Women’s Lived Experiences of Flood Disaster and Implications on Health and Nutrition: A Qualitative Study in South Punjab, Pakistan

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Objective: This qualitative study explores women’s lived experiences of climate change and its implications for maternal and child health and nutrition in flood-affected regions of South Punjab, Pakistan. Methods: Twenty-one semi-structured interviews were conducted with women in the Rajanpur district of Punjab province. Participants took part in face-to-face interviews in disaster settlement shelters. Qualitative data were analyzed using thematic analysis. Results: The findings highlight the heightened vulnerabilities of women in this marginalized region of the province during flood events. Participants reported that the 2025 floods in rural South Punjab generated multiple, interrelated challenges to women. These included disruptions to breastfeeding (BF) practices—such as reduced BF frequency due to limited access to food and water, as well as breast infections (mastitis), possibly resulting from the stressful conditions in the settlement shelter. Flood-related displacement also adversely affected girls’ and women’s hygiene, marked by the lack of adequate water and menstrual hygiene products and inadequate sanitation in temporary shelters. In addition, women reported experiences of sexual harassment linked to open shelter arrangements. Pregnant women experienced miscarriages and stillbirths, while postnatal infants faced increased mortality due to hypothermia and vector-borne diseases, including malaria and dengue fever. Conclusions: The study underscores the urgent need for robust disaster preparedness and targeted, gender-responsive interventions. Beyond economic losses, floods have profound and lasting social, emotional, and health-related consequences for vulnerable women and children in South Punjab, Pakistan. Climate change flood women’s health maternal and infant health sexual harassment disaster displacement Pakistan Figures Figure 1 Figure 2 1. Introduction Climate change has become a great threat to public health (1). Extreme rains, floods, cyclones, rising ocean temperatures, droughts, and hurricanes have negative effects on community health, occupations, economies, and the atmosphere. Asia faced more catastrophes than any other continent. The disaster-related vulnerability is exacerbated in marginalized societies due to deficiencies in resources, poverty, and inequality, which can transform this vulnerability into a calamity (2). Extremely warm or freezing temperatures can raise the hazard, such as abortions and children being delivered too soon. Also, infections might spread, and the health of mothers, infants, and the delivery and pregnancy can be affected due to climate change (3). Both vector-borne and water-borne illnesses, such as malaria, dengue fever, and diarrhea, have been detected to increase the morbidity and mortality ratios among pregnant females and infants (4). Studies show that malaria during the perinatal period can be a threat to infants and mothers, and malaria transmission spikes in disaster settlement sites. Miscarriages, anemia, low birth weight, immediate birth, and even the death of the mother or newborn may happen (5). In flood-affected areas, mothers would like to have additional support to encourage them to breastfeed their infants to save the newborn's health and well-being (6). Mothers could have a higher perception of lack of enough breastmilk to feed their baby because of hunger and anxiety. They felt weakness and suffered from an inadequate diet and stress of flood and displacement, so they thought they could not feed their infants properly (7). Breastmilk is not only important for nourishment but is also helpful in disasters such as floods (8). Females and girls suffered from infections because of the absence of sanitary commodities during menstruation (9). Ethnic restrictions have made menstrual hygiene and sanitation still tougher to approach. Current floods in Pakistan have made it more difficult for women and teenagers to control their cycles securely, which affects their strength, dignity, and well-being (10). Respiratory and diarrheal diseases spread due to ineffective hygiene (11). WASH retrieval plans emphasize educating people about health, changing communal ways and attitudes towards open defecation, and engaging the entire public to share a collective responsibility for restoring communal well-being, hygiene, and power (12). Research showed that during the flood in Assam and India, women suffered from physical and sexual violence (13). Women's vulnerability increased if they are young, widows, have an illness, or are from a lower background (14). Inequality within the community is a major cause of suffering for some, but not others (15). Females reportedly die in disasters at greater ratios than males (16). Poverty, inadequate aid in relief shelters, caregiving duties, lowered access to supplies, and misguidance are the natural distinctions in which females suffer (17). Rural Southern Punjab is a highly underdeveloped region of Punjab Province in Pakistan, characterized by a scarcity of hospitals and healthcare professionals. In its southern districts, young people lack access to basic essential services such as health care, education, clean drinking water, healthy cuisine, and proper hygiene. These deficiencies have led to general health crises, with diarrhea and malnutrition amongst young children (18). Unemployment, poverty, and illiteracy among women often lead to gender-based violence (19). Rajanpur District in South Punjab lies along the western bank of the Indus River and at the foothills of the Sulaiman Mountain Range, a geographic location that renders it highly vulnerable to recurrent flooding. During the monsoon season, intense rainfall and mountain runoff from the Sulaiman Range converge with rising water levels in the Indus River, resulting in frequent and severe floods. These recurrent flood events have caused extensive damage to agricultural land, transportation infrastructure, healthcare services, and local livelihoods, disproportionately affecting already marginalized communities. While existing research in Pakistan has largely focused on the physical and economic impacts of flooding, qualitative studies that document the gendered vulnerabilities and lived experiences of women, particularly in relation to social disruption and health consequences, remain scarce. This study addresses this critical gap by examining the lived experiences of women affected by recent flood disasters in marginalized areas of South Punjab, with particular attention to the social and health impacts of flooding on women’s well-being. 2. Methods Study Design, Sampling, and Inclusion Exclusion Criteria This study employed a qualitative research design. Purposive sampling was employed to select respondents, including those from towns that were remote and received no aid from the government. The study was conducted in the displacement centers of different villages of Rajanpur district, which were severely affected by the 2025 flood disaster. These villages include Bursa Abad, Kacha Daraigh, and Kotla Bakhu ( Figure 1 ). The participants were informed about the nature of the study, and consenting participants were asked about their experiences of the flood and impacts on reproductive, maternal, and child health, breastfeeding (BF) experiences, hygiene and sanitation, and women’s vulnerabilities during the flood (Supplementary File 1 ). The study included only those participants who were mothers, or were pregnant, or lactating. We selected both young and older rural women between the age of 18 and 45 from the most marginalized areas of South Punjab. In total, 30 respondents showed their consent to participate in the study, but the final report was compiled from 21 participants. Data collection ended after data saturation was met. ( Table 1 ). Table 1: Respondents' Sociodemographic Information Respondent Age Education Income (PKR) 1 25 No formal education 30k 2 18 Primary 25k 3 34 8 th grade 35k 4 40 Matric 30k 5 30 No formal education 20k 6 29 Middle 22K 7 40 No formal education 30k 8 44 No formal education 30k 9 20 Primary 25k 10 31 8 th grade 35k 11 45 Matric 30k 12 19 No formal education 20k 13 24 Primary 35K 14 37 No formal education 30k 15 43 No formal education 30k 16 42 Primary 25k 17 32 8 th grade 35k 18 26 Matric 30k 19 41 No formal education 20k 20 22 No formal education 30K 21 20 No formal education 30k Interviews and Data Collection Procedures Data were gathered through semi-structured interviews. Interviews were conducted at disaster displacement sites inside temporary settlement tents where participants felt secure and relaxed. The interviews were conducted in the local Seraiki language, lasting between one and two hours; during the interviews, we tried to maintain a humble and pleasant atmosphere. Participants were asked questions related to the cause of the death of infants in a flood, and sufficient food for mothers’ better health and BF frequency. We investigated how health and hygiene in public toilets were maintained. We also asked how women maintained their hygiene during menstruation and other serious challenges faced by females during the flood. They were informed that they might take a rest or leave the interview at any time and could take pauses when they experienced unease. Thematic Analysis Procedure Braun and Clarke’s structure was employed to perform the thematic analysis (20). All 21 semi-structured interviews and fieldnotes were translated from the local language into English. After gathering data from applicants who gave their consent, researchers went through the transcription cautiously, and a coding procedure was developed. Then the recoded interviews were written down. To recognize deep views, two researchers (FA and NIM) employed NVivo software to code the qualitative data line by line. Through repetitive conversations, two authors (FA and SZ) arranged connected codes into themes and simplified them. The original data were verified, besides the final themes as shown in Figure 2 . The researchers preserved clarity and precision by recognizing significant awareness from participants' shared experiences. For a better identification of the participants' scrutiny, the thematic analysis helped arrange and clarify complicated data in depth. The four major themes and multiple codes relevant to each theme have been described below ( Figure 2) . Ethical Consideration The research was conducted in accordance with the Declaration of Helsinki, and the ethical approval for this research was granted by the Department of Anthropology and the Institutional Human Ethics Committee (IHEC) of the Office of Research and Innovation Commercialization (ORIC) in the Islamia University of Bahawalpur (IUB/ORIC/449; Approval date: 28/10/2025). All of our study participants were first informed about the research nature, and then their willingness to contribute to the study was obtained from the respondents. Confidentiality, anonymity, and privacy were completely warranted. We did not reveal the actual names of participants to protect their identities. Furthermore, the anonymity of study participants was maintained through the use of pseudonyms. 3. Results The four major themes and multiple codes relevant to each theme are shown in Table 2: Table 2: Major Themes, Descriptions of Themes, and Codes Major Theme Description (Climate & Gender Lens) Significant Codes 1. Miscarriage, stillbirth, and infant mortality due to flood-induced disruptions First theme highlights how climate change–induced flooding intensified pregnancy risks and infant mortality through restricted mobility, physical trauma, exposure to infectious diseases, and the collapse of maternal health service access. Flood conditions changed routine childbirth into a life-threatening event for both mothers and infants. Disrupted access to obstetric care during floods, including transportation barriers and delayed evacuation, leading to stillbirths and infant deaths. Pregnancy loss and obstetric complications linked to flood-related stress and physical strain, such as anxiety during evacuation, prolonged walking through deep floodwater, and resulting premature rupture of membranes. Pregnancy loss due to flood-related physical injuries, including trauma from environmental debris encountered during displacement. Post-birth infant mortality associated with flood exposure, including hypothermia and increased vulnerability to vector-borne diseases. 