7g-0003

The 17th World Conference on Earthquake Engineering

17th World Conference on Earthquake Engineering, 17WCEE
Sendai, Japan - September 13th to 18th 2020
Paper N° C000825
Registration Code: Ａ00931

THE HEALTH AND DAILY LIVES OF PREGNANT, PARTURIENTAND PUERPERAL WOMEN AND CHILDREN-During the Great East Japan EarthquakeYumiko HOSOKAWA(1); Reo KIMURA(2)(1)Assitant Professor, Kobe City College of Nursing , Kobe, Japan, hosokawa@tr.kobe-gccn.ac.jp(2) Professor, Graduate School of Human Science and Environment , University of Hyogo, Himeji, Japan, rkimura@shse.u-hyogo.ac.jp

Abstract
Pregnant, parturient, and puerperal women and infants (hereinafter referred to as mothers and children) are particularly
vulnerable to health problems. Therefore, we investigated the health and daily lives of these individuals during theGreat East Japan Earthquake to identify necessary supports for them in future disasters. Specifically, we reviewed 37
studies on support conducted by healthcare professionals such as doctors, midwives, and public health nurses during theGreat East Japan Earthquake, and extracted and analyzed specific descriptions of the health conditions, daily lives anddifficulties of mothers and children during the disaster. We categorized the extracted descriptions into six groups asshown in the figure below.

“The health and daily lives of pregnant, parturient and puerperal women and children during the Great East Japan Earthquake”

The first category is “health problems associated with poor medical care and information.” Due to insufficient medicalcare and information required for evaluating and maintaining the health of mothers and children, it was impossible toensure the appropriateness of diet, excretion, sleep, temperature, exercise, and hygiene. As such, the frequency of minor
pregnancy problems increased, and abnormal conditions such as hypertension in pregnancy could not be treated. The
second category is “unexpected childcare-related events that began to occur immediately after delivery.” Unexpected
events during childcare occurred repeatedly due to the lack of sufficient childcare education and support, earlier
discharge of mothers from hospitals, and damage to essential public utilities. The third category is “a feeling ofloneliness and a sense of stagnation, coexisting with a strong will to survive with one’s children.” While mothers
developed psychosomatic illnesses due to long-term unstable mental conditions, they derived strength from theirmaternal role. The fourth category is “difficulty achieving safety and comfort in daily life.” Mothers and children were
not categorized as needing support. They moved from place to place seeking safe and comfortable living locations. The
fifth category is “additional family roles and duties.” Mothers’ roles and duties in the family and in evacuation centers
increased due to separation from or death of family members and insufficient maternal support. The sixth category is“financial burdens related to delivery and childcare, and expenses for post-earthquake recovery.”
Mothers and children required more than just medical support during the disaster because they had suffered both mental
and physical harm, and mothers had difficulty continuing childcare. Disaster education and increased public awarenessfocusing on mothers and children are required in the future to develop their self-help capabilities. Based on the resultsof this study, we consider that such education should achieve the following: improve mothers’ self-care skills and theirability to maintain their own health and that of their children, encourage mothers to actively request support, teachmothers how disasters influence mental state, establish mutual support among residents and help mothers acquirechildcare skills using familiar items.
Keywords:, the Great East Japan Earthquake, the health and daily lives, parturient, parturient, puerperal women andchildren,© The 17th World Conference on Earthquake Engineering- 7g-0003 -7g-0003

The 17th World Conference on Earthquake Engineering

17th World Conference on Earthquake Engineering, 17WCEE
Sendai, Japan - September 13th to 18th 2020

