Study exploring effects of hurricanes, colonialism, and more on pregnant people in Puerto Rico also points to possible solutions: 'Maternal mental health needs in disaster contexts are often overlooked'

Published in the journal Reproductive Health in early November, a study from researchers at the University of Michigan and Boston University evaluated the compounding impacts of 2017's Hurricane Maria, earthquakes, the COVID-19 pandemic, and colonialism on maternal and child well-being in Puerto Rico.

Corresponding author Mislael Valentín-Cortés told Climate, Gendered via email that "while newborn findings were mixed (in part due to declining birth rates and live-birth bias), the maternal health results showed consistent and meaningful harm in the wake of multiple disasters." 

"Rates of gestational diabetes, gestational hypertension, and excessive gestational weight gain increased across nearly every disaster period we examined," he continued.

These conditions can complicate pregnancies physically and mentally. And on top of these serious risks, coping with the costly effects of the disasters themselves can be stressful. Valentín-Cortés says maternal mental health services need to be prioritized as a part of crisis preparedness and long-term recovery efforts.

"Maternal mental health needs in disaster contexts are often overlooked or understood only in the short term, although stress, trauma, and social disruption can persist long after these events," he told Climate, Gendered.

The potential impacts of extreme weather on maternal mental health seem increasingly to be recognized as a matter of concern. In October, an international team of researchers, led by the University of Cambridge in the United Kingdom, announced that Wellcome had awarded the consortium £1.8 million (over $2 million U.S.) "to study the life-long and intergenerational mental health effects of extreme heat on pregnant women and their children," according to a university news release.  

Integrating effective maternal mental health care into disaster response may be just the sort of public policy measure that the study co-authors believe their findings could inform. Other such measures might include direct food deliveries for pregnant people and mobile or community-based clinics, Valentín-Cortés said, to help solve access snarled by storms and more. 

Interest in designing mobile clinics to address sexual and reproductive care needs during floods appears to be growing among nongovernmental organizations and health systems. In Pakistan, for example, Marie Stopes Society has been developing mobile gynecology services, according to a new report from YLabs.

Climate-conscious birth worker services — like those being piloted through the Doula C-Hot program in Florida — might also help. Not unrelatedly, recent reporting from the Tampa Bay Times underscored another gap that, if addressed, could benefit maternal, newborn, and child well-being: the ability to freeze — or keep frozen — breast milk, despite storm-related power outages.     

Disasters like Hurricane Maria can be naturally occurring events, but they're becoming increasingly destructive as heat-trapping pollution causes global temperatures and sea levels to rise. Meanwhile, colonialism as a compounding factor certainly is not naturally occurring. It's worth noting that Puerto Rico is a self-governing commonwealth of the United States, still a territory of the country. 

"Puerto Rico already experiences higher rates of adverse maternal and child health outcomes compared to U.S. states, and our data shows that disaster-related increases in maternal health complications were greater in Puerto Rico compared to Florida and Texas," Valentín-Cortés explained.

Importantly, both extreme weather and colonial harms can still be addressed. 

Through solutions like a just transition away from fossil fuels to cleaner, more affordable energy sources, planet-warming pollution can be mitigated while strengthening energy resilience in power-outage-prone areas. And through equitable financing for meaningful policies and enduring programs, essential care might be made more sustainable too. 

"We need systems that protect pregnant people in the long term," Valentín-Cortés said, "through equitable distribution of federal recovery funds, stronger local governance capacity, improved access to prenatal and mental health care, and disaster-preparedness plans that explicitly include maternal health as a critical priority."