2. Disruption of proper breastfeeding and infant nutrition practices during and after flood disasters Second theme examines the nutritional costs of flooding on infant feeding practices. Maternal undernutrition, dehydration, mental trauma, lack of privacy, and unsafe water collectively reduced mothers reported breastfeeding difficulties and compromised infant health and survival. Maternal undernutrition and dehydration during displacement , including insufficient food intake and limited access to fluids. Breastfeeding challenges linked to physical exhaustion, hunger, and lack of privacy , making it difficult for mothers to initiate or sustain breastfeeding. Perceived reductions in breastmilk production associated with disaster-related psychological stress and disrupted living conditions. Increased risk of infant diarrheal infections, linked to contaminated water sources and poor sanitation in flood-affected settings. 3. Compromised women’s health and hygiene in displacement settings Third theme reflects how flood-related displacement exposed women to unhygienic living conditions, increasing their vulnerability to infections, reproductive health problems, and psychological distress due to the absence of gender-sensitive sanitation and menstrual hygiene resources. Exposure to insects and disease vectors , including mosquitoes, due to unsanitary shelter conditions and poor environmental hygiene. Limited access to menstrual hygiene materials , constraining women’s ability to manage menstruation safely and with dignity. Increased risk of reproductive and urinary tract infections , associated with the use of shared, overcrowded, or poorly maintained public sanitation facilities. 4. Increased gendered vulnerabilities in post-flood situations Fourth theme reflects the increased risks of gender-based violence following flood-related displacement, where overcrowding and weakened social safety contributed to harassment, domestic conflict, and physical and sexual violence against women. Verbal harassment and humiliating treatment in displacement sites, contributing to fear, stress, and loss of dignity. Heightened family conflict and domestic tensions, often exacerbated by overcrowding, stress, and resource scarcity. Exposure to physical and sexual violence, particularly in insecure or poorly supervised displacement settings. Theme 1: Miscarriage, stillbirth and infant losses attributed to flood disaster Flood conditions severely compromised maternal and infant survival. Some women were forced to give birth on roads while attempting to flee rising waters, resulting in stillbirths. Others sustained physical injuries from falling trees and floating debris while crossing deep and fast-moving floodwaters during pregnancy, increasing the risk of pregnancy loss and obstetric complications. In addition, infants and young children died from fever and vector-borne diseases, reflecting heightened exposure to mosquitoes, delays in access to medical care, and the collapse of basic health and sanitation services during and after the floods. Explaining these multifaceted impacts of flood disaster, a young women state: “It was my 9th month of pregnancy. During the flood, my labor pains started, so my husband transported me to health care providers in the city on a donkey cart. First, I approached a lady doctor in a public hospital. She said, ‘Your hemoglobin is very low, and she can’t handle this case.’ Then, we went to another government hospital, and the doctor says [we can’t handle this here] it is a private hospital case’. So we went to a private hospital, the doctor checked and informed us that it was a baby boy, but the fetus was dead in the womb. All of my hopes were ruined because I was able to be pregnant after seven years.” (25-year-old woman) A different older woman reported the same: “It was eight months of my pregnancy. Because of the shocking trauma of the flood and thinking about my home and cattle, I felt stressed and worried as we had to leave our home and cattle. Rescue 1122 rescued as to the nearest shelter. After a while, I started feeling pain in my abdomen, but I thought it [wouldn’t be labor as it] was my eighth month, so I decided not to worry. But the pain persisted and increased, and no doctor was there, so I had to deliver the fetus on the road. My baby was not breathing.” (30-year-old woman) During the flooding, unexpectedly heavy and rapidly rising waters inundated homes with little or no warning. The force of the water entered living spaces, placing entire households at risk, including pregnant women and young children, some of whom were in danger of drowning. The suddenness of the flood caused intense shock, fear, and disorientation, disrupting daily life and exposing residents to immediate physical harm. Two interviewed women vividly described the trauma of this experience and the profound ways in which the flooding affected their sense of safety, well-being, and pregnancy, as reflected in the accounts below. “I was sleeping with my family members. My husband shouted, ‘The heavy water is coming, we will not survive. In the meantime, we were all floating in water. I tried to catch a branch of a tree, but it hit my belly. It was my five-month delivery. After a few hard hours, we arranged private ships. I survived, but my five-month-old infant in my belly couldn’t.” (20-year-old woman) “It was my last month of pregnancy, after looking through the cattle, my husband said, “The flood might have come to our side. So, pack your important items, and in a hurry,” we soon realized that the wall fell and water came in. It was so sudden that we could not understand what to do. I caught my 2-year-old son and rushed into the water. I felt something from my uterus, but I didn't take this seriously. I told my husband I could not cross the water because I felt pain in my belly. I delivered my infant under the tree with the help of the village women. It was the baby girl who was not able to take her first breath and weep. She took one hiccup and died into my lap.” (24-year-old woman) Two interviewed women described how the flooding created conditions that heightened the risk of illness, including exposure to cold, unsanitary environments, and increased contact with disease-carrying vectors. They explained that prolonged exposure to flood waters and inadequate shelter led to hypothermia, while stagnant water facilitated the spread of vector-borne diseases. According to their accounts, these overlapping health risks contributed directly to severe illness and, in some cases, to the deaths of infants and young children, underscoring the profound and life-threatening impacts of the flood on vulnerable populations. “I delivered my infant in the shelter. He was healthy, but after two days, his skin and lips turned purple. There was no doctor here in the emergency shelter. He feels cold due to a defective shelter. I ran here and there so that my infant would be saved. I saw 1122 rescue teams come to my shelter. I hoped that my baby would be alive. But the rescue team said that because the shelter was open, your baby was suffering from hypothermia. He soon died.” (32-year-old woman) “I have 5 children. Mosquitoes bite us, and my infant died in a shelter due to a mosquito bite. It was a very painful situation for me to see my infant with a fever, runny eyes, and continuous crying. Now I am afraid my other children will catch this fever.” (36-year-old woman) Theme 2: Challenges to Breastfeeding and Infant Nutrition During and After Flood Disasters Women reported significant difficulties in breastfeeding under the unhealthy conditions in displacement and shelter settings, citing shortages of adequate food and clean water as major challenges. Many explained that they were forced to reduce meal frequency or consume insufficient and low-quality food, which they believed directly contributed to reduced breastmilk production. In addition to nutritional deprivation, women described how flood-related trauma, stress, and exhaustion further undermined their confidence in the adequacy of their breastmilk. Three interviewed mothers detailed their experiences below, illustrating how the combined effects of food insecurity, poor living conditions, and psychological distress adversely affected breastfeeding practices and infant feeding. “Every time I eat rice, as there are no milk, meat, eggs, or nuts. Also, there is no clean drinking water. My breasts produce no milk now. My infant and I have become weaker day by day. In this disaster, no food was provided to us by the government. I am worried about skipping my meal. I am hungry, that’s why my infant is without breast milk.” (18-year-old woman) “Before the flood disaster, my health was good. As we had our cattle, I used to drink milk sufficiently and regularly before lactating my infant. But here in the temporary shelter, breastfeeding practice is almost limited because we have only bought chicken and rice. I feel it is a good diet that can make breastmilk more frequent. When you are hungry, it is impossible to breastfeed the baby.” (29-year-old woman) “My baby is tired to suck my empty breasts . There is no milk. It is just like deflated balloons. My infant has a skinny body. He has lost his bones. He looks malnourished. When I would eat something, then I would be able to breastfeed my baby; otherwise, it is difficult.” (31-year-old woman) In situations where breastfeeding was not possible, mothers reported being advised to use infant formulas. However, the lack of access to clean and safe drinking water made safe formula preparation extremely difficult. As a result, several infants reportedly developed diarrheal illnesses linked to contaminated water and poor sanitation conditions. One interviewed woman described this experience as follows, highlighting the risks faced by infants when alternative feeding methods were used in unsafe environments: “My baby was on breastfeeding, but my milk dried up due to the disaster. Though the government provided infant formula milk for infants in limited quantity, due to a lack of pure water and poor sanitation, my baby suffered from diarrhea. (37-year-old woman) Flood-related displacement further exacerbated challenges to women’s privacy, directly impacting their ability to breastfeed properly. Lactating mothers often seek private spaces to feed their infants comfortably and safely, but the crowded and makeshift conditions in flood relief tents provided little to no privacy. This lack of privacy created stress and discomfort, making breastfeeding more difficult and affecting both mothers’ confidence and infants’ nutrition. One mother described her experience as follows: “Tent is not my home [has no privacy]; here I feel reluctant to breastfeed my baby. My baby is hungry, and he is beating my breast with his head. What should I give him to feed?” (26-year-old woman) Theme 3: Impact of Poor Sanitation and Hygiene in Displacement Settings on Women’s Health The analysis identified three primary subthemes (codes) within this overarching theme. First, women experienced heightened exposure to insects and disease vectors, including mosquitoes, due to unsanitary shelter conditions and poor environmental hygiene, which increased their vulnerability to infectious diseases. Second, limited access to menstrual hygiene materials constrained women’s ability to manage menstruation safely and with dignity, exacerbating stress and discomfort in already challenging circumstances. Third, the use of shared, overcrowded, or poorly maintained public sanitation facilities elevated the risk of reproductive and urinary tract infections, further compromising women’s health and well-being during displacement. Collectively, these subthemes illustrate how environmental, infrastructural, and resource-related challenges intersect to create significant reproductive and general health risks for women in flood-affected shelters. When the floodwaters receded, the environment in displacement shelters became increasingly hazardous due to the proliferation of mosquitoes, flies, bugs, and beetles. These insects thrived in the unsanitary conditions and stagnant water left behind, significantly raising the risk of infections among mothers and infants. One woman described how waste and garbage were scattered around the shelters, attracting swarms of biting insects that disturbed their sleep and contributed to illness. Another mother recounted her struggle with controlling the mosquito population, explaining that her young son contracted malaria and required antimalarial medication as a result of the unhealthy shelter environment. These accounts highlight the persistent threat of vector-borne