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Experiences and Biopsychosocial Needs of Women in an Earthquake During the Postpartum Period

Published online by Cambridge University Press:  27 October 2025

Ruşen Öztürk  and
Rabia Altay Erdogan
Ruşen Öztürk*
Affiliation:
Nursing Faculty, Women Health and Diseases Department, Ege University , İzmir, Türkiye
Rabia Altay Erdogan
Affiliation:
Adıyaman University Practice Kindergarten, Adıyaman, Türkiye
*
Corresponding author: Ruşen Öztürk; Emails: rusenozturk85@hotmail.com; rusen.ozturk@ege.edu.tr
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Abstract

This study included postpartum women who survived the earthquake that occurred on February 6, 2023, with epicenters in Kahramanmaraş, and assessed their experiences, psychosocial needs using a qualitative research method. The findings were organized under 5 key themes: “psychological processes experienced during and after the earthquake,” “experiences related to pregnancy and childbirth,” “biopsychosocial problems experienced after the earthquake,” “experiences related to s workers,” and “expectations and needs of earthquake-affected mothers.” Codes were established for women that were specific to their emotional responses following the earthquake: fear, sorrow, anxiety, difficulty in controlling anger, hopelessness, exhaustion, and inability to experience the mourning process; concerning their emotional reactions at the moment of the earthquake: extreme fear, helplessness, shock, and grief response; and regarding the traumatic effects of the earthquake: post-traumatic growth and post-traumatic stress disorder. During and after an earthquake, pregnant and postpartum women have biopsychosocial needs such as shelter, food, clothing, hygiene, support, and care, and these needs should be prioritized. Early psychological interventions should be provided to help women deal with the negative traumatic experiences they encounter during this process. Relevant institutions should create individual care-focused support systems and early intervention to deliver comprehensive care following earthquake.

Keywords

Natural disasterearthquakepregnancypostpartum

Information

Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 19 , 2025 , e302
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Introduction

On February 6, 2023, Turkey witnessed its most catastrophic earthquake of the century, centered in Kahramanmaraş, and felt very strongly over a vast area, including cities Kahramanmaraş, Hatay, Adıyaman, Gaziantep, Malatya, Kilis, Diyarbakır, Adana, Osmaniye, Elâzığ, and Şanlıurfa. This earthquake caused the loss of over 48,000 lives, injuries to 80,278 individuals, the relocation of 528,146 people to other safer provinces, and the demolition or severe damage of thousands of buildings, rendering them uninhabitable.Reference Ekici1, 2

An earthquake is a geological disaster that directly affects human psychology and has social consequences. Earthquakes are traumatic due to their effects on people and society.Reference Gümüş and Çakır3 It is clear that this earthquake caused significant societal trauma, considering the extensive area affected and the number of individuals impacted in our country.Reference Yelboğa4 Society is significantly devastated by earthquakes, which have severe repercussions, including the loss of loved ones, disability, and impoverishment.Reference Gümüş and Çakır3–Reference Sirotich and Camisasca5 Nevertheless, earthquakes have a profound psychological impact on individuals, as they experience the traumatic loss of a loved one, which disrupts their sense of equilibrium in life.Reference Yelboğa4, Reference Kvestad, Ranjitkar and Ulak6 Circumstances such as the sudden/unexpected nature of these deaths, the dismemberment of the corpses, and the inability to recover the remains further make the grieving process challenging for the bereaved individuals. Consequently, it has been noted that these losses lead to post-traumatic stress disorder (PTSD) among the earthquake survivors.Reference Yelboğa4, Reference Kvestad, Ranjitkar and Ulak6 The PTSD incidence after earthquakes has been reported to range between 1.2% and 82.6%, with a mean value of 23.7%Reference Dai, Chen and Lai7 in a meta-analysis which examined the mental health outcomes after earthquakes. The prevalence of PTSD ranged from 4.1% to 67.07% in another meta-analysis.Reference Tang, Deng and Glik8 Based on factors such as the timing of the assessment, gender, education level, damage to the individual’s home, death, injury during the earthquake, witnessing death, participation in rescue efforts, job loss, lack of social support, and negative experiences following the earthquake, these differences have been determined to vary significantly between studies.Reference Dai, Chen and Lai7, Reference Tang, Deng and Glik8 In the study conducted by Kvestad and colleaguesReference Kvestad, Ranjitkar and Ulak6 in the aftermath of the 2015 Nepal earthquake, it was revealed that mothers who reported more severe negative impacts of the earthquake exhibited higher PTSD scores compared to those who did not report such impacts. Additionally, mothers who lost family members had higher PTSD scores.Reference Kvestad, Ranjitkar and Ulak6 Therefore, the impact of natural disasters on mental health seemed to be based on many factors occurring before and after the disaster.Reference Tang, Deng and Glik8

