Disaster-related healthcare system disruption and maternal-neonatal outcomes

Natural disasters disrupt healthcare systems and create crises that severely impact maternal and perinatal health outcomes. The 2023 Kahramanmaraş earthquakes caused widespread destruction in southeastern Turkey, leading to marked inequalities in healthcare access and obstetric service delivery. This study compared maternal and neonatal outcomes under disaster-related healthcare system disruption between an earthquake-affected region and an unaffected reference region.

This retrospective comparative study included 403 women who delivered between February 6 and 21, 2023, at two hospitals located in an earthquake-affected region and an unaffected reference region. Maternal and neonatal outcomes were compared between the two settings. Continuous variables were analyzed using the independent samples t-test or Mann-Whitney U-test, and categorical variables using the chi-square or Fisher's exact test. Multivariable logistic regression analysis was performed to evaluate independent associations, and adjusted odds ratios (aOR) with 95% confidence intervals were reported.

The vaginal delivery rate was significantly higher and the cesarean section rate significantly lower in the earthquake-affected region (p < 0.05). Preterm birth (45.6%) and preterm premature rupture of membranes (7.4%) were more frequent in the affected group. Neonates born in the disaster-affected setting had significantly lower birth length and head circumference. Advanced cervical dilation and labor pain at admission were more common in the earthquake-affected group. Incomplete uterine rupture (uterine dehiscence) occurred more frequently compared with the control group (24.5% vs. 6.0%), while no complete uterine rupture was observed. Bilateral tubal ligation rates were markedly higher in the disaster-affected region (43.1%).

Significant disparities in maternal and neonatal health outcomes were identified in the context of disaster-related healthcare system disruption. These findings highlight the importance of healthcare system resilience, continuity of essential obstetric services, and preparedness strategies in post-disaster settings. This study provides real-world evidence of access inequalities following a major disaster, with implications for healthcare service planning, disaster preparedness, and public health policy.