Experiences of pregnant people affected by natural disasters: a qualitative systematic review.

Abstract

Objective: This qualitative systematic review identifies, appraises, and synthesizes existing qualitative evidence on the experiences of pregnant people during natural disasters to provide a deeper understanding of the complex factors shaping these experiences.

Introduction: Support for pregnant people affected by natural disasters must address not only their physical and mental health needs but also the safety and well-being of the fetus. Such support requires consideration of pregnancy-specific risks and must address complex contextual factors, including family relationships, social support, and stress. However, evidence describing the experiences of pregnant people during natural disasters remains limited.

Eligibility criteria: This review includes studies focusing on the experiences of pregnant people living in disaster-affected areas during natural disasters. Both published and unpublished qualitative studies were eligible for inclusion, including those with data collected through interviews and observations in English or Japanese.

Methods: The databases searched included MEDLINE, CINAHL, and PsycINFO, PsycArticles (for English-language studies) via EBSCOhost, as well as CiNii and Ichushi-Web (for Japanese-language studies). Reference lists of included studies were also screened to identify additional relevant studies. Gray literature was searched using Google Scholar and ProQuest Political Science. The JBI approach was followed for study selection, critical appraisal, data extraction, and data synthesis. The ConQual approach was used to grade the synthesized findings and assess the level of confidence in the evidence.

Results: Twelve studies were included, yielding 138 findings that were grouped into 11 categories and synthesized into 3 synthesized findings: i) Overwhelming fear and uncertainty: experiencing a disaster during pregnancy is overwhelming and terrifying because it involves not knowing what is important in an unsafe and unstable situation, and uncertainties about the continuation of the pregnancy and the health of the child; ii) Decision-making and coping within the context of pregnancy: pregnant people analyze the problems and suffering caused by the disaster to decide how to deal with them, fight for fetal well-being in the chaotic situation they are experiencing, and consider their pregnancy when deciding how to escape and where to go during a disaster, iii) Survival constraints and social connectedness: facing disaster during pregnancy means surviving with food, water, and sanitation shortages, suffering setbacks in prenatal care, and relying on the support of friends and family, leading a person to recognize the crucial importance of human connections in a challenging life moment.

Conclusions: This systematic review highlights the multifaceted challenges faced by pregnant individuals during natural disasters, including psychological distress, uncertainty, and practical hardships. Strengthening infrastructure, ensuring continuity of maternal health care, and providing psychological support are essential. A holistic and targeted approach is needed to better support pregnant individuals in disaster settings, and further research is warranted to inform effective interventions.

Review registration: PROSPERO CRD42021265326.