Pregnant women who have survived major earthquake events and those who have given birth may be especially vulnerable in terms of long-term mental health issues.Reference Khanal, Khanal and Lee9–Reference Britto, Lye and Proulx11 Mental stress and physical trauma can have crucial effects on maternal and fetal health.Reference Harville and Do12, Reference Schetter and Anxiety13 The development and growth of the children can be significantly impacted by the distress experienced by the mother, which can result from inadequate care during her pregnancy and after birth, in the case of PTSD in this group.Reference Kvestad, Ranjitkar and Ulak6, Reference Surkan, Kennedy and Hurley10 One of the most significant challenges faced by pregnant women after an earthquake is the lack of access to basic health care services. Many expectant mothers are unable to attend regular check-ups that are pivotal for monitoring the health of the developing fetus during this period.Reference Ahmed, Dhama and Abdulqadir14 Furthermore, in addition to difficulties in accessing health care, exposure to environmental hazards such as dust clouds, pollutants, and inadequate sanitation further exacerbates the impact of the disaster.Reference Noji15 A study carried out on 171 pregnant women affected by the Taiwan earthquake revealed that women who experienced hunger had significantly higher negative attitude scores regarding the impact of the earthquake on pregnancy, and that greater loss of relatives was significantly associated with general health problems. Moreover, loss of a spouse was found to be the most significant determinant of low birth weight newborns.Reference Chang, Chang, Lin and Kuo16 Research has indicated that experiencing an earthquake disaster during pregnancy can bring along adverse pregnancy outcomes such as miscarriage, stillbirth, preterm birth, low birth weight (LBW), delayed fetal brain development, or the birth of small-for-gestational-age (SGA) infants.Reference Chang, Chang, Lin and Kuo16–Reference Traylor, Johnson and Kimmel18 Following birth, significantly higher rates of pregnancy complications and birth defects associated with the Wenchuan earthquake have also been observed.Reference Tan, Li, Zhang, Zhang, Han, An, Ding and Wang19 In the post-earthquake period, the lack of showers in informal shelters severely impacts the health of displaced women; breastfeeding mothers face difficulties owing to the lack of privacy and inadequate hygiene conditions, while issues related to hygiene, family planning, maternal health, sexually transmitted infections, and sexual/reproductive health are commonly reported.20 Therefore, earthquakes may contribute to deficiencies or disruptions in maternal-neonatal and postpartum quality health care, and bring on problems in postpartum family planning and nutrition for both mother and newborn.20

As a result, in addition to the mental and traumatic effects of earthquakes, women’s access to nutrition, clean water, safe living conditions, prenatal care, and other inputs related to maternal/fetal health is also limited, thus resulting in both physical and psychological stress.Reference Kvestad, Ranjitkar and Ulak6 In the literature, it is evident that the social distress caused by the earthquake has an inescapable negative impact on the biopsychosocial health of new mothers. However, it also underscores the importance and urgency of prioritizing research on women and children.Reference Kvestad, Ranjitkar and Ulak6 It is anticipated that the trauma experienced by a mother who has recently given birth will be significantly exacerbated by an earthquake disaster, along with the new life stresses of motherhood, such as postpartum care, breastfeeding, and the evolving responsibilities of the new family. Additionally, there is currently a lack of knowledge regarding the psychosocial health of new mothers in the aftermath of the catastrophic earthquake in Turkey. In this context, protecting the psychosocial health of mothers who have given birth is directly important for maternal and infant health during pregnancy and after childbirth. With the intention of importance, qualitative research on the earthquake experiences of women in the disaster area can provide health workers and policymakers with comprehensive information and the necessary knowledge to respond appropriately during and after an earthquake. In line with this purpose, the study was designed as a qualitative research study with the purpose of identifying the experiences of new mothers in relation to the earthquake, their physiological needs after the earthquake (shelter, food, transportation, and mother and baby care), to reveal the traumatic and psychosocial effects of the earthquake, and to ascertain the biopsychosocial support needs of women during and after this period.

