Chapter 37
Disasters and Women's HealthField of expertise: Disaster Obstetrics and Gynecology

Yasuhiro Miki & Kiyoshi Ito
Translated by Catherine Sachi Kikuchi

Summary
Women's health care in disasters involves many problems that cannot be dealt with by obstetrics
and gynecology collaboration alone. Collaboration with various fields such as pediatrics, perinatalcare, and mental health has become necessary. In addition, it has become clear that women's
health management in times of disaster cannot be solved simply by restoring medical facilities andsystems, and we must carefully analyze these issues and construct a comprehensive disaster
obstetrics and gynecology care system in the future.
Keywords: disaster obstetrics and gynecology, obstetrics, gynecology, cancer screening, inclusive
disaster risk reduction

Introduction
During and after a disaster, it is necessary to collaborate not only with both obstetrics andgynecology departments, but also with various other medical departments. In the face of disasters,
disaster obstetrics and gynecology is evolving into an academic and medical system that broadly
covers the field of women's medicine.

1: Problems Revealed by the Great East Japan Earthquake
At the Second UN World Conference on Disaster Reduction held in 2005, the Hyogo
Framework for Action was adopted as a basic guideline for disaster reduction activities for thefollowing 10 years. It is credited with suppressing the increase in the number of deaths fromdisasters over the decade, as the national and local governments made disaster prevention apriority and strengthened emergency response. On the other hand, even during the past decade,large-scale disasters have claimed many victims, and the damage caused by small-scaledisasters, such as those from climate change in recent years, has become increasingly diversified.
In particular, it has been pointed out that vulnerable groups such as women and children havebeen significantly affected. In the aftermath of the Great East Japan Earthquake, the Japanesepeople's spirit of helping each other drew attention. However, there have been reports of cases
where women were the only ones on dinner duty when they returned to evacuation centers after1

cleaning up their homes and searching for their relatives during the day. By picking up on individualcases, we can see that men-centered disaster prevention has a great impact on the mental healthof women. At the Third UN World Conference on Disaster Reduction held in Sendai City, Miyagi
Prefecture in 2015, the Sendai Framework for Disaster Reduction was adopted. In it, theimportance of women's and young people's leadership is stated, and the role of women as
stakeholders can be expected. In this framework, the "health of mothers, newborns, and children"and "sexual and reproductive health" were added as new keywords. Obstetrics, gynecology, andwomen's medicine are expected to play a significant role in disaster reduction in the future.

2: Paradigms Destroyed by the Earthquake
Conventional wisdom and necessary responses
Figure 37-1 summarizes the disaster cycle and the responses of obstetrics and gynecology(Ito & Miki, 2012). In the case of obstetrics, there were many cases of the Maternal and Child
Health Handbook (Boshi techō)1 being lost because of the Great East Japan Earthquake, and as aresult, the vulnerability of paper-based management became apparent. In Iwate Prefecture, thePerinatal Medical Information System Ihatov was established in 2009, and the Maternal and Child
Handbooks were restored from electronic data from registered handbooks. The establishment of adisaster-resistant management system for maternal and child health information is essential.
As for gynecology, immediately after the Great East Japan Earthquake, surgeries werecanceled and daily treatment for cancer patients was also suspended (Ito & Sugawara, 2013).
Surgery and outpatient services were resumed on the 11th day after the earthquake, andanticancer drugs and radiation therapy were resumed after about three weeks (Ito & Sugawara,2013). In order to restore the medical system as soon as possible, both physical and non-physicalmeasures, such as the establishment of a new information system and the restoration of facilities
and equipment must be addressed promptly.
During and after the chronic phase of the disaster cycle, the focus shifts from emergency
response to mental care and health management. Beginning in April that year, cervical cancer
screening (mass screening) by the Miyagi Cancer Association's traveling bus service resumed, andin the coastal areas hardest hit, the service resumed in February of the following year (Miki et al.,2020) . It was thought that the rapid restoration of clinics and screening systems would lead to a
rapid recovery of consultation rates, but in fact, even five years after the disaster, many areas had
not recovered to the consultation rates of the year before the disaster (Figure 37-2) (Miki et al.,2020). This means that there are problems in health management that cannot be recovered simply
by physical and non-physical restoration.

