Impact of flood on maternal health in rural Hyderabad, Pakistan: A mixed-methods study

This study investigates the impact of flooding on maternal health outcomes among pregnant women in rural Hyderabad, Pakistan, using a mixed-methods approach combining retrospective facility record analysis (pre- and post-flood data), quantitative surveys (n=400), and qualitative interviews (n=10). Pre- and post-flood comparisons of facility records revealed severe healthcare disruptions, with antenatal care visits declining by 60% (120±25 to 48±18/month, p<0.001) and cesarean section availability dropping from 90% to 35% post-flood. Neonatal mortality nearly tripled (12 to 34 deaths/1,000 live births, p=0.002) based on health facility data. Flood-exposed women showed significantly higher stress levels (β=3.8, p<0.001), food insecurity (β=2.3, p<0.001), and reduced satisfaction with healthcare access (2.1±1.0 vs 8.3±1.3, p<0.001). Effect sizes (Cohen's d) and β coefficients were derived from multivariate regression and between-group comparisons, with models adjusted for confounders such as income, education, and access to transport. Qualitative findings identified three key themes: (1) transportation and infrastructure barriers, (2) profound psychological distress, and (3) reliance on traditional midwives due to system failures. The study highlights critical gaps in emergency preparedness and maternal health knowledge, with flood-affected women scoring significantly lower on measures of health awareness (e.g., 3.2±1.5 vs 7.5±1.4 for water purification knowledge, p<0.001). These findings demonstrate the urgent need for flood-resilient maternal health services and targeted community education programs in vulnerable regions.