1. Introduction
At the time of the Great East Japan Earthquake, pregnant, parturient, and puerperal women (hereinafterreferred to as “mothers”) and children left evacuation centers sometime after the earthquake due to delays in
the provision of welfare evacuation centers for such individuals. According to a survey that targeted four
public health centers and 12 local governments in areas along the Iwate Prefecture coastline, there weremany people with special needs, (including mothers, children, and elderly people) in evacuation centers forthe first 24 hours after the earthquake, but most of women and children left within 72 hours after theearthquake[1]. Within 2 weeks after the earthquake, many pregnant women escaped to a less damaged area
and gave birth there[2]. It is not known how many mothers and children stayed in their homes or escaped totheir parents’ or relatives’ homes.
Medical facilities and local maternal and child health centers were not aware of mothers and children who
needed support after the disaster. As a result, no healthcare support was given to these individuals, and theirmental and physical health was compromised[3]. According to a survey on postpartum depression conductedin postpartum women who experienced the Great East Japan Earthquake, the percentage of mothers who
were at a high risk of developing postpartum depression approximately 6 months after delivery wasabnormally high, up to 21.5% [４]. Furthermore, a survey on the influence of the Great East Japan Earthquakeon mothers reported that pregnant women who received a maternity checkup within a month after thedisaster exhibited increased anxiety and worries about fetal growth, delivery, and childcare. Many of these
women showed signs of threatened premature delivery, onset or worsening of minor pregnancy problems,and mental stress symptoms such as insomnia [5].
During hospitalization, Japanese maternity hospitals usually instruct postpartum women in breastfeeding,childcare techniques such as bathing, nutrition and lifestyle required for recovery after delivery, preventionof health problems to which postpartum women are prone, and administrative procedures after delivery.
However, after the Great East Japan Earthquake, many mothers were discharged without these instructions
because the hospitals were closed, spent a great deal of time recovering their functions, or shortened patients’hospitalization periods to cope with the aftermath of the disaster [6]. Therefore, it seemed that the disaster
affected not only the mental and physical conditions of pregnant women but also the health, care, and daily
lives of postpartum women and their children.
The mental and physical health of mothers and children and childcare conditions in disaster-affected areas
remain poorly understood. Therefore, this study focused on mothers and children who were vulnerable tohealth problems during disaster, with the goal of revealing their mental and physical health, as well as
childcare conditions after the Great East Japan Earthquake.

2. Purpose
The study aimed to reveal the mental and physical health of mothers and children, as well as the details of
their daily lives, after the disaster. In addition, we considered possible support for these individuals during
the disaster by collecting a broad range of relevant information from published papers, documents, reports bypeople who engaged in support activities during the disaster, and books that describe the experiences ofmothers and children during disaster.

3. Method
3.1 Study design: Qualitative descriptive study
3.2 Literature collection method: To collect literature related to the health and daily lives of mothers
and children who were affected by the Great East Japan Earthquake, we searched a database using the
National Diet Library Search, the Scholarly and Academic Information Navigator, Ichushi-Web,
Google Scholar, and reference lists of collected literature. From the literature collected in this search,

2© The 17th World Conference on Earthquake Engineering- 7g-0003 -7g-0003

The 17th World Conference on Earthquake Engineering

17th World Conference on Earthquake Engineering, 17WCEE
Sendai, Japan - September 13th to 18th 2020

we selected reports and journals that specifically described their health and daily lives.
3.3 Analysis method: From the selected literature, we extracted descriptions of mental/physical healthand daily lives of mothers and children who were affected by the disaster. The analysis of thesedescriptions was conducted in a qualitative descriptive approach. The experiences of women during theintrapartum period were excluded from the study because the intrapartum period is particularly unusual.

4. Results
4.1 Collected literature: The 37 collected papers are listed in Table 1.
Table 1: Literature listYear1

Literature

Authors / Editors

2011 The importance of breast-feeding learned from experiences during disasters.

Type

Kiyomi Omata

ReportEtsuko Shiono

JournalFujiko Fukushima

ReportTakeshi Horiuchi

JournalSurvey on nursing support for pregnant, parturient, and puerperal women in the22011 aftermath of the Great East Japan Earthquake, based on interviews with midwives in
Miyagi P refecture

Publication / Presentation
Abstract Book of the Annual Meeting of the Japan
Academy of Neonatal Nursing, 21, 59.
Current Information of Maternal & Child Health,(64), 75-77.