1The Boshi techō or Maternal and Child Health Handbook is a small booklet first given to apregnant person, to chronicle the pregnancy, well-being, birth, and immunization of the child, up toand including the age of six. One booklet is provided for each child in Japan.

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Figure 37-1. The disaster cycle and obstetric and gynecological diseases

3Figure 37-2. Changes in the consultation rate for cervical cancer bus screenings in the coastal
areas of Miyagi Prefecture

3: A New Approach4In the aftermath of the Great East Japan Earthquake, there were many deliveries done
without prior meetings and consultations with the mother due to consultation delays in the earlystages of pregnancy, the inability to receive prenatal checkups, and the loss of the Maternal andChild Health Handbook. As mentioned in Section 2 above, there is an urgent need to digitize
medical information and build a network (Figure 37-3). It is also important to take measures at theindividual level, such as taking pictures of the handbook with a smartphone and sharing them withrelatives in remote areas.
In the area of gynecology, it is necessary to create an environment where affected womencan monitor their own health, but we need to investigate in detail what was lacking and what wasneeded. In order to manage women's health in the long term after a disaster, comprehensive
measures and actions are needed, including the enhancement of mental care (dealing with stress),disaster countermeasures from the perspective of women (including the management ofevacuation centers and temporary housing), and awareness of disaster prevention on a daily basis(Figure 37-3).

Figure 37-3. Future developments of the disaster cycle and obstetrics and gynecology

4: Achievements and the Future
A new approach to disaster science
It has been reported that postpartum mothers who were discharged from the hospital
without receiving adequate postpartum care were exposed to excessive stress for six months

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afterward, highlighting the need for collaboration between obstetrics, perinatal care (from 22 weeks
pregnant to less than 7 days after birth), pediatric care, and disaster medicine. Furthermore, theOutline of Measures for Society with a Decreasing Birth Rate (2015) emphasizes the disseminationof disaster prevention activities and drills that take infants and expectant mothers into
consideration, as well as strengthening the cooperation among relevant organizations to protect
children. In response to this, the Ministry of Health, Labor, and Welfare has further developed thetraining of pediatric perinatal liaisons for disasters. In addition, the Japanese Society of Obstetrics
and Gynecology is working to launch PEACE (Perinatal Early Assessment and Communication
system for Emergencies), which is a system for sharing information among hospitals during
disasters. In the future, not only cooperation within obstetrics and gynecology, but also cooperation
among other departments related to women's medicine will be required, and constructing an
integrated disaster obstetrics and gynecology is necessary

Conclusion - from the authors
In this section, we discussed the importance of women's leadership, which is one of thebasic guidelines of the Sendai Framework for Disaster Reduction, from the perspective of women'smedicine. “Age," "gender," and "disability" are also important keywords in this framework. An
inclusive society is a society in which people from all walks of life are not isolated, but aresupported and included in each other's lives so that they are not excluded, and in order to achieve
inclusive disaster risk reduction, a society must be inclusive on a daily basis, to a point whereinclusivity is so normal that it doesn’t require additional attention.

References
Ito, K., Miki, Y. (2012). What is Disaster Obstetrics and Gynecology? Journal of ClinicalExperimental Medicine, 242(12), 949-950. (In Japanese)
Ito, K., Sugawara, J. (2013). Obstetrics and Gynecology at the Time of the Great Earthquake. In A.
Hirakawa & F. Imamura (Eds.), Analyzing the Great East Japan Earthquake 2 (pp. 55-67).
International Research Institute of Disaster Science, Tohoku University. (In Japanese)Miki, Y., Tase, T., Tokunaga, H., Yaegashi, N., Ito, K. (2020). Cervical cancer screening rates
before and after the Great East Japan Earthquake in the Miyagi Prefecture, Japan. PLoS ONE,15(3): e0229924. https://doi.org/10.1371/journal.pone.0229924

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