) • Determine how pregnant, laboring and postpartum women will be triaged and cared for • Identify the safest place for pregnant and laboring women, newborns and their families

17. PREVENT excess neonatal and maternal morbidity and mortality (continued) • Identify, compile, and provide equipment, supplies, and practice guidelines for basic birth kits and normal deliveries, for use by mothers, midwives or health professionals to promote safe deliveries outside of traditional healthcare institutions. (Information on birth kits is included in an Appendix) • Identify, compile, and provide equipment, supplies, and practice guidelines for high risk and difficult deliveries to ensure safe deliveries in alternative sites

18. PREVENT and MANAGE the Consequences of Sexual Violence Key activities to consider during planning and implementation: Preventing sexual violence • Design and locate evacuee centers or shelters to enhance physical security • Ensure evacuees and disaster survivors are informed of the availability of services for survivors of sexual violence • Identify individual or groups who may be particularly at risk to sexual violence (single female heads-of-households, unaccompanied minors, etc.) and address their protection and assistance needs Health care responses to sexual violence • Provide a medical and forensic response to survivors of sexual violence, as medically appropriate • Pregnancy testing must be available to confirm suspicions of pregnancy when there is doubt • Make Sexual Assault Forensic Examiner (SAFE) and Sexual Assault Nurse Examiner (SANE) kits available

19. PREVENT and MANAGE the Consequences of Sexual Violence Security and Legal Issues • Ensure the presence of female protection and health staff and interpreters • Assure medical evidence documentation for legal proceedings Assessment/Incidence Data Collection • Outreach and identification of sexual violence survivors • Use emergency workers that have knowledge of forensic exams and evidence chain of custody so that a woman's ability to pursue legal channels after the disaster are protected

20. PREVENT Unplanned Pregnancies Key activities to consider during planning and implementation: • Ensure immediate availability of condoms • Access to the methods currently in use and how to link to providers • Ensure providers are have up to date knowledge of family planning methods, including exclusive breastfeeding • Ensure access to emergency contraception

21. How you can get involved • Contact your state and local offices tasked with emergency planning and offer your expertise and WISP • Write to your state and federal representatives to advocate for attention and resources for women and infants • Join the WRA! www.whiteribbonalliance.org