diseases and the added burden they impose on women’s health during displacement. “Waste material and garbage sets are scattered all around the shelters. The flood water produced mosquitoes and beetles that bite us all night. ” (40-year-old woman) “In shelters, there is an unhealthy atmosphere. We cannot control these mosquitoes. My three-year-old son is suffering from malaria and is taking antimalarial medicine.” (34-year-old woman) Addressing the limited access to menstrual hygiene materials, which constrained women’s ability to manage menstruation safely and with dignity, one woman elaborated. I have no pads for my girls and myself. In the emergency shelter, outsiders and males often come inside. Girls feel shame, stress, and anxiety. My girls are sitting in one corner of the shelter so that no one sees them. I have provided some old shirts of mine to control the blood flow.” (45-year-old woman) Although a few NGOs have made efforts to support flood-affected communities by constructing temporary toilets, their use often remains fraught with risks. The safety and cleanliness of these facilities are frequently inadequate, exposing women and children to the dangers of unsanitary conditions, lack of privacy, and the potential for disease transmission. As three interviewed women shared, these temporary toilets do not always provide a secure or hygienic environment, leaving users vulnerable to infections and discomfort. The challenges are heightened by overcrowding, poor maintenance, and the absence of gender-segregated spaces, which together contribute to feelings of insecurity and distress among women seeking basic sanitation during displacement. “My eighteen-year-old daughter suffered from a urinary tract infection. She feels vaginal itching and weeps. It is because of using unclean public toilets. Also, there is no separation between the women's toilet and the men's.” (43-year-old woman) “My whole family is struggling with infections. My 3-year-old son has a respiratory infection, my daughter has a skin allergy, and my elder son has the flu, cough, and sneezing due to filth.” (41-year-old woman) “In emergency shelters, bathing is impossible. We have itching, but we have no option except using these public washrooms. We wish we could return home soon.” (38-year-old woman) Theme 4: Sexual Harassment, Physical and Sexual Assaults, and Domestic Violence Against Women in Displacement Shelters Sexual harassment poses significant and distressing challenges for women during flood disasters. Many women and girls report feeling unsafe, particularly when leaving the shelter, as incidents of harassment from men are prevalent. The pervasive sense of fear and vulnerability profoundly impacts their daily lives throughout these trying times. Mothers, in particular, are compelled to be extremely vigilant to protect their daughters from potential threats, often restricting their movement and activities to ensure safety. This constant anxiety and the need for heightened caution add an additional layer of hardship to an already difficult situation. In interviews, women shared personal accounts highlighting the seriousness of sexual harassment in displacement settings, emphasizing the urgent need for protective measures and support for affected women and girls. “Shelter is not as safe as our home. My twenty-year-old daughter, whenever she goes to the washroom, boys taunt her with ill-mannered comments.” (40-year-old woman) “There are a lot of girls and women in the shelter. Mothers are engaging in other chores. I observe that girls and women have a man phobia, because of the boys' bullying remarks to the women.” (44-year-old woman) Incidents of domestic violence also became more common among many families, with numerous individuals reporting increased arguments and conflicts fueled by heightened frustration, anger, and a pervasive sense of insecurity stemming from their circumstances. One woman further elaborated on her experience: “I am a newlywed girl, but there is no privacy in the shelter. Some elderly women quarrel with me over petty issues. They ordered me to broom the shelter; otherwise, we will not accept you. I wish this disaster time ends soon” (19-year-old woman) Women are also at risk of experiencing physical and sexual assault within temporary shelters. Mothers frequently express fear for the safety of their daughters, worrying that they may be particularly vulnerable to such threats in emergency tents. One woman recounted the following incident: “One boy offered me friendship on behalf of saving me and my family's lives in the flood. But I refused him. He felt anger and felt insulted at rejection. He threw a rock towards me that injured my face” (20-year-old woman ) 4. Discussion During flood events, access to healthcare facilities is severely constrained, and pregnant and lactating women face compounded challenges throughout pregnancy, childbirth, and the postpartum period, which can be more problematic in disaster settlement areas. Our findings highlight multiple, interrelated difficulties experienced by women in flood-affected settings, including disrupted access to antenatal, delivery care and postnatal care, shortages of essential medical supplies, increased physical strain, heightened psychosocial stress, and reliance on informal or delayed care. These challenges not only undermine maternal health and well-being but also exacerbate existing social and health inequities, placing pregnant and lactating women at heightened risk during humanitarian emergencies. 4.1. Infant mortality due to flood water Studies show that infant mortality in flood areas is 8% higher compared to non-flood areas (21). Mothers faced trauma on the infant's death; however, self-belief, social relationships, and sensitive change help them to deal with problems (22). Our findings reveal that when women feel anxiety during pregnancy, they can lose their infant. Absence of appropriate accommodations to support mother and infant during and after delivery, particularly in disaster settlement settings with poor hygiene and sanitation resources, can exacerbate conditions leading to infant death (23). A study found that environmental transformation and dangerous climate experiences can cause compromise to newborn and infant wellbeing (24). A previous study estimated that floods have affected almost 8 million females and 16 million infants in Pakistan. Pregnant women and newborn babies need immediate therapeutic and reproductive help (25). Females suffered from the unavailability of reproductive health support and could not get the basic sterile, sanitation, and childbearing equipment (26). A study from Nigeria supports our result: women who faced challenges like the absence of facilities, the unavailability of roads and conveniences, reliance on midwives, problems in searching local hospitals, lack of support from NGOs, and incorrect route from health workers cause infant death (27). Our results that hypothermia in neonates during floods caused death are similar to studies from Southern and Northeastern Ethiopia. These studies elaborate that inappropriate thermal care in disaster settlement settings causes hypothermia, which is a main reason for neonatal mortality in low-income countries (29). Also, vector-borne diseases cause death in newborns. Evidence from Latin America showed that malaria, dengue fever, epidemic cholera, and lung diseases affected displaced people (30). Another study from Gaya and Shahpori Islands discussed that vector-borne illnesses produced challenges to global health, especially in low- and middle-income countries because of poor well-being, inadequate care, and weak monitoring (31). 4.2. Breastfeeding (BF), including BF frequency during crises The second theme of the study discusses the impact of floods on BF and BF frequency. Women reported having minimal milk production because of an inadequate diet, stress, and anxiety, which impacts the breastfeeding frequency of BF. Other studies from Pakistan also support our results (32). Research from Abruzzo, Italy, also shows that feeding practices of infants and young children are significantly affected in emergency conditions (33). A study from northern Pakistan, a geological area prone to natural disasters, also revealed that mothers were in danger of quitting breastfeeding (34). A study from Tanzania said that climate change can pose a great risk of issues during pregnancy and after pregnancy, such as dead babies, early delivery, and low breastmilk production (35). A study from marginalized South Punjab, Pakistan, elaborated that whenever mothers feel stress, work burden, and weakness, they perceive that their breastmilk production is very low, as well as the quality is poor and inadequate (36). Water insecurity affects hygiene, sanitation, and lactation procedures between breastfeeding mothers, causing malnutrition (37). Literature showed that floods caused vector-borne diseases in Khuzestan Province of Iran (38), Flu, malaria, diarrhea, and pneumonia in Ethiopia (39), chronic diarrhea and malnourishment in Andean Peru and Bolivia (40, 41). 4.3. Hygiene after disaster Our findings are consistent with the evidence, which shows that women and young girls living in flood-affected areas of Bangladesh face great challenges in maintaining their menstrual hygiene. This causes a serious impact on their well-being, self-respect, and overall health (42). Some results showed that women faced urinary tract infections due to using public toilets. Studies from other floods also similarly indicate that women in flood-prone areas suffered a big challenge of urinary tract infections, which has not attracted attention (43). From higher-income countries, a study found that community locales such as rainwater cascades, bathrooms, hand-washing sections, and showers are restricted, often not effective, and occasionally insecure or polluted for displaced families (44). Unfortunately, ethnic patterns make it disgraceful for them to wash or dry their clothing in the presence of males within the tant. Women are often forced to use outdated or waste samples of fabric to stop the menstrual period. Due to inadequate skills and a lack of suitable funds, they cleanse these garments using floodwater to eliminate the blood (45) 4.4. Post-floods harassment and sexual violence. As many women expressed, the girls faced bullying remarks from the males in shelters. The parents disliked such an atmosphere. Research has exposed how bullying can lead to sensitive or spiritual upset (46). Moreover, quarrels were reported inside saturated shelters. Literature showed that the main reasons for quarrels in floods are the previous experiences, cautions for floods, housing situations, camps, and their economy. How the community realizes and responds to floods depends on their knowledge, beliefs, and ability to deal with such disasters. Reasons for violence in floods are owing to poverty, homelessness, gender discrimination, crowded shelters, deficiency of protection in floods, and inadequate approach to health care are the main reasons for gender-based violence (47). According to Oxford Research Encyclopedia of Natural Hazards, in Iran, Japan, Australia, and Pakistan, the ratio of gender-based violence may be different before floods, but in disasters and floods, the same thing happens everywhere, supposing females to sacrifice, mitigating males’ violent performance, and accusing sufferers (48). 