Health and Labour Science Research Grant 2011. Study on the structure, equipment, andmanagement system for healthcare and welfare services that can function during a massive
3

2012 disaster. Working Group Report: An ideal care system for pregnant, parturient, andpuerperal women identified in the midwives’ activities in the community during theaftermath of the Great East Japan Earthquake.

4

2012 P roblems during a massive disaster: Telephone counseling on breast-feeding

5

2012

6

2012

The influence of the Great East Japan Earthquake on the mental and physical conditionof pregnant women

Hisae Horikawa
Mitsuko Nitta; Yukiko Tamura; Yumi

Aftermath of the Great East Japan Earthquake. Report of the Miyagi Midwives

Kato; Kazuko Yamagishi; Akiko Goto;

Association Mother and Child Support P rogram

Hatsue Ishikawa; Yoshiko Goto

Study on the establishment of welfare evacuation centers that can accept pregnant,72012 parturient, and puerperal women based on the experiences of practicing midwives in the

Eri Osawa; Fujiko Fukushima

aftermath of the Great East Japan Earthquake.
8

2012 The influence of the Great East Japan Earthquake on the mental health of mothers

Kineko Sato

Meeting
Minutes

P erinatal Medicine, 42(3), 327-330.
Journal of Rural Medicine, 61(3), 482.

Original

The Journal of Japanese Midwives’ Association,

paper

66(3), 30-31.

Meeting

The Journal of the Japan Society of Disaster Nursing,Minutes14(1), 169

Original
paper

The Japanese Journal for Midwives, 66(10), 858-863.

Emi Shibuya; Akemi Isoyama; Mihoko
92012 Circumstances surrounding mothers and children during a massive disaster

Komatsu; Kiyomi Ito;

ReportIbaraki Journal of Maternal Health, 56.

Tsunagaru.com

Book

Kadokawa Corporation

Hiromi Ueno

Document

Shiga Journal of Maternal Health, 30.

Ryoko Kajiyama; Tomoyo Akiyama
10 2012 Disaster handbook created by 812 disaster-affected mothers.
11 2012Experience as a midwife dispatched to a disaster-affected hospital to support inpatientcare.

Study group for “ Research on issues
12 2013

Activities for maternal and child health: Lessons learned from experiences after the Great related to healthcare activities for mothers
East Japan Earthquake

and children in the community during theStudy group for “ Research on issues related toReportGreat East Japan Earthquake, March 2013”
Masatoshi Murai; Naoko Izutsu; Hideo

Great East Japan Earthquake
14 2013

ReportKodamaHealth and Labour Science Research Grant. Working Group Report: Roll allocation andinformation sharing in the obstetric field during a disastercommunity during the Great East Japan Earthquake,
March 2013”.

Medical and healthcare support necessary for pregnant women during a massive disaster: Hidenori Iwama; Toshihiro Ogasawara;
13 2013 Findings from a survey on the behavior of pregnant women who were affected by thehealthcare activities for mothers and children in the

The Journal of Obstetrics and Gynaecology
Research, 65(2), 787.

Junichi Sugawara; Kumiko Okubo; Keiko
Kasai; Takahiko Kubo; Makiko Doai;

ReportTomoyo Narita; Kanami Sai ; Chika

Maternal and child health during a disaster. Roles of midwives in protecting pregnant,
15 2013 parturient, and puerperal women, P art 2: Known and unknown situations of pregnant,Honami Yoshida

JournalThe Japanese Journal for Midwives, 67 (2), 161.

Honami Yoshida

JournalThe Japanese Journal for Midwives, 67 (4), 325-327.

