In Türkiye’s Hatay province, a region devastated by the massive earthquakes that struck 3 months ago, tents and containers are now home to many displaced people, including pregnant women and new mothers. According to United Nations data, an estimated 2.4 million women of reproductive age were impacted by the earthquakes.
In Hatay, about 14 000 babies are born in a typical month. To respond to this huge need, Dr Serap Şener from the WHO Country Office in Türkiye has been tasked with supporting the Ministry of Health and the local health system to provide primary health-care services, particularly those related to reproductive and women’s health, to earthquake-affected communities.
The impact of the earthquakes on mothers and babies
The aftermath of an earthquake poses numerous challenges to women and infants, especially when it comes to reproductive health and breastfeeding. One of the biggest difficulties is the lack of safe, comfortable living environments, which can have a significant impact on physical and psychological well-being.
Hygiene is also a major concern, especially in the postpartum period. Currently, common areas for toilets and showers may not meet basic sanitary standards nor offer the privacy needed, making it hard for women and new mothers to feel safe.
“Women who are breastfeeding are particularly affected as they do not have access to private areas as they would in their homes,” says Dr Şener. “Living in tents and containers means that they cannot breastfeed in a comfortable environment, which can lead to issues such as painful mastitis. Similarly, pregnant women struggle to find a comfortable area where they can rest.”
Breast milk provides essential nutrients and antibodies that are especially important in emergencies as they help protect newborns, infants and young children from infections and diseases. With the right support, a woman’s body can make enough milk for her baby, even in stressful times.
Formula milk lacks protective antibodies and other important elements for a baby’s growth and development, which is why WHO recommends early and exclusive breastfeeding to 6 months, and continued breastfeeding for 2 years and beyond.
Formula milk also requires hygienic preparation and clean water, both of which are hard to ensure in the wake of a major disaster like an earthquake. The result is increased potential for contamination, putting unprotected babies and children at serious risk of diarrhoeal diseases.
Thus new mothers in earthquake-affected areas need access to private spaces, clean water and proper sanitation facilities, in addition to breastfeeding support. Even mothers who have stopped breastfeeding can begin again if provided with the right information and assistance from skilled helpers.
“The stress of the situation definitely affected the confidence of some women. But breastfeeding in an emergency can in turn benefit the mental health of mothers and babies by providing a sense of comfort and security at a difficult time,” explains Dr Şener.
Rebuilding socially and psychologically
Dr Şener is witnessing first-hand the challenges women face in the temporary settlements set up after the earthquakes. “Even if all your needs are met, there is nothing to spend your time on. You don't have a home or a routine. You are alive, but everything seems to have come to a halt and you sit and wait for time to pass.”
Dr Şener believes that more attention must be paid to women’s psychological and social needs. “Acknowledging that women are not just survivors but also active members of society who can contribute to its reconstruction is vital, in my opinion.”
Working in partnership
During a recent visit to Hatay's reproductive health unit, operated jointly by the United Nations Population Fund (UNFPA) and the Association of Public Health Specialists (HASUDER), Dr Şener witnessed how pregnant women in camps and container areas were receiving care, and learned about special areas created for those who had just given birth. However, this unit is the only one of its kind in Hatay, and the need for more is dire.
Alongside UNFPA, the United Nations Children’s Fund (UNICEF) is also working in earthquake-affected areas to address the health needs of mothers and infants.
Türkiye’s Ministry of Health and provincial administrations have been monitoring pregnant women in the affected provinces, reaching out and informing them of the nearest health units for delivery. Additionally, the HASUDER and the Association for Solidarity with Asylum Seekers and Migrants (SGDD-ASAM) have been coordinating aid through municipalities and providing reproductive health services.
To address risky pregnancy conditions in temporary settlements, the Health Directorate has established a system to send pregnant women to hospitals in Adana or Dörtyol, depending on their status and risk level. However, after giving birth, women have to return to temporary settlements, where adequate hygiene may not be available.
The WHO Country Office in Türkiye is therefore working with the Ministry of Health and other stakeholders to create new maternity guesthouses and containers to accommodate women who have recently given birth. This initiative aims to provide a safe, comfortable environment for women to recover and care for their infants.
“At present, we are focusing on the Ministry’s efforts to rebuild and strengthen primary health-care services in earthquake-affected areas,” Dr Şener explains. “This involves strengthening infrastructure with prefabricated units, ensuring that missing materials and equipment are provided.”
He adds, “The second step is to provide training for qualified personnel who will work in these facilities. To achieve this, we are developing different approaches for local and immigrant populations, with a focus on overcoming linguistic and cultural barriers and re-establishing systems that are familiar to local populations. Our aim? To ensure that health care is accessible to everyone.”
Last year, the WHO Country Office conducted emergency maternity care and obstetric training for Ministry of Health personnel in large cities with significant immigrant populations. Many of the gynaecologists and other health professionals who took part have worked or are still working in the earthquake-affected areas, helping to ensure safer births for women.
Advice tailored to needs
At both regional and country levels, WHO is working with women in areas impacted by the earthquakes to ensure they receive information and advice on breastfeeding. Targeted risk communication interventions and materials are created with direct input from these women to factor in their perceptions, needs and concerns using appropriate language.
Messages on breastfeeding have so far been tested through digital channels with 150 women with children under the age of 2 from the 10 most affected provinces. Testing is a necessary step to make sure messages and materials resonate with the target audience. Community interventions to support breastfeeding women are also planned to support and sustain the public health advice delivered.