title: Cluster sampling with referral to improve the efficiency of estimating unmet needs among pregnant and postpartum women after disasters.
abstract: BACKGROUND
  Women of reproductive age, in particular women who are pregnant or fewer than 6 months postpartum, are uniquely vulnerable to the effects of natural disasters, which may create stressors for caregivers, limit access to prenatal/postpartum care, or interrupt contraception. Traditional approaches (e.g., newborn records, community surveys) to survey women of reproductive age about unmet needs may not be practical after disasters. Finding pregnant or postpartum women is especially challenging because fewer than 5% of women of reproductive age are pregnant or postpartum at any time.
  
  
  METHODS
  From 2009 to 2011, we conducted three pilots of a sampling strategy that aimed to increase the proportion of pregnant and postpartum women of reproductive age who were included in postdisaster reproductive health assessments in Johnston County, North Carolina, after tornadoes, Cobb/Douglas Counties, Georgia, after flooding, and Bertie County, North Carolina, after hurricane-related flooding.
  
  
  RESULTS
  Using this method, the percentage of pregnant and postpartum women interviewed in each pilot increased from 0.06% to 21%, 8% to 19%, and 9% to 17%, respectively.
  
  
  CONCLUSIONS
  Two-stage cluster sampling with referral can be used to increase the proportion of pregnant and postpartum women included in a postdisaster assessment. This strategy may be a promising way to assess unmet needs of pregnant and postpartum women in disaster-affected communities.
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina 27599, USA. jen.horney@unc.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Horney
authors.forename: Marianne E
authors.initials: ME
authors.lastname: Zotti
authors.forename: Amy
authors.initials: A
authors.lastname: Williams
authors.forename: Jason
authors.initials: J
authors.lastname: Hsia
mesh_terms: D000293:Adolescent; D000328:Adult; D016000:Cluster Analysis; D004190:Disasters; D005260:Female; D055868:Floods; D005845:Georgia; D006301:Health Services Needs and Demand; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration; D008429:Maternal Welfare; D008875:Middle Aged; D009657:North Carolina; D010865:Pilot Projects; D011159:Population Surveillance / Q000379:methods*; D049590:Postpartum Period; D011247:Pregnancy; D012017:Referral and Consultation; D012494:Sampling Studies; D011795:Surveys and Questionnaires; D055815:Young Adult