Honami Yoshida

JournalThe Japanese Journal for Midwives, 67 (5), 398-401.

Honami Yoshida

JournalThe Japanese Journal for Midwives, 67 (6), 482-,485.

Honami Yoshida

JournalThe Japanese Journal for Midwives, 67 (7), 566-570.

Honami Yoshida

JournalThe Japanese Journal for Midwives, 67 (8), 658-660.

parturient, and puerperal women in disaster-affected areas.
Maternal and child health during a disaster. Roles of midwives in protecting pregnant,
16 2013 parturient, and puerperal women, P art 3: Reasons why midwives were needed indisaster-affected areas.
Maternal and child health during a disaster. Roles of midwives in protecting pregnant,
17 2013parturient, and puerperal women, P art 4: Medical checkups for pregnant, parturient, andpuerperal women by a visiting doctor in evacuation centers and the assessment sheet
used for their checkups (1)Maternal and child health during a disaster. Roles of midwives in protecting pregnant,

18 2013parturient, and puerperal women, P art 5: Medical checkups for pregnant, parturient, andpuerperal women by a visiting doctor in evacuation centers and the assessment sheet for
their checkups (2)Maternal and child health during a disaster. Roles of midwives in protecting pregnant,
19 2013 parturient, and puerperal women, P art 6: P rovision of locations for childcare where
mothers and children can relax.
Maternal and child health during a disaster. Roles of midwives in protecting pregnant,
20 2013 parturient, and puerperal women, P art 7: Appropriate timing of ending disasterassistance. The importance of and difficulty in supporting independence.

3© The 17th World Conference on Earthquake Engineering- 7g-0003 -7g-0003

The 17th World Conference on Earthquake Engineering

17th World Conference on Earthquake Engineering, 17WCEE
Sendai, Japan - September 13th to 18th 2020

Year

Literature

Authors / Editors

Type

Maternal and child health during a disaster. Roles of midwives in protecting pregnant,
21 2013 parturient, and puerperal women, P art 9: P erinatal outcomes in the aftermath of the Great

Honami Yoshida

Journal

Yoshiko Tanaka

JournalHonami Yoshida

JournalHonami Yoshida

JournalTokiko Ishida; Kazuko Yasuda

ReportYukie Masaka

JournalEast Japan Earthquake.
Experience of participation in the disaster-relief volunteer activities of the Japanese
22 2013 Midwives Association: Visiting newborns in Higashi-Matsubara City, Miyagi
P refecture.
Maternal and child health during a disaster. Roles of midwives in protecting pregnant,
23 2013 parturient, and puerperal women, P art 10: Findings of a survey on the needs of pregnant
and puerperal women
Maternal and child health during a disaster. Roles of midwives in protecting pregnant,
24 2013 parturient, and puerperal women, P art 11: Support for postnatal care: visiting andvaccinating newborns
25 201426 201427 2014

Experiences of visiting pregnant women, mothers and children after the disaster – Ideal
postnatal support in the future
Issues related to support for pregnant, parturient, and puerperal women at the time of a
massive disaster
Advice that midwives should give when they visit pregnant, parturient, and puerperal
women and newborns at the time of a complex disaster: Tips and tricks

Yukako Takizawa

Collectionof papers

Publication / Presentation
The Japanese Journal for Midwives, 67 (10), 878879.
The Japanese Journal for Midwives, 65 (10), 917918.
The Japanese Journal for Midwives, 67 (11), 984989.
The Japanese Journal for Midwives, 67 (12), 10841088.
Fukushima Hoken Eisei Journal, 23, 17.
Current Information on Maternal & Child Health, (2),45-47.
Reports of Nursing Research, Nursing Teacher's
Course of Center for P rofessional Education,
Kanagawa University of Human Services , 39, 241.

