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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 Sample Exposure measure(s) Outcome(s) assessed Key findings
Bahmanjanbeh (2016) Cohort
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 Fertility
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) Cohort
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
Fertility 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) Cohort
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
Fertility 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 Fertility
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 Fertility 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) Cohort
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) Fertility 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) Cohort
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) Fertility 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) Cohort
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
Fertility 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 Fertility 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 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 Fertility 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
Fertility Births—9.5% increase** in rate of childbirth among women in exposed region
Nobles (2015) Cohort
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
Fertility 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) Cohort
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 Fertility
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
Fertility 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
Fertility 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) Cohort
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 Fertility 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 Fertility 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