Understanding reproductive health challenges during a flood: insights from Belkuchi Upazila, Bangladesh.

Background: Bangladesh is exposed to natural hazards such as floods, cyclones and droughts. As such, its health systems and health infrastructure are exposed to recurrent disasters. Research studying the impacts of natural disasters on reproductive health in particular is lacking. This research contributes to this knowledge gap by studying the challenges related to menstrual regulation and post-abortion care at both the facility and community levels, and the care-seeking patterns of pregnant women during the 2016 flood in Belkuchi, Bangladesh. Methods: Six government-run primary health care facilities were assessed using a structured assessment tool prior to the flood of 2016. In total, 370 structured interviews were conducted with women in three unions of Belkuchi (Belkuchi Sadar, Daulatpur and Bhangabari) 4 months after the 2016 flood. Results: The main challenges at the facility level are a lack of services and a shortage of medicines, equipment and trained health workers. The main challenges at the community level are displacement, high rates of self-diagnosed spontaneous abortion and a lack of treatment for post-abortion complications. A majority of the interviewed women (48%) sought menstrual regulation from the residence of a nurse or family welfare visitor. In total, 73.2% of the women who experienced post-abortion complications sought medical care. Conclusion: To overcome the challenges at the facility level, it is important to construct flood-resistant health infrastructure and train health workers in menstrual regulation and post-abortion care, so that these services can be made available during a flood. At the community level, more research is required to understand the reasons for spontaneous abortions so that these, and the subsequent chronic conditions/complications women experience, may be avoided. Context specific interventions that can overcome local challenges (both at the community and facility levels) are required to promote disaster resilience at primary health care facilities.

Exploring the meaning of health security for disaster resilience through people's perspectives in Bangladesh.

There has been significant interest in the rhetoric of health security in recent years from both global and local perspectives. Understanding health in the context of disaster vulnerability presents an opportunity to examine how improved health might reduce the effects of environmental disasters and other crises. To this end, a project was implemented in Bangladesh to establish the potential of a health security approach for disaster resilience amongst people living in high risk environments. This paper explores what we might mean by health security through engaging community level perspectives in the southeast coastal belt of Bangladesh, an area prone to cyclone and flood. This has been examined with respect to variation in gender and wealth of households. Household surveys, interviews and focus group discussions were some of the methods used to collect data. The findings show that health related coping strategies and agentive capabilities in the context of impending crises vary from one micro-context to the next. This suggests a dynamic and integrative resilience that could be built on further, but one which remains remote from wider discourses on health security.

The role of microcredit in reducing women's vulnerabilities to multiple disasters.

This article explores the relationship between microcredit and vulnerability reduction for women-headed households in'multiple disasters'. Here multiple disasters are understood as disasters that occur in one specific place and cause severe devastation. The case study covers the super-cyclone in 1999, floods in 2001 and 2003, and drought in 2002 in Orissa, India. The study entailed eight months fieldwork and interviews with several governmental and non-governmental officials and 12 women-headed households from different social castes. The findings suggest that microcredit is a useful tool to replace women's livelihood assets that have been lost in multiple disasters. But inefficient microcredit delivery can cause microdebts and exacerbate caste, class and gender inequalities. It is posited that microcredit delivery cannot achieve vulnerability reduction for women in multiple disasters unless it is complemented by effective financial services, integrated policy planning and disaster management between government, non-governmental organisations and the community.

Multiple disasters and policy responses in pre- and post-independence Orissa, India.

'Multiple disasters' or disasters that occur in 'one specific place' are regular events in coastal parts of the state of Orissa in eastern India. Yet the policy framework for addressing multiple disasters is weak. This paper aims to show that policy responses in pre- and post-independence Orissa have overlooked the effects of multiple disasters. Evidence based on a review of the literature and on fieldwork indicates that Orissa has a long history of experience of multiple disasters due to its unique geographic location, political dislocation, and ineffective disaster policies that have focused only on single events. One can observe the effects of this even today in Orissa, notably inadequate measures to counteract the consequences of multiple disasters at the household level and to build people's capacity. This study posits, therefore, that multiple disasters deserve good representation in integrated disaster reduction strategies designed to mitigate their impacts.