Hirohito Metoki; Noriyuki Iwama; Zen
28 2015

Changes in blood pressure and heart rate of pregnant women after the Great East Japan

Watanabe;Hidekazu Nishigori; Junichi

The Journal of Obstetrics and Gynaecology

Earthquake relative to before the disaster

Sugawara; Kiyoshi Ito; Kazuhiko Hoshi;

Research,67 (2), 923.

Masakuni Suzuki; Nobuo Yaegashi
29 2015

Hidekazu Nishigori; Junichi Sugawara;

Transverse study on perinatal depression in the disaster-affected area in Miyagi

The Journal of Obstetrics and Gynaecology

Takashi Sugiyama; Kunihiro Okamura;P refecture after the Great East Japan Earthquake

Research, 67 (2), 641.

Nobuo Yaegashi

How to protect children from disaster from the viewpoint of crisis management. 3. The
30 2015 Great East Japan Earthquake 6) Experience of support for pregnant, parturient, andKazuyo Yagihashi

JournalHonami Yoshida

Journalpuerperal women and newborns
How to protect children from disaster from the viewpoint of crisis management. 3. The
31 2015 Great East Japan Earthquake 6) Support for pregnant, parturient, and puerperal womenand babies and infantsChild Health,18(9), 59-61. Shindan To Chiryo Sha,
Inc.
Child Health, 18(10), 770-773. Shindan To ChiryoSha, Inc.

Honami Yoshida; Kentaro Hayashi;
32 2015

P erinatal outcomes in the aftermath of the Great East Japan Earthquake and the Motherand Child Support P roject

Hiroshi Ota; Yumie Ikeda; Keiko Otsuka;
Nahoko Harada; Takanari Arai; Yosuke
Fujioka; Megumi Haruna; Hiroyuki

Original

Journal of General and Family Medicine, (38) , 136-

paper

141.

Nakao
Disaster response in perinatal medical care – Experiences in the Great East Japan33 2016

Earthquake. Survey on disaster-affected pregnant, parturient, and puerperal women.
Study on the behavior of perinatal women who experienced the Great East Japan

Junichi Sugawara

Document

Hiromi Araki

Journal

Yukie Masaka

JournalThe Fourth Meeting on the P erinatal Medical Care
SystemEarthquake in Miyagi P refecture and the support system for addressing their needs
Activities to support mothers and children in disaster-affected areas. Considering ideal
34 2016 support for mothers and children in disaster-affected areas through the activities of Baby

Bimonthly Journal: Child Care (Journal for

Smile Ishinomaki, a non-profit organization.
35 2017

nursing) , 10(6), 69-72.

Issues related to support for pregnant, parturient, and puerperal women at the time of a
massive disaster.
Agreement between Sendai City and the Miyagi Midwives Association to dispatch of

36 2018 midwives to welfare shelters for perinatal women, and the relevant efforts of the

37 2018

continuous learning on newborn and pediatric

Sachie Aoyama (Miyagi Midwives
Association) ; Sumi Misawa; Yoshiko

Association.

Goto

Support for people with special needs during disasters in general evacuation centers,

Michiyo Yamanaka; Ryoko Hidaka; Sumie

focusing on elderly people, babies, and pregnant women.

KurodaJournalReportCurrent Information on Maternal & Child Health, (2),44-47.
Clinical Midwifery: Skills Improvement, 10(6), 3745.
Japanese Journal of Medical and Nursing Education,
28-33.

4.2 Health and living conditions of mothers
Collected data were categorized into six groups (Tables 2) and 26 subgroups as follows:

Group 1: Health problems associated with poor medical care and information
Medical facilities and local maternal and child health centers lost functions due to the disaster. As a result,mothers and children were not able to receive regular medical checkups, home visit services by healthcare
professionals, or medical care that is normally available.
Subgroups of Group 1 included the following: The incidence of minor pregnancy problems and deviations from normal health conditions increased.
Deviations included gastrointestinal disorders, skin problems, urination disorders, poor blood
circulation, and allergies resulting from worsened living environment and diet. In some cases, mothers
and children could not receive any medical support in evacuation centers because no obstetricians,
gynecologists, or pediatricians were included in the disaster medical care teams.
 Mothers became mentally unstable due to increased anxiety and stress. They experienced sleep
disruption, a feeling of unwellness, weepiness, anorexia, irritation, fear, and depression.

