Delivery Under Duress

GALLE, Sri Lanka – When she saw the giant wave coming in, M.D.D. Rathayake dropped everything and ran, shouting to her neighbors. Eight months pregnant, she ran nearly two kilometers before the waters stopped chasing her. "I lost everything," she said.

Ms. Rathayake was lucky. She and her family survived; 38,000 Sri Lankans did not. She found makeshift medical care at the relocated Teaching Hospital here, and her baby was delivered in January by caesarean section.

But more than 150,000 women were pregnant in the areas of 12 countries ravaged when the tsunami struck Dec. 26, and their great needs are only now beginning to be understood.

In disaster situations, health care systems crumble just when they are most needed, especially by pregnant women. Emergency relief tends to focus on food and shelter, road clearance and security rather than on helping women in labor find a safe, clean place to deliver, or on meeting their special nutrition and care needs. But pregnancy takes no timeouts for disasters.

Yet in Sri Lanka alone, four of eight maternity clinics on the east coast were destroyed and the others were greatly damaged. The Teaching Hospital here managed to relocate its 379 patients to another facility on higher ground, losing only one infant in the raging water. But where it had 415 beds it now has 70, so Ms. Rathayake lies on a mat on the floor of a hallway. Women crying out in labor or nursing newborns lie on either side.

Even before the tsunami, one woman died every minute somewhere in the world from complications of pregnancy. Simple interventions to save those women's lives are too often unavailable: safe blood supplies; equipment for anesthesia, transfusions and caesarean sections; and personnel trained to administer them. In disaster conditions, the toll rises steadily until such materials can be brought in and distributed.

Unstable social conditions also mean rape, trafficking and other sexual violence may increase while access to support services, contraception and law enforcement vanish. In Asia, women's voluminous saris were often torn away in the flood, leaving them naked and vulnerable in a deeply conservative society.

To help destitute women like Ms. Rathayake, the United Nations Population Fund assembled and distributed 25,000 personal hygiene kits to medical centers for Sri Lankan women. It also distributed 427 crates of essential birthing supplies to hospitals and maternity clinics to help them cope with complications of pregnancy: safe blood, anesthetics and antibiotics, midwife kits and surgical equipment for caesarean sections.

Clutching her plastic bag of personal hygiene items, which included soap, toothpaste and brush, towels, underwear, comb and sanitary napkins, Ms. Rathayake said she was very grateful. "Please help the doctors more like this," she said. "They help everybody else."