Methods

Although this research was conducted to examine the experiences of postpartum women who endured the Mw 7.7 and Mw 7.6 magnitude earthquakes that occurred on February 6, 2023, at 04:17 and 13:24 Turkish local time, with epicenters in both Pazarcık (Kahramanmaraş) and Elbistan (Kahramanmaraş), it also aimed to determine the expectations and needs of these women for enhancing their psychosocial conditions and health. The research was designed as a phenomenological-qualitative study. This research aimed to understand the details of lived experiences through a phenomenological research design and provides a comprehensive analysis of people’s life experiences.Reference Erdoğan, Erdoğan, Nahcivan and Esin21, Reference Creswell and Poth22 Therefore, the research design has been preferred since it is a suitable method for examining the multifaceted experiences and impacts of earthquakes on women during the postpartum period. The research data were collected using the individual, in-depth interview method.

Recruitment and Procedures

The participants in this study were postpartum women residing in the earthquake-affected region. The research was carried out on women presenting to the Women’s Diseases and Obstetrics Clinic at İnönü University Turgut Özal Medical Center (for postpartum follow-ups or other follow-ups in the obstetrics and/or gynecology outpatient clinics). The data collection process for the research was conducted between July and December 2023 with earthquake survivors who gave birth within the first 3 months following the earthquake and were residing in tent cities, containers, dormitories, and similar places.

Participants

The study’s sample was selected through homogenous sampling and appropriate situations by oriented working groups. The inclusion criteria were: literate women over the age of 18 who had an adequate level of communication skills, had a single pregnancy that resulted in a full-term live birth with no complications, were pregnant during the earthquake, gave birth within the first 3 months after the earthquake, and resided in tent cities, containers, or dormitories. The exclusion criteria were as follows: women who were not literate in Turkish; earthquake survivors whose homes were undamaged and those whose living conditions were the same as they were prior to the earthquake. Qualitative research, which is primarily conducted through interviews and observations, does not necessitate extensive samples. This is because both observations and interviews become repetitious beyond a certain point. Therefore, the researcher must acknowledge that data saturation has been achieved when they encounter repetitions and should comprehend the necessity of elaborating the data rather than diversifying it.Reference Baltacı23, Reference Yıldırım and Şimşek24 For this purpose, interviews were conducted until data saturation was achieved and 20 participants were enrolled in this study.

Data Collection

Data collection from the study participants was conducted through individual, semi-structured interviews (30-55 minutes). During the data collection process at the hospital, the researcher scheduled appointments for women who visited in the event of potential interruptions (such as time constraints, childcare, breastfeeding, or emergencies) or the absence of a suitable environment for interviews. With the participant’s consent, in-depth interviews were conducted in either tent cities or container settlements (n = 20). The self-introduction form was incorporated into the information before the interview, and then the semi-structured interview questions were reviewed. The interview questions, prepared by the researchers in accordance with the literature and within the framework of the biopsychosocial model approach, were incorporated into this study.Reference Kvestad, Ranjitkar and Ulak6, Reference Yumbul, Wieling and Celik25–Reference Kubota, Okada, Morikawa, Nakamura, Yamauchi, Ando and Ozaki29 Five faculty members who have experience in qualitative research and public health and women’s health research provided expert insights for the semi-structured interview form. Based on expert opinion, a total of 25 questions covering earthquake-related needs have been added. These questions are divided into five main groups: questions about the earthquake’s moment, questions about its aftermath, questions about how the earthquake affected pregnancy and childbirth, and questions about identifying the need for psychosocial support.

.