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The 17th World Conference on Earthquake Engineering

17th World Conference on Earthquake Engineering, 17WCEE
Sendai, Japan - September 13th to 18th 2020

 Mothers experienced difficulty in daily life due to lack of materials and environments required forappropriate diet, excretion, sleep, exercise, hygiene, and temperature.
 Mothers could not obtain medical support for health management and information about available
medical facilities. For example, they could not obtain information about evacuation centers for people
with special needs, available professional support, and consultation services.
 Mothers were unable to trace their own health conditions because they lost their maternal handbook inwhich they recorded their own and their children’s health conditions. The hospitals’ information systems
were down, and the maternal information databases of the local governments were lost.

Group 2: Unexpected childcare-related events that began to occur immediately after
deliveryUnexpected events during childcare occurred repeatedly due to the lack of sufficient childcare educationand support, earlier discharge of mothers from hospitals, and damage to essential public utilities.
Subgroups of Group 2 included the following: Mothers could not receive instructions required for childcare, including childcare skills and lactation
guidance, during hospitalization because mothers and children were discharged earlier than usual.
Hospitals had no choice but to discharge them because there were a limited number of maternity
hospitals in operation during the disaster.
 Mothers were isolated, had anxiety about and difficulty in continuing breastfeeding, and had to decide
whether to breastfeed or bottle-feed their babies by themselves.
 Materials for childcare (e.g., water, milk, disinfected milk bottles, clothes for babies, bathtubs) were notdelivered to some mothers and children. Even though these materials were delivered to the evacuation
centers, the mothers could not go to these centers to receive them. Furthermore, materials for children
with special needs were not available.
 Mothers faced difficulty in receiving support because there were no sufficient supporters or means ofsupporters’ transportation; there were only a small number of organizations dedicated to supporting
mothers and children; information on support for mothers and children was not well communicated;and mothers had to request support by themselves.
 Mothers tried to find the best ways to care for their children, including using well water, river water, or
firewood for bathing. They did what they could do at that time.
 Mothers could not obtain accurate information or determine what information was accurate;
meanwhile, they were confused by inaccurate information provided by chain emails from their friends.
It was difficult to obtain public information.

Group 3: A feeling of loneliness and a sense of stagnation, coexisting with a strong will tosurvive with one’s children
While mothers developed psychosomatic illnesses due to long-term unstable mental conditions, they
derived strength from their maternal role.
Subgroups of Group 3 included the following: Mothers did not express their needs for support because they thought that there were people who werein more difficult situations than theirs, whereas they simultaneously felt that they were being abandoned
by others and had a sense of isolation and stagnation. This situation resulted from the worsened living
environment, separation from family members, unfamiliar childcare tasks, and the lack of people
available to mothers.
 Mothers gained a sense of safety and recovered their confidence in childcare when healthcare
professionals carefully listened to them during home visits or telephone counseling. These healthcare
professionals included midwives and public health nurses.
 Mothers found themselves having a strong will to survive with their children.
 Mothers sometimes experienced unstable attachment to their children and had a feeling of self-hatredand guilt. Mothers’ attachment to their children sometimes became unstable due to unexpected disaster.
 Mothers did not want to leave the disaster-affected area, based on concern about the lives of their

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The 17th World Conference on Earthquake Engineering

17th World Conference on Earthquake Engineering, 17WCEE
Sendai, Japan - September 13th to 18th 2020

family members including older children.
 Mothers wanted to talk with reliable people because they had no acquaintances or reliable people
nearby.
 Mothers wanted to express their feelings caused by the disaster, or share them with others.
 Mothers hesitated to continue pregnancy or deliver children in the aftermath of the disaster.

