Chris Brummitt, Banda Aceh – With the birth of her first child just one month away, Wadiana Wahab worries about the world her baby will enter.
She mainly eats rice and instant noodles and has no money for a crib, diapers or baby clothes. And while she expects to deliver at a hospital, she will likely return to the sweltering tent she calls home, where the stench of human waste hangs in the air.
"I never imagined it would be like this," said Wahab, 23, at a makeshift camp for about 5,000 refugees in Banda Aceh, the capital of Indonesia's tsunami-hit Aceh province. "It's already eight months and we have bought nothing for the baby."
With the threat of epidemics abating and most injured survivors treated, one of the most pressing medical needs now emerging across tsunami-hit countries is also one of the most basic: ensuring pregnant women stay healthy – and deliver safely.
Indonesia, the country most devastated by the December 26 earthquake and killer waves, is girding for a flood of newborns in Aceh's squalid refugee camps and ruined villages. Some experts say that birth rates among tsunami survivors may rise next year, as bereaved parents who lost children in the disaster try to rebuild their families.
Pregnant women comprise about 25,000, or 6 percent, of some 400,000 refugees in Aceh's camps, the United Nations says. Every month, some 800 babies are expected to be born in the province, on the northern tip of Sumatra island.
The figures are similar in Sri Lanka, an island nation off the coast of India, where as many as 5,000 will be delivered in the next few months, the United Nations says.
"What can we say to them? They want someone to continue the family line," said Sri Setiyati, a midwife in Banda Aceh. "It is their right to have children. We can only advise them to wait."
Despite a massive international relief effort, Aceh's devastated public health system is ill-equipped to handle the births. Though a few hospitals have reopened, smaller clinics remain shuttered. Once abdundant, midwives are now scarce, many of them having died when the sea surged.
"The [pregnant] women here are in a bad shape," said Henia Dakkak, a Palestinian public health specialist with the UN Population Fund in Banda Aceh. "If we don't start to do something in a few weeks, then we are endangering people's lives."
Health workers say most pregnant women in Aceh are not eating enough protein, meaning they may have underweight babies or may become anemic and bleed to death during labor.
Indonesian and UN authorities say a shortage of contraceptives means that many women in the camps will have unwanted pregnancies.
Still, things have improved since the disaster's immediate aftermath when many women gave birth without any medical supervision, often in unsanitary conditions in refugee camps.
Midwives flown into Aceh from Jakarta now routinely call on Wadiana and the 40 other pregnant women in her camp. A car is on call to take them to a health clinic, if needed. And a freshly painted maternity unit has just reopened in the city's public hospital, parts of which remain covered in thick mud washed in by waves.
In Sri Lanka, most refugee camps have access to a doctor. UN officials have provided hospitals with 300 emergency reproductive health kits, which include equipment to perform cesarean sections and blood transfusions and treat miscarriages.
For Wadiana, it's not just about health care, though. She said it pains her to think about being unable to prepare for the new member of her family. "Before the tsunami, we were getting excited and readying the house for the birth," she said. "Now all I can do is sit here."
Indonesia's family planning agency has been swamped by requests for condoms and other forms of birth control, agency official Tri Tjahjadi said. The office has about 16,000 contraceptives – but needs 80,000, he said earlier this week.
Workers from UN and other agencies have rushed to respond, distributing thousands of tons of contraceptives to clinics and health workers in camps, though they've been hampered by damaged roads and poor coordination.
There were concerns that Islamic leaders in this predominantly Muslim region might resist the distribution of contraceptives, sometimes believed to encourage pre-marital or extramarital sex. But UN officials say there have been no complaints in Aceh, where awareness of birth control is high. An estimated 60 percent of couples had used contraceptives before, officials say.
Zamzami and Baruna, a couple who live in a camp attached to a mosque on the outskirts of Banda Aceh, last week had their seventh child, named Rizki after the Indonesian word for "fortune."
"We have gone back to having nothing. Everything we owned was destroyed. Maybe Rizki will bring us good luck," Zamzami said, pointing to the tiny baby being breast-fed by her mother.