Skip to main content

Table 2 Summary and characteristics of 20 articles assessing fertility or contraception following natural hazard disasters 1989–2012

From: Fertility and contraception among women of reproductive age following a disaster: a scoping review

First author (year)

Study design and time period assessed

Disaster location, type and date


Exposure measure(s)

Outcome(s) assessed

Key findings

Bahmanjanbeh (2016)


Pre-disaster: 1 year before, 2011

Post-disaster: 1 year after, 2013


August 12, 2012

East Azarbaijan, Iran

All married women 15-49-years-old living in earthquake affected area

n = 44,265

6.3 and 6.4-magnitude, Richter scale—All births after earthquake were considered exposed


Contraception access

Birth Rate (per 1000 population/ year)

 1 year before: 18.5

 Year of disaster: 18.3

 1 year after: 17.8

Marriage Fertility Rate

 1 year before: 111.7

 Year of disaster: 109.1

 1 year after: 103.2

Contraceptive Coverage (%)

 1 year before: 66.9

 Year of disaster: 66.8

 1 year after: 64.9

Behrman (2016)


Pre-disaster: 5 years before, 2005

Post-disaster: 2 years after, 2012


January 12, 2010


Population survey of women 15–49-years-old

Pre-disaster: n = 10,757

Post-disaster: n = 14,287

4.61–7.65, Mercalli score—Period after earthquake considered exposed

Compared department-level destruction by Mercalli score

Contraception use and access

Contraception Use

 Difference-in-Differences (DID) suggests there is no significant effect on the probability of using a modern contraception method

Contraception Access

 Significant** increase in an unmet need for contraception.

Cohan (2002)

Longitudinal administrative



September 22, 1989

South Carolina, US

Population vital statistics for state and counties

Category 4 Hurricane—Severity determined by federal disaster declaration, and seven most severely affected counties were first reported disaster declarations.

Compared to 22 counties in South Carolina without federal disaster declaration


Birth Rate (per 100,000 population/year)

 1 year after: Net increase of 41

In the year following the hurricane, counties with a federal disaster declaration had a significant* increase in birth rate compared to counties in the state that were not declared disaster areas.

Davis (2017)


Pre-disaster: April–September 1998

Post-disaster: 2 years after, August 1999–July 2001, and 5 to 7 years after, November 2003–October 2005


October 28, 1998


Women 15–49-years-old residing in zones where precipitation occurred from hurricane

Pre-disaster: n = 5424

Post-disaster: August 1999–July 2001 n = 5353

November 2003–October 2005 n = 8734

Category 5 Hurricane—Compared

mean rainfall level per municipality during the 10-day storm period of the hurricane


Total Fertility Rate

 All women

  1998: 3.01

  2001: 2.81

  2005: 2.75

 Women in zones with below median precipitation

  1998: 3.41

  2001: 3.27

  2005: 3.02

 Women in zones with above median precipitation

  1998: 2.62

  2001: 2.36

  2005: 2.36

Djafri (2015)

Mixed methods

Population statistics: 2007–2011

Health facility-based review: conducted November 2010–May 2011


September 20, 2009

Padang, Indonesia

Population statistics of Padang City

Women 15–49-years-old receiving service at local health center at least twice before earthquake

7.6-magnitude, Richter scale—Period after earthquake considered exposed


Contraception use and access

Birth Rate (per 1000 population/ year)

 2007: 17.0

 2008: 18.3

 2009: 18.8

 2010: 19.8

 2011: 19.6

Contraceptive Use—No change

Contraceptive Access—Perceived ability to access contraception declined by 20% for 1–3 months after

Evans (2009)

Longitudinal administrative



Gulf Coast Region, US

Population vital statistics for states and counties

Storm advisories


Number of births—Change in monthly county births compared to prior year, same month

 Tropical storm watch: 3.2% decrease 10 months after**, 2.6% increase 11 months after*

 Tropical storm warning: Constant

 Hurricane watch: 2.6% increase 10 months after**, 3.7% increase 11 months after**, 0.9% increase 3 years after*

 Hurricane warning: 2.2% decrease 9 months after**, 2.6% decrease 10 months after**, 0.7% decrease 3 years after*

Grabich (2015)


Pre-disaster: August 14, 2003–October 31, 2003

Post-disaster: 2004


August 13, 2004 and September 21, 2004

Florida, US

Conceptions resulting in live birth among Florida female residents 15–45-years-old

n = 92,398

Wind severity in county (≥ 74 mph), and county distance from storm path (< 60 km)


Birth Rate (per 1000 population)

 DID—No association observed between hurricane exposure and birth rate

 GLM—Risk difference of 2.2 births per 1000 population (95% CI: 1.5, 3.0) when wind speeds are ≥ 74 mph compared to < 74 mph.