Data Analysis

The “content analysis” method was used to analyze the research data. The data has been examined using the data analysis method described by Graneheim and Lundman.Reference Graneheim and Lundman30 The researcher carried on interviews with individuals, and the data were collected by analyzing and transcribing the recordings. The data were analyzed through a qualitative data analysis program (MAXQDA). All data that were decoded was transmitted to the program. Common sentences, similar expressions, frequently used concepts, definitions, and metaphors in the participants’ statements were used to generate codes for the responses. The coding process was continued by reorganizing each sentence in accordance with the research questions. Subcategories representing groups of common codes were subsequently determined. Following this stage, more abstract main themes were generated from the subcategories, guided by the biopsychosocial model. The final themes were eventually developed by the research team through collaborative discussion. Thus, the coding of the data, identification of the themes, organization of the codes and themes, and the description of the findings were performed by the researcher. Besides, each stage was overseen by a different researcher. During the final stage, the themes were refined through discussion until a final thematic structure was established by both researchers.Reference Stans, Dalemans and Roentgen31

Ethical Issues

This study was performed in accordance with the tenets of the Declaration of Helsinki and its later amendments. The Medical Research Ethics Committee of Ege University Medical Faculty Hospital (Ethics No: 2023-1052) approved this study. Furthermore, institutional permission was also obtained from İnönü University Turgut Özal Medical Center, where the research was carried out following ethical approval (Institutional Permission No: 322140). Written consent was obtained from postpartum women residing in the earthquake zone before the interview. The consent forms contained descriptions of the study’s purpose, the benefits that would be obtained from the research, and the time to be spent on the interview. Before the interview, all participants provided verbal consent for audio recording.

Results

As illustrated in Table 1, this study was organized under five themes, including the psychological processes experienced during and after the earthquake, biopsychosocial problems encountered post-earthquake, experiences regarding health care workers, the needs of mothers affected by the earthquake, and the experiences related to the pregnancy and childbirth process.

Table 1. Overview of the themes and subthemes

Psychological Processes Experienced During and After the Earthquake

Three categories were identified for the theme “Psychological Processes Experienced During and After the Earthquake,” which is one of the themes examined in this study. These included women’s emotional reactions at the moment of the earthquake, women’s emotional reactions to the aftermath of the earthquake, and the traumatic effects of the earthquake (Table 2).

Table 2. Themes identified through interviews with the study participants

Women’s emotional reactions during the earthquake

Four codes were created under the category “Women’s Emotional Reactions during the Earthquake”: extreme fear, helplessness, shock, and grief responses. The participants discussed their anxiety during the earthquake and stated that they felt helpless, went into disbelief, and experienced grief reactions when they received news about their loved ones during the earthquake.

Women’s emotional reactions to the aftermath of the earthquake

Seven codes were established for the category “Women’s Emotional Reactions to the Aftermath of the Earthquake”: fear, grief, anxiety, difficulty in controlling anger, hopelessness, inability to mourn, and exhaustion.

In the “Women’s Emotional Reactions After the Earthquake” category, almost all participants expressed strong opinions regarding fear. They also stated that they especially experienced fear of reliving the earthquake, fear of entering houses, and fear of injuring the baby in the aftermath. In the category “Women’s Emotional Reactions After the Earthquake,” the other code on which participants expressed their views was grief and anxiety. Their circumstances in the aftermath of the earthquake also caused them to experience anxiety regarding the possibility of reliving the earthquake.

The women also expressed their opinions on the difficulty in controlling their anger after the earthquake. Participants reported that they struggled to control their fears, were easily annoyed, experienced a reduced capacity to cope with and tolerate situations, and found it difficult to cope with their caregiving roles. Participants not only expressed a feeling of insignificance following the earthquake, but they also conveyed a sense of hopelessness regarding their future while living in the tents. Similarly, they mentioned the fact that they feel exhausted and are unable to mourn properly. The women were observed to be unable to mourn, as they stated, “We couldn’t even mourn our losses.” This was due to their inability to reach their loved ones’ bodies, inadequate removal of debris, and the helplessness of their own situations.

Traumatic effects of the earthquake

Two codes were created under the category “Traumatic Effects of the Earthquake”: post-traumatic growth and PTSD. The experiences associated with acute and chronic stress disorders following trauma reveal that pregnant women experienced trauma by continuously reliving the earthquake, visualizing it, feeling frightened, and having trouble breathing when they think about it. In the category “Traumatic Effects of the Earthquake,” participants provided a comprehensive analysis of their perspectives on post-traumatic growth. They mentioned experiencing growth and increased awareness after the trauma. They have also reported that the women’s experiences related to the following: appreciating life, finding spiritual strength, being content, and feeling grateful. They were also grateful for their nuclear families’ survival.

