Attachments
Authors:
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Dr Yiqi Zhu, Adelphi University
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Dr Jean-Francois Trani, Washington University in St Louis
Executive Summary
Pakistan ranks 10th among the most affected countries by climate disasters. Rural areas are more prone to adverse effects resulting from those disasters. The summer of 2022 was characterized as record-breaking in extreme climatic variations in Pakistan, where heatwaves were immediately followed by monsoon floods that submerged a third of the country, causing the loss of life of 1500 people. Overall, it impacted the livelihood of over 33 million people. Among all persons affected, there were approximately 650,000 pregnant women in urgent need of maternal services.
To support the urgent and long-term recovery of mothers and infants from floods, this study aimed to examine the impact of the monsoon flood of 2022 on the health of expecting and lactating mothers and their children and families and propose policies and program recommendation to strengthen safe delivery practices and long-term comprehensive care towards pregnant and lactating mothers and their children in flood relief camps. This study utilized a mixed-method participatory approach, which includes three main parts: Group Model Building (GMB) workshops, case studies, and community surveys in most affected villages in Dera Ismail Khan(DI Khan) and Dadu districts of respectively Khyber Pakhtunkhwa and Sindh provinces of Pakistan.
Most families were still in a dire situation three months after the flood. Most families in DI Khan had moved back to their original residence, but families in Dadu still lived under tents. In some parts of Dadu, water had not fully retreated. Since their village was still submerged by flood water, families were not able to farm, missing on a fundamental source of income. Without a stable income, household food security suffered. Without nutritious food, mothers were not able to breastfeed children. Without sufficient income, purchasing formula milk became a huge burden. Mothers had to further sacrifice their health (do more work and eat less) to first ensure food for their children. GMB workshops showed the cycle of poverty that families were confronting after the flood. Many families had to use savings and assets in exchange of goods to survive.
In the community, access to safe and improved sanitary and hygiene facilities (WASH) was also a vast challenge after the flood and its absence was closely associated with poor maternal health. In all the workshops and case studies, participants mentioned that they got skin diseases due to being in contact with unclean water. Parents also mentioned the high cost of purchasing and transporting clean water. In addition, open defecation was common in the community in absence of improved sanitation, which further polluted sources of drinking water.
The quantitative data collected from 150 families in the considered areas provide details and a sense of the scale of the risks associated with maternal health mentioned by the communities during the GMB workshops and case studies. Among the 150 families we surveyed, there were 156 children under two years old; 64 (42.7%) of them were below two standard deviations from the height for age median of the World Health Organization (WHO) Child Growth Standards, considered as the reference for being stunted. Only three mothers did not report any delay in infant development. Breastmilk was key for children’s optimal growth, but none of the mothers were able to practice exclusive breastfeeding for children under six months old as per WHO recommendations. The main reasons were lack of breastmilk and lack of privacy.
Parents health and mental health were also severely negatively impacted by the summer 2022 floods. More than half of the mothers and fathers reported weight loss and exhaustion. Around 40% of parents have been diagnosed with diarrhea and skin diseases or reported symptoms of diarrhea and skin diseases. As for mental health, 75.3% of mothers and 71.4% of fathers scored over the threshold of significant depressive symptoms.
Quantitative data also revealed changes in access to WASH and healthcare facilities before and after the flood. Even though most families did have access to a seemingly improved water source, families reported a change in the taste of the water collected from the well. As for sanitation, 71 (47.7%) had flush family toilets inside their house before the flood, and the rest of the families used pit latrines with ventilation. However, only 26 (17.4%) families still had flush toilets inside their house, and 67 (45%) families no longer had access to any toilets but had to go outside after the flood.
To address such challenges to the flood relief and recovery process, government and nonprofit organizations were providing various services. Our researchers observed that various services were provided and infrastructures were operated by local organizations. Still, study participants reported that the services distributed by the government and nongovernmental organizations did not exist and sometimes were tainted by practices of corruption and therefore did not reach the most in need. In addition, some public assistance programs were disrupted after the flood, possibly due to a lack of funding from the government.
Findings of this study show that children and mothers were in urgent need of nutritional interventions in order not to miss key windows of optimal growth. Even though many governmental and non-governmental organizations were working on the distribution of ready-to-use therapeutic food or ration bag, there is a need for improved equity in this distribution of services, and for considering actual nutritional needs when planning the food distribution.
Second, mothers should be informed of the importance of exclusive breastfeeding for their newborn children and of keeping breastfeeding until the age of two years old. A community should also organize safe spaces for mothers to breastfeed. Breastfeeding is even more crucial in emergency, especially when the water sources are polluted.
In addition, facing the challenges of lack of income and jobs and of poor public infrastructure, a temporary cash-for-work program should be introduced. Families could be paid to assist in the community recovery process. Such an approach provides the opportunity for disaster survivors to regain dignity and self-esteem through their working contribution. It might also foster the local community’s economic recovery and reconstruction process.
As for the long-term planning for building community resilience against future climate disasters, strengthening social safety nets constitutes a vital initiative to prevent poverty following disasters. Second, with the improvement of disaster relief knowledge and widespread social media outreach, disaster warning systems and basic disaster preparedness training should be established in every community. Third, improving infrastructures, especially water management systems, is crucial to preventing future flood disasters. With climate change worsening, an increased frequency of climate disasters is inevitable. To better protect people’s life and well-being, governments need to implement strategies to promote the resilience of at-risk communities.