 Risk difference of 2.8 births per 1000 population (95% CI: 1.9, 3.7) in storm path compared to those outside 60 km buffer of storm path

Grabich (2017)


January 2003–October 2004


August 13, 2004; September 5, 21, and 25, 2004

Florida, US

Conceptions resulting in live birth among Florida female residents 15-45-years-old

n = 138,005

County exposure to hurricane weather conditions, and by wind strength (≥ 39 mph, ≥ 79 mph)


Birth Rate (per 1000 population)—Using DID estimates, no association was observed between birth rates and hurricane exposure.

 2003: 4.2

 2004: 3.8

Hamamatsu (2014)


January 1997–2011

Post-disaster: December 2011–June 2012


March 11, 2011

Tohoku, Japan

Births in each prefecture

9.0 magnitude—Seismic activity intensity measured on the Japan Meteorological Agency scale as upper 5 or more in Kanto and Tohoku regions, 13 prefectures

Compared to all 47 prefectures of Japan and 34 prefectures with score less than ‘upper 5’ on Japan Meteorological Agency seismic activity intensity scale


Number of births

Births in all of Japan were significantly* lower than expected for 4 of 7 post-disaster months studied (Dec 2011, Jan 2012, Apr 2012, and Jun 2012). Expected estimates were developed from a quadratic regression equation. In the disaster affected area, births were significantly lower than expected 5 out of 7 months (Dec 2011, Jan 2012, Mar–Apr 2012, Jun 2012), and in the non-disaster stricken areas, only 2 of 7 months had fewer births than expected (Apr 2012 and Jun 2012).

Hamilton (2009)

Longitudinal administrative

Pre-disaster: August 29, 2004–August 28, 2005

Post-disaster: August 29, 2005–August 28, 2006


August 29, 2005

Gulf Coast Region, US

Births to residents of Federal Emergency Management Agency-designated disaster counties of Alabama, Louisiana, and Mississippi

91 counties with federal disaster declarations and 14 selected counties with disaster declarations within 100-mile radius of the hurricane path


Number of births

 1 year after:

  In 14 selected counties hardest hit 19% decline overall; 30% decrease in Louisiana, 13% decrease in Mississippi, and 6% increase in Alabama.

  In 91 counties studied 4% decline overall with a significant* decline in 6 counties and significant* increase in 7 counties: 12% decrease in Louisiana, 4% increase in Alabama, and 3% increase in Mississippi.

Hapsari (2009)

Cohort, survey

Before disaster and within 1 year of disaster


May 27, 2006

Yogyakarta Province, Indonesia

Married (before disaster) women 21–49-years-old from Bantul District of Yogyakarta Province

n = 450

6.2-magnitude, Richter scale—Period after earthquake considered exposed

Contraception use and access

Contraception Use—3% stopped using contraception after disaster while, 12.5% changed contraceptive method after disaster.

Contraception Access—11% of pre-disaster users had difficult time accessing services after the disaster.

Kinoshita (2016)

Mixed methods

Pre-disaster: 2002–2003

Post-disaster: 2005–2006


December 26, 2004

Aceh Province, Indonesia

Women 15-19-years-old (born 1985–1991) from Aceh Province

n = 252

5 areas of province where > 10% of the population was displaced for 8 or more months after the tsunami


Fertility Rate (per 1000 women 15–19)

 2 years before: 3.5%

 2 years after: 4.1%

Kurita (2019)

Longitudinal administrative

January 1, 2007–December 31, 2017


March 11, 2011

Fukushima, Japan

Births registered in Fukushima per month divided by city population at beginning of month

All births after earthquake were considered exposed


Birth Rate (per 100,000 population per month)

 Pre-disaster: 69.8

 0–2 years post-disaster: 59.5

 3–7 years post-disaster: 62.9

In the two years following the disaster, birth rates were significantly* lower than expected based on estimates from Poisson regression models. More than 2 years after the disaster, the birth rate returned to expected values.