Experiences Related to Pregnancy and the Stages of Birth

Two categories were created under the second theme within the scope of the research, “Experiences Related to Pregnancy and the Stages of Birth.” These were both the physical and psychological effects of the earthquake on pregnancy and the physical and psychological effects of the earthquake on birth and postpartum (Table 2).

Physical and psychological effects of the earthquake on pregnancy

Seven codes have been created under the category “Physical and Psychological Effects of the Earthquake on Pregnancy.” These included the labor process, not feeling fetal movements, inadequate nutrition, inability to attend or delayed antenatal check-ups, experiencing bleeding, increasing the risks during pregnancy and preterm birth, and the fear of childbirth.

In the category “Physical and Psychological Effects of the Earthquake on Pregnancy,” participants extensively expressed their opinions on the labor process and difficulties. After experiencing physical and psychological challenges during the earthquake, participants reported that their contractions had increased. Additionally, some participants reported that they were unable to detect fetal movements for a period because of the anxiety they had experienced during the earthquake. It was found that pregnant women experiencing shelter and food insecurity following the earthquake were malnourished.

These participants were also unable to attend antenatal check-ups or were able to do so later. Participants stated that they could not attend their routine check-ups due to the earthquake. Some participants experienced a bleeding disorder following the earthquake, and 2 participants either had preterm births or were at risk of preterm birth during their pregnancies. During pregnancy, participants stated that the earthquake increased their fear of birthing, both because of the chance of suffering an earthquake during labor and because of the inadequate health and care environment in which they were placed.

Physical and psychological effects of the earthquake on childbirth and the postpartum process

Six codes were created under the “Physical and Psychological Effects of the Earthquake on Childbirth and the Postpartum Process” category. This included stress linked to being unprepared for the childbirth, the fear of re-experiencing an earthquake during childbirth, interruptions during breastfeeding, the perception of inadequacy and difficulty in performing the maternal role, partner support, and a lack of need for external social support.

In the category “Physical and Psychological Effects of the Earthquake on Childbirth and the Postpartum Process,” participants increasingly conveyed their opinions regarding partner support. They emphasized the significance of partner support in the aftermath of an earthquake; therefore, some participants indicated that they did not require external social support or could not allocate adequate time for it. In this category, participants increasingly expressed feelings of inadequacy and difficulty in fulfilling the maternal role. They expressed their fears of failure to provide adequate care for their children after the earthquake. The fear of experiencing the earthquake again during childbirth was another concern. Participants expressed their anxiety and fear about the safety of the building where they were giving birth, as well as the possibility of another earthquake during childbirth. Furthermore, they indicated experiencing a stressful birth process owing to inadequate preparation compared to previous pregnancies. Many of the participants stated that the earthquake destroyed all their birthing supplies. Following the earthquake, lactation interruptions were another issue. Some participants experienced nursing interruptions and the curdling of their milk following childbirth.

Biopsychosocial Problems After the Earthquake

Three codes were created for the category “Biopsychosocial Problems After the Earthquake” within the scope of the study. The codes associated with this category included the problems of sheltering, food, clothing, hygiene and self-care, communication, transportation and organization, the increase in diseases, and the lack of psychological support (Table 2).

Under the theme “Biopsychosocial Problems After the Earthquake,” almost all participants reported on sheltering problems. The participants revealed that they initially encountered challenges in locating tents and were compelled to remain outdoors. Those who subsequently discovered tents or containers were compelled to reside in an overcrowded environment. Besides, participants reported experiencing food and clothing problems after the earthquake, as well as issues with hygiene and self-care. They mentioned that they could not prioritize their hygiene and self-care after the earthquake, faced toilet and hygiene issues in tents and containers, and had trouble finding sanitary pads. Consequently, participants stated that they encountered an increase in disease incidence due to inadequate hygienic conditions. Communication issues comprise the remainder of the “Biopsychosocial Problems After the Earthquake” category. Participants reported experiencing stress due to being unable to communicate with their relatives via phone and not receiving news. Transportation and organization challenges were major issues. Road closures, assistance delivery delays, inability to arrange aid, and erratic distribution made meeting basic necessities challenging.

Another category within the scope of “Biopsychosocial Problems After the Earthquake” was the lack of psychological support. Some stated they needed psychological support but could not access it in the area.

