IT'S normal, an aid worker told her, not to menstruate after suffering severe trauma such as enduring an earthquake.
But when her period still hadn't shown up five months after January's massive tremor that claimed the lives of her husband and hundreds of thousand others in Port-au-Prince, the desperate woman spent a precious $2 on a pill to abort the fetus she knew she could never support.
After a night of writhing in pain under her tarp and next to her three children, the pale and weak woman sought help at a local makeshift clinic.
"I listened with the Doppler, and for the first time in my career, I said, ‘Sorry, Madame, but your baby is still alive,' " recalls my sister Ann Montgomery, a Toronto midwife who spent time recently in one of Haiti's camps. "She just lay there on the cot with her hands over her eyes... then gradually she got up, arranged herself, thanked me with a tired smile and left."
Natural disasters in poor countries can be so devastating, survivors sometimes wonder whether they'd have been better off dying when the Earth shook or the flood waters came rushing in.
Such catastrophes are unforgiving and indiscriminate with their victims, but studies have shown that a higher proportion of women die during the disaster.
In 2005, Oxfam reported that up to four times as many women as men died in the 2004 tsunami, and in many cases, it was the yards of material in their saris that anchored the women under the water.
As for the females who make it through alive, their vulnerability is only exacerbated, and survival can indeed often feel like death.
A study conducted post-earthquake by the Institute for Justice and Democracy in Haiti found that of the 69 victims they interviewed, many of whom had been raped, 95.7 per cent were suffering from posttraumatic stress syndrome and 53.6 per cent were suffering from depression.
"Several women indicated suicidal tendencies and some had even taken steps toward ending their lives," said the report, which was published in July.
"At least one woman said she had contemplated killing herself and her children."
Such events obviously affect men, as well.
A 2005 World Health Organization report on Gender and Health in Natural Disasters noted that men, as traditional family providers and protectors, often feel like failures if they were unable to save their loved ones. To compensate, some may take greater risks as volunteers and rescue workers in the relief effort. But they also tend to abandon women and children soon after the disaster, grabbing food aid and materials for themselves.
The 2004 tsunami in the Indian Ocean, hurricane Katrina in New Orleans in 2005, this year's earthquake in Haiti and now the floods in Pakistan, to name just a few recent natural disasters, not only killed hundreds of thousands of women, often because they'd never been taught to swim or climb a tree, they left countless female survivors to fend for themselves and their children, making them targets for sexual assault or forcing them to barter sex for food or shelter.
The head of UNICEF in flood-ravaged Pakistan said women and children make up 70 per cent of the nearly 18 million people affected by the disaster. Women in developed countries aren't immune either. When New Orleans flooded, 41 per cent of all female-headed households were already living in poverty, laying the groundwork for a bleak future.
Increasingly, relief organizations are realizing that any aid taken into a ravaged region has to take into consideration women's needs for everything from sanitary pads to protection from rapists -- but not one blueprint for help applies to all. Failing to consider cultural differences in the equation can mean the difference between help and a complete waste of effort, time and money.
For example, the Montreal-based Centre for International Studies and Co-operation (CECI) focuses solely on women during any emergency response.
"Because of the traditional role women play in food security, if you help the woman, you help her children," said Odette McCarthy, program and gender specialist with the organization. "But if you help the man, that won't happen."
She said that CECI responded to the earthquake in Haiti knowing that 47 per cent of households are headed by women.
"That has to be part of your strategy when delivering aid," said Mc-Carthy. "If it isn't, you're going to put them at more risk for sexual exploitation."
As in most disasters, the quake in Haiti destroyed women's support systems and their livelihoods, forcing them to live in crowded, unlit camps, where the sense of co-operation and sharing that was so noticeable immediately after the quake has long been replaced with a survival-of-the-fittest attitude.
For Pakistani women who are Muslim, such living conditions are intolerable. Most have never lived with other men, other than family members. And receiving aid or medical help from men is also taboo. The complete lack of privacy can lead to health problems, as noted in the 2005 WHO report.
McHugh said part of the solution is hiring local women who understand the culture to provide aid in times of disasters.
But it's also a question of attacking the root problems of women's vulnerability before a disaster strikes, McCarthy said, and not being in denial of that vulnerability when a country is in tatters.