Nandi (2018)

Longitudinal administrative

Pre-disaster: 1996–2000

Post-disaster: 2002–2006


January 26, 2001

Gujarat, India

Births occurring in 1996–2000 and 2002–2006 in Gujarat, Maharashtra, Madhya Pradesh, and Rajasthan

7.7-magnitude, moment magnitude scale—Post-disaster births in Gujarat

Compared to post-disaster births in Maharashtra, Madhya Pradesh, and Rajasthan


Births—9.5% increase** in rate of childbirth among women in exposed region

Nobles (2015)


Pre-disaster: 10 months before

Post-disaster: up to 5 years after


December 26, 2004

Aceh Province, Indonesia

Women 15–49-years-old living in Aceh Province

n = 6363

Births after tsunami in 92 communities with some mortality; high (≥ 30% of residents died) or low tsunami mortality

Compared to 191 communities that experienced no tsunami related mortality, in the same district as communities experiencing tsunami related mortality


Total Fertility Rate

 4 years after:

  Net increase of 0.7* comparing communities with some mortality to no mortality

  0.5 birth per woman higher than expected in areas of high mortality

Oyarzo (2012)


Pre-disaster: January 1–December 31, 2009

Post-disaster: March 1–December 31, 2010


February 27, 2010

Chillan, Chile

Women delivering at Herminda Martin Clinical Hospital

Pre-disaster: n = 3609

Post-disaster: n = 2553

8.8-magnitude, moment magnitude scale—All births after earthquake were considered exposed


Contraception access

Birth Rate—Compared to previous year, 9% reduction

Contraceptive Access—No change

Scapini (2021)

Longitudinal administrative


Pre-disaster: 2002-2009

Post-disaster: 2010–2016


February 27, 2010


5182 registrations from 15 regionsa

8.8-magnitude, Richter Scale

6 affected regions with modified Mercalli intensity scale level of severe or higher


Birth Rate (per 1000 inhabitants)

 Pre-disaster (2004–2009): 13.85

 Post-disaster (2010–2015): 12.87

Parallel trends assumption between affected and unaffected regions met.

DID—Affected regions had non-significant increase in birthrate compared to unaffected regions in post-disaster period.

Triple-Difference Modeling—Birth rate showed downward trend in the post-disaster period for affected and unaffected regions. Compared to the unaffected regions in the post-disaster period, the birth rate in affected regions increased* by 0.385.

Seltzer (2017)

Longitudinal administrative


Pre-disaster: 2000–2004

Post-disaster: 2006–2010


August 29, 2005

Louisiana, US

Births reported in vital statistics in New Orleans, Louisiana

Category 3 Hurricane—All births after hurricane in Orleans county and New Orleans MSA

Compared to MSAs with similar population size to New Orleans and southern, costal MSAs that were not affected by hurricane


Total Fertility Rate


 Black—4% decrease*

 Hispanic—55% increase**

 White—5% increase*

Change in TFR in post-disaster period compared to expected value based on comparable MSAs

Tan (2009)


Pre-disaster: May 12, 2007–May 11, 2008

Post-disaster: May 12, 2008 - May 11, 2009


May 12, 2008

Wenchaun, China

Births occurring at local hospitals in Du Jiang Yan and Peng Zhou

Pre-disaster: n = 6638

Post-disaster: n = 6365

8.0-magnitude, Richter Scale—All births after earthquake were considered exposed


Birth Rate—Constant (i.e., not a significant decrease)

 4.3% decrease

Tong (2011)

Longitudinal administrative

Pre-disaster: 1994–1996

Post-disaster: 1997–2000


April 1997

North Dakota, US

Births among residents giving birth in North Dakota

All births after flood were considered exposed, and six counties directly affected by flood considered most severely exposed


Birth Rate (per 1000 population)

 Entire state

  Pre-disaster: 13.1

  Post-disaster: 12.2

 Most severe counties

  Pre-disaster: 13.9

  Post-disaster: 13.0

Fertility Rate (per 1000 women 15–44)

 Entire state

  Pre-disaster: 65.3

  Post-disaster: 64.0

  1. Constant suggests results were not statistically significant at an alpha of 0.05
  2. DID difference-in-differences modeling, GLM generalized linear modeling, IUD intrauterine device, km kilometer, mph miles per hour, MSA metropolitan statistical area-level, TFR total fertility rate, US United States
  3. aArica and Parinacota, Tarapacá, Antofagasta, Atacama, Coquimbo, Valparaíso, Metropolitana de Santiago, Libertador General Bernardo O’Higgins, Maule, Biobío, La Araucanía, Los Ríos, Los Lagos, Aisén del General Carlos Ibáñez del Campo, and Magallanes y de la Antártica Chilena
  4. *P < 0.05
  5. **P < 0.01