Experiences for Health Care Workers

The predominant participant feedback was on the level of care provided by health care personnel. Most participants stated that health care workers were attentive after the earthquake. They stated that health care workers took an empathetic approach, provided assistance, mobilized for patient care, prioritized pregnant women, and offered care based on the chaotic environment and individuals’ traumatic experiences. A small number of participants (2) expressed their negative opinions, claiming that health care workers were inattentive, did not provide adequate support, and did not consider the stress that the women were experiencing.

Expectations and Needs of Mothers Affected by the Earthquake

Four codes and three categories were established within the scope of “Expectations and Needs of Mothers Affected by the Earthquake.” These included: the state’s preparedness against disasters, the formation of social support groups, the prioritization and privileging of pregnant and newly postpartum women, and the ethical and organized distribution of aid (Table 2).

The participants excessively expressed their opinion on the state’s preparedness for disasters. The participants underscored the necessity for the state to establish disaster preparedness strategies. Their expectations encompassed the construction of earthquake-resistant homes and the organized and rapid delivery of aid during disasters. Furthermore, the study participants identified several administrative and organizational issues, such as difficulties associated with accessing the bodies of deceased relatives and conducting burial procedures, indicating that their primary expectation was for the government to be more adequately prepared for disasters to prevent similar problems in the future.

The other category within the scope of “Expectations and Needs of Earthquake-Affected Mothers” was the formation of social support groups. Participants expressed the necessity of establishing social support groups that could offer psychological assistance to earthquake survivors after the disaster. Another aspect highlighted by the participants was the prioritization and preferential treatment of pregnant and recently postpartum women, particularly in terms of aid, sheltering, and food delivery. The other expectation was that aid should be distributed ethically and in an organized manner. Participants stressed that post-earthquake aid ought to be provided in a clear, systematic, and uniform manner, under appropriate ethical constraints.

Discussion

While pregnant and breastfeeding women have similar needs to the general population (food, housing, water, basic health services, infection control, and safety), they have some unique characteristics that should be recognized in an emergency. This qualitative study examined earthquake-related experiences and needs that affect postpartum women’s physical and mental health and psychosocial well-being. To this end, in-depth interviews were conducted with 20 women who had been affected by the earthquake and had recently given birth, revealing the multidimensional difficulties and problems experienced by women during and after the earthquake. The study findings were categorized under five main themes: “psychological processes experienced during and after the earthquake”; “biopsychosocial problems experienced after the earthquake”; “experiences related to pregnancy and childbirth”; “experiences for health care workers”; and “expectations and needs of earthquake-affected mothers.

Natural disasters result in multiple adverse physical and psychological health outcomes for women.Reference Fatema, Islam and East32–Reference Hawkins, Gullam and Belluscio34 Current literature emphasizes how natural disasters psychologically affect pregnant women, causing short- and long-term trauma, and increased stress and anxiety.Reference Giusti, Marchetti and Zambri35 A study conducted by Sönmez and DelibaltaReference Sönmez and Türk Delibalta36 in the earthquake-affected regions centered in Kahramanmaraş determined that although the affected women exhibited normal physical health, their mental health was poor, and the majority experienced fear after the earthquake. Qu et al.Reference Qu, Tian and Zhang26 found the overall prevalence of PTSD symptoms to be 12.2% and the prevalence of major depressive symptoms to be 40.8%. Sohrabizadeh et al.Reference Sohrabizadeh, Tourani and Khankeh33 found that all disaster-affected women exhibited depressive symptoms and that stress and anxiety increased owing to disruptions in their daily lifestyles. New mothers frequently experience PTSD in addition to depression after an earthquake.Reference Qu, Tian and Zhang26 Our study discovered that the study participants experienced shock, extreme fear, helplessness, interruption in the grieving process, anxiety, difficulty in anger control, sorrow, burnout, hopelessness, PTSD, and post-traumatic growth during and after the earthquake. Extreme fear was the most prevalent emotional response, especially observed increasingly in women who experienced loss of relatives and property damage.

