The mental and maternal health of women in flood-affected areas in Pakistan: a call for action

Pakistani authorities have claimed that the 2022 floods were the worst affecting more than 33 million people1. Natural disasters, most importantly floods, have a severely detrimental effect on the overall life of individuals. Women and children are the most susceptible to the effects of public health emergencies, despite the devastating effects this catastrophe has had on individuals of all ages. Post flooding effects on women included anxiety associated with a rise in the use of alcohol, prescription medicines, or antidepressants, as well as higher levels of stress, sleep issues, panic attacks, difficulties concentrating on daily duties, lethargy, nightmares, irritability, and mood swings. The long-term effects of these tragedies include a rise in child labor, posttraumatic stress disorder, suicidal thoughts, and substance abuse. It is well established that several issues, including homelessness, lack of access to education, and the trauma of losing loved ones, can have an impact on children’s cognitive wellness during crises2,3. In the context of flooded populations, it is vital to address how to adequately deliver correct and effective psychological therapy at scale for persons with a broader spectrum of mental health symptoms, particularly women. Women who have experienced floods felt anxiety during periods of heavy rain are linked to higher levels of stress, sleep issues, panic attacks, trouble concentrating on daily chores, lethargy, nightmares, rage, mood swings, and greater usage of prescription medicines including antidepressants4. Due to several issues including poverty, a lack of finances, limited educational opportunities, inadequate infrastructure, a lack of skilled manpower, and a lack of awareness and knowledge of postflood mental health, women from developing nations like Pakistan are particularly vulnerable. In general, mental health concerns have been regarded as a neglected topic, particularly in Pakistan where it is considered a stigmatized issue. Due to a lack of energy and inadequate privacy, women in displacement camps discontinue breastfeeding. According to studies, lack of privacy, stress, and unsanitary circumstances affect 75% of those who have been forced to relocate5. First-time lactating mothers in displacement camps are compelled to abandon breastfeeding due to a variety of social, emotional, psychological, and physical stresses and community prejudices5. Furthermore, the rate of psychological distress, anxiety, depression, and posttraumatic stress disorder in these flood-affected women has also been found to increase with evacuation and temporary accommodation. Women are more likely to be affected by floods than men because they are responsible for taking care of family and children. Pregnant women are especially vulnerable. So, the government should make sure that healthcare agencies are prepared for flooding beforehand and that they have detailed plans and trained professionals to deal with the mental and maternal health of flood-affected women. Regarding maternal health, the government should ensure adequate health care facilities are available so pregnant women can avoid potential health risks, such as infections or miscarriages. In addition, there should be access to prenatal care so expectant mothers can track their progress throughout the pregnancy. Recognizing and responding to distress is important, and the responses should be flexible and varied depending on each woman’s needs and social support. Postdisaster, emotional damage is often overlooked when measuring the severity of a disaster. Women suffer from emotional trauma in far greater numbers than men, and this disparity is magnified after a natural disaster. To deal with this, their safety must first be secured with adequate shelter, food, medications, and clothing to begin the process of healing from psychological trauma which can be fostered through psychoeducational interventions by psychologists and other mental health professionals. A multisector approach involving communities, families, and agencies is the best way to achieve this. This approach will help to restore social cohesion and family ties, which can help promote a speedy recovery. It is an essential component of psychological first aid6, which is now recognized as an important set of principles for psychosocial care. In addition, educational programs can be devised to help people better understand the impact of traumatic events on individuals’ mental health. Counselling and support should be integrated with primary care in the affected communities. Community-level mental health field workers should be recruited to provide first-line emotional and practical support to women experiencing acute distress to help identify early signs of more serious mental illness like stress, anxiety, depression, and other behavioral disorders. It is also important to provide ethical and competent mental health services that are culturally relevant to help-seeking women in the affected areas. This means that the staff providing these services need to be local to the area, and preferably also culturally knowledgeable. These can also be designed as mobile units to effectively deliver mental health services to communities where women can’t travel due to flood water. Community groups provide a valuable opportunity for members to share their experiences and support each other. This can help survivors realize that they are not alone in their struggles and emotions, and can provide traumatized individuals with the resources they need to cope with their experiences. These groups should be led by trained professionals who can support and assist the members. Establishing such psychosocial schools and community centers can be a valuable way to provide support to those with limited personal resources. There is also an urgent need for more qualified psychologists and other mental health professionals to help in the aftermath of disasters and after traumatic events. By providing efficient credentialing and incentives, the government can help to increase the number of professionals who are able to help. So there is a need for businesses and the government to work together to make sure there are enough mental health services available to everyone who needs them. City, state, and federal governments, as well as the insurance industry, need to work together to develop short-term and long-term solutions that make it easier for people to access quality care with parity between mental health and physical health services. In addition, government organizations should work with research funding agencies to identify such areas of research that will help develop mental health awareness and response strategies tailored to specific groups and make policies accordingly7. Ethics approval statement None. Sources of funding None. Author contribution A.N. and A.A. were involved in the study concept, the collection of the data, drafting, literature review, data validation, supervision, and editing of the manuscript. R.T. and A.A.A.B. were responsible for the literature review and revising the manuscript for important intellectual content. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Areeba Ahsan. Data availability statement None.