4.5. Limitations and Strengths of the Study Limitations of the study While this research provides critical insight into the profound suffering experienced by women during flood events and the far-reaching effects of climate change on their health, several limitations should be acknowledged. First, the findings are based on participants' self-reported experiences and perceptions, which may introduce subjectivity and potential biases. These personal accounts, while invaluable for understanding lived realities, might also lead to an overemphasis or underrepresentation of certain issues due to recall bias or emotional responses during interviews. Additionally, the qualitative nature of the study, with its focus on in-depth exploration of individual incidents and coping mechanisms, limits the generalizability of the results to broader populations. The sample size, though diverse in age, background, and profession, may not fully capture the range of experiences and challenges faced by all women in flood-affected regions. Furthermore, logistical constraints in disaster settings, such as restricted access to certain areas or populations, may have influenced the breadth and depth of data collected. Despite these limitations, the study offers a nuanced interpretation of the experiences, observations, and adaptive strategies of women affected by floods, contributing valuable perspectives to the understanding of gendered vulnerabilities in disaster contexts. Strengths of the Study One of the primary strengths of this study lies in the diversity and richness of its participant pool. By engaging 21 individuals from varied age groups, professional backgrounds, and social categories, the research captures a broad spectrum of perspectives and experiences, enhancing the credibility and depth of the findings. The study’s methodology, including using female interviewers, fostered a safe, open, and supportive environment, encouraging participants to candidly discuss complex and sensitive issues—including gender-based vulnerabilities, income disparities, and health challenges—without reservation. This approach not only facilitated the collection of genuine, real-life narratives but also ensured that the data reflected honest accounts of lived experiences. The research offers a valuable framework for informing local disaster management programs, health interventions, and gender-sensitive policies, providing actionable insights for supporting vulnerable populations in flood-affected regions. By centering the voices of those most impacted, the study contributes significantly to the understanding of gendered vulnerabilities and supports the development of more effective, inclusive disaster response strategies. Conclusion Women in marginalized districts of South Punjab, Pakistan, encounter a range of interconnected challenges when floods impact their communities. This study illustrates how disasters can disrupt many aspects of daily life, increasing health, social, and psychological risks. Floods may contribute to adverse maternal and infant health outcomes, including cases where women experience infant loss, while ongoing food insecurity can affect nutrition and breastmilk production. Physical strain and limited access to nutritious food can influence the well-being of mothers and children, raising vulnerability throughout and following the disaster. Temporary shelters and settlements sometimes lack adequate hygiene and sanitation facilities, which can contribute to reproductive and urinary tract infections among women and girls. Overcrowded living conditions may also exacerbate these health risks and complicate recovery and daily routines. Displacement, crowded shelters, and diminished social protections during floods may also heighten the risk of harassment, gender-based violence, and attempted sexual assault. The findings of this study suggest a need for disaster response strategies that prioritize women’s health, safety, and dignity. Integrating psychosocial and emotional support services, particularly for pregnant women, mothers, and adolescent girls, into emergency response plans could help address trauma and stress resulting from displacement and loss. Additionally, effective implementation of policies and protections against harassment, gender-based violence, and sexual assault remains important during disaster response and recovery. Training programs and community-based preparedness initiatives that encourage cooperation, safety, and good hygiene practices may further support resilience among flood-affected populations. Focusing on reducing gendered vulnerabilities and supporting equitable, woman-centered disaster preparedness and response may contribute to safer and healthier communities in Pakistan. Declarations Conflict of Interest The authors state no conflicts of interest are involved in the study. Author Contributions The Authors’ contribution is as follows: Conceptualization and data collection: F.A., S.Z., and A.Y; methodology: F.A., RA., N.I.M., F.A., S.Z., and Y.A.T.; data analysis: F.A., R.A., SZ., A.Y., H.A.S. and Y.A.T; supervision: F.A., N.I.M., and H.A.S.; writing—original draft: F.A and S.Z.; writing—review and editing: F.A., R.A., N.I.M., F.A., A.Y., H.A.S., and Y.A.T. All authors have read and agreed to the published version of the manuscript. We will be thankful for your consideration. Funding This research received no external funding. Acknowledgments We acknowledge the study respondents for sharing their lived experiences. Data Availability The original data presented in this study are included in the article. Further inquiries can be directed to the corresponding author(s). Ethical approval and consent to participate This study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Department of Anthropology and Institutional Human Ethics Committee (IHEC) of the Office of Research and Innovation Commercialization (ORIC) in the Islamia University of Bahawalpur (IUB/ORIC/449; Approval date: 28/10/2025). We took informed consent from all participants involved in the study. Their opinions, experiences, and sensitivities were treated with the greatest privacy. Consent for publication Not applicable Author Details Farooq Ahmed is Associate Professor and Chairman of Department of Anthropology at The Islamia University of Bahawalpur, Bahawalpur Pakistan. Dr. Razia Anjum is Senior Lecturer at Department of Psychology, Bath Spa University, Academic Centre, Ras al Khaimah, United Arab Emirates. Prof. Najma Iqbal Malik is Chairperson of Department of Psychology at University of Sargodha, Sargodha, Punjab, Pakistan. Sidra Zia is Research Associate, Department of Anthropology, The Islamia University of Bahawalpur, Bahawalpur Pakistan. Dr. Asma Yasmeen is MBBS and FCPS from Nishtar Medical College, Multan & Quaid e Azam Medical College, Bahawalpur. Haleema Al Sabbah is Professor at Department of Public Health, College of Health Sciences, Abu Dhabi University, Dubai, United Arab Emirates. Dr. Yihenew Alemu Tesfay is Assist. Prof. at Department of Social Anthropology, Bahir Dar University Faculty of Social Sciences, Bahir Dar, Ethiopia. Competing interests The authors declare that they have no competing interests. Clinical trial number Not applicable. References Abdullah AS, Dalal K, Halim A, Rahman AF, Biswas A. Effects of climate change and maternal morality: perspective from case studies in the rural area of Bangladesh. International journal of environmental research and public health. 2019 Dec;16(23):4594. Yuceturk GD. 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Determinants of infant young child feeding among mothers of malnourished children in South Punjab, Pakistana qualitative study. Frontiers in Public Health. 2022 May 19;10:834089. Ahmed F, Malik NI, Bashir S, Noureen N, Ahmad JB, Tang K. Political Economy of Maternal Child MalnutritionExperiences about Water, Food, and Nutrition Policies in Pakistan. Nutrients. 2024 Aug 10;16(16):2642. Mahdevar P, Sharififard M, Maraghi E, Jahanifard E, Bigdeli S. Challenges of Controlling Vector and Vector-borne Diseases at the Flood Disaster of Khuzestan Province in 2019 According to the Experts of Health Center. فصلنامه سلامت در حوادث و بلایا. 2022 Sep 10;8(1):15-26. Abrahim S, Aliyi M, Ali M, Melese T. Impacts and causes of flood hazards on public health and socio-economicThe case of Hirna Town, West Hararghe Zone, Oromia National Regional State, Ethiopia. Journal ISSN. 2022;2766:2276. Brown KH. Diarrhea and malnutrition. The Journal of nutrition. 2003 Jan 1;133(1):328S-32S. Mathez-Stiefel SL, Vandebroek I, Rist S. Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia. Journal of Ethnobiology and Ethnomedicine. 2012 Jul 24;8(1):26. Al-Mamun M, Kalam A, Karim MZ, Alam M, Khan TH. Menstrual hygiene management in flood-affected Bangladeshaddressing socio-cultural barriers, infrastructure gaps, and policy responses. Frontiers in Public Health. 2025 Apr 4;13:1538447. Azhar A, Amir F, Shakeel A, Ali SH. A rising threat of urinary tract infections among the flood-affected women of Pakistanchallenges and recommendations. Medicine, Conflict and Survival. 2023 Jul 3;39(3):250-7. Anthonj C, Poague KI, Fleming L, Stanglow S. Invisible strugglesWASH insecurity and implications of extreme weather among urban homeless in high-income countries-A systematic scoping review. International Journal of Hygiene and Environmental Health. 2024 Jan 1;255:114285. Maknun SS, Nahar N, Kabir H. Women health and menstrual hygiene management in natural disastersa study in Islampur Upazila of Jamalpur district. Journal of the Asiatic Society of Bangladesh, Science. 2017 Jun 20;43(1):83-99. Zhang Y, Xu C, Dai H, Jia X. Psychological distress and adolescents’ cyberbullying under floods and the COVID-19 pandemicparent–child relationships and negotiable fate as moderators. International journal of environmental research and public health. 2021 Nov 23;18(23):12279. Ullah W, Haijun D, Shah AA, Alotaibi BA, Rauf A. Behind the floodwatersViolence against women, and disaster management capacities in flood-affected areas of Pakistan. Climate Risk Management. 2024 Jan 1;46:100653. Parkinson D. Gender-based violence and disaster. InOxford Research Encyclopedia of Natural Hazard Science 2022 Feb 24. Additional Declarations No competing interests reported. Supplementary Files InterviewGuideofFloodDisasterandImplicationsonWomenYATClean.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 19 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviewers invited by journal 15 Feb, 2026 Editor assigned by journal 30 Jan, 2026 Submission checks completed at journal 29 Jan, 2026 First submitted to journal 29 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8646645","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":583023177,"identity":"2b1e89e2-83b2-45f3-8e24-5f6b34b8d52e","order_by":0,"name":"Farooq 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08:16:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8646645/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8646645/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107483223,"identity":"e7d69900-c343-418f-80a0-bb07bf01c6d1","added_by":"auto","created_at":"2026-04-22 02:26:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":170139,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMap of the Flood-Affected Area in the Southern Region of Punjab Province in Pakistan\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8646645/v1/853290f8302413ac06999a3b.png"},{"id":107257956,"identity":"da01b4d0-600c-4436-ae1f-995ee1264d97","added_by":"auto","created_at":"2026-04-19 12:36:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":307604,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSignificant Codes Developing Major Themes on Flood Disaster and Impacts on Women's Health\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8646645/v1/2cd956294800a77f273be2b9.png"},{"id":107485811,"identity":"c2bac446-fd64-49a2-b062-b7319d1b52c7","added_by":"auto","created_at":"2026-04-22 02:36:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1402462,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8646645/v1/bfbb55a3-a389-4ac6-a824-48d350812edc.pdf"},{"id":107257954,"identity":"a9a0f43a-2ecb-4a96-b95e-ff5e36721e32","added_by":"auto","created_at":"2026-04-19 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Introduction ","content":"\u003cp\u003eClimate change has become a great threat to public health (1). Extreme rains, floods, cyclones, rising ocean temperatures, droughts, and hurricanes have negative effects on community health, occupations, economies, and the atmosphere. Asia faced more catastrophes than any other continent. The disaster-related vulnerability is exacerbated in marginalized societies due to deficiencies in resources, poverty, and inequality, which can transform this vulnerability into a calamity (2). Extremely warm or freezing temperatures can raise the hazard, such as abortions and children being delivered too soon. Also, infections might spread, and the health of mothers, infants, and the delivery and pregnancy can be affected due to climate change (3). Both vector-borne and water-borne illnesses, such as malaria, dengue fever, and diarrhea, have been detected to increase the morbidity and mortality ratios among pregnant females and infants (4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudies show that malaria during the perinatal period can be a threat to infants and mothers, and malaria transmission spikes in disaster settlement sites. Miscarriages, anemia, low birth weight, immediate birth, and even the death of the mother or newborn may happen (5). In flood-affected areas, mothers would like to have additional support to encourage them to breastfeed their infants to save the newborn\u0026apos;s health and well-being (6). Mothers could have a higher perception of lack of enough breastmilk to feed their baby because of hunger and anxiety. They felt weakness and suffered from an inadequate diet and stress of flood and displacement, so they thought they could not feed their infants properly (7). Breastmilk is not only important for nourishment but is also helpful in disasters such as floods (8). Females and girls suffered from infections because of the absence of sanitary commodities during menstruation (9). Ethnic restrictions have made menstrual hygiene and sanitation still tougher to approach. Current floods in Pakistan have made it more difficult for women and teenagers to control their cycles securely, which affects their strength, dignity, and well-being (10).