Damage to the homes following the earthquake, and a shortage of food, water, and materials for children, exacerbated other issues. Disaster studies in pregnant and postpartum women indicate that they exhibit an increased incidence of preterm birth, premature rupture of membranes, and malnutrition.Reference Harville and Do12, Reference Oyarzo, Bertoglia, Avendaño and Bacigalupo37, Reference Yao, Robinson and Zucchi38 Additionally, they experienced mental health issues such as depression, a lack of confidence in childcare, and anxiety about fetal health status.Reference Bloem and Miller39 Social issues such as deterioration of living environments, decline in health service quality, and changes in medical costsReference Traylor, Johnson and Kimmel18, Reference Bloem and Miller39, Reference Suzuki, Sato and Mıyazakı40 were also observed in this demographic. Kyozuka et al.Reference Kyozuka, Murata, Yasuda and Ishii41 reported that pregnancy complications such as gestational hypertension, respiratory diseases, and psychological problems increased in pregnant women during and immediately after the earthquake. Thus, earthquakes cause higher birth complication rates, and these risks lead to mental disorders such as secondary stress factors, especially for peripartum women.Reference Ren, Chiang and Jiang42 Consistent with previous reports, our study discovered that pregnant women directly experienced the physiological effects of the earthquake on pregnancy, including bleeding, pain, the threat of preterm birth, inadequate antenatal check-ups, the absence of fetal movement sensations, and adverse malnutrition outcomes.

Social support is pivotal for resilience, quality of life, and welfare during stressful and emergency situations, but it also helps alleviate depression following an earthquake.Reference Giusti, Marchetti and Zambri35, Reference Ren, Chiang and Jiang42 Like Giusti et al.,Reference Giusti, Marchetti and Zambri35 this study found that the support from partners of pregnant and postpartum women was very strong in the post-earthquake period and stressed the importance of closeness between the partners. Khatri et al.Reference Khatri, Tran and Fisher43 reported high partner support among pregnant women following the Nepal earthquake. The study participants indicated that they became increasingly dependent on their partners during pregnancy and the postpartum period. Most participants expressed the need for social support groups but mentioned that they could not allocate time for maternal roles and highlighted the importance of peer group conversations. Researchers found that gathering around their tents and container homes to share their earthquake-night recollections helped rural women cope with the aftermath.Reference Yoosefi Lebni, Khorami and Ebadi Fard Azar44 Suzuki et al.Reference Suzuki, Sato and Mıyazakı40 found that pregnant and postpartum women felt the tragedy enhanced their relationships and that they needed to build close relationships with familiar people after the disaster. These results reveal that women need psychosocial, peer, and spousal support following the earthquake. Therefore, traumatic life experiences increase the need for trust and loyalty among partners and the community, and positive life experiences during this process become a vital support source.

The current study discovered that although public hospitals provided health care, their damage or use for earthquake victims in emergencies disrupted antenatal care for pregnant women, causing them excessive fear and stress during childbirth. Moreover, it was observed that the support at the discharge was inadequate. One study reported that neglecting women’s health care needs during earthquakes could jeopardize their health and that natural catastrophes left some health and essential needs unmet.Reference Yoosefi Lebni, Khorami and Ebadi Fard Azar44 For efficient disaster response and recovery, pregnant women’s health care needs must be prioritized in planning. Most participants expressed their satisfaction with the care provided by health care professionals during childbirth. Giusti et al.Reference Giusti, Marchetti and Zambri35 reported that most women experienced childbirth as a positive experience and were satisfied with the services provided. The women stated that they were particularly satisfied with the charity and kindness of health care personnel and the care they received as earthquake victims. Similarly, many participants in our study noted that health care workers were empathetic, supportive, mobilized for patient care, prioritized them due to their pregnancy, and offered care based on the chaos in the patient’s environment and their traumatic experiences.