Group 4: Difficulty achieving safety and comfort in daily life
Mothers and children were not categorized as needing support. They moved from place to place seeking
safe and comfortable living locations.
Subgroups of Group 4 included the followings:
 Mothers moved from place to place seeking safe and comfortable living locations. Mothers and children
could not achieve safety and comfort during daily living, which had been guaranteed before the disaster.
Evacuation centers were not safe or comfortable places to take care of children.
 Mothers and children were not categorized as people vulnerable to disaster, and no support
organization knew where they were.
 Due to limited accessibility, mothers had difficulty moving to destinations such as evacuation centers,
hospitals, and homes, and often had to walk to their destinations because there was no other means oftransportation. It was physically hard for mothers to move around. Due to this lack of mobility, it was
not easy for them to travel to receive relief supplies, meet others, or go shopping.

Group 5: Additional family roles and duties
Mothers’ roles and duties in the family and in evacuation centers increased due to separation from ordeath of family members and insufficient maternal support.
Subgroups of Group 5 included the followings:
 In addition to their roles as mothers and wives, mothers’ roles and duties increased due to separationfrom or death of family members. Evacuation to distant relatives’ homes or evacuation centers also
increased their burdens.
 Mothers performed all activities of daily life, including childcare, household duties, and carrying ofwater and supplies by themselves.

Group 6: Financial burdens related to delivery and childcare, and expenses of postearthquake recovery
Subgroups of Group 6 included the followings:
 Additional expenses were required for medical checkups and delivery because mothers had to go toother hospitals and medical checkup facilities due to closure of medical facilities and local
governments’ facilities.
 Financial burdens increased because income decreased due to loss of family members’ jobs, continued
living in shelters, and purchasing of furniture to rebuild their lives.
Table 2: Health and living conditions of mothers

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The 17th World Conference on Earthquake Engineering

17th World Conference on Earthquake Engineering, 17WCEE
Sendai, Japan - September 13th to 18th 2020

4.3 Health and living conditions of newborns and infants (hereinafter referred to as “babies”)
Collected data were categorized into four groups (Tables 3) and 13 subgroups as follows:

Group 1: Babies were at high risk of impairment in growth and development.
Risk factors included changes in living environment, high infection risk, lack of availability of allergyfriendly milk, and lack of medical services such as regular checkups and immunization.
Subgroups of Group 1 included the followings:
 Babies could not be kept warm and were at risk of hypothermia.
 Even minimal medical care services required for the growth and development of babies, such asprovision of vitamin K2 syrup and medical checkups, were unavailable.
 It was not possible to receive continuous medical support because medical facilities in disaster-affectedareas were closed, and mothers had to go to distant pediatric clinics.
 Allergy-friendly milk was unavailable.
 Vaccination programs were unavailable.

Group 2: Babies experienced health problems such as skin problems, cystitis, and allergic
symptoms during the disaster although they are preventable in normal times.
Contributing factors included insufficient nursery items such as diapers and clothes, being unable to take abath, and lack of appropriate environments for childcare.
Subgroups of Group 2 included the followings:
 Babies repeatedly developed health problems, including diarrhea and cold symptoms.
 Babies developed skin problems, cystitis, and allergic symptom.