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRespiratory and diarrheal diseases spread due to ineffective hygiene (11). WASH retrieval plans emphasize educating people about health, changing communal ways and attitudes towards open defecation, and engaging the entire public to share a collective responsibility for restoring communal well-being, hygiene, and power (12). Research showed that during the flood in Assam and India, women suffered from physical and sexual violence (13). Women\u0026apos;s vulnerability increased if they are young, widows, have an illness, or are from a lower background (14). Inequality within the community is a major cause of suffering for some, but not others (15). Females reportedly die in disasters at greater ratios than males (16). Poverty, inadequate aid in relief shelters, caregiving duties, lowered access to supplies, and misguidance are the natural distinctions in which females suffer (17).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRural Southern Punjab is a highly underdeveloped region of Punjab Province in Pakistan, characterized by a scarcity of hospitals and healthcare professionals. In its southern districts, young people lack access to basic essential services such as health care, education, clean drinking water, healthy cuisine, and proper hygiene. These deficiencies have led to general health crises, with diarrhea and malnutrition amongst young children (18). Unemployment, poverty, and illiteracy among women often lead to gender-based violence (19).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRajanpur District in South Punjab lies along the western bank of the Indus River and at the foothills of the Sulaiman Mountain Range, a geographic location that renders it highly vulnerable to recurrent flooding. During the monsoon season, intense rainfall and mountain runoff from the Sulaiman Range converge with rising water levels in the Indus River, resulting in frequent and severe floods. These recurrent flood events have caused extensive damage to agricultural land, transportation infrastructure, healthcare services, and local livelihoods, disproportionately affecting already marginalized communities. While existing research in Pakistan has largely focused on the physical and economic impacts of flooding, qualitative studies that document the gendered vulnerabilities and lived experiences of women, particularly in relation to social disruption and health consequences, remain scarce. This study addresses this critical gap by examining the lived experiences of women affected by recent flood disasters in marginalized areas of South Punjab, with particular attention to the social and health impacts of flooding on women\u0026rsquo;s well-being.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design, Sampling, and Inclusion Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a qualitative research design. Purposive sampling was employed to select respondents, including those from towns that were remote and received no aid from the government. The study was conducted in the displacement centers of different villages of Rajanpur district, which were severely affected by the 2025 flood disaster. These villages include Bursa Abad, Kacha Daraigh, and Kotla Bakhu (\u003cstrong\u003eFigure 1\u003c/strong\u003e). The participants were informed about the nature of the study, and consenting participants were asked about their experiences of the flood and impacts on reproductive, maternal, and child health, breastfeeding (BF) experiences, hygiene and sanitation, and women\u0026rsquo;s vulnerabilities during the flood \u003cstrong\u003e(Supplementary File 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eThe study included only those participants who were mothers, or were pregnant, or lactating. We selected both young and older rural women between the age of 18 and 45 from the most marginalized areas of South Punjab.\u0026nbsp;In total, 30 respondents showed their consent to participate in the study, but the final report was compiled from 21 participants. Data collection ended after data saturation was met. (\u003cstrong\u003eTable 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 1: Respondents\u0026apos; Sociodemographic Information\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRespondent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome (PKR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e25k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e8\u003csup\u003eth\u003c/sup\u003e grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e35k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eMatric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e20k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e22K\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e25k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e8\u003csup\u003eth\u003c/sup\u003e grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e35k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eMatric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e20k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e35K\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e25k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e8\u003csup\u003eth\u003c/sup\u003e grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e35k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eMatric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e20k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30K\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30k\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterviews and Data Collection Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were gathered through semi-structured interviews. Interviews were conducted at disaster displacement sites inside temporary settlement tents where participants felt secure and relaxed. The interviews were conducted in the local Seraiki language, lasting between one and two hours; during the interviews, we tried to maintain a humble and pleasant atmosphere. Participants were asked questions related to the cause of the death of infants in a flood, and sufficient food for mothers\u0026rsquo; better health and BF frequency. We investigated how health and hygiene in public toilets were maintained. We also asked how women maintained their hygiene during menstruation and other serious challenges faced by females during the flood. They were informed that they might take a rest or leave the interview at any time and could take pauses when they experienced unease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThematic Analysis Procedure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBraun and Clarke\u0026rsquo;s structure was employed to perform the thematic analysis (20). All 21 semi-structured interviews and fieldnotes were translated from the local language into English. After gathering data from applicants who gave their consent, researchers went through the transcription cautiously, and a coding procedure was developed. Then the recoded interviews were written down. To recognize deep views, two researchers (FA and NIM) employed NVivo software to code the qualitative data line by line. Through repetitive conversations, two authors (FA and SZ) arranged connected codes into themes and simplified them. The original data were verified, besides the final themes as shown in \u003cstrong\u003eFigure 2\u003c/strong\u003e. The researchers preserved clarity and precision by recognizing significant awareness from participants\u0026apos; shared experiences. For a better identification of the participants\u0026apos; scrutiny, the thematic analysis helped arrange and clarify complicated data in depth. The four major themes and multiple codes relevant to each theme have been described below (\u003cstrong\u003eFigure 2)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted in accordance with the Declaration of Helsinki, and the ethical approval for this research was granted by the Department of Anthropology and the Institutional Human Ethics Committee (IHEC) of the Office of Research and Innovation Commercialization (ORIC) in the Islamia University of Bahawalpur (IUB/ORIC/449; Approval date: 28/10/2025). All of our study participants were first informed about the research nature, and then their willingness to contribute to the study was obtained from the respondents. Confidentiality, anonymity, and privacy were completely warranted. We did not reveal the actual names of participants to protect their identities. Furthermore, the anonymity of study participants was maintained through the use of pseudonyms.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eThe four major themes and multiple codes relevant to each theme are shown in Table 2:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Major Themes, Descriptions of Themes, and Codes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003cp\u003e\u003cstrong\u003eMajor Theme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription (Climate \u0026amp; Gender Lens)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificant Codes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1. Miscarriage, stillbirth, and infant mortality due to flood-induced disruptions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eFirst theme highlights how climate change\u0026ndash;induced flooding intensified pregnancy risks and infant mortality through restricted mobility, physical trauma, exposure to infectious diseases, and the collapse of maternal health service access. Flood conditions changed routine childbirth into a life-threatening event for both mothers and infants.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eDisrupted access to obstetric care during floods, including transportation barriers and delayed evacuation, leading to stillbirths and infant deaths.\u003c/li\u003e\n \u003cli\u003ePregnancy loss and obstetric complications linked to flood-related stress and physical strain, such as anxiety during evacuation, prolonged walking through deep floodwater, and resulting premature rupture of membranes.\u003c/li\u003e\n \u003cli\u003ePregnancy loss due to flood-related physical injuries, including trauma from environmental debris encountered during displacement.\u003c/li\u003e\n \u003cli\u003ePost-birth infant mortality associated with flood exposure, including hypothermia and increased vulnerability to vector-borne diseases.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2. Disruption of proper breastfeeding and infant nutrition practices during and after flood disasters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eSecond theme examines the nutritional costs of flooding on infant feeding practices. Maternal undernutrition, dehydration, mental trauma, lack of privacy, and unsafe water collectively reduced mothers reported breastfeeding difficulties and compromised infant health and survival.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eMaternal undernutrition and dehydration during displacement\u003c/strong\u003e, including insufficient food intake and limited access to fluids.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBreastfeeding challenges linked to physical exhaustion, hunger, and lack of privacy\u003c/strong\u003e, making it difficult for mothers to initiate or sustain breastfeeding.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePerceived reductions in breastmilk production\u0026nbsp;\u003c/strong\u003eassociated with disaster-related psychological stress and disrupted living conditions.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIncreased risk of infant diarrheal infections,\u003c/strong\u003e linked to contaminated water sources and poor sanitation in flood-affected settings.