A woman’s previous pregnancy-related experiences also impact childbirth and childcare.Reference Koike, Tsuda and Matsuzawa45 Caregiving in the first two years following childbirth, as well as the need for physical and mental support, are significant. The 2016 Kumamoto earthquake forced many people to live in difficult conditions, such as evacuation centers and cars. Evacuation centers either lacked or had very limited space for breastfeeding or changing diapers.Reference Suzuki, Sato and Mıyazakı40 The approach used after major earthquakes, both globally and in our country, focuses on search and rescue operations. The ensuing panic and organizational issues can delay the provision of services for basic needs such as shelter, toilets, and baths, leaving disaster survivors to endure hardships and fight for survival. The failure to resolve these perpetually increasing problems, which negatively affect individuals’ health, leads to even greater issues.Reference Kipay46 Thus, the emergency shelters may not meet the physical (private toilets, warm environments), privacy, and intimacy needs of women and families.Reference Giusti, Marchetti and Zambri35 The study found that earthquake-affected mothers struggled to achieve their basic necessities. Giusti et al.Reference Giusti, Marchetti and Zambri35 examined the needs of pregnant or breastfeeding women during the Italy earthquake, the lack of breastfeeding support after hospital discharge, and unreliable breast milk supplement donations and distribution. Suzuki et al.Reference Suzuki, Sato and Mıyazakı40 stated that postpartum women experienced additional problems such as malnutrition, the need for infant care support, a lack of suitable environments for breastfeeding and baby care, and anxiety about their babies and other children after the earthquake. Similarly, our study observed that postpartum earthquake survivors expressed concerns and anxiety about shelter, food, clothing, hygiene, self-care, increased illnesses, transportation, organization, and communication issues. Due to these issues and the demands of parenting, women are raising their babies in difficult situations. It is anticipated that these biopsychosocial, multifaceted adversities may threaten the mental and cognitive health of mothers and babies in the short and long term.Reference Qu, Tian and Zhang26, Reference Abdullah, Alsulaiman and Sarraj47 Given our country’s disaster and earthquake susceptibility, a comprehensive plan needs to be urgently implemented to mitigate future seismic damage and destruction. The experiences and lessons learned from this earthquake may help planners prioritize the above efforts in the future.Reference Biswas, Rahman Mashreky and Dalal48

In our study, earthquake-affected mothers expected that the state should be prepared for disasters, social support groups should be established, aid should be organized according to ethical rules, and priority and special consideration should be given to pregnant and recent mothers. Abdiani et al.Reference Abdiani, Tamtomo and Prasetya49 found that robust governmental support for affected mothers after the Indonesian earthquake significantly reduced postpartum depression. The broad estimates of the prevalence of mental health issues during pregnancy post-earthquake are evidently dependent on local conditions and post-disaster responses.Reference Dai, Chen and Lai7, Reference Khatri, Tran and Fisher43 Therefore, post-earthquake disaster logistics procedures are an essential stage of disaster management. However, the challenges experienced during the earthquakes in Kahramanmaraş and Hatay demonstrated that disaster logistics processes were neither sufficient nor effective, leading to serious issues.Reference Pelit50 According to earthquake-affected individuals, including mothers, post-disaster rescue operations are poorly coordinated and basic survival necessities like shelter and food could not met.Reference Yalçın51

This study has multiple limitations. The necessity of conducting meetings with earthquake victims in the hospital or at their residences was challenging due to time constraints. The study results are limited to the sample group included in the study and cannot be generalized. Moreover, during the data collection process, the emotional sensitivity of the participants heightened when sharing their experiences, which was challenging for both the researchers and participants during and after the interviews.

Conclusions

The results of this study reveal that earthquakes have negative effects on pregnant women and mothers who have given birth in a biopsychosocial multidimensional way. It has been revealed that women have a hard time coping physically and psychologically during this process. Their urgent needs for shelter, food, clothing, hygiene, and care are not adequately met, and the psychological interventions necessary to help them cope with their negative experiences are not initiated early enough. The results highlight the need to prioritize the biopsychosocial needs of pregnant women and women who have given birth, one of the post-earthquake vulnerable groups, and the importance of planning effective interventions by organizations before and after earthquakes in a timely and adequate manner.

In conclusion, pregnant and postpartum women expect all disaster-related activities to be planned and for the relevant authorities and institutions to provide their support regularly and urgently after an earthquake, during the preparation, immediate response, and recovery phases. While basic requirements and medical care are supplied early on, trauma psychological impacts should be assessed. In addition to societal and cultural limitations, women’s health requirements like menstruation, pregnancy, and breastfeeding should be considered during natural disasters.

Acknowledgments

We are grateful to the TÜBITAK-1002 module program for their funding support. We would also like to express our thanks to all earthquake victims who participated in the research.

Author contribution

Study conception and design: RO, RAE; Data collection: RAE; Data analysis and interpretation: RO, RAE; Drafting of the article: RO; Critical revision of the article: RO.

Funding statement

This study has also been funded as a project support from the TÜBİTAK 1002-B Emergency Support Module.

Competing interests

No potential conflict of interest was reported by the author(s).

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Table 1. Overview of the themes and subthemes

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Table 2. Themes identified through interviews with the study participants