Group 3: Caregivers of babies, and the environment surrounding babies, changed.
These changes resulted from separation from (or death of) family members, as well as moving to new
locations.
Subgroups of Group 3 included the followings:
 Caregivers of babies changed.
 Babies and toddlers had less chance of going outside because the number of safe playgrounds (e.g.
Childcare Support Center) decreased after the disaster.
 Babies and toddlers had less chance to go outside with their mothers due to the worsened environment
in their living areas after the disaster.
Group 4: Babies became mentally unstable.
They cried more frequently and did not stop clinging to their mothers because they did not understand
why the environment had changed.
Subgroups of Group 4 included the followings:
 Babies cried at night and cried for minor reasons.
 Babies wanted milk all the time.
 Babies did not stop clinging to their mothers.
Table 3: Health and living conditions of newborns and infants

7© The 17th World Conference on Earthquake Engineering- 7g-0003 -7g-0003

The 17th World Conference on Earthquake Engineering

17th World Conference on Earthquake Engineering, 17WCEE
Sendai, Japan - September 13th to 18th 2020

5. Discussion
5.1 Preparation for maintaining the health of mothers and children during disaster
Mothers and children experienced various kinds of mental and physical problems during disaster. Manymothers had to comfort their babies, who were crying because they did not understand the situation andsuffering from health problems after the disaster, even as the mothers themselves suffered from healthproblems and anxiety. The health problems that have been revealed in this study are common in daily lifeand can be prevented. Common childcare knowledge, emergency goods, preparation for disaster, and disaster
drills were effective during past disasters 【 7 】 . Therefore, it is important to acquire knowledge about
preventive physical healthcare, such as infection control and nutrition during disasters, as well as aboutnormal psychological responses to disaster. In addition, it is useful to learn a wide range of childcare
knowledge, e.g., the accessible daily goods that can be substituted for standard childcare goods, as well as
alternative childcare methods. Support for acquiring this knowledge is necessary to enhance self-care inmothers.
Changes in the living environment after a disaster compromised the childcare environment and imposed
psychological burdens on mothers, e.g., anxiety and feelings of isolation and stagnation. In such a situation,
however, mothers did their best to care for their children without sufficient essential public utilities. Whenmothers wished to express their feelings, healthcare professionals helped them gain a sense of safety andrecover their confidence in childcare. Assistance for mothers and children increased their zest for life. A
connection with other people helps people affected by disaster maintain their mental health and recover. Thus,
the development of community relations as part of disaster preparations contributes to support for mental andphysical health, daily life, and childcare during disasters.

5.2 Support system for mothers and children during disaster
In Japan, the regular prenatal checkup program specified by Article 13 of the Maternal and Child HealthAct has contributed considerably to the decrease in perinatal mortality. In addition, local governments haverecently started a medical screening program for postpartum women based on the guidelines of the Ministryof Health, Labour and Welfare. These programs have provided continuous support for women during
pregnancy and the child-rearing period 【8】. During the disaster, however, it was difficult for mothers toreceive regular checkups and medical care, and to seek support. It is difficult for public agencies to beaware of the needs of pregnant women, particularly during early and middle pregnancy, unless they
voluntarily ask for support. For future disasters, therefore, it is important to establish an outreach programthat provides long-term, community-rooted, seamless support for mothers and children that can be initiatedimmediately after disaster.
This study revealed that information necessary for maintaining the health of mothers and children was
unavailable during the disaster. Therefore, in order to support mothers and children, it is necessary toestablish a two-way communication system to request support, establish consultation services, and ensure
access to appropriate information sources.

6. Acknowledgement
This research is based on a funded research project "Establishment of a Disaster Prevention andManagement Educational Hub for Improving Disaster Prevention Literacy among a Wide Ranging
Stakeholders” (Representative: Reo Kimura, University of Hyogo), which is supported by the
SECOM Foundation for Promotion of Science and Technology, and a consigned research project"Project on Comprehensive Resilience Improvement in Tokyo Metropolitan Area: Building a
Collaborative System for Data Utilization that Contributes to Improvement of Comprehensive
Resilience Centering on the Tokyo Metropolitan Area" (Area Representative: Keiko Tamura,
Niigata University) by the National Research Institute for Earth Science and Disaster Resilience.

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The 17th World Conference on Earthquake Engineering

17th World Conference on Earthquake Engineering, 17WCEE
Sendai, Japan - September 13th to 18th 2020

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