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3. Compromised women\u0026rsquo;s health and hygiene in displacement settings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eThird theme reflects how flood-related displacement exposed women to unhygienic living conditions, increasing their vulnerability to infections, reproductive health problems, and psychological distress due to the absence of gender-sensitive sanitation and menstrual hygiene resources.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eExposure to insects and disease vectors\u003c/strong\u003e, including mosquitoes, due to unsanitary shelter conditions and poor environmental hygiene.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLimited access to menstrual hygiene materials\u003c/strong\u003e, constraining women\u0026rsquo;s ability to manage menstruation safely and with dignity.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIncreased risk of reproductive and urinary tract infections\u003c/strong\u003e, associated with the use of shared, overcrowded, or poorly maintained public sanitation facilities.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4. Increased gendered vulnerabilities in post-flood situations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eFourth theme reflects the increased risks of gender-based violence following flood-related displacement, where overcrowding and weakened social safety contributed to harassment, domestic conflict, and physical and sexual violence against women.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eVerbal harassment and humiliating treatment in displacement sites, contributing to fear, stress, and loss of dignity.\u003c/li\u003e\n \u003cli\u003eHeightened family conflict and domestic tensions, often exacerbated by overcrowding, stress, and resource scarcity.\u003c/li\u003e\n \u003cli\u003eExposure to physical and sexual violence, particularly in insecure or poorly supervised displacement settings.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Miscarriage, stillbirth and infant losses attributed to flood disaster\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFlood conditions severely compromised maternal and infant survival. Some women were forced to give birth on roads while attempting to flee rising waters, resulting in stillbirths. Others sustained physical injuries from falling trees and floating debris while crossing deep and fast-moving floodwaters during pregnancy, increasing the risk of pregnancy loss and obstetric complications. In addition, infants and young children died from fever and vector-borne diseases, reflecting heightened exposure to mosquitoes, delays in access to medical care, and the collapse of basic health and sanitation services during and after the floods. Explaining these multifaceted impacts of flood disaster, a young women state:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It was my 9th month of pregnancy. During the flood, my labor pains started, so my husband transported me to health care providers in the city on a donkey cart. First, I approached a lady doctor in a public hospital. She said, \u0026lsquo;Your hemoglobin is very low, and she can\u0026rsquo;t handle this case.\u0026rsquo; Then, we went to another government hospital, and the doctor says [we can\u0026rsquo;t handle this here] it is a private hospital case\u0026rsquo;. So we went to a private hospital, the doctor checked and informed us that it was a baby boy, but the fetus was dead in the womb. All of my hopes were ruined because I was able to be pregnant after seven years.\u0026rdquo; (25-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA different older woman reported the same:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It was eight months of my pregnancy. Because of the shocking trauma of the flood and thinking about my home and cattle, I felt stressed and worried as we had to leave our home and cattle. Rescue 1122 rescued as to the nearest shelter. After a while, I started feeling pain in my abdomen, but I thought it [wouldn\u0026rsquo;t be labor as it] was my eighth month, so I decided not to worry. But the pain persisted and increased, and no doctor was there, so I had to deliver the fetus on the road. My baby was not breathing.\u0026rdquo; (30-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDuring the flooding, unexpectedly heavy and rapidly rising waters inundated homes with little or no warning. The force of the water entered living spaces, placing entire households at risk, including pregnant women and young children, some of whom were in danger of drowning. The suddenness of the flood caused intense shock, fear, and disorientation, disrupting daily life and exposing residents to immediate physical harm. Two interviewed women vividly described the trauma of this experience and the profound ways in which the flooding affected their sense of safety, well-being, and pregnancy, as reflected in the accounts below.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was sleeping with my family members. My husband shouted, \u0026lsquo;The heavy water is coming, we will not survive. In the meantime, we were all floating in water. I tried to catch a branch of a tree, but it hit my belly. It was my five-month delivery. After a few hard hours, we arranged private ships. I survived, but my five-month-old infant in my belly couldn\u0026rsquo;t.\u0026rdquo; (20-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It was my last month of pregnancy, after looking through the cattle, my husband said, \u0026ldquo;The flood might have come to our side. So, pack your important items, and in a hurry,\u0026rdquo; we soon realized that the wall fell and water came in. It was so sudden that we could not understand what to do. I caught my 2-year-old son and rushed into the water. I felt something from my uterus, but I didn\u0026apos;t take this seriously. I told my husband I could not cross the water because I felt pain in my belly. I delivered my infant under the tree with the help of the village women. It was the baby girl who was not able to take her first breath and weep. She took one hiccup and died into my lap.\u0026rdquo; (24-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTwo interviewed women described how the flooding created conditions that heightened the risk of illness, including exposure to cold, unsanitary environments, and increased contact with disease-carrying vectors. They explained that prolonged exposure to flood waters and inadequate shelter led to hypothermia, while stagnant water facilitated the spread of vector-borne diseases. According to their accounts, these overlapping health risks contributed directly to severe illness and, in some cases, to the deaths of infants and young children, underscoring the profound and life-threatening impacts of the flood on vulnerable populations.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I delivered my infant in the shelter. He was healthy, but after two days, his skin and lips turned purple. There was no doctor here in the emergency shelter. He feels cold due to a defective shelter. \u0026nbsp;I ran here and there so that my infant would be saved. I saw 1122 rescue teams come to my shelter. I hoped that my baby would be alive. But the rescue team said that because the shelter was open, your baby was suffering from hypothermia. He soon died.\u0026rdquo; (32-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I have 5 children. Mosquitoes bite us, and my infant died in a shelter due to a mosquito bite. It was a very painful situation for me to see my infant with a fever, runny eyes, and continuous crying. Now I am afraid my other children will catch this fever.\u0026rdquo; (36-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2:\u003cem\u003e\u0026nbsp;\u003c/em\u003eChallenges to Breastfeeding and Infant Nutrition During and After Flood Disasters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWomen reported significant difficulties in breastfeeding under the unhealthy conditions in displacement and shelter settings, citing shortages of adequate food and clean water as major challenges. Many explained that they were forced to reduce meal frequency or consume insufficient and low-quality food, which they believed directly contributed to reduced breastmilk production. In addition to nutritional deprivation, women described how flood-related trauma, stress, and exhaustion further undermined their confidence in the adequacy of their breastmilk. Three interviewed mothers detailed their experiences below, illustrating how the combined effects of food insecurity, poor living conditions, and psychological distress adversely affected breastfeeding practices and infant feeding.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Every time I eat rice, as there are no milk, meat, eggs, or nuts. Also, there is no clean drinking water. My breasts produce no milk now. My infant and I have become weaker day by day. In this disaster, no food was provided to us by the government. I am worried about skipping my meal. I am hungry, that\u0026rsquo;s why my infant is without breast milk.\u0026rdquo; (18-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Before the flood disaster, my health was good. As we had our cattle, I used to drink milk sufficiently and regularly before lactating my infant. But here in the temporary shelter, breastfeeding practice is almost limited because we have only bought chicken and rice. I feel it is a good diet that can make breastmilk more frequent. When you are hungry, it is impossible to breastfeed the baby.\u0026rdquo; (29-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My baby is tired to suck my empty breasts\u003c/em\u003e. \u003cem\u003eThere is no milk. It is just like deflated balloons. My infant has a skinny body. He has lost his bones. He looks malnourished. When I would eat something, then I would be able to breastfeed my baby; otherwise, it is difficult.\u0026rdquo; (31-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn situations where breastfeeding was not possible, mothers reported being advised to use infant formulas. However, the lack of access to clean and safe drinking water made safe formula preparation extremely difficult. As a result, several infants reportedly developed diarrheal illnesses linked to contaminated water and poor sanitation conditions. One interviewed woman described this experience as follows, highlighting the risks faced by infants when alternative feeding methods were used in unsafe environments:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My baby was on breastfeeding, but my milk dried up due to the disaster. Though the government provided infant formula milk for infants in limited quantity, due to a lack of pure water and poor sanitation, my baby suffered from diarrhea. (37-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFlood-related displacement further exacerbated challenges to women\u0026rsquo;s privacy, directly impacting their ability to breastfeed properly. Lactating mothers often seek private spaces to feed their infants comfortably and safely, but the crowded and makeshift conditions in flood relief tents provided little to no privacy. This lack of privacy created stress and discomfort, making breastfeeding more difficult and affecting both mothers\u0026rsquo; confidence and infants\u0026rsquo; nutrition. One mother described her experience as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Tent is not my home [has no privacy]; here I feel reluctant to breastfeed my baby. My baby is hungry, and he is beating my breast with his head. What should I give him to feed?\u0026rdquo; (26-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: Impact of Poor Sanitation and Hygiene in Displacement Settings on Women\u0026rsquo;s Health\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis identified three primary subthemes (codes) within this overarching theme. First, women experienced heightened exposure to insects and disease vectors, including mosquitoes, due to unsanitary shelter conditions and poor environmental hygiene, which increased their vulnerability to infectious diseases. Second, limited access to menstrual hygiene materials constrained women\u0026rsquo;s ability to manage menstruation safely and with dignity, exacerbating stress and discomfort in already challenging circumstances. Third, the use of shared, overcrowded, or poorly maintained public sanitation facilities elevated the risk of reproductive and urinary tract infections, further compromising women\u0026rsquo;s health and well-being during displacement. Collectively, these subthemes illustrate how environmental, infrastructural, and resource-related challenges intersect to create significant reproductive and general health risks for women in flood-affected shelters.\u003c/p\u003e\n\u003cp\u003eWhen the floodwaters receded, the environment in displacement shelters became increasingly hazardous due to the proliferation of mosquitoes, flies, bugs, and beetles. These insects thrived in the unsanitary conditions and stagnant water left behind, significantly raising the risk of infections among mothers and infants. One woman described how waste and garbage were scattered around the shelters, attracting swarms of biting insects that disturbed their sleep and contributed to illness. Another mother recounted her struggle with controlling the mosquito population, explaining that her young son contracted malaria and required antimalarial medication as a result of the unhealthy shelter environment. These accounts highlight the persistent threat of vector-borne diseases and the added burden they impose on women\u0026rsquo;s health during displacement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Waste material and garbage sets are scattered all around the shelters. The flood water produced mosquitoes and beetles that bite us all night.\u003c/em\u003e\u0026rdquo; (40-year-old woman)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In shelters, there is an unhealthy atmosphere. We cannot control these mosquitoes. My three-year-old son is suffering from malaria and is taking antimalarial medicine.\u0026rdquo; (34-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAddressing the limited access to menstrual hygiene materials, which constrained women\u0026rsquo;s ability to manage menstruation safely and with dignity, one woman elaborated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eI have no pads for my girls and myself. In the emergency shelter, outsiders and males often come inside. Girls feel shame, stress, and anxiety. My girls are sitting in one corner of the shelter so that no one sees them. I have provided some old shirts of mine to control the blood flow.\u0026rdquo; (45-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAlthough a few NGOs have made efforts to support flood-affected communities by constructing temporary toilets, their use often remains fraught with risks. The safety and cleanliness of these facilities are frequently inadequate, exposing women and children to the dangers of unsanitary conditions, lack of privacy, and the potential for disease transmission. As three interviewed women shared, these temporary toilets do not always provide a secure or hygienic environment, leaving users vulnerable to infections and discomfort. The challenges are heightened by overcrowding, poor maintenance, and the absence of gender-segregated spaces, which together contribute to feelings of insecurity and distress among women seeking basic sanitation during displacement.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My eighteen-year-old daughter suffered from a urinary tract infection. She feels vaginal itching and weeps. It is because of using unclean public toilets. Also, there is no separation between the women\u0026apos;s toilet and the men\u0026apos;s.\u0026rdquo; (43-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My whole family is struggling with infections. My 3-year-old son has a respiratory infection, my daughter has a skin allergy, and my elder son has the flu, cough, and sneezing due to filth.\u0026rdquo; (41-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In emergency shelters, bathing is impossible. We have itching, but we have no option except using these public washrooms. We wish we could return home soon.\u0026rdquo; (38-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4: Sexual Harassment, Physical and Sexual Assaults, and Domestic Violence Against Women in Displacement Shelters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSexual harassment poses significant and distressing challenges for women during flood disasters. Many women and girls report feeling unsafe, particularly when leaving the shelter, as incidents of harassment from men are prevalent. The pervasive sense of fear and vulnerability profoundly impacts their daily lives throughout these trying times. Mothers, in particular, are compelled to be extremely vigilant to protect their daughters from potential threats, often restricting their movement and activities to ensure safety. This constant anxiety and the need for heightened caution add an additional layer of hardship to an already difficult situation. In interviews, women shared personal accounts highlighting the seriousness of sexual harassment in displacement settings, emphasizing the urgent need for protective measures and support for affected women and girls.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Shelter is not as safe as our home. My twenty-year-old daughter, whenever she goes to the washroom, boys taunt her with ill-mannered comments.\u0026rdquo; (40-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There are a lot of girls and women in the shelter. Mothers are engaging in other chores. I observe that girls and women have a man phobia, because of the boys\u0026apos; bullying remarks to the women.\u0026rdquo; (44-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIncidents of domestic violence also became more common among many families, with numerous individuals reporting increased arguments and conflicts fueled by heightened frustration, anger, and a pervasive sense of insecurity stemming from their circumstances. One woman further elaborated on her experience:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I am a newlywed girl, but there is no privacy in the shelter. Some elderly women quarrel with me over petty issues. They ordered me to broom the shelter; otherwise, we will not accept you. I wish this disaster time ends soon\u0026rdquo; (19-year-old woman)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWomen are also at risk of experiencing physical and sexual assault within temporary shelters. Mothers frequently express fear for the safety of their daughters, worrying that they may be particularly vulnerable to such threats in emergency tents. One woman recounted the following incident:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;One boy offered me friendship on behalf of saving me and my family\u0026apos;s lives in the flood. But I refused him. He felt anger and felt insulted at rejection. He threw a rock towards me that injured my face\u0026rdquo; (20-year-old woman\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eDuring flood events, access to healthcare facilities is severely constrained, and pregnant and lactating women face compounded challenges throughout pregnancy, childbirth, and the postpartum period, which can be more problematic in disaster settlement areas. Our findings highlight multiple, interrelated difficulties experienced by women in flood-affected settings, including disrupted access to antenatal, delivery care and postnatal care, shortages of essential medical supplies, increased physical strain, heightened psychosocial stress, and reliance on informal or delayed care. These challenges not only undermine maternal health and well-being but also exacerbate existing social and health inequities, placing pregnant and lactating women at heightened risk during humanitarian emergencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1. Infant mortality due to flood water\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudies show that infant mortality in flood areas is 8% higher compared to non-flood areas (21). Mothers faced trauma on the infant\u0026apos;s death; however, self-belief, social relationships, and sensitive change help them to deal with problems (22). Our findings reveal that when women feel anxiety during pregnancy, they can lose their infant. Absence of appropriate accommodations to support mother and infant during and after delivery, particularly in disaster settlement settings with poor hygiene and sanitation resources, can exacerbate conditions leading to infant death (23). A study found that environmental transformation and dangerous climate experiences can cause compromise to newborn and infant wellbeing (24). A previous study estimated that floods have affected almost 8 million females and 16 million infants in Pakistan. Pregnant women and newborn babies need immediate therapeutic and reproductive help (25). Females suffered from the unavailability of reproductive health support and could not get the basic sterile, sanitation, and childbearing equipment (26). A study from Nigeria supports our result: women who faced challenges like the absence of facilities, the unavailability of roads and conveniences, reliance on midwives, problems in searching local hospitals, lack of support from NGOs, and incorrect route from health workers cause infant death (27). Our results that hypothermia in neonates during floods caused death are similar to studies from Southern and Northeastern Ethiopia. These studies elaborate that inappropriate thermal care in disaster settlement settings causes hypothermia, which is a main reason for neonatal mortality in low-income countries (29). Also, vector-borne diseases cause death in newborns. Evidence from Latin America showed that malaria, dengue fever, epidemic cholera, and lung diseases affected displaced people (30). Another study from Gaya and Shahpori Islands discussed that vector-borne illnesses produced challenges to global health, especially in low- and middle-income countries because of poor well-being, inadequate care, and weak monitoring (31).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2. Breastfeeding (BF), including BF frequency during crises\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe second theme of the study discusses the impact of floods on BF and BF frequency. Women reported having minimal milk production because of an inadequate diet, stress, and anxiety, which impacts the breastfeeding frequency of BF. Other studies from Pakistan also support our results (32). Research from Abruzzo, Italy, also shows that feeding practices of infants and young children are significantly affected in emergency conditions (33). A study from northern Pakistan, a geological area prone to natural disasters, also revealed that mothers were in danger of quitting breastfeeding (34). A study from Tanzania said that climate change can pose a great risk of issues during pregnancy and after pregnancy, such as dead babies, early delivery, and low breastmilk production (35). A study from marginalized South Punjab, Pakistan, elaborated that whenever mothers feel stress, work burden, and weakness, they perceive that their breastmilk production is very low, as well as the quality is poor and inadequate (36). \u0026nbsp;Water insecurity affects hygiene, sanitation, and lactation procedures between breastfeeding mothers, causing malnutrition (37). Literature showed that floods caused vector-borne diseases in Khuzestan Province of Iran (38), Flu, malaria, diarrhea, and pneumonia in Ethiopia (39), chronic diarrhea and malnourishment in Andean Peru and Bolivia (40, 41).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3. Hygiene after disaster\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings are consistent with the evidence, which shows that women and young girls living in flood-affected areas of Bangladesh face great challenges in maintaining their menstrual hygiene. This causes a serious impact on their well-being, self-respect, and overall health (42). Some results showed that women faced urinary tract infections due to using public toilets. Studies from other floods also similarly indicate that women in flood-prone areas suffered a big challenge of urinary tract infections, which has not attracted attention (43). From higher-income countries, a study found that community locales such as rainwater cascades, bathrooms, hand-washing sections, and showers are restricted, often not effective, and occasionally insecure or polluted for displaced families (44). Unfortunately, ethnic patterns make it disgraceful for them to wash or dry their clothing in the presence of males within the tant. Women are often forced to use outdated or waste samples of fabric to stop the menstrual period. Due to inadequate skills and a lack of suitable funds, they cleanse these garments using floodwater to eliminate the blood (45)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4. Post-floods harassment and sexual violence.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs many women expressed, the girls faced bullying remarks from the males in shelters. The parents disliked such an atmosphere. Research has exposed how bullying can lead to sensitive or spiritual upset (46). Moreover, quarrels were reported inside saturated shelters. Literature showed that the main reasons for quarrels in floods are the previous experiences, cautions for floods, housing situations, camps, and their economy. How the community realizes and responds to floods depends on their knowledge, beliefs, and ability to deal with such disasters. Reasons for violence in floods are owing to poverty, homelessness, gender discrimination, crowded shelters, deficiency of protection in floods, and inadequate approach to health care are the main reasons for gender-based violence (47). According to Oxford Research Encyclopedia of Natural Hazards, in Iran, Japan, Australia, and Pakistan, the ratio of gender-based violence may be different before floods, but in disasters and floods, the same thing happens everywhere, supposing females to sacrifice, mitigating males\u0026rsquo; violent performance, and accusing sufferers (48).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.5. Limitations and Strengths of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile this research provides critical insight into the profound suffering experienced by women during flood events and the far-reaching effects of climate change on their health, several limitations should be acknowledged. First, the findings are based on participants\u0026apos; self-reported experiences and perceptions, which may introduce subjectivity and potential biases. These personal accounts, while invaluable for understanding lived realities, might also lead to an overemphasis or underrepresentation of certain issues due to recall bias or emotional responses during interviews. Additionally, the qualitative nature of the study, with its focus on in-depth exploration of individual incidents and coping mechanisms, limits the generalizability of the results to broader populations. The sample size, though diverse in age, background, and profession, may not fully capture the range of experiences and challenges faced by all women in flood-affected regions. Furthermore, logistical constraints in disaster settings, such as restricted access to certain areas or populations, may have influenced the breadth and depth of data collected. Despite these limitations, the study offers a nuanced interpretation of the experiences, observations, and adaptive strategies of women affected by floods, contributing valuable perspectives to the understanding of gendered vulnerabilities in disaster contexts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the primary strengths of this study lies in the diversity and richness of its participant pool. By engaging 21 individuals from varied age groups, professional backgrounds, and social categories, the research captures a broad spectrum of perspectives and experiences, enhancing the credibility and depth of the findings. The study\u0026rsquo;s methodology, including using female interviewers, fostered a safe, open, and supportive environment, encouraging participants to candidly discuss complex and sensitive issues\u0026mdash;including gender-based vulnerabilities, income disparities, and health challenges\u0026mdash;without reservation. This approach not only facilitated the collection of genuine, real-life narratives but also ensured that the data reflected honest accounts of lived experiences. The research offers a valuable framework for informing local disaster management programs, health interventions, and gender-sensitive policies, providing actionable insights for supporting vulnerable populations in flood-affected regions. By centering the voices of those most impacted, the study contributes significantly to the understanding of gendered vulnerabilities and supports the development of more effective, inclusive disaster response strategies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWomen in marginalized districts of South Punjab, Pakistan, encounter a range of interconnected challenges when floods impact their communities. This study illustrates how disasters can disrupt many aspects of daily life, increasing health, social, and psychological risks. Floods may contribute to adverse maternal and infant health outcomes, including cases where women experience infant loss, while ongoing food insecurity can affect nutrition and breastmilk production. Physical strain and limited access to nutritious food can influence the well-being of mothers and children, raising vulnerability throughout and following the disaster. Temporary shelters and settlements sometimes lack adequate hygiene and sanitation facilities, which can contribute to reproductive and urinary tract infections among women and girls. Overcrowded living conditions may also exacerbate these health risks and complicate recovery and daily routines. Displacement, crowded shelters, and diminished social protections during floods may also heighten the risk of harassment, gender-based violence, and attempted sexual assault.\u003c/p\u003e\n\u003cp\u003eThe findings of this study suggest a need for disaster response strategies that prioritize women\u0026rsquo;s health, safety, and dignity. Integrating psychosocial and emotional support services, particularly for pregnant women, mothers, and adolescent girls, into emergency response plans could help address trauma and stress resulting from displacement and loss. Additionally, effective implementation of policies and protections against harassment, gender-based violence, and sexual assault remains important during disaster response and recovery. Training programs and community-based preparedness initiatives that encourage cooperation, safety, and good hygiene practices may further support resilience among flood-affected populations. Focusing on reducing gendered vulnerabilities and supporting equitable, woman-centered disaster preparedness and response may contribute to safer and healthier communities in Pakistan.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors state no conflicts of interest are involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Authors\u0026rsquo; contribution is as follows: Conceptualization and data collection: F.A., S.Z., and A.Y; methodology: F.A., RA., N.I.M., F.A., S.Z., and Y.A.T.; data analysis: F.A., R.A., SZ., A.Y., H.A.S. and Y.A.T; supervision: F.A., N.I.M., and H.A.S.; writing\u0026mdash;original draft: F.A and S.Z.; writing\u0026mdash;review and editing: F.A., R.A., N.I.M., F.A., A.Y., H.A.S., and Y.A.T. All authors have read and agreed to the published version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe will be thankful for your consideration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the study respondents for sharing their lived experiences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original data presented in this study are included in the article. Further inquiries can be directed to the corresponding author(s).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Department of Anthropology and\u0026nbsp;Institutional Human Ethics Committee (IHEC) of the Office of Research and Innovation Commercialization (ORIC) in the Islamia University of Bahawalpur (IUB/ORIC/449; Approval date: 28/10/2025). We took informed consent from all participants involved in the study. Their opinions, experiences, and sensitivities were treated with the greatest privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFarooq Ahmed is Associate Professor and Chairman of Department of Anthropology at The Islamia University of Bahawalpur, Bahawalpur Pakistan. Dr. Razia Anjum is Senior Lecturer at Department of Psychology, Bath Spa University, Academic Centre, Ras al Khaimah, United Arab Emirates. Prof. Najma Iqbal Malik is Chairperson of Department of Psychology at University of Sargodha, Sargodha, Punjab, Pakistan. Sidra Zia is Research Associate, Department of Anthropology, The Islamia University of Bahawalpur, Bahawalpur Pakistan. Dr. Asma Yasmeen is MBBS and FCPS from Nishtar Medical College, Multan \u0026amp; Quaid e Azam Medical College, Bahawalpur. Haleema Al Sabbah is Professor at Department of Public Health, College of Health Sciences, Abu Dhabi University, Dubai, United Arab Emirates. Dr. Yihenew Alemu Tesfay is Assist. Prof. at Department of Social Anthropology, Bahir Dar University Faculty of Social Sciences, Bahir Dar, Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdullah AS, Dalal K, Halim A, Rahman AF, Biswas A. Effects of climate change and maternal morality: perspective from case studies in the rural area of Bangladesh. International journal of environmental research and public health. 2019 Dec;16(23):4594.\u003c/li\u003e\n\u003cli\u003eYuceturk GD. 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Behind the floodwatersViolence against women, and disaster management capacities in flood-affected areas of Pakistan. Climate Risk Management. 2024 Jan 1;46:100653.\u003c/li\u003e\n\u003cli\u003eParkinson D. Gender-based violence and disaster. InOxford Research Encyclopedia of Natural Hazard Science 2022 Feb 24.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Climate change, flood, women’s health, maternal and infant health, sexual harassment, disaster displacement, Pakistan","lastPublishedDoi":"10.21203/rs.3.rs-8646645/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8646645/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eClimate change is occurring at a remarkably rapid rate and is widely recognized as a major threat to reproductive, maternal, and infant health.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eThis qualitative study explores women’s lived experiences of climate change and its implications for maternal and child health and nutrition in flood-affected regions of South Punjab, Pakistan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eTwenty-one semi-structured interviews were conducted with women in the Rajanpur district of Punjab province. Participants took part in face-to-face interviews in disaster settlement shelters. Qualitative data were analyzed using thematic analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The findings highlight the heightened vulnerabilities of women in this marginalized region of the province during flood events. Participants reported that the 2025 floods in rural South Punjab generated multiple, interrelated challenges to women. These included disruptions to breastfeeding (BF) practices—such as reduced BF frequency due to limited access to food and water, as well as breast infections (mastitis), possibly resulting from the stressful conditions in the settlement shelter. Flood-related displacement also adversely affected girls’ and women’s hygiene, marked by the lack of adequate water and menstrual hygiene products and inadequate sanitation in temporary shelters. In addition, women reported experiences of sexual harassment linked to open shelter arrangements. Pregnant women experienced miscarriages and stillbirths, while postnatal infants faced increased mortality due to hypothermia and vector-borne diseases, including malaria and dengue fever.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The study underscores the urgent need for robust disaster preparedness and targeted, gender-responsive interventions. Beyond economic losses, floods have profound and lasting social, emotional, and health-related consequences for vulnerable women and children in South Punjab, Pakistan.\u003c/p\u003e","manuscriptTitle":"Women’s Lived Experiences of Flood Disaster and Implications on Health and Nutrition: A Qualitative Study in South Punjab, Pakistan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 12:36:09","doi":"10.21203/rs.3.rs-8646645/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"121873188727543154042696343893369666436","date":"2026-03-19T04:18:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T21:05:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126525388591308359647186581486514725016","date":"2026-03-18T20:55:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-15T21:39:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-30T12:05:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-29T16:38:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-01-29T16:25:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5ed3510-0a5e-4137-98b5-d599feccfd98","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-19T12:36:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 12:36:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8646645","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8646645","identity":"rs-8646645","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}